Healthcare leaders continue to grapple with an expanding list of threats to the industry’s stability, from workforce shortages and reimbursement pressures to the growing role of artificial intelligence and the erosion of patient trust. Below, CEOs, CFOs, COOs and other clinical executives from health systems across the country share the trend they believe poses the greatest risk to healthcare today.
Every executive featured in this article will speak on panels at Becker’s 14th Annual CEO + CFO Roundtable, taking place November 2-5, 2026, in Chicago. Attendees will have the opportunity to hear these and other health system leaders discuss the challenges shaping strategy for the year ahead, from financial sustainability and workforce retention to AI governance and rural healthcare access.
Registration is open now for the 14th Annual CEO + CFO Roundtable. Register here to secure your spot and join the conversation with the executives featured below.
If you would like to join as a speaker or a reviewer, please contact Mariah Muhammad at mmuhammad@beckershealthcare.com or agendateam@beckershealthcare.com.
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Question: What is the most dangerous trend in healthcare today?
CEO + President
Erik Wexler. President and CEO of Providence (Renton, Wash.): The most dangerous trend in healthcare today is the widening disconnect between the demands placed on the healthcare system and the resources available to meet them.
Across the country, patients and communities are counting on providers to deliver timely access, advanced treatments and high-quality care. At the same time, health systems are facing growing financial pressures, workforce shortages, administrative burdens and policy changes that make it increasingly difficult to meet those expectations sustainably.
What’s most concerning is that many of these challenges have practical, achievable solutions. Whether it’s reducing unnecessary administrative burdens that add costs without improving care, advancing payment reforms for Medicare Advantage plans through the bipartisan Medicare Advantage Prompt Pay Act (H.R. 5454/S. 2879) that would improve payer accountability for payment delays, or embracing new technologies that help caregivers spend more time with patients, there are opportunities to make the system work better for everyone.
At Providence, we’re partnering with policymakers, industry leaders, employers, technology companies and community organizations to help build a system that is more accessible, affordable and sustainable. Progress will require collaboration, innovation and a shared commitment to ensuring people can get the care they need, when and where they need it.
Richard Mulry. President and CEO of Northwell Holdings (New Hyde Park, N.Y.): Even if we’re not all in the same boat, we’re navigating the same ocean — so I’ll say this as our experience rather than as advice.
The most dangerous trend in healthcare right now is borrowed conviction: letting someone else’s roadmap, or someone else’s press release, stand in for your own operating strategy. AI has created a kind of gravitational pull where the fear of being late is doing more to pressure capital allocation than the actual problems in front of us. I see both failure modes from where I sit. One is committing deeply and early to solutions that will be absorbed into the core platforms we’ve already paid for, which leaves us maintaining technical debt that has no strategic value. The other, quieter failure is paralysis — waiting for the platform vendors to deliver while the workforce, the workflows, and the cost structure stay exactly as they were.
So we spend most of our energy trying to find the true gaps and to move first where the risk is lowest and the enterprise impact is highest, which today usually means business process automation. That work is bounded and measurable, and it earns us the room to explore clinical solutions without betting the enterprise on them. We’re also accustomed to the system serving as customer zero, which lets us validate operating leverage before we invest behind a thesis. Participation driven by optics and paralysis look like opposites, but we’ve come to see them as the same failure: outsourcing judgment to the market’s clock instead of your own operating priorities. What has changed most for us is the tempo — the horizon on a strategy in this space has gotten much shorter, so we check in with each other far more often than we used to, and we’ve gotten more comfortable revisiting a decision we made two quarters ago.
Martha Henley. CEO of Unity Medical Center (Manchester, Tenn.): The most dangerous trend I see is how many decisions about patient care are now made in an office by people who have never seen the patient. Thirty day readmissions are a good example. In a rural community, a patient may come back because the nearest specialist is a long drive away, or because there was no ride to the follow up appointment, not because we failed them the first time. Follow through can be challenging for some patients. None of that is visible to the person reviewing the case. The same pattern shows up in denials, where care that was necessary, documented, and delivered gets turned down against a definition rather than an actual patient. need. At the same time, the rates in our contracts have not kept up with what it actually costs to keep a service open in a small community. Rural hospitals are not smaller versions of large ones. Until the people setting the terms spend time where the care happens, the terms will keep missing.
Joe Avelino, RN, BSN. CEO of College Medical Center (Long Beach, Calif.): A dangerous trend I see is when leaders become too dependent on artificial intelligence. AI will undoubtedly become an increasingly important tool to help us identify patients at risk, improve access to care, streamline administrative burdens, and support better clinical decision-making. However, AI cannot replace the healing power of a compassionate physician, a reassuring nurse, a dedicated social worker, or a sitter who simply sits quietly with someone during their darkest moment. Think about this, our patients may not always remember their diagnosis or the medication we prescribed, but they will remember how we made them feel and whether they were treated with dignity, respect, and compassion. As we embrace innovation, let us ensure that AI enhances the human connection rather than replaces it.
Greg Rosencrance, MD. President and CEO of WVU Medicine Thomas Hospitals (Morgantown, W.Va.): At WVU Medicine Thomas Hospitals, the most dangerous trend we face is the growing disconnect between the increasing healthcare needs of our communities and the resources available to meet them. Our patients are older, sicker, and often require more complex care, while hospitals continue to navigate workforce shortages, rising costs, and declining reimbursement. Rather than allowing those challenges to define us, we have chosen to invest in our caregivers, expand access to advanced services, and strengthen the clinical capabilities our communities deserve. Every strategic decision we make is guided by a simple principle: quality and safety come first, because access to exceptional care close to home matters. I believe the organizations that will succeed in the years ahead are those that never lose sight of their mission, continue to innovate with purpose, and earn the trust of the patients and communities they are privileged to serve.
Paul Hiltz. President and CEO of Naples (Fla.) Comprehensive Health: The most dangerous trend I see is losing our experienced caregivers to burnout. What impresses me most about our teams at NCH is their willingness to pitch in and support one another, no matter the circumstances, even when it isn’t their problem to solve. I think of a nurse who stayed well after her shift ended to make sure the next care team had everything they needed for a patient with complex needs, so nothing would fall through the cracks. That instinct to look out for each other and for the patient is exactly what we lose when we let seasoned people burn out. I believe part of my job is making sure our teams feel supported enough to stay, not just recruited to arrive. If we protect the people who care for our neighbors, they will be here to care for them for years to come.
