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Inside the Conversations Shaping Hospital CEO Strategy in 2026

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https://www.healthleadersmedia.com/ceo/inside-conversations-shaping-hospital-ceo-strategy-2026

Hospital and health system executives at the HealthLeaders CEO Exchange prioritized growth and governance for a changing healthcare landscape.

KEY TAKEAWAYS

Hospital CEOs are investing in ambulatory care through integrated access points and strategic partnerships that expand services outside the hospital campus.

Leaders are standardizing enterprise functions where it creates value while preserving local decision-making so hospitals can respond to the needs of their communities.

Leadership continuity and succession planning are vital as organizations prepare for a future that looks considerably different than the past.

The HealthLeaders CEO Exchange offered a window into how hospital and health system leaders are viewing strategy during a time of unavoidable industry transformation.

Across two days of roundtable discussions in Avon, Colorado, executives shared approaches for remolding their organizations around care models that emphasize access, leadership structures that give local teams room to execute, and partnerships that create value for patients and communities.

Here’s a look at the conversations that took place and what they mean for the immediate future of hospital decision-making.

Growth follows the patient

Ambulatory care strategy has become imperative for providers wanting to grow in the current environment in which care isn’t bound by the hospital’s four walls.

Several CEOs spoke about creating integrated care sites that combine primary care with behavioral health, dental services, rehabilitation, and optometry. Others discussed hybrid emergency department and urgent care facilities that simplify access for patients who are unsure where to seek treatment. Mobile care services and virtual specialty were also highlighted as organizations look for ways to expand access across urban and rural markets.

One executive described an approach that challenged years of competition between neighboring organizations.

“Historically, the CEOs hated each other,” the executive said. “When she and I both became CEOs, within six months of each other, we were like, ‘Let’s start a different path.'”

The relationship led to a shared walk-in clinic that has since become a wider ambulatory strategy across the region. The model increased access, generated revenue for both organizations, and strengthened relationships with community leaders, according to the executive.

Another participant described their organization’s philosophy as “no wrong door,” with patients entering the system through whichever service best fits their needs while gaining access to additional care during the same visit.

The discussion reflected how executives are focusing on bringing care closer to patients through flexible access points that improve convenience and support long-term financial performance.

Balancing scale and local leadership

As health systems continue to grow, CEOs are rethinking ways to preserve decision-making close to the communities they serve.

Executives at the Exchange described centralizing functions such as marketing and revenue cycle while allowing local leaders to shape implementation based on market conditions. Several attendees said enterprise standards provide direction, though each hospital requires flexibility to address its workforce and patient population.

One executive summarized their philosophy in three words: “Implementation is local.”

That perspective echoed an earlier discussion on systemness, where leaders debated which functions benefit from standardization and which remain stronger when managed locally. Participants acknowledged that scale can improve efficiency, though additional layers of governance can also slow decisions and weaken ties to the community.

Accountability starts with setting clear expectations for local leaders and sharing what works across the organization.

Leadership evolves with the organization

Roundtables at the Exchange also revealed how leadership expectations continue to change.

Executives spoke about building stronger relationships across finance, operations, and clinical teams through greater transparency and more frequent collaboration. Several described spending time with frontline employees and creating environments where staff feel comfortable raising concerns. Those efforts, participants said, strengthen trust and improve execution.

Leadership continuity also emerged as an important advantage. Executives said longer CEO tenures help strengthen relationships with physicians, employees, community organizations, and elected officials while giving strategic initiatives time to mature.

When change does happen, internal succession planning can mitigate organizational turbulence, with leadership development serving as an investment in long-term organizational stability.

Ultimately, one message became clear by the end of the Exchange: Hospital leaders are looking well past incremental improvements.

“The hospital models are dead,” a rural hospital executive said. “Everybody’s trying to do CPR on the old model versus thinking about what’s the new model.”

Whether it’s ambulatory expansion, virtual care, partnerships, leadership structures, or organizational design, CEOs are strategizing through the lens of what comes next.

The Margin Myth: Why One of the Insurance Industry’s Favorite Talking Points is Designed to Mislead You

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https://healthcareuncovered.substack.com/p/the-margin-myth-why-one-of-the-insurance?utm_source=post-email-title&publication_id=255152&post_id=201468246&utm_campaign=email-post-title&isFreemail=true&r=59t65&triedRedirect=true&utm_medium=email

Health insurers love to talk about profit margins. But return on equity — the metric investors actually use—reveals an industry generating outsized returns.

When UnitedHealth Group reported its first-quarter 2026 results, it disclosed something that didn’t make many headlines: an annualized return on equity of 26.2%.

