Hospital executives across the country are sounding the alarm: rising costs, worsening workforce shortages, financial headwinds, and policy instability are converging to threaten the foundation of care delivery.
The traditional models — built for a different era — are increasingly unsustainable in the face of accelerating demographic, economic, and social shifts. Hospital executives are wondering how much their organizations can take and grappling for meaningful change before it’s too late.
“How do we transform an unsustainable care delivery model into one that is affordable, equitable and aligned with what patients truly need before the system collapses under its own weight?” said Trampas Hutches, president of Portland-based MaineHealth’s mountain region. “I see firsthand how workforce shortages, rapidly aging populations, financial instability and consumer expectations are converting to demand bold action. We must radically rethink partnerships, risk-based models and the role of technology, not just to cut costs, but to rebuild trust and relevance in the communities we serve.”
Health systems are striking deals with community organizations, health plans and big retailers or tech companies to redesign processes and programs. They’re also aligning or collaborating with regional neighbors to share resources, adding revenue streams and doubling down on philanthropy to meet their patient care mission during this transition.
“The challenge is less about innovation and more about execution at scale, across deeply entrenched systems,” said Mr. Hutches. “Our future depends on whether we can lead that transformation with urgency, humility and a clear sense of purpose.”
Executive teams are also closely watching the political and economic shifts on Capitol Hill to stay compliant and build a strong foundation for the future. The next budget could include further funding cuts for public health and health equity initiatives.
“One of the most pressing and widely discussed topics today centers around healthcare policy and funding,” said Marie Langley, CEO of Desert Valley Medical Group in Victorville, Calif. “While there is widespread consensus on the urgent need for reform, progress is often hindered when initiatives are launched without sustained support, only to have critical resources withdrawn mainstream. The inconsistency not only undermines long-term planning but also places immense strain on healthcare systems that are already stretched thin. As we navigate these shifts, adaptability becomes essential, especially for organizations committed to serving vulnerable populations.”
Legislators are also mulling Medicaid and 340B cuts that would significantly affect all hospitals, but be particularly detrimental to rural, community and safety-net hospitals that depend on these funding mechanisms for uninsured patients.
“Any reduction or restructuring in [Medicaid] will disproportionately affect underserved communities that rely on these programs for access to essential care,” said Ms. Langley. “As leaders in healthcare, we must remain vigilant, advocate for stability and continue seeking innovative solutions.”
David Lubarsky, MD, president and CEO of Westchester Medical Center Health Network in Valhalla, N.Y., also sees the possible Medicaid cuts and narrowing of ACA marketplace eligibility as a threat to hospitals across the nation.
“What happens when millions are quietly dropped from [Medicaid] coverage and the tab lands squarely on the backs of America’s hospitals? It’s not just deferred care; it’s a ticking time bomb of preventable emergencies, avoidable admissions and a slow-motion collapse of access in underserved communities,” he said. “Emergency departments are morphing into the nation’s primary care safety net, without the funding, staffing or policy support to match. This isn’t belt-tightening; it’s asking healthcare systems to hold the line on a battlefield they didn’t choose, with lives and livelihoods hanging in the balance.”
Deborah Visconi, president and CEO of Paramus, N.J.-based Bergen New Bridge Medical Center, is thinking about how to build a sustainable healthcare system while navigating the relentless financial, workforce and technical pressures. Clinician shortages and rising labor and technology costs make it challenging for hospitals with already thin margins to invest in their future.
“We’re at a critical inflection point,” said Ms. Visconi. “The demands on our systems are greater than ever, driven by higher acuity patients, an aging population, mental health and addiction crisis, health disparities and a fatigued workforce. At the same time, we are innovating, integrating AI responsibly and assuring that we deliver the care our communities need in an affordable manner. Leaders must find new models that balance mission with margin, community care with cutting-edge technology and compassion with efficiency.”
With so many challenges that need attention today, it’s easy for leaders to focus on short-term fixes instead of long-term strategy. But the top leaders elevate to set the course for lifecycle sustainability.
“It’s not just about managing the present; it’s about reimagining the future of healthcare with resilience, purpose and equity at its core,” said Ms. Visconi.
Andrew Molosky, president and CEO of Chapters Health System in Temple Terrace, Fla., also values innovation and strategic vision amid uncertainty about state and federal healthcare policies, reimbursement structures, capital and investment markets, and more.
“When there is this much uncertainty it presents a crossroads for organizations to either sit on the proverbial sidelines and wait out the unknown or to forge ahead bravely, albeit blindly, into new endeavors,” he said. “There likely isn’t a single answer befitting all but occasionally these windows come along to define your organizational approach to risk tolerance and strategic planning, and what one does with them is telling.”
