Healthcare finance trends for 2026: A dynamic mix of opportunity and risk.

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 (AI).

Each year, CommerceHealthcare^® analyzes extensive recent data and perspectives to identify prominent elements of the leadership agenda. Healthcare Finance Trends for 2026 synthesizes several major themes across four business sectors:

• Financial and reimbursement. Revenue and margins were positive for 2025, but labor costs stayed stubbornly high. Cost control will be a 2026 watchword. So will the search for growth, which will continue to center on outpatient care. Government cuts are a substantial overhang for everyone.
• Patient financial experience. As in previous Trends reports, affordability is a headline issue with many ramifications for patients and providers. Patient financing will need to expand to meet growing needs.
• Technology. The push for process automation in healthcare finance appears to be accelerating and is gaining new impetus from agentic AI. Promising benefits are also being derived from digital payment rails and financial transactions that are completely digital.
• Leadership directions. Converging trends are fueling leaders’ desires to build strong, integrated ecosystems that many feel are an industry necessity. Leadership roles are also shifting to meet the strategic future.

Financial uncertainty and risks constrain planning.

A snapshot of key 2025 financial metrics shows improvements coupled with some negative results that keep leaders apprehensive about 2026.

On the positive side.

Gross operating revenue rose 11.4% year-over-year (YOY) through September. Inpatient revenue was up 9.8%, and outpatient increased 12.8%.^{footnote [1]} Healthy volume gains were a driver. Increases for inpatient admissions and outpatient visits were 5.3% and 9.8% YOY, respectively.^{footnote [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.^{footnote [3]} For health systems, the median stood at a modest 1.1%.^{footnote [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.^{footnote [5]}

On the negative side.

Mounting hospital expenses represent a major concern. They increased 7.5% YOY through September.^{footnote [6]} Labor continues to be a stressor as a competitive market drove a rise in median base pay for healthcare staff of 4.3% in 2025, up from 2.7% in 2024.^{footnote [7]}

Another negative is bad debt and charity care expense. These categories have been rising for several years (Figure 1).^{footnote [8]} Through September 2025, they were up another 11% relative to 2024.^{footnote [9]}

Figure 1
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Outlook for 2026.

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.^{footnote [10]} Eighty-four percent of administrative and clinical leaders cite financial pressures as their greatest threat for the coming year.^{footnote [11]} Cost discipline is essential. Healthcare consulting firms report fastest expansion from helping organizations achieve operational and financial improvement.^{footnote [12]}

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.^{footnote [13]} The Ambulatory Surgery Center (ASC) segment is steadily expanding. Almost 51% of eligible surgeries were performed at ASCs in 2024.^{footnote [14]} Volume will rise 9% between 2023 and 2028.^{footnote [15]}

Health systems have also been acquiring or opening Urgent Care Centers (UCC) to tap another growth segment and enter new markets cost effectively. In the first half of 2025 alone, 430 UCCs opened, 40% affiliated with hospitals.^{footnote [16]}

Rough waters further ahead.

Three-quarters of surveyed executives say lowering operating costs tops their performance priority list over the next five years.^{footnote [17]} Fitch Ratings sees the longer-term “clouded by legislative changes, demographic shifts, and persistent labor and inflationary pressures” and asserts that financial flexibility will be decisive.^{footnote [18]}

That flexibility eludes many providers. Analysts continue to warn of a serious and growing split between financially healthy and less healthy organizations. As one report states, “The divide between haves and have-nots persists as high-margin and for-profit systems spend more aggressively than low-margin and nonprofit peers to expand and transform their portfolios.”^{footnote [19]}

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 (Figure 2).^{footnote [20]} With their reliance on Medicaid, 75% of skilled nursing facility administrators express significant concern about reductions.^{footnote [21]}

Figure 2 
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Medicaid: Running the numbers.

