Building a health system ready for what’s next

Financial stability isn’t the strategy—but it makes strategy possible

A roughly 1% operating margin may look like recovery after years of pandemic-era disruption, but it doesn’t represent genuine financial strength. It’s a narrow ledge from which not-for-profit health systems are expected to fund technology modernization, ambulatory expansion, aging facilities, workforce investments, clinical innovation, and community needs.

When financial improvement is interpreted as permission to return to business as usual, organizations risk spreading capital across too many priorities without creating the performance needed to sustain them. Day 1 challenged leaders to view financial stability not as the destination, but as the platform from which strategic flexibility is built.

Why it matters for healthcare

• Thin margins leave little room for error as capital requirements increase across facilities, digital capabilities, ambulatory access, workforce, and advanced clinical care.
• Maintaining the status quo may feel less risky than major transformation, but it can gradually consume the capital and capacity needed for future growth.
• Scale will remain important, but organizations may achieve it through partnerships, affiliations, shared services, or focused capability investments—not only traditional mergers.

What leaders should do now

• Connect the strategic plan directly to a multiyear financial and capital plan.
• Define the performance improvement required to fund each major growth priority.
• Establish clearer criteria for determining what the organization will build, buy, partner on, scale, or stop.
• Reassess legacy capital commitments against future market and consumer needs.

Figure 2.

Source: Strategy Intelligence analysis, 2026.

Future-ready organizations will turn connected data into better decisions

The summit showcased no shortage of compelling data, from market forecasts to quality outcomes and patient utilization. But the more important lesson was about what happens after the numbers appear on a screen.

Health systems routinely analyze financial performance, labor, quality, market share, patient experience, and utilization through separate structures—a collection of technically accurate views that don’t add up to a shared enterprise story. Leaders may know what happened without agreeing on why it happened or what should happen next.

Creating a competitive advantage is dependent on bringing the right evidence together so leaders can make better strategic decisions, execute them more quickly, and maintain alignment across the organization. That means starting with the strategic question, combining multiple forms of evidence, and surfacing the tension within the decision—not simply presenting another dashboard.

The approach can materially change how organizations think about investment. In cardiovascular care, for example, five-year inpatient demand is projected to grow 48%, while the median wait for a new cardiology patient has reached 32 days. Yet demand alone does not answer where or how to invest. Procedure-level quality data showed mortality ranging from 8% at hospitals performing fewer than 10 major cardiac valve procedures annually to 2% at hospitals performing more than 250. Physician-led analysis of product, price, and utilization variation also generated $2.2 million in validated savings that could be reinvested in future cardiovascular growth and technology. Viewed together, the evidence creates a far more complete investment case than any one metric could provide.

The same integrated view can also prevent organizations from investing too quickly. Average occupancy may suggest that a system needs more beds, but capacity is rarely distributed evenly across facilities, units, or patient populations. For instance, one health system reduced emergency department length of stay by 15% year over year even as emergency demand continued to rise, demonstrating that workflow and throughput improvements can release capacity before new physical assets are added.

Why it matters for healthcare

• Disconnected metrics make it difficult to distinguish isolated performance issues from broader structural challenges.
• Enterprise performance increasingly depends on combining market, clinical, operational, workforce, and financial signals.
• Capital decisions made from incomplete evidence can lead organizations to build capacity, expand services, or distribute care in ways that do not produce the expected clinical or financial value.
• Integrated evidence can help leaders determine not only whether to invest, but where to invest, how to fund the investment, and which parts of the organization must align to execute it.

What leaders should do now

• Create a focused enterprise scorecard that connects strategic priorities to clinical, operational, workforce, and financial outcomes.
• Use performance reviews to drive decisions, not simply report activity.
• Begin major decisions with the question the organization is trying to answer rather than the dataset or dashboard already available.
• Bring together demand, quality, operations, supply chain, and financial evidence before committing capital.
• Define the cross-functional alignment required for execution, including the roles of strategy, finance, physicians, quality, nursing, operations, and supply chain.

Figure 3.

Note: Allother site-of-care detail includes clinic, hospice, OP rehab, public clinic, ruralclinic, skilled nursing facility, and/or urgent care. Sources: Vizient Strategy Intelligence Consumer Survey, 2025; Impact of Change", 2026; HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) 2022. Agency for Healthcare Research and Quality, Rockville, MD; Proprietary Strategy Inte lligence All-Payer Claims Data Set, 2023; The following 2023 CMS Limited Data Sets (LDS): Carrier, Denominator, Home Health Agency, Hospice, Outpatient, Skilled Nursing Facility; Claritas Pop-Facts", 2026; Strategy Intelligence analysis, 2026.

Ambulatory growth is not a real estate strategy

Care continues to leave the hospital, but it’s not necessarily moving into health system-owned settings. Patients now have more choices about where they receive care, how they access it, and which organizations they allow to manage the relationship.

