McKinsey: AI & Data are Redefining US Healthcare Efficiency

McKinsey’s "What to expect in US healthcare in 2026 and beyond" report has a clear message: technology is not just supporting healthcare, it’s becoming its growth engine. 

“Health services and technology (HST) is expected to continue as the fastest growing segment in healthcare,” the consultancy says in the report.

“Software platforms have a growing role within the healthcare ecosystem, enabling providers and payers to become more efficient in an increasingly complex environment.

"Technological innovation – for example Gen AI and machine learning – is creating opportunities for stakeholders across segments by automating workflows, promoting data connectivity and interoperability and generating actionable insights.”

Healthcare: Where pressure creates digital opportunity

According to McKinsey's analysis, industry EBITDA as a percentage of national health expenditures (NHE) fell from 11.2% in 2019 to 8.9% in 2024, meaning much of the sector is wrestling with tighter margins, rising utilisation and reimbursement headwinds. 

However, key growth segments – especially HST, specialty pharmacy and non‑acute care – are attracting greater investment as efficiency imperatives drive outsourcing and digital reinvention.

This is why McKinsey notes that technological innovation is a theme that extends across payer operations, provider performance management and care delivery redesign. 

For McKinsey, AI‑enabled transformation is moving beyond the experimental phase. Now, technology is essential for ensuring efficiency and cost management.

“Adoption will favour solutions that are measurable, implementable and reduce burden – especially in under-resourced settings where funding programs may accelerate upgrades,” Brian Litten, Co-Founder and Managing Partner of AI technology healthcare venture capital firm Saltgrass, writes on LinkedIn.

Michael Dreher, Advisory Board Member of SiMLQ, adds: “McKinsey & Company’s latest healthcare outlook highlights the challenges – rising costs, workforce shortages, reimbursement pressure, regulatory change and growing demand from an ageing population are forcing healthcare leaders to operate at two speeds: short-term resilience and long-term reinvention.

“AI is no longer theoretical. From prior authorisation and revenue cycle to workforce optimisation and supply chain execution, healthcare is finally seeing technology applied where it matters most — removing friction from complex, manual workflows that drain efficiencies and strain morale.”

How technology is automating healthcare’s back office

Healthcare payers, for example, are under pressure from rising medical and pharmacy costs, membership losses and regulatory shifts. 

McKinsey forecasts that “after 2027, payer recovery will depend on adoption of new care models, optimised pricing models, industry partnerships,and AI-enabled backend transformations”.

In practice, that translates to automation in claims adjudication, predictive modeling for risk adjustment and machine learning to detect fraud and optimise operations.

Providers face a parallel challenge, McKinsey’s research finds.

Labour cost instability, mounting uncompensated care and evolving reimbursement models have created thin margins. 

But McKinsey points to a likely turnaround: “Beyond 2027, the shift of uninsured individuals into employer-sponsored coverage as they gain eligibility in their current roles or seek new employment with health coverage will support provider margin recovery. 

“Providers are expected to adopt further cost-management measures to support margins.” 

Next-generation revenue‑cycle solutions, decision‑support analytics, and AI-assisted clinical scribing are among the tools enabling that recovery.​

​In short, McKinsey sees the next phase of US healthcare differently to increasing spending, instead focusing on building smarter systems.

Its research finds that vendors that build trust through clinical-grade accuracy, integration fluency and measurable outcomes will define the new value pool. 

Those who miss the wave, however, risk being written out of healthcare’s US digital transformation.