Tyler Stapp. CEO of Trego County Lemke Memorial Hospital (WaKeeney, Kan.): The most dangerous trend in healthcare today is the tendency to focus more on the challenges than on the opportunities to adapt. Healthcare will continue to evolve, and organizations that resist change risk falling behind. While workforce shortages, financial pressures, and regulatory demands are significant, they also create opportunities to rethink how we deliver care and operate more effectively. Strong leaders recognize that adversity is not a barrier but a catalyst for innovation and continuous improvement. Our responsibility is to build resilient organizations that embrace change, empower their teams, and remain focused on delivering exceptional patient care.
Rick E. Smith. CEO of Troy (Ala.) Regional Medical Center: At Troy Regional and likely in many other rural healthcare settings, the most dangerous trend is the accelerating loss of access to care. Unlike a single disease or technology, it’s a systemic issue: hospitals close, clinicians leave, specialty services disappear, and patients must travel farther for even routine care. This creates a cascade of worse health outcomes.
I consider these trends as the ones with the most impact to rural facilities:
- Rural hospital closures
- Severe workforce shortages
- Maternal healthcare deserts
- Financial pressure from value-based care
The greatest long-term risk may be the widening gap between healthcare needs and available workforce in rural communities. Every other challenge —hospital closures, aging populations, mental health access, maternal care, and chronic disease management — is intensified by having too few clinicians and too few financially sustainable care sites.
Trevor Sawallish. CEO of North Memorial Health (Robbinsdale, Minn.): The most dangerous trend in healthcare is asking the wrong people to carry the burden. The continued transfer of financial risk away from insurers and policymakers and onto patients and care delivery organizations is creating an existential crisis. Through higher deductibles, co-pays, and coinsurance, patients are paying more for care. At the same time, hospitals and clinics are being asked to assume greater financial accountability for factors they often cannot directly influence. This shift masks the true cost of care and makes informed decision-making harder for patients, employers, and taxpayers. Transparency and aligned incentives, not risk shifting, are what healthcare needs most.
Erik Mikaitis, MD. CEO of Cook County Health (Chicago): One of the most dangerous trends in healthcare today is growing disengagement from care, coupled with increasing mistrust in the medical community. Patients are being asked to navigate an increasingly complex system, from insurance coverage and referrals to prior authorizations and changing eligibility rules. Recent federal policy changes are making that even more difficult for individuals who rely on coverage through insurance marketplaces or Medicaid.
When people encounter confusing processes, administrative barriers, or repeated obstacles to getting care, frustration often turns into disengagement. That disengagement, in turn, can reinforce mistrust, as people begin to question whether the healthcare system is designed to serve them or whether it is worth engaging with at all. At the same time, skepticism toward science-based medicine is being amplified at the national level, further eroding confidence in proven medical interventions and public health guidance. We see this disengagement and skepticism in vaccination rates, which are dropping precipitously.
Together, these forces create a dangerous cycle: the harder it is to access and navigate care, the less people engage with the health system, and the less they engage, the more susceptible they become to misinformation and delayed care. Rebuilding trust and making healthcare simpler to access and navigate are among the most urgent challenges facing our health system.
Steve Davis. CEO of Cincinnati Children’s Hospital: The most dangerous trend in healthcare today may be the assumption that AI adoption alone will improve performance, without equal investment in the human judgment, analytical skill, and training required to use it safely and effectively. AI can strengthen decision-making, but only if organizations pair adoption with deliberate development of the critical thinking and analytical skills needed to use these tools safely and effectively. As adults, we learn by doing, so we should ensure AI-enabled workflows continue to create opportunities for hands-on learning, reflection, and skill growth. Organizations will need thoughtful reskilling and upskilling plans for employees whose roles are being reshaped by AI. If we redeploy people into AI-enabled workflows without that support, we risk weakening employee confidence, capability, and engagement. The goal should be to use AI as a tool that amplifies human expertise, not one that unintentionally diminishes it.
Mimi Coomler. CEO of Tucson Medical Center; Chief Hospital Executive of TMC Health (Tucson, Ariz.): The most dangerous trend in healthcare today is the growing distance between patients and the care they need.
As a nurse, I have seen what happens when care is delayed, difficult to navigate or no longer available close to home. A missed appointment, a coverage disruption or the loss of a local service can quickly become a medical crisis. For patients and families, access is not an abstract policy issue. It can determine whether someone gets better, gets worse or gets care at all.
But access means more than having a hospital, clinic or appointment available. It also means ensuring that patients feel seen, heard and cared for when they reach us.
Healthcare is facing extraordinary financial, workforce and regulatory pressures. We must become more efficient, use technology wisely and build sustainable systems of care. But we cannot allow those pressures to create greater distance between caregivers and patients.
The greatest risk is that we build a healthcare system that is technically advanced but increasingly difficult to reach, navigate or experience as humans. Our responsibility as healthcare leaders is to protect access while preserving the compassion and personal connection that are at the heart of healing.
Margaret Dimond, PhD. President of UM Health Regional Network (Ann Arbor): The dangerous and compelling trends in healthcare are vast, but what keeps me awake at night is the fact that not only do we face nursing shortages, it is also the dearth of jobs we had in abundance just 10 years ago. I call it the tech desert, especially in more rural hospitals. From respiratory, radiology, cardiac rehab, etc., there are key shortages, despite offers with sign on bonuses and more. It is impacting timely testing for both in and outpatients. The causal factors include lack of ‘introduction’ of healthcare options that do not include college degrees, to lack of formalized partnerships between school systems and hospitals. Al or automation cannot fully replace the technicians needed to perform needed diagnostic testing for patients who are suffering, and physicians who need conclusive results before surgery, or a clinical treatment plan can be developed.
