US Health Care 2026 Mid-Year Outlook

By Alicia Janisch, US Health Care sector leader and vice chair, Deloitte Tax LLP, Jay Bhatt, D.O., MPH, MPA, managing director of the Deloitte Center for Health Solutions, Deloitte Services LP, and Maulesh Shukla, Senior Manager, the Deloitte Center for Health Solutions, Deloitte Services LLP

Last December, we shared findings about a health care industry bracing for a year of uncertainty. In that 2026 US Health Care Outlook, 43% of surveyed leaders said they felt uncertain or neutral about the industry’s 2026 performance, up from 28% in the previous year.ⁱ

Health Plans: Health plans entered the year under pressure from elevated utilization and increasing operational complexity and acuity.ⁱⁱ However, medical cost trend improved slightly in the first quarter for several health plans, and stronger-than-expected final 2027 Medicare Advantage rates provided some breathing room.ⁱⁱⁱ At the same time, the expiration of enhanced ACA premium tax credits, together with other Marketplace policy changes, has increased uncertainty around affordability, enrollment, and risk-pool composition. Under current law, CBO projects average monthly ACA marketplace enrollment to decline from 22.4 million in 2025 to 13.1 million in 2027.^iv

Hospitals and health systems: Hospitals and health systems face a different version of the same operating test: resilient demand but fragile finances. Higher volumes may not fully offset labor challenges, supply concerns, and uncompensated care pressures.^v

Together, both sectors are entering the second half of 2026 with less room for error and a tougher operating test.^vi

Against this backdrop, our 2026 outlook identified three critical strategies for health care organizations aspiring to build resilience and achieve sustainable growth:

• Empowering consumer health through digital experiences
• Scaling Gen AI and Agentic AI
• Advancing cross-industry collaborations.

At mid-year, all three remain central, but each now involves a sharper leadership trade-off to help turn strategy into results.

1. Digital consumer experience: Bridging the speed and readiness gap

Consumer expectations are moving faster than the system. Consumers are continually adapting how they manage their health and well-being.^vii Roughly one in three adults now turns to AI for health information and advice - a telling sign of how quickly expectations are shifting.^viii

The experience an organization offers may no longer be a soft attribute. Deloitte’s recent analysis of HundredX™ data shows consumers who rate their health plan or health system highly on technology and app experience are about ten times more likely to be loyal, and nearly three times more likely to say the organization delivers better value, than those who rate it poorly.^ix Seemingly, loyalty and perceived value are decided at the interface.

The core trade-off may be speed versus readiness. Health care organizations should respond to rapidly evolving consumer preferences, but speed alone may not be enough. Move too slowly, and consumers may look elsewhere for guidance, access, and value. Move too superficially, and the organization may create a faster front door into the same slow system.

Ambition appears high, but scaling remains hard. Deloitte’s recent care delivery transformation research suggests the intent is real, while the operating speed is still catching up. All respondents said care delivery transformation was either a top enterprise priority or very important, yet health systems rated themselves only 2.7 out of 5 on their ability to scale. The gap is not aspiration; it is the ability to convert intent into scaled, daily operating change.^x

Loyalty therefore can be better understood as an operating outcome, not just a marketing one. It can be built through transparency about data and AI, digital experiences that are genuinely integrated rather than bolted together, and inclusive design. It also may not be earned the same way for every population. Different consumers engage with digital health on different terms: some may be willing to pay more for easier access to specialists and advanced technology, while others may seek affordable digital access to curb their health care spending.^xi

A leadership question is therefore one of pace: where can health systems and health plans move quickly enough to meet consumers where they already are, and where should they slow down long enough to redesign the workflows, roles, data, and accountability that make the experience more meaningful?

2. Gen AI and Agentic AI: Scaling with discipline

Some AI initiatives are reaching an inflection point. Our 2026 survey of 64 health system and health plan CFOs found that AI initiatives launched over the past two years are now splitting almost evenly into thirds^xii: one-third have scaled across multiple functions; one-third remain in pilot or limited use; and one-third have been paused or abandoned.^xiii

That split points to a second major trade-off: experimentation versus execution discipline. It could be easy to read the abandoned initiatives as waste as pilots progress, but the reality is likely more nuanced. Stopping a use case can signal discipline when leaders determine that it does not create enough value in a defined period of time, is not feasible, carries unacceptable risk, or cannot scale. The greater concern may be the initiatives that remain in pilot for a prolonged period. A pilot without a fixed time horizon and explicit success metrics is not an experiment; it can be a standing expense waiting for someone to defend it.

Effective pilots should use a clock and a scorecard. Run properly, a pilot generally has a defined window, agreed measures of value, and a real decision – scale, stop, or revise – waiting at the end. Pilots remain an appropriate way to learn; the discipline is about keeping them from becoming permanent. Some health care organizations are beginning to apply this rigor to keep AI experimentation from multiplying past the point of usefulness.^xiv

A leadership test is where to deploy and focus capital. Leaders who focus on investments where AI can deliver measurable impact, integrate into real workflows, satisfy regulatory and ethical expectations, and earn the confidence of the clinicians, employees, members, and patients are likely the ones turning AI from a portfolio of pilots into an operating capability. The willingness to stop should be as strategic as the willingness to start.

3. M&A and partnerships: Choosing what to own, share, or leave behind

Collaboration and dealmaking are gaining momentum. Some health care organizations report they are looking beyond their traditional boundaries for growth, and interest in collaboration, regional and national alliances, and M&A has climbed sharply. Fifty-nine percent of surveyed health care finance leaders now say M&A will rise as a priority for their organization in 2026, up from 42% in our 2025 CFO study.^xv When a capability is too slow to build, leaders report that they are increasingly willing to buy it or partner for it.

