Speakers at RISE National 2026 made it clear that the future of health care will be defined by trust, data modernization, proactive compliance, prevention, and a renewed focus on the human experience.
Here are five lessons we took away from the sessions:
Be adaptable amid continued market volatility
Speakers described a health care landscape marked by instability, rising costs, policy swings, and operational strain. Indeed, Eric Musser, vice president for federal affairs at the National Committee for Quality Assurance (NCQA), referred to this moment as a “generational storm of uncertainty,” and Abe Sutton, director of the Center for Medicare and Medicaid Innovation (CMMI) and deputy administrator at CMS, said that Medicare and Medicare Advantage are at a “pivotal moment” due to affordability concerns.
Interoperable data is essential
It’s no longer optional to have real-time, interoperable data. NCQA’s Musser said the shift to digital, interoperable clinic data is designed to reduce burden, and support prevention, chronic disease management, and care coordination. Arjuna Swaminathan, chief artificial intelligence officer at the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG), also warned that AI-generated charts and synthetic identities expose vulnerabilities in outdated systems.
Be proactive with compliance
Across OIG and Department of Justice (DOJ) sessions, speakers stressed that oversight in Medicare Advantage is intensifying. OIG’s Megan Tinker, chief of staff, highlighted risks in access, risk adjustment, and marketing integrity. Edward C. Crooke, assistant director of the Civil Division’s Fraud Section at DOJ emphasized unprecedented enforcement results and broader liability extending to vendors and executives. To address compliance, make sure you are proactive and have defensible documentation. Conduct internal audits and use data analytics to spot outliers.
Rebuild trust and address the human experience
There are deep trust gaps between payers, vendors, providers, and patients, according to Rachel Harrington, Ph.D., senior product strategist for NCQA. Caregivers highlighted that instability, poor communication, and fragmentation erode trust. Fraud discussions showed how AI‑driven deception threatens trust in data itself. Therefore, it’s imperative to be transparent, provide consistent communication, engage with beneficiaries earlier, and recognize the realities of patients and caregivers.
AI is transformative but needs guardrails
While Sutton and Swaminathan see enormous potential for AI to augment care, reshape fraud, reduce unnecessary referrals, and cut costs, they also stressed the importance of human oversight and stronger guardrails. “AI can flag patterns, but you, with your functional knowledge and your human judgment, determine intent,” Swaminathan said. “You provide the clinical context and ethical stewardship that no algorithm can replicate. The golden result is the integrity loop when the power of AI meets the wisdom of humanity.”