At Becker’s 2025 CEO + CFO Roundtable, the message from the nation’s top health system executives was clear: transformation is no longer optional — it’s an expectation.
Across keynotes and panels, leaders spoke candidly about navigating a volatile environment defined by policy shifts, inflation, technology disruption, and workforce fatigue. Yet rather than retrench, they’re re-architecting how hospitals and health systems operate to build leaner, smarter and more adaptable organizations designed for the next decade of healthcare.
Here are 14 key themes from the conference.
1. Transformation is now a leadership mandate. Executives frame the next two to three years as a period of decisive, structural change rather than incremental tweaks. Strategy conversations are shifting from “projects” to operating-model redesign: what services to provide, where, and how. Leaders emphasize building teams and governance that can adapt quickly to policy shocks and market volatility.
“It has been a treacherous year for us all. It’s a year of having to have courage. It’s a year of really beginning to embrace transformation,” said Erik Wexler, president and CEO of Providence. “What I would say about our health system is we quickly came to the conclusion that we’re being called to transform in the United States when it comes to healthcare.”
2. Future-proofing the C-suite: skills, structures, and cadence. Boards and CEOs are retooling the C-suite for 2026 and beyond. Expect tighter spans of control, decision frameworks, and explicit change-management capabilities. Quarterly pulse surveys and leadership development are becoming core infrastructure. CEOs and CFOs are aligning more closely around shared purpose, transparency and long-term stewardship. Financial leaders are increasingly embedded with clinical and academic teams, helping connect strategic growth to sustainable operations and mission-driven care.
“Develop your executive team. Invest in them,” said EJ Kuiper, president and CEO of FMOL Health in Baton Rouge, La. “It’s not as much trying to predict what the next disruptors will be. It’s creating teams that are resilient, that are able to adapt to what I promise you will be an ever-changing environment.”
3. Access is future growth. Access has emerged as a top priority for CEOs. Leaders are reimagining care to meet patients where they are, ensure loyalty and improve outcomes.
“One of the big investments we’ve made this year is in what we call our primary health division, which has been focused on getting people into primary care and getting care plans and annual visits put in place that start to get people to do exactly what you do with going to the dentist twice a year or taking your care in for annual services,” said David Banks, CEO of AdventHealth.
Systems are focused on the digital front door for patient self-scheduling, e-visits and telehealth to expand access in addition to alleviating bottlenecks and creating additional capacity. Access reliability is increasingly treated as a strategic key performance indicator alongside quality and safety.
4. Local autonomy inside a national backbone. One emerging operating model: national scale where it matters (IT, supply chain, revenue cycle), regional leadership for market nuance, and fully empowered local C-suites to execute. This structure aims to avoid “franchise medicine” while harvesting the benefits of standardization. It’s how large systems can keep the human relationships central to each region and community.
“We keep regional leadership because actually regional systems outperform national systems,” said Mr. Banks. “We wanted to maintain the dynamics that strong regional systems have. When you look across the state of Florida, when you look at our Metro Denver, when you look at why we partner with the University of Chicago, it’s for regional strength and then when we get to the local level, it’s our C-suites – CEOs, CMOs, CNOs, CFOs – they’re the ones that bring it to life. The patients are walking through their doors. They’re not walking through some corporate headquarters’ doors. They are responsible for translating the mission of the organization in real time, creating those feel-whole moments, one person at a time.”
5. M&A market may cool. In today’s volatile reimbursement environment — particularly around Medicaid, ACA subsidies and supplemental funding programs — hospital leaders are taking a more measured approach to growth. Instead of moving quickly on acquisitions or partnerships, many are adopting a “wait-and-see” stance, closely watching state and federal policy shifts before committing capital.
“We’re going back through a very significant reprioritization of our capital,” said Rick Carrico, CFO of Baptist Health, based in Louisville, Ky. “Oddly enough, we just did it last year and with all that’s come to pass environmentally, things are going to change. We’re going to be very careful about the amount of capital we commit. It’s got to be calibrated with the cash flow that we generated. We’ve been very clear about that with the groups that shepherd the prioritization efforts. We’ve got three markets that we’re doing really inpatient capacity expansions, which we know are going to pay off, so we’re going to stay committed to those. But the strategic capital is really going to go through a more serious vetting.”
6. Value creation through disciplined capital and service mix. Health systems are revisiting capital allocation with a hard ROI lens and re-prioritizing projects that directly advance access, efficiency, or workforce stability. Leaders are also rebalancing service portfolios to expand ambulatory/procedural capacity and avoiding low-value duplication across nearby sites. The goal is margin resilience without compromising mission.