Wyatt Brieser. CEO of Hammond-Henry Hospital (Geneseo, Ill.): The most dangerous trend in healthcare today is the erosion of a stable, employed workforce. Healthcare organizations are increasingly reliant on agency staff and locum tenens providers, creating a renter culture rather than an owner culture. When caregivers lack long-term connection to an organization, accountability, continuity, and ultimately quality can suffer. While these challenges existed before COVID-19, the pandemic accelerated them and exposed underlying fractures in the healthcare workforce. Many frontline caregivers have lost the joy, purpose, and fulfillment that once drew them to patient care, and are leaving for roles that offer better compensation, greater flexibility, or less direct exposure to the daily pressures of healthcare.
Patients feel the impact as well. Care becomes more fragmented, teams become less familiar, and the trusted relationships that are foundational to healing are harder to build and maintain. Healthcare organizations are, at their core, people serving people, and no technology or strategic initiative can replace a committed caregiver at the bedside or in the clinic. Until we restore meaning, stability, and support for frontline caregivers, we will continue to see costs outpace reimbursement, quality concerns, and frustrated patients. This is particularly being felt in rural communities where nearly one-third of hospitals find themselves at risk of closure but they are just the canary in the mine.
Jay Dennard. President of Gwinnett Hospital Foundation; System Vice President of Governmental and Community Affairs at Northside Hospital (Atlanta): The most dangerous trend in healthcare today is the widening gap between what it actually costs to deliver high-quality care and what health systems are reimbursed for providing it. At Northside Hospital, we feel this directly as we work to expand access across one of the fastest-growing regions in the country — every new bed or service line has to be paired with the operational discipline to sustain it, not just the capital to build it. Compounding this is a persistent workforce shortage that limits how quickly we can bring new capacity online, even when community need and funding already exist. When margin pressure and workforce constraints collide, health systems risk being forced to choose between growth and financial sustainability — and the communities with the greatest need feel it first. Our approach is to pursue both at once: expanding access responsibly while investing in the workforce pipeline that makes it sustainable.
Peter D. Banko. President and CEO of Baystate Health (Springfield, Mass.): Artificial intelligence is the most dangerous trend in healthcare today. Better said, the promise of AI is the most dangerous trend. Vendors are peddling potential partnerships using AI to transform literally every part of our clinical enterprise and business. AI can be a most profound catalyst (in the order of magnitude of the Industrial Revolution) that can help us solve massive systemic challenges. Before taking that dangerous lunge, we need to understand and put frameworks into place around the governance, ethical, and emotional impact of AI on our industry.
Lisa Carter. President of Southern Region at Ballad Health (Johnson City, Tenn.): Because the healthcare system in our country is extremely complex, and the economic principles of supply and demand sometimes do not translate to the system, consumer frustration continues to grow. This frustration, coupled with declining public trust, is creating extreme challenges for delivering healthcare. These trends affect patient experience, team member engagement, organizational reputation, and long-term sustainability of services. Far too often we see consumer frustration manifested with violent and aggressive behavior towards frontline care givers. This dynamic then compounds the issues with team member engagement. These trends are compounded within rural communities because of the difficulty with recruiting and retaining quality providers and already limited resources. Working to find lasting solutions to these challenges is top of mind for my health system.
Matthew Fry. President and CEO of Freeman Health System (Joplin, Mo.): It won’t surprise anyone that artificial intelligence, while one of our greatest opportunities, is also one of healthcare’s greatest risks. We’re already seeing how reliance on large language models can shape whether people seek medical attention at all, or whether they trust the advice of the professionals trained to give it. As these tools become part of everyday life, it falls to all of us – healthcare providers included – to keep our audiences grounded in timely information so they can make sound decisions about their health.
At Freeman Health System, we’ve invested in upgrading our electronic medical record system and streamlining our patient portal so our patients can access their care information and interact with their providers from the comfort and convenience of their homes. We also strive to make sure our website and social media pages are updated with the latest information, including multiple ways people can contact their providers or various departments to meet their needs.
In the race to innovate, we can’t forget that healthcare is personal. The empathy and judgment a provider brings to a patient relationship can’t be replicated by a model, and it shouldn’t be. There’s real value in using new technology to make care more efficient and more accessible, but never at the expense of our industry’s first responsibility: caring for people.
Tom Vasko. CEO of Newman Memorial Hospital (Shattuck, Okla.): The most dangerous trend in healthcare today is not workforce shortages, artificial intelligence or reimbursement reform. It is the growing fragmentation of America’s healthcare system and the dangerous belief that rural healthcare can continue to deteriorate without compromising the health of the nation.
America does not have an urban healthcare system and a rural healthcare system. It has one healthcare system. Urban and rural healthcare are too often viewed as separate conversations competing for finite resources. They are not. They are codependent components of the same healthcare ecosystem, and one cannot sustainably thrive while the other declines. Rural hospitals provide care for nearly 60 million Americans, serve as the first point of access for millions more, stabilize critically ill and injured patients, and function as the connective tissue between local communities and tertiary medical centers. When rural healthcare weakens, the consequences inevitably reverberate throughout the entire healthcare continuum.
Compounding this challenge is the persistent misconception that hospitals, as an industry, are financially thriving. While select organizations have regained financial stability, many hospitals, particularly those serving rural America, remain in a constant state of preservation rather than progression. Strategic discussions too often center on sustaining essential services instead of investing in workforce development, advanced technologies, precision medicine, digital transformation and the next generation of clinical innovation. At the same time, many rural facilities are attempting to deliver twenty-first century medicine within aging infrastructure that was never designed for today’s clinical standards, workforce expectations or technological demands. Hospitals should be discussing how to reimagine care delivery, modernize infrastructure, improve energy efficiency, create environments that attract patients, retain exceptional clinicians, and invest in innovation. Instead, too many are simply trying to keep the lights on. A healthcare system focused on survival cannot simultaneously lead the world in advancing medicine.
Nowhere is this disparity more evident than in maternal healthcare. Today, fewer than half of rural hospitals in the United States continue to offer obstetrical services, and since 2020, approximately 139 rural hospitals have closed or announced the closure of their labor and delivery units. More than one third of United States counties are now classified as maternity care deserts, leaving millions of women with diminished access to prenatal, obstetrical and postpartum care. Oklahoma has become a powerful illustration of this national challenge, with vast rural regions facing significant gaps in obstetrical care and too many expectant mothers traveling long distances or relying on emergency departments when labor begins. The result is both predictable and profoundly troubling. Across America, women continue to deliver babies in emergency departments, ambulances and facilities without dedicated obstetrical teams or immediate surgical capability simply because those services no longer exist in their communities.
