As hospitals and health systems head into 2026, CFOs are preparing for a year of financial pressure, operational challenges and looming policy shifts. From changes in Medicaid funding to accelerating inflation and ongoing margin compression, finance leaders say innovation, strategic discipline and cross-functional collaboration will be key to maintaining sustainability and care access.
Becker’s connected with CFOs from Bon Secours Mercy Health, Care New England, Duke University Health System, ECU Health, ProMedica and Sanford Health, who shared their 2026 predictions and outlined how they plan to respond to ongoing industry pressures. They highlighted strategies such as strengthening collaboration between clinical and financial teams, leveraging AI and technology to improve efficiency, pursuing integration and economies of scale and aligning enterprise-wide growth initiatives with long-term sustainability goals.
Editor’s note: Responses have been lightly edited for clarity and length.
Todd Conklin. Executive Vice President and CFO of Care New England Health System (Providence, R.I.): I predict that changes in federal subsidies and Medicaid policy will disrupt business plans significantly for health systems nationally.
Preparation for these changes will require innovation and transformational change to ensure access to care is protected, services can be delivered at sustainable cost levels and health systems can continue to succeed operationally and financially despite another instance of deterioration in the way services are covered through commercial insurance or government funding.
Travis Crum. CFO of Bon Secours Mercy Health (Cincinnati): Margin pressure isn’t going away in 2026. Healthcare organizations that build solid operational and financial discipline will be better equipped to handle pressures, navigate the changes coming with legislation and continue to invest in future growth.
High-quality care, innovation and thoughtful expense management will remain critical, and systems that make it easier for patients to access care will continue to create real value for their communities. To prepare, leaders should work more closely across clinical, financial and compliance teams to improve outcomes for patients and strengthen the organization for the long term.
Lisa Goodlett. Senior Vice President, CFO and Treasurer of Duke University Health System (Durham, N.C.): After a year of substantial change across the industry, 2026 will require health systems to be exceptionally disciplined in how they manage clinical, operational and financial performance. Continued pressure from Medicare Advantage dynamics, reimbursement challenges and labor constraints will make it essential for organizations to align strategically across the enterprise and pursue growth that strengthens their physician and provider footprint.
Preparation begins with clarity of focus and curiosity. Leaders will need to foster collaboration across functions, strengthen integration efforts and advance initiatives that enhance efficiency and cost stewardship. At the same time, creativity remains essential. Health systems that combine disciplined execution with innovative approaches to growth and care delivery will be best positioned to navigate the pressures ahead and continue serving their communities effectively.
Terry Metzger. CFO of ProMedica (Toledo, Ohio): Overall, most health systems are expected to achieve small, modest gains in the upcoming year. However, to achieve even these modest amounts, there are key financial predictions to consider as we move into 2026.
State changes to Medicaid: Gains will largely depend on specific market conditions and any changes to state Medicaid funding mechanisms. It is crucial for health systems to stay informed about their state Medicaid reimbursements and plan accordingly. In some states, positive changes may occur, while others might fail to provide adequate support, putting additional strain on health system budgets.
Accelerating inflation: Another significant factor to watch for in the coming year is accelerating inflation. We are already seeing increased inflationary pressures in the latter part of 2025 and anticipate that it will continue into 2026. This inflation is driving up costs for labor, drugs, services and even utilities within health systems. Given the fixed nature of payer contracts and the inability to adjust reimbursements in real time, we are likely to see a decline in net cash flows, which will likely have a negative impact on our margins.
Patients’ ability to pay: And of course, those same inflationary pressures will impact patients directly, as prices for the basics like groceries and gas rise. Consequently, there could be an increase in the percentage of defaults among uninsured patients, as well as in copay defaults among insured patients. This situation could add to the financial losses health systems are facing.
Boost economies of scale: With financial pressures on the horizon, health systems can better position themselves for success by adopting a strategic plan and exercising discipline to achieve cost savings through economies of scale. It will be important to manage costs efficiently, particularly in areas like shared services and overhead expenses, while exploring innovative solutions to optimize resource utilization.