A strategic question is shifting from build versus buy to own versus partner versus exit. The 2026 story appears to be about repositioning as much as growth. Leaders are likely asking where control is essential, where collaboration is sufficient, and where continued ownership may be tying up capital, management attention, or strategic flexibility.

Hospitals and health systems are editing their portfolios. Hospital and health system dealmaking, which regained its footing in late 2025, carried that strength into the new year. The first quarter of 2026 saw the highest quarterly deal volume and value in recent memory.^xvi Yet, a telling number is buried in the mix: two-thirds of the deals were divestitures. This is not a sector expanding indiscriminately; it is one editing itself. Health systems are likely making deliberate choices about where they intend to compete, where they need to scale, and where they can no longer afford continued exposure. Large and national systems are pruning underperforming or non-core markets to shore up balance sheets, free up capital, and concentrate on the geographies and capabilities that matter most.^xvii

Health plans are using partnerships to extend reach and capability. For health plans, the same trade-off may be showing up differently. Rather than owning every capability, many are looking outside conventional health care borders to expand reach, improve engagement, and access capabilities they may not be able to build fast enough on their own. Roughly two-thirds of surveyed health plan CFOs are likely to pursue partnerships with technology and digital health firms, employers, and local businesses, and nearly half are open to alliances with financial services companies and community-based organizations.^xviii

The leadership posture will likely become more deliberate. Withdrawing from what no longer fits, focusing on where organizations can win, and partnering to extend reach beyond traditional industry lines are not separate maneuvers. Together, they can reflect a more coherent approach to capital, capability, and strategic focus at mid-year.

The implications for health care leaders in the second half of 2026

The second half of 2026 may be the proving ground for leadership decisions. Health plans and health systems should consider making sharper choices about where to move quickly, where to redesign before scaling, and where to redirect capital and attention. Important decisions will likely fall into three categories:

• Digital experience: Where to speed up to meet consumer expectations, and where to slow down long enough to redesign workflows, roles, data, and accountability.
• AI: Which initiatives to scale, which to revise, and which to stop before pilots become permanent costs.
• M&A and partnerships: What to own, what to partner for, and what to leave behind to strengthen strategic focus.

Those choices may do more than shape the balance of 2026. They could set the operating posture for 2027, when affordability, access, trust, margin discipline, and resilience are likely to face an even sharper test.

The leaders who can make those choices clearly – who can name what they will fund, defend, and walk away from – are the ones most likely to define health care’s next chapter rather than merely react to it.

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Endnotes

ⁱ Alicia Janisch, Wendy Gerhardt, Maulesh Shukla, 2026 US Health Care Outlook, Deloitte Insights, 11 December 2025

ⁱⁱ Paige Minemyer, Moody's: Insurers' 2026 outlook is negative as cost pressures continue to batter industry, Fierce Healthcare, 17 March 2026

ⁱⁱⁱ Bruce Jaspen, Health Insurers Are Performing Better But There’s Trouble Ahead, Forbes, 10 May 2026; Rebecca Pifer Parduhn, CMS finalizes higher Medicare Advantage rates for 2027 in gift to insurers, Healthcare Dive, 7 April 2026

^iv Congressional Budget Office, Federal Subsidies for Health Insurance Baseline—02-2026, February 2026

^v Dave Muoio, Hospital margins inched higher in April, but still remain below 2025; Fierce Healthcare, 22 June 2026; AHA, Assessing the Health Care Environment for 2026: Key Signals for the Field, accessed 29 June 2026

^vi Bruce Jaspen, Health Insurers Are Performing Better But There’s Trouble Ahead, Forbes, 10 May 2026; Dave Muoio, Hospital margins inched higher in April, but still remain below 2025; Fierce Healthcare, 22 June 2026; Nick Hut, Hospital margins decline in 2026 as expenses outpace revenue, HFMA, April 22, 2026, 

^vii Mikalya Holzwarth, et.al, The tortoise and the hare of care: Health AI insights from Rock Health’s 2025 Consumer Adoption Survey, RockHealth, 23 March 2026

^viii Alex Montero, et.al, KFF Tracking Poll on Health Information and Trust: Use of AI For Health Information and Advice, KFF, 25 March 2026; Mikalya Holzwarth, et.al, The tortoise and the hare of care: Health AI insights from Rock Health’s 2025 Consumer Adoption Survey, RockHealth, 23 March 2026 

^ix Deloitte analysis of over 42,000 pieces of consumer feedback on 41 large health insurers and health system organizations from HundredX™ on a 12-month trailing basis ending March 2026.

^x Christy Lemak, et.al, Why doing many of the right things still may not be enough to transform care delivery, Deloitte Insights, 2 June 2026

^xi Anwesha Dutta, The growing disconnect between virtual health availability and consumer demand, Deloitte Insights, Deloitte Insights, 16 October 2024; Deloitte, Patients prefer virtual visits for convenience, cost, 28 November 2024

^xii Findings from Deloitte Center for Health Solutions 2026 Health Care CFO survey

^xiii Findings from Deloitte Center for Health Solutions 2026 Health Care CFO survey

^xiv Joyce Famakinwa, How to prevent AI pilot overload inside health systems, Modern Healthcare, 16 June 2026

^xv Findings from Deloitte Center for Health Solutions 2026 and 2025 Health Care CFO surveys

^xvi Kristofer Blohm and Courtney Midanek, M&A quarterly activity report: Q1 2026, Vizient, 9 April 2026

^xvii Alan Condon, 7 large health systems selling hospitals, Becker’s Hospital Review, 15 June 2026; Patsy Newitt, The great hospital sell-off: How major health systems are betting big on ASCs, Becker’s ASC review, 21 May 2026

^xviii Findings from Deloitte Center for Health Solutions 2026 Health Care CFO survey

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