Most organizations are doing scenario planning to help gauge the future effects of Medicaid change provisions. It’s a challenging endeavor. One assessment is how many will lose coverage due to the new requirements for adult beneficiaries to work at least 80 hours per month. Some sense can be gleaned from current recipient work status. Figure 3 indicates that 64% were employed in 2023, and some of the unemployed have reasons likely to exempt them from the requirement.^{footnote [22]} 

 
Figure 3 
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Independent calculations suggest a range of financial impacts from enrollment declines:

• Revenue. One analysis examined Medicaid disenrollment scenarios ranging from 5% to 20%, assuming those disenrolled don’t obtain alternative coverage. The results suggest that the average hospital could lose between 0.4% to 1.4% of annual net revenue.^{footnote [23]} Safety net hospitals are said to be at particular risk, and the concern extends beyond rural institutions. A study discovered that when these hospitals are segmented by financial distress measures and high levels of Medicaid patients, 85% of the most vulnerable to Medicaid cuts are in urban areas.^{footnote [24]}
• Margins. Hospitals in Medicaid expansion states might experience operating margin declines in the 11% to 12% range, with safety-net hospitals falling 25%–30%.^{footnote [25]} Looking across all federal cuts and addressing by health system size produced the projected 2028 impacts displayed in Figure 4.^{footnote [26]}

 
Figure 4 
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The Affordable Care Act.

As of this report’s publication, the fate of the enhanced ACA subsidies is unresolved. If the tax credits expire, analysts see lost revenue across providers of more than $32 billion and increased uncompensated care of $7.7 billion.^{footnote [27]}

The Medicare dilemma.

Approximately 10,000 people become eligible for Medicare every day.^{footnote [28]} Millions will terminate from private coverage, which generally carries higher reimbursement levels. By 2030, 55% of all enrollees will be in private plans versus 59% pre-pandemic.^{footnote [29]}  

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.^{footnote [30]} Automation and efficiency investments have been cited by 37% health system leaders as their leading action to counteract burnout, staff shortages and financial pressures.^{footnote [31]}

Strong rationale.

The case for intensified investment in automation rests on three pillars. One is the substantial cost savings opportunity. The high-quantity administrative transactions monitored by the Council for Affordable Quality Healthcare (CAQH) were up 13% in 2024.^{footnote [32]} CAQH places the industry savings from fully automating these transactions at $18 billion.

Second, paper-based and manual processes still abound in healthcare finance. A study showed that 68% of payers reimburse providers using paper checks, up from 60% in 2023, and over half of providers send checks to patients for refunds.^{footnote [33]}

A third automation driver is the need to reduce process complexity. Leaders express frustration with ongoing points of friction and disconnects. Supply chains often may work with clinical administration but not coordinate with RCM. Another example among many is remittance management (Figure 5). Delays, errors, and omissions can result from the multiple people, payment types, workflows and information sources involved.

Figure 5 
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Growing adoption of automation solutions.

Healthcare payments solutions that are delivering results include the following:

• Accounts payable automation. This software features a hub that consolidates payables into a single file, executes the diverse payments according to supplier preferences, and automatically generates a reconciliation report (Figure 6). The single platform streamlines the process and creates efficient exception-based workflows for staff.

 
Figure 6 
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• Remittance automation. A unified platform approach is also being deployed to help automate the receivables posting and reconciliation process. The platform directs remittances across multiple revenue systems and routes correspondence and denials automatically.
• Robotic process automation. Rules-based automation software can execute many of the highly predictable and repetitive actions in RCM. The U.S. healthcare market is expected to grow at over 26% annually through 2034.^{footnote [34]}

Agentic Artificial Intelligence: The next wave.

Many see the fast-moving technology of AI “agents” as the next wave in healthcare automation. Agentic AI possesses three attributes: ability to remember across tasks and changing states; use of AI models to assess and complete tasks; and decision-making on when to access external systems on a user’s behalf (Figure 7).^{footnote [35]} Agents can be designed to act autonomously or as “copilots” to assist humans.