Leverage AI: To improve overall efficiency and reduce lost revenue, health systems should strategically incorporate AI where appropriate. AI technology can enhance healthcare staff productivity by automating routine tasks, providing clinical decision support, optimizing operations and ultimately reducing employee burnout. This alone could save health systems on recruitment and training costs and potentially lower our own healthcare expenses related to stress-related illnesses.
Demand fair-share reimbursement: Given the increased financial pressures, health systems should closely examine the gap between reimbursements from traditional Medicare and Medicare Advantage. According to the Medicare Payment Advisory Commission, Medicare programs spend approximately 20% more on Medicare Advantage compared to traditional Medicare. However, Medicare Advantage payers reimburse health systems significantly less for services provided to Medicare Advantage enrollees than they receive for providing the same care to traditional Medicare patients. This disparity is troubling for those nonprofits actually delivering the care, and I anticipate that more health systems will insist that for-profit payers address these underfunding gaps in Medicare Advantage during their contract negotiations in 2026.
Nick Olson. Executive Vice President and CFO of Sanford Health (Sioux Falls, S.D.): As we head into 2026, I expect healthcare finance to be shaped by a dual imperative: disciplined stewardship and strategic investment. Organizations that can maintain strong operating performance while modernizing for the future will be best positioned to navigate evolving market pressures and a dynamic operating environment.
At Sanford Health, we enter this next chapter from a position of strength. Our long history of strong financial performance, combined with our Premier Performance Plan, is helping us identify efficiencies, optimize investments and create the capacity to invest in what matters most: our people, our patients and our communities. Our continuous planning model strengthens this work by enabling us to adapt quickly and stay aligned with our long-term vision.
In 2026, we will continue advancing initiatives that expand access, enhance quality and support long-term sustainability — scaling virtual and integrated care models, modernizing digital infrastructure and investing in “grow-our-own” workforce pathways.
Integration remains central to our strategy. Following our merger with Marshfield Clinic Health System, expansion in Rapid City (S.D.), combination with Prairie Lakes Healthcare System in Watertown, S.D., and acquisition of Lewis Drug, we are fully leveraging the strengths of an integrated system to deliver more connected, patient-centered care. We are also focusing our health plan efforts in markets where we can provide both care and coverage because that is where our model delivers the greatest value.
Looking ahead, the Rural Health Transformation Program offers a once-in-a-generation opportunity to reshape rural care. CMS’ focus on telehealth, AI and workforce development aligns directly with the needs of rural providers, and success will require close partnership among CMS, states and health systems.
At the same time, we must be prepared to navigate a shifting policy landscape. Federal decisions around coverage and affordability — including the future of Enhanced Premium Tax Credits — will significantly influence access for rural families and the financial stability of rural health systems. Maintaining affordable coverage is essential to preventing delays in preventive care, worsening chronic disease and increases in uncompensated care. Strong collaboration among providers, states and federal policymakers will be critical to sustaining the coverage infrastructure that supports long-term rural care transformation.
Ultimately, our strategy for 2026 is about leading from strength — managing wisely today so we can continue to grow, innovate and deliver on our mission to care, comfort and cure for generations to come.
Andy Zukowski. CFO of ECU Health (Greenville, N.C.): From a rural health and safety-net provider care perspective, we are in a time of significant financial uncertainty due to Medicaid rate challenges in the state of North Carolina and federal policy changes. Specifically, the state faces a shortfall in their budget to fully fund the 10% base provider payment rate; while this is separate from the federal cuts, it could accelerate projected reductions from the One Big Beautiful Bill starting in October 2027 through 2032.
These two policy changes combined will make delivering rural health more difficult and requires us to prepare now by rethinking traditional models of rural health access. At the same time, we are focused on partnering with state and federal lawmakers to find solutions, including opening the state’s first rural emergency hospitals and ensuring rural communities have access to the high-quality care they deserve. We’re committed to being the solution to this problem with focus on and not limited to collaboration with decision makers to solve the realities of rural healthcare and the importance of supporting its sustainability both here in Eastern North Carolina and in rural communities across the state and nation.
