As healthcare organizations enter 2026, leaders are navigating one of the most transformative periods in modern healthcare. From the acceleration of AI-driven workflows to rising patient financial responsibility and shifting sites of care, the year ahead presents both challenges and opportunities for innovation. Below highlights six defining trends shaping revenue integrity, operational performance, and the patient financial experience, as well as the critical questions every healthcare leader should be asking now.

1. AI and tech-driven healthcare services. The 2026 CPT code update reflects a growing shift toward digital health services like shorter duration remote patient monitoring and AI services that augment physician capabilities and improve patient care. As AI- and tech-driven services continue to expand, providers will be able to identify warning signs of underlying health problems, manage chronic disease, monitor post-acute care, and enable highly personalized treatment plans.

Questions: How will your organization leverage current trends in the healthcare industry (e.g., the increased adoption of digital health services) to promote quality care, positive outcomes, and lower costs? And how will you ensure your billing teams capture all appropriate revenue by accurately reporting new and emerging codes?

2. Rising healthcare and drug costs. As healthcare costs continue to increase, hospital year-end margins remain slim, and experts say 2026 will be another year of powerful inflationary forces. Shifting to cost-effective care models (including home-based care) and value-based contracts will be imperative. So will educating consumers about the cost of their care and how to make healthcare more affordable.

Questions: What is your organization doing to shift care to the most appropriate, lower cost setting? What about managing chronic conditions proactively? Do you leverage real-time eligibility and benefit checks for virtual care and home-based models? Does the organization also provide clear, up-front cost estimates and leverage digital tools for patient statements and payments? Does it leverage the patient call center to provide patient financial education? 

3. Increased use of GLP-1 medications. One in eight adults say they are currently taking a GLP-1 medication for weight loss, diabetes, or another condition, and some experts say these numbers could increase as oral GLP-1 medications become available. In addition, on November 6, 2025, President Trump announced deals with Eli Lilly and Novo Nordisk that slash prices and bring coverage to eligible beneficiaries for just a $50 copay, down from over $1,000 per month out-of-pocket. 

Questions: How will your organization stay on top of restrictions on clinical criteria and step therapies for GLP-1 weight management use? Many GLP-1 medications remain covered only under their non–weight-loss FDA-approved uses. As health plans continue to regard GLP-1 drugs as a top cost inflator, they may increasingly integrate coverage for the treatment of obesity with wraparound services like nutritional counseling, behavioral coaching, and digital weight management tools for patients. Understanding ever-evolving requirements, adapting to current trends in the healthcare industry, and providing patient education will be paramount.

4. Rapidly shifting patient coverage. In the wake of new Medicaid eligibility (including new work requirements and financial criteria) and the potential expiration of advanced premium tax credits, many patients may become uninsured or underinsured, necessitating the need for up-front navigation to marketplace plans, financial assistance, or charity care.

Questions: How will your organization improve front-end processes to determine coverage and eligibility and route patients to the appropriate resources? What about strengthening patient collections to reduce bad debt?

5. Surges in behavioral health. Utilization of inpatient and outpatient behavioral health services will continue to soar throughout 2026, and organizations must prepare to expand capacity beyond traditional visits, strengthen community partnerships, and adopt new revenue models.

Questions: How will your organization adapt to these current trends in the healthcare industry? For example, does (or will) your organization leverage collaborative care models within primary care and bill accurately for those services? What about telemedicine visits for mental health? Does the organization have formal agreements with mobile crisis units and crisis stabilization centers? Does every chronic disease workflow include behavioral health screening?

6. Increase payer scrutiny. In 2026, many payers will intensify downcoding, prior authorization, and documentation scrutiny to reduce spend, making it imperative for organizations to leverage AI and automation within their revenue cycle to improve accuracy and speed-to-cash.

Questions: What are your organization’s plans to implement or advance automated coding, eligibility, authorization, and denial prediction in light of these current trends in the healthcare industry? How will you leverage human billers more effectively for audit defense, payer escalation, and relationship-driven work in an age of automation?

Looking ahead
To stay ahead of 2026’s trends, healthcare leaders must tightly align financial operations with changing care models and patient expectations. Key priorities include:

• Deploying AI and automation to reduce manual touches and denial risk—enabling clean claims from the start.

• Protecting reimbursement as services expand into virtual, ambulatory, and home settings.

• Strengthening authorization integrity, coding accuracy, and real-time eligibility checks to manage rising utilization driven by GLP-1 therapies, behavioral health demand, and chronic-care complexity.

• Improving the patient financial experience with clearer estimates, digital payment options, and compassionate collection strategies that maintain affordability and trust.

  Organizations who treat their revenue cycle as both a compliance engine and a consumer experience will accelerate cash, reduce write-offs, and position themselves as the financially strong partners payers and patients rely on in 2026.

Learn how Global Healthcare Resource can help your organization navigate these current trends in the healthcare industry with greater ease.