 
Figure 7 
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Agentic AI is being used by 35% of larger organizations and 30% of those with under $1 billion net patient revenue.^{footnote [36]} The global healthcare market is expanding at a blistering 45.6% compound annual clip through 2030.^{footnote [37]} RCM process automation will be a clear beneficiary of this trend.

Beware the AI obstacles.

Migrating from AI pilots to full implementation has proven challenging. Cost and access to talent are barriers for many. Moreover, successful agentic AI at scale requires commitment to four “enablers”:

• People: Equip the workforce and introduce new roles.
• Governance: Ensure autonomy control and prevent agent sprawl.
• Technology architecture: Build a foundation for interoperability and scale.
• Data: Accelerate data productization and address quality gaps in unstructured data.^{footnote [38]}

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.

Digital payment rails.

Digital payments are central to quick payment processing. The global market for healthcare digital payments is projected to rise at 12.8% annually to reach almost $22 billion by 2029.^{footnote [39]} Patient demand is growing. For example, 40% want providers to support contactless payments and online portal payments.^{footnote [40]} 

CommerceHealthcare^® regularly tracks digital rails. Continuing growth can be seen in the data on several popular modes:

• ACH. Healthcare has consistently increased use of this near real-time mechanism. The industry logged 141 million payments in the third quarter of 2025, a 6.8% increase over the same period in 2024.^{footnote [41]}
• Virtual cards. Digital credit cards facilitate electronic payments to suppliers. A bank administers the program by loading funds to the virtual card, sending a unique card number to the vendor, and completing the transaction through direct payment or automatic deposit into a merchant account. Commercial volume is steadily increasing (Figure 8). Healthcare is participating in this growth, with use in AP and throughout the supply chain to generate efficiencies and tap revenue sharing opportunities with the banks providing the cards. Consumer acceptance is growing as well. Over 40% of recently surveyed individuals used one in the past six months.^{footnote [42]}

 
Figure 8 
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• Near real-time/instant payments. The Clearing House’s network has experienced steady volume growth since 2020 and processed 115 million transactions across industries for $405 billion in the third quarter of 2025.^{footnote [43]} Started in 2023, the FedNow network has seen double-digit volume increases every quarter.^{footnote [44]} Instant payments are expected to represent 22% of global payment volume by 2028.^{footnote [45]}
• Digital wallets. By storing card, bank account, and related information in a digital wallet, payments can be issued via computer or mobile device. The E-wallet market will reach $1.1 trillion in 2035, representing an annual growth rate of 22.1%.^{footnote [46]} In 2023, the Federal Reserve surveyed businesses using wallets and instant payments and found that the chief motivations are to reduce cost (48%), provide flexibility for customers (39%) and maintain 24/7 access to payment services (35%).^{footnote [47]} Those benefits are highly desirable in healthcare and augur well for industry adoption.

Digital financial transactions.

Fast processing will also transform the entire financial transaction suite. AI and other advanced technologies, along with robust system integrations, are creating solutions that learn and improve over time to perform transactions.

• Immediate identification of coding and billing issues. Claims are analyzed as they are prepared, permitting automated error detection prior to submission. That promises to avoid payment delays and denials. The aim is to create immediate “payment precision.”^{footnote [48]}
• Intelligent payment routing. The overall market for payment orchestration platforms, including solutions that execute fast payments and smart routing, will attain $6.2 billion by 2030, advancing 18.6% annually. Healthcare is the fastest growth segment at 25% per year.^{footnote [49]}
• Rapid credit decisions. Advanced technology permits automated decisions about loans or credit lines to “reduce risk, improve speed, and enhance lending accuracy.”^{footnote [50]} Credit analysis can also accommodate near real-time data such as cashflow transactions, mobile wallet activity and rental payments.^{footnote [51]} The overall global market will grow 13% to $21.3 billion by 2033, with healthcare “increasingly adopting credit decisioning software to manage patient financing, equipment leasing, and postpaid service contracts.”^{footnote [52]}
• Smart contracts. A growing use of blockchain technology is creating digital contracts that reflect changes rapidly and monitor relevant payments. The smart healthcare contracts market is estimated at over $3 billion currently and increasing to nearly $16 billion in 2033.^{footnote [53]}
• Employer-employee transactions. Over the next five years, 47% of firms expect to use AI for rapid, customized employee benefits servicing.^{footnote [54]}

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.^{footnote [55]} 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.”^{footnote [56]} The issue has multiple facets.

