The annual pilgrimage to San Francisco delivered exactly what you'd expect: management teams putting their best foot forward, guidance ranges that leave room for "beat and raise" narratives, and enough strategic buzzwords to fill a bingo card. But buried in the presentations were genuine signals about where healthcare is heading in 2026 and beyond.
The Great Specialty Pivot
Every publicly traded healthcare company at JPM25 is telling you the same thing: commodity businesses are dead. specialty is the only margin story that matters.
McKesson, Cencora, and Cardinal are all racing to own the physician relationship through vertical integration. Carrier vertical integration is dead. Long live drug distributor vertical integration! MSO investments include areas of key specialty drug cost / utilization growth like oncology, autoimmune, and retina. Control the point of prescribing, lock in contracts and drug margin and everything else follows. McKesson's USON touches 20% of U.S. cancer patients. Cencora accelerated full OneOncology acquisition to capture synergies immediately. Cardinal's chasing the 80-90% of specialty physicians who remain unaffiliated. The white space in multispecialty, oncology adjacent areas represents the next frontier now that oncology is maturing.
Meanwhile, data moats are separating AI winners from also-rans. Tempus is building 400+ petabytes of multimodal data and claiming to be "AWS, GCP, and Azure in one company." Waystar's uniting 7.5B payment transactions with clinical data through iodine. The competitive advantage isn't the LLM itself but access to proprietary organized information. As underlying technology becomes increasingly fungible, differentiation lies in platform-ization, expertise, data sophistication.
V28 did exactly what CMS intended: separated companies built on coding arbitrage from those focused on genuine care delivery. Both Alignment and Astrana saw RAF scores increase post-implementation, indicating the advantage of conservatism in a rapidly shifting payment and policy environment, and distinct advantages while competitors got crushed.
The oral GLP-1 transition is flipping from headwind to tailwind across distribution as refrigeration and special handling burdens diminish. Eli Lilly management claims leading GLP-1 companies now control ~80% of global manufacturing capacity.
Medicaid under structural pressure with state-specific chaos. Acadia's quantification of New York's out-of-state Medicaid prohibition and California staffing ratio requirements creating material headwinds for Medicaid-indexed businesses.
Other great reads and overviews:
What's the most underappreciated theme you're tracking from JPM?