At Newman Memorial Hospital, we have experienced this reality firsthand. I still remember sitting in our emergency department as a mother progressed through labor without the immediate support of an on site surgical team or operating room capability. Thankfully, a certified nurse midwife was present, and the baby was delivered safely and successfully. It was a moment of profound relief, but also a sobering reminder that if a complication had arisen or an emergent cesarean delivery had been required, the nearest higher level of care was not around the corner. It was distant, and in those moments, distance matters. For many families across rural Oklahoma, this is not a hypothetical scenario. It is an increasingly common reality. That experience solidified the belief that emergency departments should never become the default maternity unit for rural America. It also fueled our commitment to reestablish labor and delivery services, not simply to restore a program, but to restore dignity, safety, and equitable access to care for families who deserve the same standard of care regardless of where they live.
This should never become acceptable. Access to safe maternity care is not merely a rural issue. It is a reflection of the priorities of an entire healthcare system. If we are serious about improving outcomes, reducing disparities and strengthening America’s healthcare infrastructure, we must move beyond preserving rural healthcare and begin modernizing it. That requires sustainable reimbursement models, strategic investment in infrastructure, workforce development, technology and clinical programs that allow rural hospitals to recruit outstanding professionals, embrace innovation, and deliver the same level of excellence expected in any community across America. Rural healthcare should not aspire merely to survive. It should be empowered to lead, innovate and flourish.
Healthcare is foundational infrastructure. Just as our nation invests in roads, bridges, ports, and energy systems because they are essential to economic prosperity and national security, we must view healthcare infrastructure through the same lens. Strong hospitals do more than care for patients. They sustain communities, attract employers, strengthen local economies and preserve the vitality of rural America.
History will not judge American healthcare solely by the sophistication of medicine delivered in our largest academic medical centers. It will judge us by whether every American, regardless of geography, could access that level of care when it mattered most. Until we recognize rural healthcare as a national strategic asset rather than a peripheral expense, healthcare equity will remain aspirational rather than achievable. A nation’s healthcare system is only as strong as its most vulnerable community. Most people rarely think about the strength of their healthcare system until they find themselves under the surgical lights, in the emergency department, or standing beside the bed of someone they love. At that moment, geography, policy and politics disappear. Only access, quality, and time matter.
J. Stephen Jones, MD. President and CEO of Inova (Fairfax, Va.): One of the most dangerous trends in healthcare today is the growing loss of trust in science and medical expertise. Medicine does not work without trust. Science continues to advance what we can do for patients and trust is what allows those advances to make a difference. A patient has to believe that the physician sitting across from them is offering honest, personalized guidance grounded in scientific evidence. If that trust is lost, it becomes much harder to prevent disease, diagnose illness and help patients make informed decisions about their care.
The problem isn’t that people have access to more information – in many ways that’s a good thing. The problem is that reliable medical evidence now competes on equal footing with opinion and outright falsehood, and a confident voice online can sound just as credible as someone who has spent decades at the bedside. The answer is not to talk patients out of their questions – it’s to be the relationship they trust enough to bring those questions to.
That is also why AI raises the stakes on relationships rather than replacing them. At Inova we’re already using it in thoughtful ways – with strict governance – to improve the patient experience and support our care teams. But AI can’t replace clinical judgment. It can’t replace experience. And it can’t replace the thoughtful, personal conversations that help patients make informed decisions about their most precious asset: their health.
I learned early on that trust isn’t automatic. Trust must be earned and is easily eroded. Innovation will continue to transform healthcare, but trust will always be the foundation of good medicine.
Shawn McCoy. CEO of Deaconess Health (Evansville, Ind.): It seems our sector is under constant attack from both federal and state government policies and national payer actions. Combined they are eroding the revenues needed to deliver high quality and timely care.
Some states are already aggressively reducing Medicaid rolls and the pending work requirement will drive more self pay and bad debt onto hospitals. At the same time scrutiny of the 340B program causes concern as so many rely on the program savings to make up for the shortfalls from other programs such as Medicare and Medicaid. National payer policies and their deployment of AI tools have made it even more difficult to be paid for the services we deliver.
Together, these issues are impacting top line revenue while we face an unprecedented rise in wages and supply costs. It is becoming a difficult problem to solve for many, especially rural hospitals.
Swannie Jett. CEO of Park DuValle Community Health Center Inc. (Louisville, Ky): Good afternoon, I believe one of the most dangerous trends happening today is related to recruiting and retention. Organizations across many industries are struggling to attract and keep qualified employees, creating significant challenges for long-term stability and growth. As competition for talent continues to increase, salaries have escalated beyond what many organizations originally budgeted for or anticipated. Many employers are finding it difficult to balance rising labor costs with the need to maintain quality services, invest in infrastructure, and meet other operational demands.
In addition, recruiting and retention challenges extend beyond compensation alone. Employees are increasingly seeking workplace flexibility, professional development opportunities, and a healthy work-life balance. Organizations that fail to address these expectations may continue to experience staffing shortages and high turnover rates. If these workforce challenges continue unchecked, they have the potential to significantly impact productivity, organizational performance, and the ability to effectively serve communities and stakeholders.
Melvin Price, DPM. President and CEO of MCR Health (Bradenton, Fla.): The most dangerous trend in healthcare today is allowing short-term financial pressures to dictate long-term healthcare strategy.
Financial sustainability is essential, but organizations that focus solely on the next quarter risk underinvesting in the very things that drive long-term success — people, physician development, innovation, preventive care, and community partnerships.
As healthcare leaders, our responsibility is to balance today’s operational realities with tomorrow’s opportunities. That means making difficult financial decisions without losing sight of our mission or the patients and communities who depend on us.
Sustainable healthcare isn’t built by choosing between financial performance and patient care. It’s built by recognizing that the two are inseparable. The organizations that will lead the future of healthcare will be those that can successfully balance both.
Ashwani Bhatia, MD. CEO of BayCare Clinic (Green Bay, Wis.): The most dangerous trend in healthcare today is the growing gap between rising costs, increasing demand for care, and a shrinking workforce. Healthcare premiums continue to increase faster than inflation and wage growth, leaving employers questioning whether they can continue to afford the coverage they provide while still receiving meaningful value.