Patients are under pressure.

Many patients are struggling to meet their self-pay obligations. The need for financial assistance will be strong throughout 2026. The latest figures confirm the trend:

• Individual out-of-pocket expenditures are projected to increase 6.4% in 2025, 3.7% in 2026 and 2027, and 3.9% yearly from 2028 to 2033.^{footnote [57]}
• Employer health insurance is also climbing. The average 2025 employee contribution for family coverage is $6,850, up 6% from the previous year and 23% from 2020.^{footnote [58]} The average copay for a hospital admission is $313.
• Individual plans carrying deductibles of $2,000 or more are held by 34% of workers.^{footnote [59]} Even after employer contributions, the average deductible in these plans has jumped from $1,061 in 2007 to $1,768 in 2024.^{footnote [60]}
• Medicare Part B premiums have risen 9.7% for 2026.

Additional stressors could stem from the Medicaid and ACA cutbacks. For example, expiration of the enhanced ACA premium credits is estimated to boost costs for subsidized beneficiaries from an average of $888 in 2025 to $1,904 in 2026.^{footnote [61]}

The effects of affordability problems.

Difficulty paying for services precipitated 29% of survey respondents to skip or delay some recommended care during the past twelve months.^{footnote [62]} The figures were 38% for Medicaid recipients and 41% for the uninsured. During 2026, 47% fear being unable to afford necessary healthcare.^{footnote [63]}

Affordability challenges lead many to assume medical debt. As Figure 9 shows, the amounts involved are not trivial. Almost six in ten healthcare borrowers took on debt of $500 or more within the past year.^{footnote [64]} The median amount borrowed in that same period by patients 50 and older was $3,000.^{footnote [65]}

 
Figure 9 
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High healthcare costs also add to the burden placed on the 23 million adults shouldering eldercare responsibilities.^{footnote [66]} This scenario adds a layer of complexity to the affordability problem.

Financial impact on healthcare organizations.

Patient affordability barriers heighten collection risk. Provider collection rates from commercially insured patients fell three percentage points in 2024 to 34.4%.^{footnote [67]} Payment of hospital bills within a year of service by those with commercial insurance or Medicare Advantage (MA) declined to roughly 46% by 2023, down from the mid-50s pre-pandemic.^{footnote [68]}

How are organizations coping?

Various strategies are being employed to manage the mounting financial exposure while simultaneously maximizing help for patients in need.

• Upfront payments. More providers are asking patients for upfront payment of some portion of their bill. An analysis found that the share of all payments collected prior to service was 11.2% for those with private insurance and 17.9% for Medicare Advantage.^{footnote [69]} For elective services, the numbers were 14.5% and 24.1% respectively. There is clear room to grow upfront payments.
• Predictive analytics. Technology is improving patient cost estimating and transparency as well as facilitating instant credit decisioning.
• Expanded patient financing programs. U.S. patient financing reached $16 billion in 2024 and has seen 3.2% compound annual growth over the past five years.^{footnote [70]} CommerceHealthcare^® has written extensively on the need for health systems, hospitals and practices to expand their payment plans to offer no- or low-interest credit lines with longer durations and higher dollar amounts. That strategy greatly helps personalize assistance and structure comfortable repayment schedules. Extending financing based on pre-service estimates is another consumer-friendly step. Organizations typically turn to external financial institutions to achieve the necessary scale for such expanded programs.
• Charity care tradeoff analysis. Some are conducting sensitivity analyses to determine the ROI of increasing charity care levels beyond the required thresholds in order to offset burgeoning collection costs. As a leading industry advisor explained, “They’re doing the math to determine the point at which increasing total charity care spending as a percentage of gross revenue can reduce the cost to collect on some accounts.”^{footnote [71]}
• Attention to equitable access. Organizations are maintaining their commitment to providing equitable care access regardless of socioeconomic status.

