For a more in-depth analysis of 2026 healthcare financial trends, find our full trends report here.
A dynamic mix of risk and reward has shaped 2026. This CommerceHealthcare® report examines key issues across these areas:
- Financial & Reimbursement
- Patient Financial Experience
- Technology and Automation
This report tracks the status of the themes at mid-year to help leaders evaluate current directions.
Finance and reimbursement updates.
Financial pressures remain a dominant factor as organizations balance technology investments with cost control and margin improvement.
Profitability showing strain.
Operating margins have been improving, but still lag behind 2025. Through April, hospital year-to-date (YTD) operating margins were 2.5% with corporate and other allocations and 8.3% without them.1 Recently, 72% of CFOs reported that their organizations are experiencing margins of 2% or lower.2
Expenses, especially labor, continue to escalate.
Total hospital expenses increased 7.1% year-over-year (YOY) in the first quarter.3 Labor costs remain a challenge as staffing shortages continue across hospitals post-acute facilities, limiting admissions and extending hospital stays.4
Revenue and volume are encouraging.
Through April, hospital net operating revenue logged a 7% increase from the prior year, helped by growth in outpatient care.5 Volume is also growing. YOY inpatient admissions have risen 4.8%, while outpatient visits gained 3%.6
1. Kaufman Hall, “National Hospital Flash Report,” June 2026.
2. S. Morse, “More Than 70% of CFOs Report Margins of 2% or Less,” Healthcare Finance, April 21, 2026.
3. Strata Decision Technology, “Monthly Healthcare Industry Financial Benchmarks,” May 2026.
4. Z. Siddiqi, “Nursing Homes Limit Admissions Due to Labor Shortages, Ziegler CFO Survey States,” Skilled
Nursing News, July 8, 2025.
5. Kaufman Hall, “National Hospital Flash Report,” June 2026.
6. Strata, “Strata Performance Trends,” June 2026.
Bad debt and uncompensated care rising sharply; cash flow steady.
Relative to 2025, bad debt and charity care per calendar day were up a concerning 15% YTD through April.7
Looming Medicaid cuts gaining clarity.
Providers continue to brace themselves for substantial cuts in Medicaid over the next several years. Hospitals serving lower-income areas may be at significant risk of closure or service reductions if other government payments insufficiently blunt the Medicaid impact. Also slated for restriction is the Medicaid Managed Care State Directed Payments Program, which federal officials believe has been a conduit for states to gain additional funding.
Affordable Care Act (ACA) enrollments down, premiums up.
Subsidies to help individuals obtain insurance through the ACA marketplaces have now expired. Federal data shows that 23.1 million people signed up during the 2026 open enrollment period, a drop of more than one million.
Providers wrestling with Medicare Advantage (MA) trends.
Providers see prior authorization policies and payment disputes as adding to their cost and hindering access for patients. An MA trend is expansion of Special Needs Plans (SNPs) that cover dual Medicaid-Medicare enrollees, chronic care and beneficiaries needing long-term care.
Patient financial experience updates.
An HFMA assertion is that “the healthcare system is not making progress toward improving affordability” and could slip into “crisis mode.”8 A national poll saw 32% of respondents indicating they’re very worried about being able to afford healthcare. These challenges lead many to defer needed care or avoid it entirely. In early 2026, 26% of surveyed adults said they had postponed surgical or medical treatment sometime over the past four years due to cost.9
The patient financing imperative.
Demand for patient financial assistance from health systems, hospitals and practices is high. U.S. patient financing has been growing at a 4.1% compound annual rate for five years and stood at over $18 billion in 2025.10 Flexible payment plans with affordable financing options can better meet patients’ varying financial needs.
Well-delivered financial assistance is one cornerstone of positive patient financial experience.