At the same time, shortages of physicians, nurses, and other healthcare professionals, especially in rural communities, are making it harder for patients to access timely, high-quality care. The question is no longer whether we have a workforce shortage. The real question is whether we have reached a point where traditional solutions are no longer enough.
If we continue to do what we’ve always done, we will fall further behind. At BayCare Clinic, we see the need to invest in the next generation of healthcare professionals, embrace technology and AI to improve efficiency, reduce administrative costs, and support our workforce, and build stronger regional partnerships to improve access while delivering greater value for patients and employers.
If we fail to act now, we risk creating a healthcare system that is not only too expensive to sustain but also unable to provide timely access to the care our communities need. The organizations that succeed will be those willing to innovate, collaborate, and remain focused on delivering high-quality, patient-centered care for future generations.
Kathy Parrinello, RN, PhD. President and CEO of Strong Memorial Hospital and Highland Hospital, University of Rochester Medicine (N.Y.): The most dangerous trend in healthcare today lies in the federal government’s shift away from assuring the responsibility for a national social safety net, including access to healthcare, and the belief that supporting taxation to support a social safety net is an attack on individual liberty. In a country with untethered mobility across the country, relying on states to determine the level of safety net support, and regulation of healthcare services, forces a struggle in assuring all Americans have appropriate access to healthcare and other critical social services. In July of 1966, Lyndon Johnson, in the passing of the Medicare and Medicaid programs, suggested that ‘we should resolve now that the health of this Nation is a national concern; that financial barriers in the way of attaining health shall be removed.’ Now, 60 years later, we are faced with a backward slide to that commitment which so many of us had assumed had become an unalienable right.
Arthur Gianelli. President and Chief Transformation Officer of One Brooklyn Health (N.Y.): Medicaid is insurance. We do not treat it that way. We fund it as a welfare program — an expenditure to be minimized rather than a promise to be kept — and we pay accordingly: a fraction of the commercial rate for the identical procedure, in the identical operating room, by the identical surgeon, for a patient who arrives sicker, later, and with fewer resources of every kind. That is the most dangerous trend in American healthcare, and its danger lies in the fact that it is neither an accident nor a recent development. It is policy — some of it explicit, much of it implicit, and remarkably durable across administrations of both parties.
So long as this trend holds, the consequences follow with a grim logic: inequity persists by design, zip codes remain the most reliable predictor of health status we have, health systems manage their Medicaid exposure the way they manage any other liability – as something to shed, and the hospitals that care for the poor are themselves poor. We have built a delivery system in which caring for the most challenging patients carries a financial penalty, and we then profess surprise when institutions respond rationally to the incentive we created. The remedy is not mysterious: pay for the care of a Medicaid patient what that care actually costs. Until we do, no amount of innovation, integration, or artificial intelligence will close a gap that our own payment policy continues to force open.
Zachary Yoder, RN. President of St. Mary Medical Center, Holy Family Medical Center and St. Luke Medical Center, OSF HealthCare (Peoria, Ill.): One of the most dangerous trends in healthcare today is the growing imbalance between increasing patient complexity and the demands placed on the healthcare workforce. As clinicians care for sicker patients with fewer resources and greater administrative responsibilities, the risk of burnout, compassion fatigue, and workforce attrition continues to rise. These challenges can ultimately affect patient safety, quality of care, and the overall patient experience.
At the same time, rapid technological advancements, while offering tremendous opportunities, can unintentionally create additional burdens if they are not thoughtfully implemented and integrated into clinical practice. Addressing these issues requires healthcare organizations to invest in their people as intentionally as they invest in innovation. Supporting the well-being, professional development, and resilience of nurses and other healthcare professionals is essential to sustaining high-quality care. Strong leadership, interdisciplinary collaboration, and evidence-based decision-making are critical to navigating today’s complex healthcare environment. By prioritizing both our workforce and our patients, we can build a safer, more resilient healthcare system for the future.
David Rahija. President of Northwest Community Hospital, Endeavor Health (Evanston, Ill.): One of the most dangerous trends in healthcare today is making healthcare too transactional and fragmented. Consuming healthcare services is not like buying a latte or ordering a pair of pants online. Health is longitudinal, continuous, and needs to be tailored to the health needs of each person. Overly fragmenting care in the short term could lead to greater healthcare consumption down the road.
Timothy Layman, DNP, MSN, RN. President and Chief Administrative Officer of St. Mary’s Hospital, Hospital Sisters Health System (Decatur, Ill.): The most dangerous trend in healthcare today is the growing gap between the complexity of care delivery and the financial, workforce, and operational capacity to sustain it. Hospitals are being asked to manage increasingly complex patients while simultaneously facing reimbursement pressure, workforce shortages, rising labor and supply costs, and significant regulatory demands. The danger is that organizations can begin to normalize operating with insufficient capacity, putting pressure on clinicians, delaying investments, and ultimately compromising access, quality, and patient experience. At the same time, healthcare is becoming increasingly dependent on technology, data, and AI, yet many organizations still struggle with fragmented systems and inadequate interoperability.
The greatest risk is not any single financial or clinical challenge; it is the cumulative effect of these pressures eroding organizational resilience. Leaders must therefore focus not simply on cutting costs, but on redesigning care delivery, strengthening the workforce, investing in technology that produces measurable value, and protecting the capabilities that directly influence patient outcomes. The health systems that succeed will be those that can simultaneously improve quality, access, workforce stability, and financial sustainability rather than treating them as competing priorities.
Paula Stabler, MSN, RN. President of OhioHealth Van Wert Hospital (Columbus): The most dangerous trend in healthcare today is the widening gap between the growing demands placed on healthcare organizations and the resources available to meet them. Health systems are expected to improve quality, expand access, adopt new technologies, strengthen the workforce, and remain financially sustainable all while reimbursement continues to fall behind the true cost of care.
As a rural hospital within a large health system, I see both the challenges and the opportunities this creates. Rural hospitals are essential to the health and economic vitality of their communities, yet they cannot succeed in isolation. Strong health systems provide the scale, expertise, and resources needed to help rural hospitals innovate, while local leaders ensure decisions remain grounded in the unique needs of the communities they serve.