The employer predicament.

Employers are caught between the twin poles of absorbing rising costs in their insurance plans or passing all increases on to their workforces. Those costs are expected to grow 9.1% in 2026.^{footnote [72]} Fifty-one percent of companies say they are likely or very likely to raise employee cost-sharing amounts for 2026.^{footnote [73]}

Still, most are reluctant to be aggressive. They’re alternatively pursuing an array of direct moves with payers and providers. A survey revealed companies’ leading efforts:

• Evaluating vendor performance (46%)
• Placing medical plans out to bid (36%)
• Conducting medical claims audits to increase efficiency (33%)
• Reviewing prior authorizations and qualifying payments for out-of-network services (22%)^{footnote [74]}

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.

Communicate clear information.

Consumers have significant gaps in understanding the financial aspects of their care. An investigation of patient interactions at one health system revealed that most are “confusion-driven,” including “do I qualify for financial assistance?”^{footnote [75]} A survey of beneficiaries found that 75% find shopping for a Medicare plan confusing.^{footnote [76]} This data speaks to substantial variability in health literacy, defined as “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions.”^{footnote [77]}

Enhanced communication that helps patients navigate their financial obligations and options is vital. Failure can be detrimental, as indicated in a study revealing that 63% of patients would switch healthcare providers due to poor communication.^{footnote [78]}

Greatly elevate price transparency.

One way to allay patient confusion is sharper clarity on healthcare pricing. Wide price variation among hospitals, surgery centers, and other facilities for the same procedures has been well publicized. One recent analysis saw negotiated rates across the country for six inpatient procedures vary an average of nine times from minimum to maximum. The authors call for better “facility-level data to drive informed healthcare purchasing decisions.”^{footnote [79]} 

Pre-service estimates can be an important channel for a more transparent financial experience. A 2023 Gallup poll noted that eight in ten adults are unaware of the costs involved in advance of their care.^{footnote [80]}

Progress in this area is mixed. Forty-one percent of patients received estimates over the past year, increasing from 29% in 2022, but accuracy slipped from 78% to 71%.^{footnote [81]} Estimating can be challenging, and some believe prices should be accompanied by relevant quality data to optimize consumer choices.^{footnote [82]}

Use technology helpfully.

Three in four leaders say technology advancements over the next five years will be positive for patient experience.^{footnote [83]} Solutions will be driven by a combination of mobile communications, patient portals and AI. 

Mobile text messaging is commonplace today. Surveys show that 76% of patients want the ability to initiate two-way, AI-driven text communications, and 41% say they’re more likely to pay their bill on time when providers text from a recognizable 10-digit phone number.^{footnote [84]} Voice-initiated mobile payments will add convenience. They’re projected to grow nearly 16% annually through 2029.^{footnote [85]}

Patient portals are now deployed by 90% of health systems. However, between 15% and 30% of patients use them.^{footnote [86]} A portal offers tremendous capability to aggregate financial and clinical information and communicate it conveniently to patient users. Portals also can be a conduit for extending patient financing.

Agentic AI is likely to play a major role, independently and in tandem with portals. Experts caution that the challenge in developing agents lies in the complexity of today’s financial experience, which involves deriving answers from and executing steps across numerous processes and sources, including those from third party vendors.^{footnote [87]}

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.^{footnote [88]} The issue spans industries: 84% of CIOs are increasing funding for 2026 with a median budget jump of 26%.^{footnote [89]}

Healthcare’s risk exposure remains elevated:

• Between 2012 and 2024, over 700 annual data breaches occurred involving 500 or more individuals, a run rate of approximately two breaches and 758,288 records per day.^{footnote [90]}
• Healthcare retains the distinction among industries of having the highest average breach cost, though the figure decreased to $7.4 million from $9.8 million last year. Healthcare also takes the longest time to identify and contain a breach at 279 days.^{footnote [91]}
• Only half of smaller physician practices have phishing or spoofing mitigation strategies, while 20% have no email archiving or audit trail, hampering incident investigation.^{footnote [92]}

AI’s role.

