In November, THMA convened Chief Financial Officers across two distinct forums—the CFO Forum for large health systems and the CFO Circle designed for regional and independent systems. What stood out most was not the difference in audience—but how aligned the conversations were. In sessions centered on balancing growth with financial constraints, the conversations sounded strikingly similar. CFOs across system sizes are moving beyond pure cost containment and actively designing new, disciplined paths to growth. In both rooms, conversations moved quickly from naming shared pressures to swapping ideas, stress-testing approaches, and building on one another’s thinking in real time. CFOs discussed a wide range of strategies—from unconventional contracting models to creative revenue diversification — underscoring just how many levers finance leaders are actively exploring.
The conversations converged on a shared reality: CFOs across system sizes are moving beyond pure cost containment and actively designing new, disciplined paths to growth. Notably, the CFO Circle discussion reinforced that these shifts are not limited to large systems. Smaller and mid-sized organizations are experimenting with equally substantive strategies—and in some cases, some of the most inventive thinking is emerging from environments where constraints are forcing faster experimentation.
Why it matters: Persistent margin pressure, payer volatility, and capital constraints are forcing CFOs to rethink their role. Rather than waiting for scale, policy relief, or market stabilization, finance leaders are taking ownership of growth—while applying sharper governance and accountability than in past innovation cycles.
Key Takeaways:
CFOs are shifting from cost control to financial reinvention. Leaders described a clear evolution from defensive margin protection toward proactive growth strategies that preserve flexibility and local control.
Direct-to-employer arrangements are emerging as a powerful lever. One regional health system shared how it bypassed traditional payer structures to partner directly with local employers—aligning incentives around population health, lowering employer costs, and generating meaningful downstream revenue. The speed and simplicity of execution surprised peers and reframed what is possible without scale.
Discipline is what makes innovation viable. CFOs emphasized milestone-based investment, tight governance, and cross-functional accountability to ensure new ventures strengthen—not strain—the core enterprise.
Growth requires operational and cultural alignment. Transparent data, shared physician governance, and workforce accountability were cited as prerequisites for sustaining both margin improvement and innovation.
360 Takeaway: Across forums and system sizes, CFOs are converging on the same lesson: disciplined creativity—not austerity or scale alone—is becoming the defining competency of financial leadership. Whether through new contracting models or tightly governed ventures, CFOs who actively design their own growth engines are better positioned to navigate ongoing volatility.