HIMSS 2026 kicks off in Las Vegas today. 25,000 healthcare leaders are on the ground, nearly a third from the C-suite. The big shift this year — AI conversations are moving from "should we" to "we're doing it, now what."

Microsoft just turned Dragon Copilot into a clinical AI platform. What started as an ambient documentation tool is now an app store for clinical AI — with partners like Optum, Regard, and Canary Speech building directly inside the workflow. They're also offering a 60% discount to rural hospitals, which is not an accident given everything happening with Medicaid right now.

Telehealth got the runway it's been asking for. Federal telehealth approvals extended two years, and hospital-at-home waivers run through 2030. If you've been waiting to make a real infrastructure commitment to virtual care, that hesitation just got removed.

Hospitals are already closing units and laying off staff because of the Medicaid cuts — and we're still in the early innings. Maternity wards, community health centers, hospital clinics — the closures are happening this month, not in some future projection. Shelby breaks down what's driving it, what's still coming in 2027, and what healthcare leaders need to do right now before it gets worse.