That number — not the profit or operating margin — is what Wall Street uses to evaluate whether a business is making good use of the money investors have put into it. And by that measure, UnitedHealth wasn’t just profitable, it was posting returns that outpace the broader S&P 500, dwarf most of its sector peers, and rival industries that Americans actually regard as highly lucrative.

So why do we keep hearing about margins?

Because margins are the health insurance industry’s favorite misdirection. And understanding the difference between the two figures is essential to understanding why the health insurance business is far more profitable — and far more extractive — than its lobbyists want you to know.

What Margin Actually Measures

Profit margin measures how many cents of profit a company keeps for every dollar of revenue that flows through it. For a health insurer, revenue is primarily premiums and fees — the massive river of money that employers, individuals, and government programs pour in every month to pay for coverage.

That river is enormous. In 2025, UnitedHealth took in $447.6 billion in revenue — nearly half a trillion dollars. A 5% margin on $447.6 billion is still a lot of profit. But when industry defenders cite the 5% figure, they’re counting on you to hear “five cents on the dollar” and think health insurers are not all that profitable.

(Note: In its first quarter 2026 earnings press release, the company reported that in the first quarter of 2026, its insurance division, UnitedHealthcare, had an operating margin of 6.6% and that Optum, the division that operates a huge PBM and hundreds of physician practices and other clinical operations across the country, had an operating margin of 5.1%. The press release didn’t even mention return on equity. You have to look at the company’s 10Q filing with the SEC to find the 26.2% ROE disclosure.)

I know this tactic well because I used it myself. During my nearly sixteen years at Cigna, where I was vice president of corporate communications, one of my standard moves was to cite the most recent margin figure when talking to journalists or writing talking points for our Washington lobbyists to use with members of Congress and their staff. It was technically accurate yet deeply misleading — exactly the combination that makes for effective spin. The goal was to create the impression that Cigna was a low-profit business barely keeping the lights on, when the return on equity told an entirely different story. I never brought up ROE and can’t recall a reporter asking about it.

What Return on Equity Actually Measures

Return on equity — ROE — measures how much profit a company generates relative to the money its shareholders have invested. It is essentially a report card on management’s ability to turn the money shareholders have invested into earnings. Investors and analysts use it to evaluate whether a business is creating or destroying value.

By this measure, UnitedHealth’s performance is striking:

  • Q1 2026: 26.2% annualized ROE
  • Full-year 2023: 27.0% ROE
  • Full-year 2022: 27.2% ROE

Even in 2025 — the year the Medicare Advantage cost crisis hammered earnings across the industry — UnitedHealth’s full-year ROE came in at 12.8%, which is still above the median for health care support services companies (roughly 9.9%, per the Stern NYU January 2026 sector database).

To put 26–27% in context: the S&P 500 long-run average ROE runs in the 14–18% range. The general and broader insurance sector average is around 19%. The health care support services sector average — the category that most directly captures managed care companies — sits at just under 10%. UnitedHealth, in its normal operating years, is generating returns nearly three times that sector median, making it one of the most capital-efficient, high-return enterprises in American corporate life.

How a Relatively Small Margin Becomes a Massive Return

Health insurers operate with enormous revenue bases relative to their equity. When a company takes in close to half a trillion dollars in revenue but only has around $100 billion in shareholders’ equity on its balance sheet, even a modest net margin generates a big return on the invested capital.

In the insurer’s case, the “borrowed” capital isn’t debt in the traditional sense — it’s the float. Premiums come in at the beginning of the month. Claims go out throughout the month and into the next. That gap — the time between collection and payment — allows insurers to invest billions in securities, real estate and other holdings, earning investment income on money that technically belongs to the people whose claims haven’t been paid yet. UnitedHealth consistently earns more than $1 billion in investment income every quarter. It made $1.1 billion on its investments in the first quarter of this year and $1.0 billion in the same quarter last year. In 2024, when the company made $34.4 billion in earnings from its operations, its investment income totaled $5.2 billion.

This means that the company’s business model compounds the ROE advantage at every level: high premium volume, leveraged equity base, investment float.

UnitedHealth’s ROE advantage is even clearer when you look across the sector. Humana — which has been savaged by Medicare Advantage losses and is now posting a last-twelve-months ROE of roughly 6.8% — shows what happens when the underlying business goes wrong. Elevance and Cigna, facing similar MA cost pressure through 2024 and 2025, have also seen their returns compress. (In a move that likely will boost ROE, Cigna last year sold all of its Medicare Advantage business.)

But here’s what’s important to understand about those compressed numbers: Not a single major insurer posted an actual loss for the full year 2024. As one observer noted, the investor panic of 2025 was triggered not by losses but by smaller profits than expected. Elevance’s stock dropped 20% in two days when the company announced it expected to earn $5.4 billion instead of $6.4 billion. In any other industry, $5.4 billion in annual profit would not be considered a crisis.

