Healthcare finance leaders are heading into the second half of 2026 with a shared sense of urgency and a familiar set of pressures making their work harder. Rising labor costs, reimbursement shortfalls, regulatory uncertainty, and payer friction are squeezing margins across health systems of every size and type, from community hospitals to major academic medical centers.
The challenges are not new, but their intensity and interconnectedness are forcing finance teams to think beyond cost control and toward broader questions of operational resilience and long-term sustainability.
Becker’s asked five healthcare finance leaders to share their single biggest financial priority for the second half of 2026 — and what’s standing in the way. Their responses reflect a sector navigating simultaneously workforce costs, Medicaid and Medicare reimbursement changes, physician alignment, 340B program erosion, and the slow-moving benchmarks that leave academic health systems perpetually playing catch-up.
Question: What is your single biggest financial priority for the second half of 2026, and what’s standing in the way?
Tammy Wallace. CFO for UCLA Health (Los Angeles): Our focus is on strengthening margin resilience and maintaining balance sheet strength while sustaining our missions across clinical care, research, and education. To do so, we are emphasizing a comprehensive and strategic portfolio of revenue and efficiency enhancements. The challenge we face is an operating and policy environment where changes and uncertainty at both the federal and state level continue to exert downward pressure on reimbursement for patient care, while payer administrative practices do not consistently align with contracted terms.
Krista Fakoory. Chief of Staff to the CFO for UC San Diego Health (San Diego): My role as the chief of staff at UC San Diego Health is to align funding for physicians with affordability and the strategic priorities of the Health System. What keeps me up at night is the quickly evolving physician landscape, including CMS changes to the Medicare Physician Fee Schedule that significantly alter wRVU values, the efficiency impact of AI adoption in select specialties, and Medicare reimbursement that significantly lags inflation in the physician space. Like many academic health systems, our funds flow is based on benchmarks; unfortunately, those benchmarks lag by more than a year, failing to capture impactful changes that are occurring in the national and local markets. Our relationship and partnership with the chairs in our school of medicine is what helps us navigate all of these challenges. Without that partnership and trust, we would face significant retention and recruitment problems in a time when there are major physician shortages in several specialties.
Suhail Nath. Finance Director for UofL Health and UofL Hospital (Louisville): As the regional trauma-I center, UofL Health supports a wide range of programs across the continuum of care. For the second half of 2026, one of our top financial priorities is to cohort patients appropriately within our IDN to ensure they receive the right level of care and services. This is particularly important for academic medical centers, which face tightening margins due to regulatory changes affecting Medicaid State Directed Payments and, potentially, Medicare site neutrality. Combined with rising labor and supply costs, these challenges require us to maximize efficiency with our resources. Effective patient cohorting will enable providers to round more efficiently and on time, enhance patient quality and satisfaction, and streamline the discharge process. This will help reduce throughput and boarding issues in our ED and PACU, supporting our broader goals as an IDN as patient quality, satisfaction, and provider reimbursement become increasingly interconnected.
Jessica P. Bush. Director of Finance for St. Luke’s University Health Network, Warren Campus (Phillipsburg, N.J.): One of the biggest financial priorities for the second half of 2026 and into the next fiscal year is balancing sustainability while ensuring continued access to care in a challenging healthcare environment. For many hospitals, especially community-based organizations like ours at St. Luke’s Warren, the challenge goes beyond expense control. It’s about maintaining stable volumes, physician coverage, and core services amid rising labor costs and reimbursement pressures. As finance leaders, our focus has been on workforce productivity, managing overtime, aligning physicians, and ensuring growth expectations are grounded in operational reality.
The challenge is compounded by how interconnected these issues are. Physician departures, staffing shortages, patient utilization shifts, and market competition all directly impact financial stability. Today, finance leadership is about more than reporting numbers, we help navigate uncertainty, weigh operational risks, and support decisions that strengthen long-term resilience, all while keeping patient care and quality outcomes at the center.
Robert Brewer, PharmD. Manager, Pharmacy Finance and Medication Acquisition for Stormont Vail Health (Topeka, Kan.): Our top financial priority for the second half of 2026 is protecting and rebuilding margin within our oncology and infusion services by optimizing biosimilar selection across payers, reimbursement models, and acquisition costs in a post-DSH to RRC environment. This effort is challenged primarily by the orphan drug exclusion removing 340B pricing on many high-cost agents that drive our savings, compounded by tightening manufacturer controls — including medical claims requirements and distribution limitations — that restrict consistent access to favorable pricing even at the covered entity level. At the same time, ongoing contract pharmacy restrictions limit our ability to offset these losses, while payer-driven biosimilar preferences create fragmentation that can force suboptimal financial choices. Together, these pressures increase operational complexity across purchasing, billing, and site-of-care strategies, making it more difficult to standardize and fully capture margin opportunit
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