Ambulatory care is moving to the center of health system strategy — and leadership structures are shifting with it.
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 model projects outpatient volumes will grow another 17% over the next decade. At the same time, health system CEOs have told Becker’s they plan to accelerate ambulatory investments in 2026 to support financial sustainability and expand access closer to home.
That growth is prompting structural changes at the leadership level. In April, leaders from four health systems shared how ambulatory expansion is reshaping reporting lines, decision-making authority and executive roles.
At Menomonee Falls, Wis.-based Froedtert ThedaCare Health, leaders have made targeted changes since forming a combined system in 2024, including establishing dedicated executive oversight for ambulatory services.
A key priority has been reducing fragmentation between care settings, said Mark Cockley, MD, senior vice president of population health and president of the system’s accountable care organization.
“Reporting lines have been streamlined to reduce fragmentation between inpatient and outpatient operations resulting in collaborative clinical handoffs between the teams,” he said. “In many cases, ambulatory leaders now have direct connections to enterprise-level executives in addition to working relationships with regional leadership. This change has strengthened alignment around growth, access and care delivery across the continuum, rather than optimizing for individual sites of care or creating clinical silos.”
Vancouver, Wash.-based PeaceHealth is taking a similar approach, focusing on integration across care settings as more services shift outpatient, said Mark Korth, chief transformation and integration officer.
“Across the communities we serve, we have inpatient, outpatient and post‑acute teams working more closely as one,” he said. “We are also aligning shared services and systemwide goals to better support ambulatory and outpatient care. For patients, these changes mean better access, stronger coordination between caregivers, and a more consistent experience no matter where they enter our system.”
At New Hyde Park, N.Y.-based Northwell Health, the shift has accelerated efforts to bring decision-making to the front lines, COO Kevin Beiner said.
“Our guiding principle is to make the big feel small — to push decision-making as close to the front line as possible so that the people delivering care are empowered to lead it,” Mr. Beiner said. “Across our ambulatory network, we have exceptional physicians supported by strong professional administrators who understand their markets and their patients. As we continue to scale, we are actively working to dismantle obstacles and strip away unnecessary bureaucracy that slows those teams down.”
For Clearwater, Fla.-based BayCare Health System, ambulatory care has long been a strategic focus, so structural changes have been more incremental. The most notable shift has been elevating ambulatory leadership to the executive cabinet, according to C. Todd Jones, chief strategy officer and chief ambulatory services officer.
“This role was expanded to combine responsibility for ambulatory services with system strategy, reflecting the increasing importance of outpatient care as a primary growth vehicle and a central driver of long-term system performance,” Mr. Jones said, referring to his role. “The change clarified system-level decision rights around ambulatory access, network development, physician integration and capital prioritization while reinforcing alignment between growth strategy and day-to-day operational execution.”
Hospital vs. market leadership structures
As more care moves outside hospital walls, leadership models are following.
Froedtert ThedaCare has shifted service lines to operate more consistently at a regional or enterprise level rather than within individual hospitals. That change gives leaders broader geographic accountability and supports more standardized care models and coordinated growth across outpatient sites, Dr. Cockley said.
Northwell has also moved toward regional leadership over the past five years and has identified a clear next step as the structure has matured: bringing greater agency and accountability closer to the front line.
“But decentralization alone isn’t enough,” Mr. Beiner said. “We are equally focused on maintaining a consistent standard of care and a unified culture across the entire organization — and that’s where our clinical service lines play a critical role. For us, this is not an either-or proposition. We are deliberately building physician and administrative leadership capacity both centrally and out in the markets.”
Because ambulatory care has been organized at the system level for several years at BayCare, the elevation of ambulatory services to a senior executive role reinforced the existing system leadership model, rather than shifting from hospital-centric structures, Mr. Jones said.
“It allowed us to scale outpatient and ambulatory growth without fragmenting accountability or creating competing leadership silos at the market or facility level,” he said.
What’s next?
Leaders expect ambulatory growth to continue reshaping leadership roles over the next several years — particularly as care delivery models become more distributed and technology-enabled.
In the future, Froedtert ThedaCare anticipates expanded scope for ambulatory leaders, including oversight of virtual care, hospital-at-home models, retail partnerships and community-based access points, Dr. Cockley said.
“It should also be expected that roles focused on access, care coordination and navigation will become more prominent at the leadership level,” he said. “Ensuring a seamless patient journey across ambulatory, virtual and acute settings will require leaders who break down barriers and operate outside of traditional silos.”
BayCare expects leadership roles to continue evolving toward increased emphasis on end-to-end access, network design, digital enablement and site-of-care optimization.
“Rather than creating entirely new executive structures, BayCare anticipates continued expansion in the scope and complexity of existing roles, with leaders expected to operate across inpatient, outpatient and virtual environments,” Mr. Jones said. “The overarching goal is to ensure leadership structures support scale, consistency and consumer-centric access while remaining agile as care delivery continues to shift beyond the hospital walls.”
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