UnitedHealth’s annualized 2026 ROE of 26.2% — reported even as the company is under federal criminal investigation — suggests the underlying earnings machine remains intact beneath the turbulence.

What the Sector Data Actually Shows

The NYU Stern sector database, updated as of January 2026 using data across thousands of U.S. companies, puts the managed care picture in relief:

  • Health care support services: 9.89% median ROE
  • General insurance: 19.07%
  • Property and casualty insurance: 18.71%
  • Drugs/pharmaceuticals: 24.04%
  • Financial services (non-bank/non-insurance): 28.82%

UnitedHealth’s historical 27% ROE places it at or near the top of all of these categories — not just its own sector, but across the American corporate economy (with the exception of some of the biggest tech companies, whose ROEs are consistently at the very top). The company that processes your prior authorization denial is generating returns that rival the most profitable financial services firms in the country and even has a greater return than most pharmaceutical companies.

A December 2025 analysis by Milliman, an actuarial firm, made explicit what the ROE data implies. Examining the spread between for-profit and nonprofit health insurers, the analysts found that for-profit companies hold less capital and surplus relative to their premium volume — and that this “additional leverage leads to an even higher return on equity than their nonprofit and not-for-profit counterparts.”

What that means is that for-profit insurers have engineered their balance sheets to maximize the return on every dollar of equity, using premium float and leverage, in ways that nonprofit plans structurally cannot replicate.

Why This Matters for Policymakers

The margin talking point is not merely misleading — it is strategically deployed to block reform.

When Congress considers capping insurer profits, or lowering Medicare Advantage overpayments, or modifying and strengthening the Affordable Care Act’s medical loss ratio requirements, the industry’s first move is to present itself as a low-margin business operating on thin ice.

The margin talking point says: don’t look at us, we’re barely getting by. The ROE data gives the lie to this. A company earning 26% on equity is not on thin ice. It is extracting premium value from the health care system at a rate that most American industries can only envy — and doing so while denying claims, managing risk scores, and fighting every form of regulatory oversight.

How Insurers Are Using the Courts to Rewrite the No Surprises Act

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https://healthcareuncovered.substack.com/p/how-insurers-are-using-the-courts?utm_source=post-email-title&publication_id=255152&post_id=190610279&utm_campaign=email-post-title&isFreemail=true&r=59t65&triedRedirect=true&utm_medium=email

A wave of coordinated lawsuits is transforming the No Surprises Act’s arbitration system into a battlefield where insurers seek to intimidate physicians, rewrite the law and consolidate control.

As I have written, Congress passed the No Surprises Act (NSA) to safeguard patients from unforeseen medical expenses and establish a neutral, independent dispute resolution (IDR) process for payment conflicts between insurers and out-of-network providers. That design was meant to replace brinkmanship with an independent referee. What Congress designed as a neutral arbitration system is now being challenged by Big Insurance through coordinated litigation designed to narrow, intimidate, and ultimately reshape the law.

Major insurance conglomerates — including UnitedHealthcare entities, Elevance/Anthem affiliates and Blue Cross Blue Shield plans — have launched a coordinated series of federal lawsuits against providers, hospitals, and revenue-cycle vendors who have used IDR at scale. Employing nearly identical language, legal arguments, and allegations, these lawsuits are not isolated ordinary litigation. It is lawfare.

Narratively, these suits recast lawful engagement in the NSA’s IDR process as “abuse,” but functionally they are designed to intimidate physicians from seeking NSA protection. A Pennsylvania suit from UnitedHealthcare against NorthStar Anesthesia presents the most urgent and perilous threat to independent physicians. If Unitedhealthcare prevails, insurers will be able to obtain judgments of fraud against physicians who incorrectly file NSA disputes. The effects of this will be catastrophic for independent physician practices, who cannot afford to litigate against billion dollar behemoths that have armies of lawyers on staff and retainer.

If successful in these efforts, the insurers will further weaken physician practices and make them ripe for acquisitions, continuing the dangerous path of vertically integrated insurance corporations – and the further decimation of independent physician practices.

The “Flooding” Myth

The lawsuits all start in a similar fashion. Each one claims that the defendant “abused” federal legislation “designed to protect patients from unexpected medical bills” and asserts that “the IDR process has not functioned as intended.” This wording appears verbatim in cases filed months apart, across different jurisdictions, against completely different defendants. Insurers adopt the same basic allegation: providers or billing companies “flooded,” “overwhelmed,” or unleashed an “avalanche” of IDR disputes that insurers assert were ineligible.

