Module 5 Executive Summary: Pathways to Financial Sustainability

As health systems continue to face mounting financial pressures & economic uncertainty, many are shifting from a growth mindset to one of preservation—a change that imperils the work of addressing persistent health disparities in C-suite priorities. According to THMA's annual survey of CXO priorities, health equity has consistently declined in priority rankings. In 2025, only one CXO persona—the CHRO—ranked it among their top five priorities.

While health systems are not standing still, today’s health system executives find themselves in an environment where the overall budgetary “pie” will be shrinking. In THMA’s latest finance outlook survey (n=40), 65% of finance executives expected their health system operating budget to decrease or stay the same—the first time in the history of THMA’s Finance & Budgeting Survey since 2021 that almost half of respondents anticipate their operating budget to decrease.

In the same survey, finance executives ranked financial measures that they identified as the most important for preparing for potential economic headwinds—with an overwhelming majority prioritizing short-term measures such as cost containment and revenue cycle improvements.