The organizations that will thrive are those that successfully balance system-wide efficiency with local agility, investing in people, technology, and partnerships while never losing sight of their mission: delivering safe, high-quality care close to home.
Lance Sewell. President of Orlando Health South Lake Hospital; Senior Vice President of Orlando Health (Fla.): My initial thought had to do with the impersonality of care being provided but after speaking with my 83-year-old father yesterday, it became apparent that untested information being provided on social media and other mechanisms for care of elderly patients seems to be a dangerous trend. Senior citizens are adjusting to technology and while there are many benefits, the information or misinformation availability related to diagnosis and treatment is concerning. In addition to an aging population with many ailments, the subspecialization of providers and clinicians is concerned with the overall need for access to care. While there are numerous tailwinds for the healthcare system as a whole, the other challenge is the ‘Amazon-ing’ of healthcare when it comes to facilities where real estate costs challenge the accessibility of healthcare. While I hope our conversion to healthcare as an online shopping experience is quick; there are many opportunities for fragmenting the provider to patient relationship. All in all, the access to the right information and care (technological, educational level and competency) remains the most dangerous trend.
CFO
Rob Chestnut. Senior Vice President and CFO of LMH Health (Lawrence, Kan.): I believe the most dangerous trend in healthcare relates to our workforce. We continue to struggle with recruitment in many clinical areas due to a shrinking workforce. This is happening at a time when reimbursement is not keeping pace with increasing wages. These competing factors are leading to margin compression that is not sustainable over the long-term horizon. Training opportunities are an essential element of relieving the shortfall in qualified healthcare professionals. It will not be easily solved.
Brad Bivens. CFO of Parkside Psychiatric Hospital & Clinic (Tulsa, Okla.): The most dangerous trend in healthcare today is the growing disconnect between the cost of providing care and the reimbursement required to sustain it. Nowhere is that more evident than in behavioral health.
Organizations are being asked to expand access, recruit and retain clinical staff, invest in technology, improve quality, and prepare for increasing regulatory demands while reimbursement often fails to keep pace. As a result, many providers are forced to delay investments, reduce services, or operate with unsustainable margins.
At Parkside, our conversations are centered on building a financially resilient organization without compromising patient care. That means improving revenue cycle performance, leveraging data to make faster operational decisions, evaluating strategic service line growth, and ensuring every dollar is invested where it has the greatest impact on patients.
Healthcare cannot continue relying on organizations to absorb rising costs indefinitely. Financial sustainability is not just a business issue; it is an access-to-care issue. If providers are not financially healthy, the communities that depend on them will ultimately have fewer options for care.
COO
Robert Wiehe. Senior Vice President and Chief Operating Officer of UC Health (Aurora, Colo.): The most dangerous trend in healthcare today is that government and payer pressures are increasingly dictating operational decisions that don’t align with what’s best for population health. Reimbursement models, reporting burdens, and payer administrative requirements consume a growing share of leadership bandwidth and capital, often pulling focus toward compliance and margin protection rather than the clinical and community investments that would move the needle on outcomes. Prior authorization delays, narrow networks, and shifting coverage rules force health systems into decisions driven by what will get paid rather than what a patient actually needs, and that gap is widening. At UC Health, we stay grounded by asking whether a given operational decision genuinely serves our patients and community, not just whether it satisfies a payer or some other requirement, but that’s an increasingly uphill battle as the rules multiply and often work against each other. The systems that stay grounded and do right by their communities are the ones willing to push back on policy and payer design that conflicts with good medicine, rather than simply optimizing around it. Left unchecked, this dynamic is quietly reshaping healthcare into a system optimized for compliance and reimbursement instead of health.
John Harding. Executive Vice President and COO of Children’s Minnesota (Minneapolis): I think one of the most dangerous trends in healthcare today is the growing gap between the care people need and the care they receive. We continue to see individuals delay or forgo services because of cost, convenience, complexity, or difficulty getting access when and where they need it. As providers, we also must be honest about the role we play. Too often, patients are motivated to seek care, but our systems make it harder than it should be to schedule appointments, navigate referrals, or move efficiently through the care journey. The result is that conditions become more serious, outcomes worsen, and costs increase for everyone involved. At the same time, we’re rapidly adopting artificial intelligence, which has tremendous potential to improve access, efficiency, and decision-making. But AI is only as good as the governance, oversight, and human judgment that surround it. If we embrace technology without appropriate safeguards, we risk creating new problems while trying to solve existing ones. Ultimately, healthcare’s biggest challenge isn’t a lack of innovation, it’s ensuring that innovation makes care more accessible, trustworthy, and easier for patients and families to navigate.
Roberta Schwartz, PhD. Executive Vice President of Houston Methodist Hospital; Chief Innovation Officer of Houston Methodist: Healthcare is facing growing demand as our population ages and more people need care, while workforce shortages continue to place pressure on the system. To meet these challenges, we must transform how healthcare is delivered. That means investing in innovative tools and technologies that expand access, improve efficiency and help clinicians care for more patients without increasing administrative burden or contributing to burnout. Our goal is to ensure patients receive timely, high-quality care while supporting the healthcare workforce that makes it possible.
Benjamin M. Schwartz, MD. President of Academic Delivery at Banner Health (Phoenix): The most dangerous trend in healthcare today is that we lose the human element. Technology and our research capabilities are advancing fast, with things now possible that have never existed before. The business of healthcare, how we pay for and deliver care, is growing more complex by the day. It can all start to feel very abstract and removed from the actual human sitting in the exam room, the very person all of this is built to serve. At Banner, our partnership with the University of Arizona keeps us grounded in that reality. We are not just pushing the boundaries of medicine together, we are training the next generation of providers to understand that technology and complex systems should facilitate community health, not complicate it. The goal has always been simple: make sure we provide the best care to the patients and communities we serve.
Clinical Executives
Leong Koh, MD. Executive Medical Director of Northwest Permanente (Portland, Oregon): Two of the most dangerous trends in healthcare today are people losing coverage and overcoming misinformation. Both these issues point to the same underlying reality: when access or trust breaks down, the foundation of preventive care collapses. Physician leaders can play a role to address this challenge by advocating for policy changes that increase access, supporting the spread of coordinated, value-based care, and rebuilding trust through clear, evidence-based communication at every touchpoint.