Those characterizations are based on bad data. Before the NSA went into effect, the Departments of Health and Human Services, Labor, and Treasury projected that the independent dispute resolution (IDR) process would see roughly 17,000 disputes annually. In reality, the system received nearly hundreds of thousands of disputes in its first year. That mismatch didn’t happen by accident. The departments based their projections on New York’s experience with a state arbitration system, scaling the state’s dispute numbers nationally. But New York’s law relied on an independent benchmark called FAIR Health that sharply reduced disputes. This is a structural feature the federal law does not have.

A more realistic comparison was available at the time: Texas. Unlike New York, Texas operated an arbitration system without an external benchmark making it a better comparison for the federal No Surprises Act. In its first year, the Texas system received nearly 49,000 arbitration requests for a population of just under six million people. That experience should have been a clear signal that arbitration volume would be far higher than federal projections suggested. Insurers have used this modeling error to their rhetorical advantage in their litigation.

Culture Building Resolutions

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Culture Building Resolutions

Toxic culture means working harder to reach average.

Sick culture is an invisible cost that shows up on the bottom line.

Make resolutions that impact the way you treat each other while you work.

Culture reveals itself when…

  1. Success stories are shared.
  2. Teams miss deadlines.
  3. Raises are given.
  4. A leader walks into the room.
  5. Something goes wrong.
  6. Customers complain.
  7. Innovation is needed.
  8. Conflict heats up.
  9. Performance review time comes around.
  10. Someone earns a promotion.

Culture Building Resolutions

#1. Unsung Hero

Commit to trace success back to quiet contributors. Who made winning possible?

#2. Post-Mortem

Focus less on “who” and more on “what.”

When deadlines are missed, commit to remove friction. Ask, “What got in the way?” Empower people. Streamline processes.

Note: Friction could be an incompetent person.

#3. Equity Audit

Decouple raises from likeability. Choose metrics that reflect value added.

#4. Thermostat

Commit to notice your shadow. Enter spaces with curiosity instead of critique. Notice the energy in the room. Shape your impact intentionally.

#5. Learning First

Treat a mistake as a free masterclass.

  • What was done?
  • What wasn’t done?
  • What are we learning?
  • What will we do differently next time?

#6. Frontline

Make resolutions about complaints. Spend one hour a month listening to customer complaints. Gather the team and call unhappy customers.

#7. Wild Idea

Create space for ideas that might not work. Run pilot programs.

#8. Constructive Friction

Stop peacekeeping and start peacemaking. Lean into the tension. Teach teams how to debate without attacking.

#9. No Surprises

No one ever hears feedback for the first time during an annual review. Commit to provide real time coaching.

Healthy culture is never an accident. Image of a self-indulgent leader delegating dirty work to others.

#10. Succession

Promote people who lift others, not just solo performance.

Final Thought

Leading people includes building environments. Make resolutions that lead to flourishing at work.

What culture building resolutions would most impact your organization?

5 Ways to Show Up Like a Leader and Build Culture Every Day

It’s Likely You Have a Toxic Workplace. Now What? SHRM

CEO sentiment improves, but hiring outlook is gloomy

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https://www.axios.com/newsletters/axios-macro-c74d84c0-d533-11f0-89d1-ad2b72267b52.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosmacro&stream=business

CEO sentiment increased for the third consecutive quarter, even as America’s most prominent executives expect underlying job market conditions to remain weak.

Why it matters: 

The economic outlook among CEOs has steadily improved since plunging in the aftermath of President Trump’s initiation of the global trade war.

  • Under the hood, however, there is evidence that structural economic changes — including the proliferation of AI — are weighing on hiring intentions, a warning sign for the labor market.

By the numbers: 

The Business Roundtable’s CEO Economic Outlook Index rose by 4 points in its fourth-quarter survey, which was fielded from the final weeks of November through earlier this month.

  • The index is still shy of the highest level of the Trump 2.0 era and slightly below the historical average of 83.

Zoom in: 

The increase reflects a more upbeat view of company revenue in the next six months: Expectations for sales rose 6 points, though the survey does not ask respondents to adjust for the prospect of higher prices.

  • Plans for capital expenditures — investments in equipment, buildings or software — ticked up 2 points, following a 10-point surge in the previous quarter.
  • Hiring plans also improved relative to last quarter — up 4 points — though it is the survey’s lone indicator below the level that signals growth.

What they’re saying: 

“Notably this quarter, more CEOs plan to reduce employment than increase it for the third quarter in a row – the lowest three-quarter average since the Great Recession,” Business Roundtable CEO Joshua Bolten said in a statement.

