Healthcare executives are guarded about the future of their organizations’ financial performance, driven largely by concerns over governmental payment reductions and coverage changes resulting from the One Big Beautiful Bill Act (OB3), according to the Mindsets 2026 Healthcare Executive Leadership Report from Forvis Mazars.
The slowdown in financial performance will increase pressure on top lines, while talent and workforce challenges will create obstacles to executing the growth strategies necessary to offset rising input costs, the report notes.
“Compared to prior years, executives expect financial performance to be softer going forward amid regulatory, inflationary, and payor-related pressures,” said Brad Brotherton, national sector leader for the Healthcare Practice at Forvis Mazars.
These and other findings comprise the healthcare sector analysis in the report released this month. The 200 executives surveyed for the 2026 report represent a cross section of the healthcare industry that includes nonprofit, for-profit, and private equity-backed hospitals and health systems; physician group practices; senior living and long-term care providers; community health centers; and home care and hospice providers. Organizations of varying sizes and geographic regions were included to achieve a balance of responses.
Healthcare leaders cite OB3, signed into law in July 2025, as particularly concerning. The law brings a sweeping, in-depth tax and economic policy overhaul designed to significantly alter federal taxes, credits, and social spending.
More than 43% of executives expect OB3’s effects to reduce their organization’s operating margins by 3% or more, with 46% citing state-directed payment changes as their single greatest concern related to the bill.
Healthcare leaders are also closely monitoring state legislative sessions for indicators of how state Medicaid programs and financing structures may shift in response to reduced federal support for safety-net programs.
On the managed care front, executives report persistent contracting challenges with Medicare Advantage (MA) plans: 34% say they terminated at least one MA contract in the last 12 months, and 33% are considering doing so in the next 12 months.
Five Key Themes for Navigating Healthcare Leadership Challenges
The report addresses five major themes in healthcare: aligned growth, financial discipline, regulatory excellence, strategic agility, and talent optimization.
- Aligned Growth: Executives increasingly view executing on aligned growth as essential to long-term sustainability, recognizing that cost-cutting strategies alone are insufficient.
- Financial Discipline: In the short term, leaders are prioritizing financial discipline and operational efficiency. In the longer term, executives expect these efforts to be increasingly enabled by AI.
- Regulatory Excellence: Navigating regulatory changes remains a top challenge for healthcare leaders, and many executives are uncertain about the pipeline of reimbursement talent required for the function to play a strategic role.
- Strategic Agility: The cadence of strategic planning is increasing across healthcare organizations, but many still struggle to translate those plans into measurable results due to operating model constraints and limited time investment.
- Talent Optimization: Executives continue to view workforce shortages, rising labor costs, and turnover as significant challenges and limitations on the ability to execute aligned growth strategies.
Executives are increasingly turning to AI and technology solutions to help improve efficiency, but they will need infrastructure and a strategic approach to implement them.
“Executives note scribing, scheduling, clinical decision making, and diagnostics as some of the most common areas where their organizations are investing in AI to support their clinical workforce,” said David Tate, managing partner of the Healthcare Consulting practice at Forvis Mazars. “At the same time, organizations will need to focus on data governance and change management to deploy these solutions safely and effectively.”
The Healthcare Practice at Forvis Mazars serves more than 5,200 clients nationwide, helping them stay ahead of an evolving regulatory landscape, overcome workforce pressures and other margin improvement challenges, develop strategic plans that support growth and lasting change, and position themselves to deliver quality care and better health outcomes in the communities they serve.
The Mindsets 2026 Healthcare Executive Leadership Report is available for download at forvismazars.us/mindsets-2026.