7. Kaufman Hall, “National Hospital Flash Report,” June 2026.
8. Healthcare Financial Management Association and Vitalic Health, “U.S. Healthcare Vitals Tracker,” September 2025.
9. West Health, “One-Third of Americans Making Financial Trade-Offs to Pay for Healthcare,” March 12, 2026.
10. IBIS World, Medical Patient Financing in the US., December 2025.
Communication.
Successful organizations have used consistent, proactive communications to improve customer satisfaction and point-of-care collections. They discuss payment plans earlier in the patient journey, stress options and affordability concerns rather than just collection, and get help from outside financial institutions that are skilled at assuming and managing the patient responsibility process.11
Transparency.
Some expect “real-time price transparency” to emerge as a game-changer for the patient financial experience. Using AI and automated data integration, “real-time transparency tools enable health plans and providers to instantly exchange care plans, eligibility, and coverage information at the moments that matter most.”12
Technology.
Several recent analyses have focused on the promise of artificial intelligence (AI) and other technologies to personalize the financing process. A health system CFO observed that today’s payment prediction tools are strong, but they’re not “factoring in unique patient personas or circumstances. There’s definitely an opportunity to go deeper.”13
Technology and automation updates.
Technology is the wellspring of advancements in financial automation, digital payments and cybersecurity.
AI expanding fast in healthcare finance.
Investment in AI in finance and RCM is on a clear upward trajectory. Overall, health systems report a 67% increase in adoption of AI for three or more applications in 2026 relative to 2025.14 As of late 2025, 38% of organizations were using generative AI to achieve administrative efficiency in RCM, finance, claims and related departments.15
Powerful automation drivers.
Administrative inefficiencies remain costly. Estimations show healthcare could save an estimated $19 billion16 through automation, while hospitals spent $43 billion in pursuing payments from insurers.17
11. Healthcare Financial Management Association, “Patient POS Collections Pose a Growing Problem for RCM Departments,” June 8, 2026.
12. Advisory Board, “Infographic: Real-Time Transparency,” June 2026.
13. Cedar, Healthcare Financial Experience Study, March 2026.
14. Eliciting Insights, “Health System Adoption of AI Solutions: 2026,” February 2026.
15. McKinsey & Company, “Generative AI in Healthcare: Adoption Matures as Agentic AI Emerges,” April 2026.
16. Ibid.
17. American Hospital Association, “Costs of Caring,” March 2026.
Overcoming barriers to AI-driven automation success.
Digital payment adoption continues to accelerate. ACH transactions, virtual credit cards, near-real-tome payments and digital wallets are all seeing rapid growth, while embedding finance is expanding digital payment options for providers and patients alike.
Healthcare cyber incidents grew again in 2025 and remain an evergreen issue.18 Advanced technology is fueling the assault. Automated bots are said to make up over half of today’s internet traffic and “relentlessly probe every public website for simple flaws.”19
Scanning the landscape at mid-year reveals an issue gaining prominence. AI agents being deployed in organizations can be hacked. Insider breaches can result because the targeted agents have access to sensitive internal information. With an estimated 45 digital identities per employee, continuous network monitoring for unsanctioned AI apps or unusual data access patterns is a complex undertaking.20
AI also offers new defenses. Autonomous systems may “fundamentally shift the defensive posture of critical infrastructure, finding and closing vulnerabilities faster than any human team could.”21
Conclusion.
The financial picture is relatively stable, though still precarious for most organizations. Healthcare’s strides in automating financial processes and improving patient financial experiences are impressive, though incomplete. Patient affordability and reimbursement changes are clear risks, while AI and technology look increasingly beneficial.
CommerceHealthcare® solutions are provided by Commerce Bank.
18. Health-ISAC, “Cybersecurity Trends and Threats in the Health Sector 2025:Q4,” January 2026.
19. Sonicwall, 2026 Cyber Protect Report, March 2026.
20. A. Loten, “Hackers Turn to AI Agents to Steal Companies’ Data, Wall Street Journal, June 3, 2026.
21. Health-ISAC, “Claude Mythos and its Health Sector Implications,” May 2026.
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