Chandu Vemuri, MD. Chief Medical Officer of University of Michigan Health Sparrow (Ann Arbor): The most dangerous trend in healthcare is that healthcare systems are reacting to changes in healthcare rather than proactively shaping its future. To advance U.S. healthcare, a collaborative and innovative approach involving key stakeholders is essential. This approach will enable us to effectively serve the needs of our patients in a timely, accessible, affordable, and financially sustainable manner.
Zafar Jamkhana, MD. Vice President of Medical Affairs and Chief Medical Officer of SSM Health St. Mary’s Hospital – St. Louis and SSM Health Saint Louis University Hospital (St. Louis): The most dangerous trend I see is the steadily rising cost of delivering care — driven by global economic pressures, supply chain disruption, and the escalating price of pharmaceuticals and advanced technology — at the very moment we are asking a young workforce to manage growing complexity without fully equipping them with the tools and preparation they need.
Nearly every disease state today is being addressed with a higher-priced drug or a more advanced device, yet we are not seeing the same pace of innovation directed at making care more accessible, affordable, and timely for our communities. Layered on top of this is a growing regulatory and reporting burden that consumes enormous clinical and administrative resources without clearly improving the value of care our patients receive. We have to be honest with ourselves: the resources available to deliver high-quality care will be constrained for the foreseeable future. That reality calls for genuine introspection — going back to the drawing board, rigorously identifying spending that adds no value to patients, and partnering with regulators and with one another to retire requirements that create work without creating value. If we do that together, we will be able to live up to the mission statements we all hold ourselves to.
Mark G. Moseley, MD. President of USF Tampa General Physicians; Executive Vice President of Tampa General Hospital (Fla.): In my opinion, the most dangerous trend in healthcare today is not financial pressure, artificial intelligence, or workforce shortages. It is a distraction. We are surrounded by more information, more data, more technology, and more competing priorities than ever before. The result is a culture of perpetual urgency where everything feels important and little receives our full attention. The danger is that distraction does more than fragment our focus; it can also diminish our humility. We begin to confuse speed with wisdom and activity with progress. To be clear, speed is not the enemy. Healthcare operates in an environment of uncertainty where decisiveness, adaptability, and forward momentum matter. But speed without reflection can become recklessness, just as excessive deliberation can become paralysis. The challenge for leaders is navigating that polarity; moving fast enough to meet the moment while remaining humble enough to change course when new information emerges. Healthcare remains a profoundly human enterprise, and many of its hardest problems are too complex to be solved with certainty alone. The organizations that thrive in the years ahead will not necessarily be those with the most resources or technology. They will be those able to maintain clarity of purpose, disciplined focus, and the humility to adapt when circumstances change.
Asa Oxner, MD. Vice President and Associate Chief Medical and Quality Officer of Ambulatory at Tampa General Hospital (Fla.): The two most dangerous threats to our health system and patients right now are proposed changes to 340B pharmaceutical pricing and proposed restrictions on remote patient monitoring.
Proposed changes to 340B — whether through narrowing the statutory definition of who qualifies as a 340B patient or shifting drug acquisition costs onto health systems — would have the same downstream effect: reduced patient eligibility, narrowed medication formularies, and smaller margins available for reinvestment in charity care. This is not an abstract risk for TGH. As a charity safety-net hospital, our capacity to care for the uninsured, a population that has grown sharply over the past nine months at our hospital, depends directly on 340B dollars being reinvested into that mission.
The proposed rule barring third-party contractors from supporting patient management would make RPM administratively unaffordable for small and rural health systems. RPM is an evidence-based intervention proven to improve chronic disease management and reduce acute hospital utilization, but under this change, it would only remain viable at large health systems with the resources to build the infrastructure in-house. TGH currently has a hybrid of partly in-sourced and part vendor RPM services, which allows us to deliver at scale for our moderate and high risk patients. Our patient eligibility would have to constrict.
Mandy Richards, DNP, RN. Chief Nursing Executive and President of Children’s Health at Intermountain Health (Salt Lake City): The most dangerous trend in healthcare is not one single issue, but the convergence of many at once. If there were only one trend, it would be far easier to solve the problems facing healthcare today. From a nursing leadership perspective, the danger is that workforce strain, burnout, patient safety risk, AI and technology, and financial pressures are all accelerating at the same time. Combined together, these pressures can reduce bedside capacity, weaken safety culture, and erode trust between patients and care teams.
I believe these trends are an opportunity to simplify and redesign healthcare to better support the people closest to patients. So even though we face complex problems and dangerous trends, our solution at Intermountain Health is simple. Our mission is to help people live the healthiest lives possible, and that will always be our north star as we redesign care for the people and communities we serve.
Rachel Hoover. CEO of University of Maryland Faculty Physicians, University of Maryland School of Medicine (Baltimore): The erosion of the physician workforce due to burnout is the most concerning trend in healthcare today. For an academic physician group like ours in Maryland, it has become imperative to ensure that patients receive the right care from the right provider at the right time. Achieving this requires a thoughtful placement of our advanced practice provider workforce and a deliberate examination of our clinical care pathways. By aligning patients with the most appropriate clinician and optimizing team-based care, we can ensure our physicians focus their expertise where it adds the greatest value while also maintaining the highest standards of patient care and access.
Angelo Milazzo, MD. Chief Medical Officer of Duke Health Integrated Practice (Durham, N.C.); Chief Clinical Officer of North Carolina Children’s Hospital and Health System: As we drive efficiency and chase growth, the erosion of time spent listening to patients is among the more dangerous trends in healthcare. Time is a precious commodity, and it takes time with patients — focused, intentional, purposeful time — to effectively evaluate and manage disease. Most diagnoses are made through obtaining a thorough history, which requires a meaningful conversation without the constraints and pressures of a too-short office visit.
As appointment times shorten, the space for a comprehensive collection of information from the primary source contracts, and clinicians become more reliant on ancillary studies outside of the episode of care. While throughput may increase on the front end of care delivery, efficiency erodes (and costs increase) on the back end. Whole systems for triage, inbound message response, and out-of-office follow-up have been stood up to manage the care that, otherwise, would have been provided during the face-to-face encounter. This threatens patients’ satisfaction with their experiences of care, and their perception of its quality. In turn, this diminishes clinicians’ satisfaction with delivering care, which may jeopardize quality more materially.