  • About one-quarter of CEOs say they will increase hiring, while 35% say employment will shrink at their respective firms. The remaining 40% plan to keep hiring steady.
  • A smaller share of CEOs plan to slash workers relative to last quarter, but the figures still show a notable shift among top executives.
  • Consider the results from this time last year: A similar share of CEOs expected no change in employment levels, but just 21% said they anticipated cutting jobs, while 38% planned to increase hiring.

“CEOs’ softening hiring plans reflect an uncertain economic environment in which AI is driving sizeable [capital expenditures] growth and productivity gains while tariff volatility is increasing costs, particularly for tariff-exposed companies, including small businesses,” Bolten said today.

The big picture: 

The in-the-dumps hiring plans signaled by big firm CEOs — alongside a string of layoff announcements in recent months — signal a possible shift for the steady-state labor market that has persisted in recent years.

  • Powell raised the possibility that the labor market might be even weaker than government data suggests.
  • The economy has added a monthly average of 40,000 payroll jobs since April. But “we think there’s an overstatement in these numbers, by about 60,000, so that would be negative 20,000 per month,” Powell said at yesterday’s press conference.
  • “The labor market has continued to cool gradually, maybe just a touch more gradually than we thought,” he added.

The bottom line: 

CEOs feel more optimistic, though that confidence boost is not expected to translate into more hiring — an unusual dynamic for the economy.

  • “Although the results signal that CEOs are approaching the first half of 2026 with some caution, they are starting to see opportunities for growth,” Cisco CEO Chuck Robbins, who chairs the Business Roundtable, said in a statement.
  • “With the Index near its average, it reflects the resilience of the U.S. economy,” he added, citing pro-growth tax policies and fewer regulations.

Why Main Street’s pain matters

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https://www.axios.com/newsletters/axios-macro-83421180-d11c-11f0-9403-0b728297acc1.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosmacro&stream=business
Illustration of a hanging sign that reads "Main St." swinging and hanging from one chain

The economic fortunes of mom-and-pop businesses are diverging from those of their larger counterparts — a pre-existing gap that now appears to be getting bigger, faster.

Why it matters: 

The evidence is in the private-sector labor market, that in recent months, has been propped up by large companies as smaller firms — typically responsible for 40% of U.S. employment — shed workers.

The big picture: 

Larger businesses have been able to adapt to a tough economic backdrop — historic tariffs, high interest rates and a more cautious consumer — in ways far more challenging for small companies with fewer resources.

  • “It’s evident that medium and large firms are better positioned to weather what’s going on,” said ADP chief economist Nela Richardson.
  • “They can set prices, they can change suppliers. They can hire contractors instead of permanent employees in a more sophisticated way. They can hire globally, not just in their local region. They have more tools in the toolbox,” Richardson said.

By the numbers: 

The hiring gap between small and big businesses is getting worse, a fresh sign that small business firings are holding down jobs growth across the economy.

  • As we mentioned yesterday, the private sector shed 32,000 jobs in November, according to payroll processor ADP. Small firms — those with fewer than 50 employees — accounted for all of the losses.
  • Those businesses reported a net loss of 120,000 jobs, the most small businesses have cut since the pandemic’s onset. Larger businesses grew, but not enough to offset the cuts elsewhere.

“Small business hiring really started to slow in April and I attribute some of this to tariffs and the higher cost of doing business that small companies are much less able to absorb,” Peter Boockvar, chief investment officer at One Point BFG Wealth Partners, wrote in a note.

  • “The natural reaction is to cut costs elsewhere and we know that labor is their biggest cost,” Boockvar added.

The intrigue: 

Bloomberg recently reported that there are more small businesses filing for bankruptcy under a special federal program this year than at any point in the program’s six-year history.

  • Subchapter V filings, which allow firms to shed debt faster and cheaper, are up 8% from last year, according to data from Epiq Bankruptcy Analytics.
  • Chapter 11 filings — a process used by larger businesses — are up roughly 1% over the same time frame.

Threat level: 

Main Street is bearing the brunt of an economic slowdown in ways that might make it even harder for small shops to compete with larger companies.

  • One bright spot: Despite that pain, applications to start new businesses — ones likely to employ other people — remain notably higher than in pre-pandemic times, according to the latest data available from the Census Bureau.

What to watch: 

The Trump administration shrugged off the ADP data that indicated a hiring bust. Commerce Secretary Howard Lutnick told CNBC that the cuts were due to factors unrelated to tariffs, like immigration crackdowns.

  • That hints at a debate among monetary policymakers, who are trying to gauge how much weak jobs growth is a byproduct of fewer available workers.
  • But ADP had earlier told reporters that small businesses generally had less demand for workers — not that staff weren’t available for hire.

The job market’s soft underbelly

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For an economy that’s rapidly expanding, the usual drivers of job creation sure aren’t carrying their weight.

