Healthcare CFOs are navigating a complex and volatile environment shaped by policy uncertainty, workforce shortfalls, technological disruption, and evolving payer dynamics.
Those industrywide challenges framed the discussions at September’s HealthLeaders CFO Exchange.
But while sharing concerns about the current environment, the executives gathered in California reiterated what the Bank of America healthcare team has heard from organizations around the country: Across the board, healthcare leaders are focused on balancing innovation with financial resilience, while staying grounded in their mission to serve their patients and communities.
Bracing for upcoming policy changes
Pending federal policy changes are the most significant threat to the financial stability of many healthcare organizations, and that tension loomed over every session. CFOs are bracing for the impact of the One Big Beautiful Bill: a reduction in Medicaid reimbursements, stricter Medicaid eligibility requirements for individuals, a rollback of Affordable Care Act subsidies and other provisions that could result in 10 million to 14 million Americans losing insurance coverage over the next 10 years. Providers expect the legislation to increase uncompensated care and decrease current state-directed support payments, pushing many systems into the red and threatening rural facilities in particular.
“The major driving topic at every session was federal policy issues. There is so much uncertainty; CFOs are preparing for the worst-case scenario,” said Bank of America’s Kara Savoian, Senior Client Relationship Manager for Global Commercial Banking. From an overall financial and liquidity standpoint, most CFOs said their systems should be fine for the next year or two; they are more concerned about the outlook over the next three to five years.
CFOs are actively developing strategies to protect the quality of their patient service if and when cutbacks happen. Smaller systems are forming strategic partnerships to enhance purchasing power, share distribution infrastructure, reduce costs and cover regional healthcare needs. “To avoid making difficult decisions about cutting services altogether, providers are looking to partner to try to provide care in their communities,” said Bank of America’s David Garcia, Treasury Sales Executive for Global Payments Solutions. For their part, larger systems report radical service line redesigns and creating archetypes like ambulatory surgery centers and outpatient clinics to better align with community needs.
Protecting financial security
In this fraught environment, effective cash management is paramount. Bank of America’s team typically recommends nine months of cash on hand to weather a potential crisis. CFOs increasingly rely on advanced tools like Bank of America’s CashPro, which utilizes AI to forecast cash needs and deliver real-time visibility into current and projected liquidity—empowering executives to make proactive, informed decisions in an unpredictable environment.
A key part of financial security is improving processes in order to get paid faster and more accurately for services. Healthcare providers are looking to AI to help process claims and respond to denials more quickly. While many organizations are actively exploring and investing in AI across functions, from optimizing revenue cycles to automating clinical workflows, leaders are grappling with the sheer volume of AI opportunities and how to quantify ROI. Many CFOs report that so far, AI has been a cost center rather than a cost saver.
“Systems are evaluating AI and looking for effective ways to work with partners to deploy AI in the revenue cycle—reviewing billing and streamlining the claims process to get paid more quickly,” said Bank of America’s Susan Beat, Treasury Sales Manager for Global Payments Solutions. “For instance, Bank of America’s revenue cycle solutions can play a role in addition to what third-party vendors bring to the table.”
Managing system costs
In addition to the stresses brought by new federal policies, CFOs remain under pressure to manage rising operational costs. Workforce shortages, particularly in nursing and for physicians in rural areas, continue to strain operations. Operators are working to build pipelines of talent by reaching out to college and even high school students—then encouraging them to remain and work as practitioners in their local communties.
Some systems are exploring new revenue streams to bolster the bottom line. That includes concierge services, cosmetic procedures and other out-of-pocket offerings that bypass insurance altogether.
The big-picture takeaway? Amid persistent challenges and anticipated industry disruptions in 2026 and beyond, CFOs are stepping up as strategic leaders. Our Bank of America team sees firsthand how they’re not just reacting to change—they’re driving it. From staying ahead of regulatory shifts to rethinking capital allocation and operational models, CFOs are deeply engaged in navigating their organizations through the rapidly evolving healthcare marketplace.