Sriram Vissa, MD. Vice President of Medical Affairs and Chief Medical Officer at SSM Health DePaul Hospital (St. Louis): The most dangerous trend in healthcare today is the growing mismatch between workforce supply and patient demand. Across the country, hospitals are facing persistent shortages of nurses, surgical staff, imaging technologists, respiratory therapists, and other highly specialized clinical professionals. At the same time, health systems are competing for a limited labor pool, driving wage inflation and escalating operating costs at an unsustainable pace.
For many organizations, the challenge is no longer just recruiting talent but retaining experienced clinicians while maintaining access, quality, and safety. As staffing shortages intensify, hospitals face increased risks of delayed care, reduced capacity, longer wait times, and workforce burnout.
Long-term solutions will require more than aggressive recruitment efforts. Healthcare organizations, educators, and policymakers must invest in local schools, expand training programs, increase clinical placement opportunities, and create stronger pathways into healthcare careers. Building a larger and more sustainable workforce pipeline is essential to meeting the growing needs of our communities and ensuring access to high-quality care in the years ahead.
Sunil Patel, MD. Chief Medical Officer of Prime Healthcare (Ontario, Calif.): One of the biggest challenges facing Prime Healthcare Illinois is that the cost of caring for patients continues to rise faster than reimbursement. This is especially difficult for our safety-net hospitals, which serve many Medicaid, uninsured, and underinsured patients. If upcoming Medicaid changes reduce coverage or payments, these hospitals could see more uncompensated care and even greater pressure on essential services.
Staffing, medication, supply, and technology costs are all increasing. When reimbursement does not keep up, hospitals have less flexibility to retain staff, maintain important service lines, and invest in quality and access. The impact is greatest in communities that already have limited healthcare resources.
The greatest threat to healthcare is not a single disease, technology, or competitor. It is the slow weakening of the financial foundation that allows hospitals and physicians to care for their communities. Without sustainable reimbursement, access and quality will eventually decline.
Riley Meyer, DO. Chief Medical Officer of BayCare Clinic (Green Bay, Wis.): The decline in services and closures of rural hospitals represents the most dangerous trend in healthcare today. Across our region, rural hospitals are increasingly struggling to recruit and retain qualified physicians, advanced practice providers, nurses, and other essential healthcare professionals. At the same time, mounting financial pressures have forced some facilities to reduce critical services, while others have been forced to close their doors entirely.
The consequences of these challenges extend far beyond the walls of the affected hospitals. As access to local healthcare diminishes, patients in rural communities must travel greater distances to receive medical care. Delays in diagnosis and treatment become more common, preventive care suffers, and health disparities continue to widen.
When rural hospitals reduce services or close, the responsibility for caring for these patients shifts to neighboring regional medical centers that are already operating near or at capacity. This influx of patients places additional strain on emergency departments, inpatient units, and specialty services, leading to longer wait times, overcrowding, and increased pressure on an already limited healthcare workforce. Ultimately, the erosion of rural healthcare infrastructure creates a ripple effect that negatively impacts not only rural communities, but the entire regional healthcare system.
Karyn Baum. Chief Medical Officer of UnityPoint Health Meriter Hospital (West Des Moines, Iowa): Sadly, I think the most dangerous trend right now is the erosion of trust in healthcare. There has been loss of trust between patients and providers (and the system in general), leading to challenges establishing the relationships so essential to effective patient and community care. We see the consequences, from reduced willingness to follow treatment plans to assaults on staff. Equally troubling has been the declining trust by healthcare staff and providers with institutions, from government agencies to health systems and professional organizations. If this trend continues, we will see ongoing burnout, violence, poor quality outcomes, and fewer people entering these fields. As leaders we need to consider carefully what concrete steps we can take to rebuild the loss of trust among all these groups, knowing that it will take time, patience, and humility.
Faye Collins, DNP, RN. Chief Nursing Officer of Meriter Market at UnityPoint Health (West Des Moines, Iowa): From a nurse leader perspective, I would propose that the most dangerous trend in healthcare today is a loss of human connectedness. I see this on so many levels; at the bedside with increased threats of violence against staff, AI entering the clinical realm, communication with our physician partners through a secure chat rather than an engaged discussion, and leaders spending less time really listening to their teams. There is less kindness around us, more misunderstanding, less trust. We need to recenter on the human side of healthcare, remember the gift and responsibility that is our profession, and reconnect to each other and to our patients.
Megan Isley, DNP, RN. Chief Nursing and Quality Executive of Adena Health (Chillicothe, Ohio): The most dangerous trend in healthcare today is the growing gap between the cost of delivering care and the resources available to sustain it, particularly in rural communities. As Adena Health’s chief nursing and quality executive, I see how financial pressures extend far beyond budgets. They influence our ability to recruit and retain staff, invest in new models of care, and ensure patients can access the services they need close to home. When those pressures grow, patients often delay care or travel farther for treatment, which can lead to more serious health concerns over time. Rural communities deserve the same access to high quality, compassionate care as anyone else. At Adena Health, we remain committed to investing in our team, strengthening partnerships, and finding innovative ways to ensure our communities continue to receive that level of care.
Angelina Fakhoury, MSN, RN. Chief Nursing Officer and Vice President of Patient Care Services at City of Hope (Duarte, Calif.): The most dangerous trend in healthcare today is the widening gap between the complexity of patient care and the experience level of the workforce caring for them.
Patients are living longer with more complex conditions, while healthcare organizations continue to navigate retirements, turnover, and shortages in highly specialized roles. In oncology, cellular therapy, and other advanced specialties, expertise is developed over years, not months. When experienced clinicians leave, organizations lose valuable clinical judgment, mentorship, and institutional knowledge that are difficult to replace.
Addressing this challenge requires more than recruitment. Healthcare leaders must invest in retention, professional development, succession planning, and environments where clinicians feel supported and empowered to build long-term careers. At City of Hope, we believe creating clear pathways for growth and fostering a culture of engagement are critical to ensuring our workforce is prepared to meet the increasingly complex needs of patients.
The organizations that successfully develop and retain specialized talent will be the ones best positioned to deliver safe, high-quality care in the years ahead.
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