7. AI from hype to hard ROI. Deployed thoughtfully, AI is delivering time back to clinicians (e.g., ambient documentation), faster throughput, and better contact-center performance. Executives are setting pre-agreed metrics, tracking outcomes, and sunsetting tools that don’t meet expectations. The shift is away from “solutions in search of problems” toward a small set of scaled, durable use cases.
“My sense is that you want to have clear, measurable impact with [AI pilots] and you know that needs to go either in the clinical realm, financial realm or operational realm,” said Chip Davis, PhD, CEO of Rochester (N.Y.) Regional Health. “We have really reframed how we’re using these tools.”
8. Interoperability remains healthcare’s productivity tax. Operational sophistication still trails clinical advances because data can’t move seamlessly across organizations. Executives compare healthcare unfavorably to banking/airlines on everyday data liquidity and coordination. Expect tougher questions of vendors and policymakers to unlock cross-system continuity.
9. Workforce strategy = business strategy. Organizations are investing in leadership pipelines, generationally tuned scheduling (e.g., 8- vs 12-hour shifts), and clear clinical ladders to keep talent. Leaders are rethinking culture, flexibility and development to meet the needs of a multigenerational workforce. Career pathways, education pipelines and AI-driven efficiencies are helping reduce burnout and strengthen retention. Regular engagement surveys (with visible action) are now table stakes. Retention economics and culture economics are treated as the same conversation.
“Healthcare is at the end of the day about people taking care of people. We have really doubled down on leadership development and creating an environment for our employees, our team members, that is the best place to work,” said Mr. Kuiper. “When you’re in a financial crunch, it’s relatively easy to cut back on those kinds of things and benefits and leadership development, but that always comes back to haunt you in the long run. The way we justify it is creating an environment that people want to come to or stay in, which drives your turnover down and we’ve seen substantial improvements over the last couple of years.”
10. Nursing-led innovation is indispensable. Executives argue cost curves won’t bend without nurses at the design table for virtual care, documentation, and automation. Health systems are building nursing innovation councils and ensuring technology reduces burden and protects bedside time. Ratios, safety, and satisfaction move together when nurses co-own change.
“We will not bend a cost curve unless nursing is at the table driving some of the innovation,” said Mimi Coomler, CEO of Tucson Medical Center. “We are wedded to nurse to patient ratios because our nurses cling to that because it is seen as a key to patient safety and I believe that if you haven’t started a nursing innovation team or co-op in your organization, it’s important. It’s time to invite them to the table and let them drive.”
11. From duplication to differentiation across markets. Where systems operate multiple sites in tight geographies, leaders are pruning duplicate service lines and concentrating volumes where it makes sense. The balancing act: protect access and speed while aligning capabilities and cost structures. Transparent criteria and community engagement make the changes durable.
“If I’ve got three facilities and they’re within two miles of each other, do I need to replicate the same services in those facilities? Or if I’ve got a rural facility that can’t provide particular care, that we can’t provide the right volumes or in a manner that we want to, I want to provide it somewhere else or provide it a different way using technology,” said Pete November, CEO of Ochsner Health.
12. Virtual and hybrid care are standard, not pilots. Telehealth and remote support models (e.g., virtual nursing) are now integral to access and experience. Leaders highlight patient-satisfaction lifts and save clinician time when virtual layers backstop on-site teams. The near-term focus is embedding these models into everyday throughput, not treating them as bolt-ons.
“We now have the capability to have eyes and ears on our patients in the rooms, and that is helping support frontline nurses with providing care,” said Mr. Davis. “When that call bell goes off, if the nurse is not able to get to them immediately, that remote nurse is able to have discussions with the patients. Our patient satisfaction has skyrocketed with that.”
13. Use the crisis window to accelerate durable change. Leaders see the current challenges — legislation, reimbursement, labor, and cost inflation — as a forcing function. The priority list: strip out basic waste, lock in measurable AI wins, expand access capacity, and harden consumer-grade operations. Don’t bolt new tech onto old processes; redesign the processes first.
“It’s a time to be bold,” said Terry Gilliland, CEO of Danville, Pa.-based Geisinger. “Great companies, great systems, in these moments when you’re in a crunch and you’re getting compressed, it’s an opportunity for leaders to take it by the horns and run with it.”
14. More tough decisions ahead. Health system leaders are learning to embrace the ambiguity of leading through rapid policy changes and AI transformation. But many hospitals will still struggle financially next year and CEOs will make tough decisions on where to spend valuable resources. We’ll likely see more layoffs and workforce reductions as AI becomes more sophisticated, and hospitals brace for more uncompensated care in the future.
“We’re asking every hospital in Ascension to be capital responsible,” said Saurabh Tripathi, CFO of St. Louis-based Ascension. “Think about your capital in the wisest way. Instead of building a new arms race of hospital towners, think about where do you want to provide that access to your patients?”
