For a more in-depth analysis of 2026 healthcare financial trends, find our full trends report here.
Healthcare leaders face a challenging 2026. Risks will be more pronounced, though rewards remain achievable. Simultaneous pressures include ongoing cost increases, potentially major reimbursement losses from Medicaid and other cutbacks, growth investment imperatives, and never-ending cybersecurity threats. The dynamic environment also features rapidly expanding opportunities to advance transformative change through automation and artificial intelligence.
CommerceHealthcare® analyzes extensive data and perspectives to identify prominent elements of the leadership agenda, synthesizing several major themes across four business sectors:
- Financial and reimbursement
- Patient financial experience
- Technology
- Leadership directions
Financial uncertainty and risks constrain planning.
Gross operating revenue rose 11.4% year-over-year (YOY) through September. Inpatient revenue was up 9.8%, and outpatient increased 12.8%.[1] Healthy volume gains were a driver. Increases for inpatient admissions and outpatient visits were 5.3% and 9.8% YOY, respectively.[2]
Hospital operating margins stayed in positive territory throughout 2025 and sat at 2.9% (including shared services allocations — 6.5% without) year-to-date through September.[3] For health systems, the median stood at a modest 1.1%.[4] Cash positions are also encouraging. Industry cash on hand at midyear was 215 days, with improving cash-to-debt and median debt-to-capitalization ratios signaling some liquidity cushion.[5]
Mounting hospital expenses represent a major concern. They increased 7.5% YOY through September.[6] Labor continues to be a stressor as a competitive market drove a rise in median base pay for health care staff of 4.3% in 2025, up from 2.7% in 2024.[7]
The 2026 outlook is cautious at best, and organizations anticipate little relief from financial constraints on their strategies. Over eight in ten CFOs view business conditions as their primary concern.[8] Eighty-four percent of administrative and clinical leaders cite financial pressures as their greatest threat for the coming year.[9] Cost discipline is essential. Healthcare consulting firms report fastest expansion from helping organizations achieve operational and financial improvement.[10]
At the same time, growth is a critical pursuit. Outpatient care continues to offer attractive top and bottom line opportunity. Volume is projected to increase 18% through 2035 versus 5% for inpatient.[11] The Ambulatory Surgery Center (ASC) segment is steadily expanding. Almost 51% of eligible surgeries were performed at ASCs in 2024.[12] Volume will rise 9% between 2023 and 2028.[13]
Medicaid and other government cuts complicate providers’ financial risk calculus.
Organizations enter the year deeply concerned about the looming Medicaid funding reductions and potential termination of Affordable Care Act (ACA) enhanced subsidies for individuals. Leaders see these reimbursement changes as carrying the greatest negative impact among several federal policy changes proposed or enacted. With their reliance on Medicaid, 75% of skilled nursing facility administrators express significant concern about reductions.[14]
Accelerating automation in finance gaining fresh impetus from AI.
With tight financial control paramount today, it’s not surprising that providers are ramping up investment in technologies that automate finance and revenue cycle management (RCM) processes. Back-office RCM receives 29% of healthcare IT spend, creating a nearly $19 billion market.[15] Automation and efficiency investments have been cited by 37% health system leaders as their leading action to counteract burnout, staff shortages and financial pressures.[16]
Emergence of same-day payment transactions.
Healthcare payments will see not only greater automation but also increasing near real-time processing. That promises to supercharge benefits such as convenience, cost savings and quality. Various technologies enable rapid execution of actual payments and their underlying and adjacent transactions.
Affordability a headline issue for 2026.
Affordability continues to be a dominant healthcare motif. National health expenditures will grow at a faster pace than gross domestic product through 2033.[17] An HFMA analysis concluded that “the healthcare system is not making progress toward improving affordability” and warned that change is needed to avoid further slippage into “crisis mode.”[18]
Emphasis on communication, transparency, technology to improve patient financial experience.
Positive financial experiences contribute to overall patient engagement, satisfaction, and trust-building. Improvement rests on three strategic pillars in 2026, blending communication, transparency and technology.
Cybersecurity stays top of mind.
Cybersecurity is a perennial priority. It commands the largest spending increase in current healthcare IT budgets for 31% of surveyed organizations. That ranks just behind the 39% citing AI/automation.[19] The issue spans industries: 84% of CIOs are increasing funding for 2026 with a median budget jump of 26%.[20]
Pressure mounting to strengthen the healthcare ecosystem.
A growing chorus of stakeholders is calling for healthcare to accelerate structural reform. A health system CEO captured the sentiment: “Leaders are challenged to catalyze genuine systemic transformation in healthcare cost structure, quality and accessibility, moving beyond superficial reforms.”[21] A primary goal is to establish a fully aligned ecosystem. That will require organizations to form robust partnerships and achieve digital maturity.
Leadership requirements changing.
New leadership requirements are emerging in response to healthcare’s complex demands for change. Several recent directions stand out. C-suite roles are expanding. These executives “are expected to help lead across technology, clinical operations and staff culture.”[22] It’s a demanding position as evidenced by the fact that 71% of healthcare organizations (inclusive of technology firms) have changed CFOs since 2020, with turnover at 22% in 2024.[23]
Several health systems have eliminated or subordinated individual hospital CEO and COO positions in favor of regional leaders who manage groups of hospitals. The objective is to bolster market expansion, cost savings and the push to integrated ecosystems.
Senior positions have been created in recent years in AI, digital transformation, patient experience, strategy, and revenue generation — to name a few. Most of these reflect a desire to harness emerging technologies and orchestrate critical strategies across the enterprise.
Conclusion.
This report maps financial and operational challenges whose direction and intensity aren’t fully certain. Leaders will remain very wary throughout 2026. At the same time, the data spotlights both the efficacy of actionable solutions such as RCM automation and the accelerating new opportunities driven by AI, digital payments and same-day transactions. Organizations are adapting leadership and engaging strong collaborators to position themselves to use these solutions effectively and to form efficient ecosystems. CommerceHealthcare® will continue to support providers in these efforts.
CommerceHealthcare® solutions are provided by Commerce Bank.
CommerceHealthcare® solutions are provided by Commerce Bank.