As health systems move beyond an era defined by geographic expansion and scale, CEOs are beginning to rethink a fundamental question: What counts as growth today?
Leaders are reframing the answer away from footprint and volume, and toward margin durability, care model evolution, ambulatory reach and service line depth.
The shift is well underway: Outpatient services accounted for 57% of hospital revenues in 2024, up from 52% in 2020, according to the American Hospital Association. The AHA’s Sg2 forecasting models projected outpatient volumes will grow another 17% over the next decade.
Health systems began the year with a stronger focus on measured growth as a result of ongoing economic uncertainty and federal policy shifts, according to a report from Kaufman Hall. Many have stepped away from “growth for growth’s sake” and turned to intentional, proactive planning.
Becker’s connected with five health system leaders to discuss what growth means to their organizations today, where they anticipate the most meaningful growth in 2026 and the metrics that will matter most over the coming years.
Houston Methodist President and CEO Marc Boom, MD, put it plainly: The system does not try to be the biggest — it strives to be the best.
“Growth means more than just expanding our footprint. It’s growing in ways that best serve our patients: for example, incorporating technology that allows for a more seamless check-in or discharge process,” Dr. Boom said. “What no longer counts is checking boxes to simply say you have a presence in that area.”
Timothy Pehrson, CEO of Oklahoma City-based Integris Health, described a similar discipline through the system’s “smart growth” strategy, which is focused on health value rather than volume at all costs. Integris defines growth as expanding access and capabilities while raising quality, safety, experience and affordability of care, and avoids opportunities likely to dilute margin, stretch operations too thin or fail to advance community health.
“The discipline is what to say ‘no’ to, because there’s lots of opportunities out there,” Mr. Pehrson said. “The question for us isn’t, ‘Can we grow here?’ It’s, ‘Does this make us stronger in ways that help us better serve Oklahomans?’ You might be able to grow in a non-core market, but does that make you stronger operationally? If it creates distraction, then does that make sense?”
David Herman, MD, CEO of Duluth, Minn.-based Essentia Health, said the system’s definition of growth has shifted toward affordability, predictability and a more integrated knowledge of patients as individuals — anticipating their needs before they have to ask.
“We serve a large rural footprint, and we know that some pharmacies are unstable or closing,” Dr. Herman said. “When a patient’s pharmacy closes, do we reach out to each and every one of those patients and inform them? Do we ask, ‘How do you want to get your medications now?'”
Most meaningful growth in 2026
For some systems, the most significant near-term growth is happening at the ambulatory and community levels.
Houston Methodist opened its seventh network hospital in 2025 and is already expanding it. The system plans to open more comprehensive care centers and two new emergency care centers in 2027, Dr. Boom said.
Outpatient expansion remained a key area of investment for health systems in 2025 as some pulled back on inpatient expansions. Increasing costs and value-based care models are driving an “ambulatory boom” across the country as leaders have said ambulatory care investments will accelerate in 2026.
Marlton, N.J.-based Virtua Health’s most meaningful 2026 growth will be an expansion of its ambulatory surgery center strategy, structured as joint ventures, Chief Strategy Officer Stephanie Fendrick said. The system is also expanding its physician network and making strategic investments in home care, measuring success through hospital length of stay, patient outcomes and recovery levels.
“It’s really about new patients, where they are within the community, and delivering more accessible and coordinated care,” Ms. Fendrick said.
For UC San Diego Health, the most meaningful near-term growth will be building out its clinically integrated network and primary care footprint — through both owned practices and partnerships — to ensure access across the region, CEO Patty Maysent said. She cited a focus on stabilizing health systems in areas such as Imperial Valley and the northern part of the county that were close to closing. A key access metric: Can a patient reach primary or express care within 10 minutes of where they live?
Essentia Health’s top 2026 growth priority is post-discharge care. Dr. Herman said the system is focused on reaching every patient within the first 36 hours after leaving the hospital.
“We know that’s the most vulnerable time for the patient, either because of medication reconciliation or unanticipated symptoms,” he said. “If we can touch them meaningfully within that first 36 to 72 hours, they’re much less likely to be readmitted, and much more likely to be satisfied with the care they received.”
The metrics signaling growth
Over the next three to five years, the leaders converged on a few themes: patients served, margin sustainability and coordination quality.
For UC San Diego Health, the broadest measure will be total patients served across all settings — inpatient, ambulatory, post-acute and at home. Ms. Maysent said the system is building capabilities through its Joan & Irwin Jacobs Center for Health Innovation and a forthcoming initiative to monitor patients via devices outside traditional clinical environments.
“At the end of the day, our two focuses are on fiscal sustainability and quality metrics,” Ms. Maysent said. “That’s what people get out of bed for every day — ensuring that we’re delivering on our clinical quality, and on our financial imperatives so that we can support the rest of this work.”
Virtua similarly tracks lives served year over year and whether new patients stay. Key indicators include retention across the continuum, access to services, measurable gains in clinical outcomes and patient experience and sustained or improved margins.
For Essentia Health, Dr. Herman said the focus is reducing the cost per episode of care — and avoiding unnecessary care altogether.
“A lot of it will be knowing them better and getting them the care they need before they need that care, so we can avoid that clinic visit, that ED visit or that hospitalization.”
At Becker's 4th Annual CEO + CFO Roundtable, taking place November 2–5 in Chicago, more than 1,500 hospital and health system executives tackle decisions that determine whether organizations thrive or merely survive: protecting margins under cost pressure, choosing where to grow, renegotiating payer relationships, stabilizing the workforce and proving real ROI on technology. This is where leaders work through them together, face-to-face. Apply for complimentary registration now.