That means adding clinics, urgent care sites, or outpatient facilities is not, by itself, an ambulatory strategy. Growth will depend on whether patients can find the right service, schedule it quickly, navigate it easily, and see a compelling reason to remain within the system. The 2025 Vizient Strategy Intelligence National Consumer Survey found that while 82% of patients would like to remain loyal throughout their care journey, only about one-third are able to—underscoring how access, affordability, and other pressures can pull them away.

Several discussions showed how easily that connection can break. A patient who can’t secure a timely appointment may turn to a retailer, virtual provider, independent practice, or direct-to-consumer platform. The immediate loss may look like a single visit, but the greater risk is losing the downstream relationship—including the data, referrals, and future care that come with it.

Why it matters for healthcare

• A growing share of care is moving into ambulatory, virtual, home-based, and direct-to-consumer settings.
• Traditional health systems can no longer assume that clinical reputation alone will overcome delays, inconvenience, or fragmented access.
• Losing patients at the front door can affect an entire service-line relationship, not simply a single encounter.
• Different markets and services may require different approaches: direct competition, partnership, referral alignment, or selective exit.

What leaders should do now

• Evaluate ambulatory growth at the service-line and local-market level rather than through a single enterprise strategy.
• Identify where the organization has a differentiated clinical, geographic, or consumer advantage.
• Map the patient’s entry into the system and remove avoidable scheduling, navigation, and referral friction.
• Look upstream for opportunities to retain patients earlier, including direct access, primary care integration, and virtual-to-physical pathways.

Figure 4.

Source: Vizient pharmacy program participant data, October 2023-September 2024; Strategy Intelligence analysis, 2026.

Innovation changes the care model—and the business model

Some of the day’s most forward-looking conversations focused on cell and gene therapies, precision medicine, virtual care, theranostics, and other advances that could fundamentally improve how disease is diagnosed, treated, and managed. But innovation rarely changes only the clinical intervention—it also reshapes the patient journey, alters utilization, shifts care into new settings, and introduces new workforce, infrastructure, and financial demands.

A therapy that replaces years of recurring treatment may dramatically improve a patient’s life while disrupting the economics of an established service line. A virtual model may extend the reach of clinicians, but only if the surrounding workflows, staffing, technology, and accountability structures are redesigned with it. The same is true of partnerships. As care extends beyond the hospital, the performance of outside providers increasingly becomes part of the health system’s own clinical and financial performance.

Pharmaceutical innovation makes those enterprise-wide implications especially clear. Vizient analysis shows that just 10 drugs account for 27% of total pharmacy spend, with several affecting multiple service lines at once. That concentration makes treatment trends increasingly relevant to decisions about access, care delivery, financial exposure, and service-line growth.

These shifts can also force organizations to reconsider where care should be delivered. The answer is not always to centralize every advanced service at the largest facility; instead, ask which patients and procedures benefit from concentration—and which can remain closer to home. That distinction has implications for network design, referral pathways, clinical standards, and capital allocation. A future-ready system will use procedure-level, risk-adjusted evidence to define the role of each facility, concentrate care where scale improves outcomes, and distribute it where quality remains comparable.

Why it matters for healthcare

• Clinical innovation can disrupt existing revenue streams and utilization patterns even as it creates better patient outcomes.
• Emerging therapies may require new diagnostics, facilities, workforce capabilities, financial navigation, and longitudinal care models.
• As organizations assume more accountability for total cost and outcomes, the performance of external partners becomes part of the health system’s own performance.
• Partnerships without shared metrics and governance can expand complexity without producing strategic value.
• A relatively small number of high-cost therapies can shape spending and strategy across multiple service lines.
• Broad service-line strategies can obscure meaningful differences in the relationship among procedure volume, quality, access, and cost.

What leaders should do now

• Evaluate major innovations through a multidisciplinary process involving clinical, strategy, finance, pharmacy, facilities, operations, and access leaders.
• Model both the clinical value and the downstream impact on utilization and service-line economics.
• Define measurable clinical, operational, and financial expectations for strategic partners.
• Connect pharmacy utilization and spend data to service-line planning so leaders can anticipate where new therapies may create clinical opportunity, operational demand, or financial risk.
• Use procedure-level quality and demand evidence to determine which services should be concentrated and which can be distributed across the network.

By the end of Day 1, it was clear that progress will depend less on how many initiatives an organization launches than on how well it chooses, funds, and scales the ones that matter. That means protecting room to invest, responding earlier to changes in demand, and building the discipline to make innovation part of the operating model rather than a collection of pilots.

Vizient Strategy Intelligence connects demand forecasting, competitive visibility, and referral insights to help health systems identify opportunity, strengthen networks, and prioritize investments. See where care is moving—and where to invest next.