AI has the ability to introduce both new threats and defensive capabilities. Security experts are especially worried about deepfakes and so-called shadow AI.

Deepfakes are artificial images, video or audio that are highly realistic and often designed to impersonate a human. Use is growing rapidly. Over the past few years, new deepfake tools have emerged at an annual rate more than double that of previous periods, and the average time needed to create a deepfake image is now 27 seconds (Figure 10).^{footnote [93]}  The global deepfake market is predicted to be $25 billion in 2034, propelled by 41.5% compound annual growth.^{footnote [94]}

 
Figure 10 
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Deepfakes have unleashed new modes of attack in identity theft, data breaches, payment fraud, disinformation, and other categories. Studies have shown that people have difficulty distinguishing fakes from real. Detection technologies are being developed in response.

Unauthorized employee use of AI is growing. Labelled “shadow AI,” this use can involve sensitive internal information. Shadow AI security incidents across industries accounted for 20% of breaches in 2024.^{footnote [95]}

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.”^{footnote [96]} A primary goal is to establish a fully aligned ecosystem. That will require organizations to form robust partnerships and achieve digital maturity.

“Ecosystemness.”

Organizations have been striving for “systemness,” functioning as integrated entities across sites of care, information systems and workflows. Some now believe the notion should expand to “ecosystemness.” This outward focus prioritizes collaboration with “other providers, insurance companies, pharmaceutical companies, research institutions, digital health startups, and community enterprises.”^{footnote [97]} PwC foresees emergence of “entirely new value pools” from this ecosystem.^{footnote [98]}

Digital maturity.

Technology is a major catalyst for the fully aligned ecosystem. Health systems, hospitals and practices must do more than just adopt technologies. They must rapidly achieve digital maturity, which is the “ability to integrate digital technologies across operational, patient engagement, and decision-making processes” so that the enterprise functions in a “digitally optimized way.”^{footnote [99]}

Getting help: The partnering imperative.

Leaders recognize that they need help to develop vibrant ecosystems. Strategic alliances and partnerships have been part of the playbook for years, and over one-third of healthcare CFOs say they have generated strong impact from them.^{footnote [100]}

Careful selection of financial partners is essential in finance/RCM. The proliferation of digital health startups and early stage companies creates a confusing innovation landscape.

Picking the winners in the payments technology space is certainly challenging. Funding for companies in the first half of 2025 was just $4.6 billion, well off 2024’s pace (Figure 11).^{footnote [101]} Entering 2026, the funding environment remains hampered by economic concerns, a slow initial public offering market and other factors.

 
Figure 11 
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The demands of ecosystem building reinforce the value of providers entering and managing effective alliances with financial partners who are well-capitalized, tested, and trusted.

Leadership requirements changing.

New leadership requirements are emerging in response to healthcare’s complex demands for change. Several recent directions stand out.

Broadening scope of responsibility.

C-suite roles are expanding. CFOs are particularly experiencing this trend, described in last year’s CommerceHealthcare^® Trends Report as the “exponential CFO.” These executives “are expected to help lead across technology, clinical operations and staff culture.”^{footnote [102]} 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.^{footnote [103]}

Market-based executives.

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.

New leadership roles.

Consistent with the trends outlined in this report, 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.

The emphasis on technology and innovation can be seen in a recent poll of CFOs and other C-suite leaders that identified the new roles of highest importance over the coming three years (Figure 12).^{footnote [104]}

 
Figure 12 
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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.

Disclosures: