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ACA marketplace enrollment drops, the largest nursing strike in New York City history, AI for healthcare

In 2025, many health system leaders renewed an enterprise-wide strategy while navigating major uncertainties. They evaluated growth, advanced ambulatory and service line efforts, and balanced performance, growth, and transformation. In 2026, health systems will need to clearly define how they’ll transform to fulfill their missions and better serve patients.

Hospitals are getting squeezed from all sides, so winning will come down to nailing the basics—tight operations and finances, great quality, a workable payer mix, steadily better clinical talent, and a patient experience that’s easy and welcoming—with strong board and leadership teamwork to pull it all off.

The healthcare payment landscape continues to face uncertainty as support grows for additional “site neutrality” in reimbursement, with the policy goal of reducing or eliminating payment differentials between hospital-based outpatient departments (HOPDs) and freestanding physician offices or ambulatory care sites for the same services.

Health system executive leaders and boards have recently weathered numerous existential challenges, from COVID-19 to cyberattacks to the One Big Beautiful Bill.

As health systems face growing pressure to lower costs, increase market share and run more efficiently, one thing is clear — the strength of their ambulatory care portfolio is quickly becoming a key differentiator.

In healthcare today, organizations can face opportunities across geographies and sectors, each with their own unique benefits and risks. But like a fruit tree at harvest time, these opportunities can be time sensitive.

Amid shifting perceptions of healthcare expertise, board and C-suite leaders must define the basic principles of their organization and its role in medicine, patient care and public health and consider how they will make decisions when these principles might conflict with current perceptions.

Fluency across clinical and financial perspectives is redefining leadership in healthcare

The financial challenges facing hospitals and health systems—from the One Big Beautiful Bill’s looming impacts to difficult operating conditions—are also keeping insurers up at night.

By effectively putting strategy into action, hospitals and healthcare systems can thrive amid today’s financial and operational challenges and position themselves to confront the looming threats that are just around the corner.

Key Takeaways The rapid adoption of value-based care (VBC) is accelerating the pressure on provider groups to take on downside risk—yet the right path forward is far from one-size-fits...