Why it matters: 

Anemic job growth in key sectors is a sign that there is more underlying weakness in worker demand than the low unemployment rate might suggest.

  • It makes for a weaker starting point, as companies see new opportunities around the corner to use AI to automate their work.
  • It’s not a new trend: These sectors showed weak job creation or outright job losses for the last couple of years of the Biden administration.
  • But it is striking that a GDP surge fueled by data center and AI investment hasn’t been enough to generate more robust hiring.

By the numbers: 

Overall employment is up 0.8% over the 12 months ended in September, but the hiring has been driven in significant part by health care, state and local government, and other less cyclical sectors.

  • Manufacturing employment is down 0.7% over the last 12 months. Tariffs are weighing on the sector, but its job losses long predate the Trump trade wars, with year-over-year job losses for more than two years.
  • Temporary help employment, which tends to be a volatile indicator underlying growth trends, is down 3%. It has been losing jobs for three consecutive years.
  • Two other sectors that tend to correlate with overall economic momentum, transportation and warehousing and wholesale trade, are also adding jobs at rates below that of overall job growth (0.6% and 0.2%, respectively).

Stunning stat: 

As Bloomberg flagged, two sectors — health care and social assistance, and leisure and hospitality — accounted for more than 100% of net job gains so far in 2025.

  • Excluding those sectors, employment dropped by 6,000 jobs in the first nine months of the year.

Zoom out: 

There’s not much reason to think these numbers are driven by AI-related opportunities for companies to increase productivity and rely on fewer human workers, particularly given that the phenomenon isn’t new.

  • But it is more plausible that seeing such opportunities on the horizon has made companies more reluctant to hire in the absence of overwhelming need.
  • BlackRock chief investment officer for global fixed income Rick Rieder wrote in a note after last week’s jobs report that “what we think we are seeing now is … essentially a hiring pause in anticipation of AI.”

Of note: 

A report out this morning from the McKinsey Global Institute finds that AI and robotics technologies could, in theory, automate 57% of U.S. work hours.

  • “AI will not make most human skills obsolete, but it will change how they are used,” the authors find. “As AI takes on common tasks, people will apply their skills in new contexts,” they write, such as less time researching and preparing documents and more time framing questions and interpreting results.

The bottom line: 

Beneath the headline numbers, there is some good reason that attitudes toward the job market are glum.

Layoff Trends

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Layoff trends in 2025 indicate an increase in job cuts compared to 2024, with US employers announcing nearly 950,000 cuts through September, the highest number since 2020. Key drivers include cost-cutting measures, the strategic implementation of artificial intelligence (AI), and a cooling labor market. 

Key Trends

  • Elevated Numbers: Total US job cuts through October 2025 were over one million, a 65% increase from the same period in 2024. October 2025 had the highest number of layoffs for that month in 22 years.
  • AI as a Primary Driver: AI adoption is a leading cause for job cuts as companies restructure for efficiency and reallocate resources. Companies like Amazon and Intel have cited AI as a reason for significant workforce reductions.
  • “Forever Layoffs”: A new trend involves smaller, more regular rounds of layoffs (fewer than 50 people) that create ongoing worker anxiety and impact company culture. These rolling cuts often stay out of headlines but contribute significantly to the overall job cuts.
  • Method of Notification: The process is becoming more impersonal, with many employees being notified of their termination via email or phone call rather than in-person meetings.
  • Hiring Slowdown: Alongside the layoffs, there has been a sharp drop in hiring plans, with planned hires for the year at their lowest level since 2011. 

Affected Industries

While tech has been significantly impacted since late 2022, other industries are also facing substantial cuts in 2025: 

  • Technology: Remains a leading sector for cuts as companies continue to restructure after pandemic-era overhiring and focus on AI.
  • Retail and Warehousing: Companies like Target and UPS are cutting thousands of jobs due to changing consumer demands, automation, and a push for efficiency.
  • Energy and Manufacturing: Oil giants such as Chevron and BP are making cuts as part of cost-reduction strategies and market consolidation.
  • Finance and Consulting: Firms like PwC and Morgan Stanley are trimming staff, citing factors like low attrition rates and the need to realign resources.
  • Media and Communications: Companies like CNN and the Washington Post have made cuts to pivot toward digital services and reduce costs. 

Economic Context

The overall U.S. labor market remains relatively healthy despite the uptick in layoffs, though it is showing signs of cooling. The unemployment rate has inched up, and consumer sentiment has declined. The Federal Reserve is monitoring the situation and has implemented interest rate cuts to help stabilize the job market. 

For detailed lists and trackers of layoffs, you can consult resources such as the Challenger, Gray & Christmas, Inc. reports, the TrueUp Layoffs Tracker, and Layoffs.

