Major transformation may be ahead with regulations, AI and financial pressures driving impact on the industry
COSTA MESA, Calif., December 15, 2025–(BUSINESS WIRE)–Experian Health today unveiled its predictions for the healthcare industry, a year that will be significantly shaped by new regulations, mounting financial pressures, and the shift from AI awareness to adoption. As the revenue cycle grows increasingly complex, healthcare organizations must look to harness technology to enhance human expertise in 2026.
The following are five predictions that will define the next phase of healthcare in the near term and beyond:
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Challenge of Claim Denials: Claim denials will remain one of the most persistent and costly challenges for healthcare providers in 2026. According to Experian Health’s recent State of Claims survey, more than one-third of providers say that 10 percent or more of claims are denied. That problem won’t go away in the coming year. While AI offers proven results to streamline claims management, adoption remains low, with just 14 percent of respondents using AI to help with claim denials. For large-scale adoption, organizations need confidence in the technology and vendors must ensure transparency and auditability of these technologies without introducing new complexities.
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Regulation Impacts on Patient Experience: Providers will see a significant rise in self-pay patients, creating revenue impacts as changes from the One Big Beautiful Bill Act (OBBBA) begin in 2026 and more broadly go into effect in 2027. The Congressional Budget Office projects the number of uninsured Americans will increase by 10 million by 2034. With regulatory changes in patient coverage, financial operations and administrative processes, providers must focus on optimizing their systems and workflows. Experian Health’s OBBBA survey found many providers aren’t prepared for the new law, with providers saying eligibility (43%) and billing (42%) are the primary areas requiring improvement.
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Evolution of AI: In the next six months, we will see providers rapidly adopt AI to solve their top pain points with the most immediate impact on data accuracy and patient engagement. Experian Health’s new AI survey among providers found the top use cases of AI are:
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52% for insurance eligibility and benefits verification
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45% for patient scheduling
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44% for patient registration
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Use cases will focus on specific projects as teams get trained and build up their in-house expertise. Broader scopes and robust implementation of AI may take a few years but there is optimism to leverage the technology at scale as the survey showed that 53% of respondents feel AI will be adopted widely but require oversight, while more than a third say AI will become essential for operational efficiency.
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