The healthcare policy tempo heading into 2026 is defined by two forces moving in tandem: aggressive cost-containment and an equally aggressive push to modernize how care is delivered and administered. In Avalon’s webinar Healthcare in 2026: The Decisions, Disruptions, and Trends Shaping Tomorrow, Dr. Bill Kerr, CEO of Avalon Healthcare Solutions, and Julie Barnes, Founder and CEO of Maverick Health Policy, unpacked the year’s most consequential federal actions — and what they signal for payers, providers, and innovators preparing for what’s next.
2025 in Review: A Historic Volume of Federal Activity
To underscore the scale of change, Barnes opened with a striking data point: President Trump signed 225 executive orders in 2025, far exceeding recent administrations. The volume wasn’t just political theater — it reflected a policy environment where weekly developments reshaped priorities in real time.
Maverick’s year-in-review “roadmap” highlighted how much of that activity flowed through HHS and CMS, with policy themes clustering into three dominant areas:
- Deregulation
- Payment reform
- Technology integration
HHS Priorities: Affordability, Technology, and a New Center of Gravity
Barnes and Dr. Kerr emphasized that the current federal posture is unusually consistent: a sustained, “laser” focus on affordability and modernization, paired with a willingness to challenge traditional power centers in healthcare.
Dr. Kerr noted the most surprising shift isn’t just what is being pursued, but who is being prioritized — patients and affordability outcomes more than legacy stakeholders. Barnes framed it as a “tech-driven mindset” increasingly visible in HHS leadership, where the question is less “how has this always worked?” and more “how can this work faster, cleaner, and better?”
Interoperability Reboot: From Mandate to Execution
A central through-line was the renewed attempt to make interoperability functional — not merely compliant. Barnes pointed to the CMS Health Tech Ecosystem Interoperability Framework as a milestone, led by Amy Gleason, Acting Administrator for Digital Health Services and Senior Advisor to CMS.
The discussion positioned interoperability as the foundation for multiple downstream goals:
- Price transparency tools that actually work
- Faster coverage determinations
- Better coordination across fragmented care
- Scalable AI-enabled insights
Transparency in Coverage: Standardization Comes Next
Barnes highlighted updated expectations for the Transparency in Coverage Rule. The original intent — publicly available pricing — has run into a practical problem: the data has been too inconsistent and unwieldy to use. The new push: standardization and streamlined formats so analytics firms, employer tools, and consumer-facing platforms can interpret and apply the pricing files meaningfully.
Payment Reform: Site Neutrality and Targeting “Waste”
Both speakers framed site-neutral payment policies as a core lever for cost control, building bipartisan momentum but accelerating under current leadership. The rationale: eliminating payment differentials that reward care delivery in higher-cost settings when the same service can be delivered elsewhere.
In parallel, CMS leadership continues to spotlight fraud, waste, and abuse, extending scrutiny into areas like DME, hospice, and risk adjustment — and even influencing unexpected, proposed rate changes looking ahead.
Congress and Coverage Volatility: Progress Meets Political Risk
While most momentum was attributed to HHS, Congress remains consequential — and unpredictable. Barnes flagged:
- Looming budget deadlines and shutdown risk
- A House-passed healthcare package with provisions that matter to diagnostics, including:
- delaying PAMA-related lab reimbursement cuts
- advancing multi-cancer early detection coverage discussions
Dr. Kerr noted the tension: pushing back lab cuts appears inconsistent with the administration’s affordability narrative, but Barnes pointed to political reality — labs have strong champions, and diagnostics are increasingly central to questions of appropriate coding, risk adjustment, and care accuracy.
AI in Healthcare: Acceleration Without a Clear Rulebook
A major segment focused on AI’s rapid adoption — and the widening gap between industry deployment and government oversight. Barnes cited HHS’s Request for Information (RFI) seeking input on accelerating safe, responsible AI in clinical care, asking stakeholders what’s blocking implementation and what would build public trust across:
- Regulation
- Reimbursement
- Research
Dr. Kerr extended the conversation to what AI adoption means operationally and socially:
- Studies increasingly show AI outperforming clinicians in knowledge-based tasks
- More surprisingly, some curated models have been rated as more empathetic than physicians — raising questions about access, rural care, and mental health support
- Patient behavior is shifting from “Googling symptoms” to “AI-guided self-triage,” changing the pressure dynamics inside primary care
FDA and Digital Tools: Lower-Risk Pathways Expand
Barnes described emerging federal signals that lower-risk digital products may face fewer barriers to market — particularly in wellness and certain clinical decision support categories. The broader implication: more on-ramps for tech-forward solutions, even as the ecosystem struggles with a practical question Dr. Kerr raised bluntly: what happens when consumer tools conflict with clinically validated devices?
Prior Authorization: Technology as the Only Path Forward
The panel returned to prior authorization as both unavoidable and ripe for modernization. Barnes anticipated more CMS movement on:
- Electronic prior authorization
- API-driven connectivity between payer claims systems and provider EHRs
Dr. Kerr reframed the long-term opportunity: not eliminating prior authorization, but shifting toward real-time coverage determinations at the point of care — so patients leave the exam room with a plan that can actually be executed. He tied this directly to Avalon’s “shift left” concept: using clinical data (including lab results) to streamline what can be approved without friction.
Coverage Outlook: Employer Insurance Grows — But Pressure Rises
In a poll-driven discussion, the group landed on employer-sponsored coverage as the projected largest payer segment after ACA subsidy changes. But Barnes challenged the optimism: with enhanced ACA subsidies expired, Medicaid changes underway, and Medicare Advantage under pressure, cost-shifting is likely to intensify — and commercial/employer plans are often where providers turn to make up shortfalls.
Dr. Kerr added a concern that the coverage landscape may deteriorate for those losing subsidies, pushing more people into the uninsured category and driving higher-cost utilization through emergency care — worsening both the human and financial impact.
Long-Term Trajectory: Physicians as “Air Traffic Controllers”
To close, Barnes shared a provocative future-state view echoed by multiple physician-led companies: in 10 years, physicians may function less as primary executors of care and more as supervisors of automated decision tools, remote monitoring, and AI-enabled workflows.
Dr. Kerr agreed the direction is plausible — pointing to COVID-era shifts that moved more work “up the license” (pharmacists, remote care, self-testing) and repositioned the physician as an advisor and synthesizer. The outcome: a care model where technology expands capability, and clinicians orchestrate increasingly complex inputs.
As Barnes summarized in response to a question about political staying power: technology modernization tends to persist across administrations — the debate is usually pace, not direction. For healthcare leaders, the strategic imperative is clear: build operational agility now, because the policy and technology environment shaping 2026 is already moving at full speed.