Hospital expense growth is outpacing revenue

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https://www.healthcarefinancenews.com/news/hospital-expense-growth-outpacing-revenue

Hospital financial and operational performance could be threatened by a trend showing a growth in the cost of expenses outpacing that of revenue, according to a Kaufman Hall National Hospital Flash Report.

“While performance has generally been strong this year, profitability has decreased slightly over the past few months. Bad debt and charity care also continue to rise. In addition, operating margins for health systems are about one percent lower than hospital margins. This points to potential challenges for hospitals and health systems to weather future uncertainty,” said Erik Swanson, managing director and group leader, Data and Analytics, at Kaufman Hall.

WHY THIS MATTERS

What the report shows is that hospital performance has softened in recent months. 

While patient volumes and revenues are trending upward, bad debt and charity care are also elevated.

Expense growth is outpacing revenue growth, with non-labor expenses  putting pressure on hospitals. Supplies are up 26% compared to 2022, and drugs costs are up 31% compared to 2022.

Margins have improved over prior years, though there has been some softening in recent months. Given an uncertain future outlook, many hospitals are taking steps to build long-term resiliency, the report said.

Operating margins in August 2024 were 4.6% but fell to 5% in December 2024. Starting in January, margins jumped to 6.9% and remained in the 6.2% range until this past June, when they fell to 5.5% and in July, 5.3%.

Profitability is down from 48% in July 2024 to 27% this year.

THE LARGER TREND

Data for the report came from more than 1,300 hospitals sampled on a monthly basis from Strata Decision Technology.

The sample of hospitals for the report represents all types of hospitals in the United States, from large academic to small critical access hospitals, geographically and by bed size.

Kaufman Hall, a Vizient company, provides advisory services and management consulting.

From Budget Battles to Consumer Backlash: Paul Keckley on the Future of U.S. Health Care

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https://strategichcmarketing.com/from-budget-battles-to-consumer-backlash-paul-keckley-on-the-future-of-u-s-health-care/?access_code=667226

The U.S. health care industry is approaching a critical inflection point, according to veteran health care strategist Paul Keckley. In a candid and thought-provoking keynote at the 2025 Healthcare Marketing & Physician Strategies Summit (HMPS) in Orlando, Keckley outlined the challenges and potential opportunities health care leaders must navigate in an era of unprecedented economic uncertainty, regulatory disruption, and consumer discontent.

Drawing on decades of policy experience and his signature candid style, Keckley delivered a sobering yet actionable assessment of where the industry stands and what lies ahead.

Paul Keckley, PhD, health care research and policy expert and managing editor of The Keckley Report

Health care now accounts for a staggering 28 percent of the federal budget, with Medicaid expenditures alone ranging from the low 20s to 34 percent of individual state budgets. Despite its fiscal significance, Keckley points out that health care remains “not really a system, but a collection of independent sectors that cohabit the economy.”

In the article that follows, Keckley warns of a reckoning for those who remain entrenched in legacy assumptions. On the flip side, he notes, “The future is going to be built by those who understand the consumer, embrace transparency, and adapt to the realities of a post-institutional world.”

A Fractured System in a Fractured Economy

Fragmentation complicates any effort to meaningfully address rising costs or care quality. It also heightens the stakes in a political climate marked by what Keckley termed “MAGA, DOGE, and MAHA” factions, shorthand for various ideological forces shaping health care policy under the Trump 2.0 administration.

Meanwhile, macroeconomic conditions are only adding to the strain. At the time of Keckley’s address, the S&P 500 was down 8 percent, the Dow down 10 percent, and inflationary pressures were squeezing both provider margins and household budgets.

“Economic uncertainty is not just about Wall Street,” Keckley warns. “It’s about kitchen-table economics — how households decide between paying for care or paying the cable bill.”

Traditional Forecasting Is Failing

One of Keckley’s key messages was that conventional methods of strategic planning in health care, based on lagging indicators like utilization rates and demographics, are no longer sufficient. Instead, leaders must increasingly look to external forces such as capital markets, regulatory volatility, and consumer behavior.

“Think outside-in,” he urges. “Forces outside health care are shaping its future more than forces within.”

He encourages health systems to go beyond isolated market studies and adopt holistic scenario planning that considers clinical innovation, workforce shifts, AI and tech disruption, and capital availability as interconnected variables.

Affordability and Accountability: The Hospital Reckoning

Keckley pulls no punches in addressing the mounting criticism of hospitals on Capitol Hill, particularly not-for-profit health systems. Public perception is faltering, with hospital pricing increasing faster than other categories in health care and only a third of providers in full compliance with price transparency rules.

