Government funding uncertainty and Medicaid cuts are the biggest concerns for the majority of healthcare finance leaders in 2026, according to a new report from Strata Decision Technology.
The cloud-based financial analytics platform surveyed healthcare financial professionals nationwide for its annual financial outlook report. Eighty-two percent of respondents were leaders at healthcare systems, while others included medical groups (25%), single hospitals (15%), affiliated provider practices (13%) and more.
Labor expense was the second most-cited financial concern (48%), followed by payer rates and negotiations (30%), margin compression (28%), non-labor expenses (25%), inflation (23%), regulatory challenges (22%), labor recruitment and retention (18%) and data modernization (16%).
Amid uncertainty, 57% of leaders report reducing costs as their top priority for the year—followed closely by managing strategic and performance improvement initiatives (51%) and measuring and managing productivity (43%).
Strata Chief Growth Officer Frank Stevens said in a statement that healthcare organizations are “entering a new phase where discipline and execution matter more than ever.”
“The organizations that will succeed are those that can move faster, turn data into action, and align their teams around clear performance goals,” Stevens said. “As the pace of change accelerates, organizations need more than better insight; they need the ability to act on it in real time. That requires ensuring their technology investments support day-to-day decision-making.”
Forty-three percent of respondents expect margins to increase over the next year, up from 36% in the 2025 iteration of the report. Moreover, 22% expect margins to stay the same—down from 44% in 2025. Fourteen percent of respondents expected margin decreases in 2025, which increased to 25% in the latest report.
The biggest challenge for leaders managing margins is executing and tracking initiatives, as more than half listed it as their top obstacle.
Expected growth comes amid confidence in organizations’ abilities to adjust strategies—53% of respondents report feeling “somewhat confident” and 43% report feeling “very confident.”
Organizations say they plan to invest further in strategic decision capabilities, including better analytics and insight (60%), comparative data and benchmarks (53%), best practice assistance on existing tools (40%), artificial intelligence solutions (29%), service line predictions (20%) and volume predictions (18%).
Researchers said the results “point to a clear mandate” for healthcare finance leaders.
“Performance improvement will not come from technology alone or cost-cutting in isolation,” the report said. “It will come from disciplined alignment across people, processes, and systems.”