“Economic uncertainty is not just about Wall Street. It’s about kitchen-table economics — how households decide between paying for care or paying the cable bill.”

“We have to get honest about trust, transparency, and affordability,” he says. “I’ve been in 11 system strategy sessions this year. Only one even mentioned affordability on their website, and none defined it.”

Keckley also predicts that popular regulatory targets like site-neutral payments, the 340B program, and nonprofit tax exemptions will face intensified scrutiny.

“Hospitals are no longer viewed as sacred institutions,” he says. “They’re being seen as part of the problem, especially by younger, more educated, and more skeptical Americans.”

The Consumer Awakens

Perhaps the most urgent shift Keckley outlines is the redefinition of the health care consumer. “We call them patients,” he says, “but they are consumers. And they are not happy.”

Keckley cites polling data showing that two out of three Americans believe the health care system needs to be rebuilt from the ground up. Roughly 40 percent of U.S. households have at least one unpaid medical bill, with many choosing intentionally not to pay. Among Gen Y and younger households, dissatisfaction is particularly acute.

“[Consumers] expect digital, personalized, seamless experiences — and they don’t understand why health care can’t deliver.”

These consumers aren’t just passive recipients of care; they’re voters, payers, and critics. With 14 percent of health care spending now coming directly from households, Keckley argues, health systems must engage consumers with the same sophistication that retail and tech companies use.

“They expect digital, personalized, seamless experiences — and they don’t understand why health care can’t deliver.”

Tech Disruption Is Real

Keckley underscores the transformative potential of AI and emerging clinical technologies, noting that in the next five years, more than 60 GLP-1-like therapeutic innovations could come to market. But the deeper disruption, he warns, is likely to come from outside the traditional industry.

Citing his own son’s work at Microsoft, Keckley envisions a future where a consumer’s smartphone, not a provider or insurer, is the true hub of health information. “Health care data will be consumer-controlled. That’s where this is headed.”

The takeaway for providers: Embrace data interoperability and consumer-centric technology now, or risk irrelevance. “The Amazons and Apples of the world are not waiting for CMS to set the rules,” Keckley says.

Capital, Consolidation, and Private Equity

Capital constraints and the shifting role of private equity also featured prominently in Keckley’s remarks. With declining non-operating revenue and shrinking federal dollars, some health systems increasingly rely on investor-backed funding.

But this comes with reputational and operational risks. While PE investments have been beneficial to shareholders, Keckley says, they’ve also produced “some pretty dire results for consumers” — particularly in post-acute care and physician practice consolidation.

“Policymakers are watching,” he says. “Expect legislation that will limit or redefine what private equity can do in health care.”

Politics and Optics: Navigating the Policy Minefield

In the regulatory arena, Keckley emphasizes that perception often matters more than substance. “Optics matter often more than the policy itself,” he says.

He cautions health leaders not to expect sweeping policy reform but to brace for “de jure chaos” as the current administration focuses on symbolic populist moves — cutting executive compensation, promoting price transparency, and attacking nonprofit tax exemptions.

With the 2026 midterm elections looming large, Keckley predicts a wave of executive orders and rhetorical grandstanding. But substantive policy change will be incremental and unpredictable.

“Don’t wait for a rescue from Washington. The future is going to be built by those who understand the consumer, embrace transparency, and adapt to the realities of a post-institutional world.”

The Workforce Crisis That Wasn’t Solved

Keckley also addresses the persistent shortage of health care workers and the failure of Title V of the ACA, which had promised to modernize the workforce through new team-based models. “Our guilds didn’t want it,” Keckley notes, bluntly. “So nothing happened.”

He argues that states, not the federal government, will drive the next chapter of workforce reform, expanding the scope of practice for pharmacists, nurse practitioners, and even lay caregivers, particularly in behavioral health and primary care.

What Should Leaders Do Now?

Keckley closed his keynote with a challenge for marketers and strategists: Get serious about defining affordability, understand capital markets, and stop defaulting to legacy assumptions.

“Don’t wait for a rescue from Washington,” he says. “The future is going to be built by those who understand the consumer, embrace transparency, and adapt to the realities of a post-institutional world.”

He encouraged leaders to monitor shifting federal org charts, track state-level policy moves, and scenario-plan for a future where trust, access, and consumer empowerment define success.

Conclusion: A Health Care Reckoning in the Making

Keckley’s keynote was more than a policy forecast; it was a wake-up call. In a landscape shaped by economic headwinds, political volatility, and consumer rebellion, health care leaders can no longer afford to stay in their lane. They must engage, adapt, and transform, or risk becoming casualties of a system under siege.

“Health care is not just one of 11 big industries,” Keckley says. “It’s the one that touches everyone. And right now, no one is giving us a standing ovation.”