Nearly 60% of healthcare finance leaders are targeting operating margin improvement of 2 percentage points or more over the next two years, even as fewer than half say their organizations are prepared to manage the challenges that could derail those targets, according to a Deloitte survey published Aug. 12.
The Deloitte Center for Health Solutions surveyed 64 U.S. healthcare finance leaders in spring 2026: 32 from health systems with more than $1 billion in revenue and 32 from health plans with more than 500,000 members.
Six key takeaways from the survey:
1. The margin targets are aggressive by industry standards. Nearly 60% of surveyed finance leaders are aiming for operating margin improvement of at least 2 percentage points over the next two years. Within that group, 27% are targeting improvement of more than 5 percentage points. Deloitte flagged those goals as ambitious for a sector that typically operates on low single-digit margins and where many organizations have reported sustained financial pressure in recent years.
2. Preparedness is the weak link. On average, 47% of surveyed finance leaders said their organizations are well prepared to manage the external forces and internal capability gaps that could affect operating margins. Deloitte measured what it calls “preparedness gaps,” the distance between the share of leaders who expect an issue to hit margins and the share who feel ready to manage it. Those gaps averaged 42 percentage points for external market forces, compared with 35 percentage points for enterprise capability gaps.
3. Affordability is the widest gap, and pricing is still the top lever. Consumer affordability and access pressures produced one of the largest gaps in the survey. While 89% of finance leaders said those pressures are likely to have a moderate-to-major impact on margins, only 41% said their organizations are well prepared to manage them. The strategies in use run against that finding. Among surveyed health plans, 59% cited premium pricing and benefit design as their top margin lever, and 44% of health systems cited increasing service prices. Deloitte’s position is that price-led growth may be harder to sustain as a durable margin approach given persistent affordability pressure.
4. GLP-1 and specialty drug costs are the second major gap for payers. Among health plan finance leaders, 85% expect GLP-1 and specialty drug costs to have a moderate-to-major margin impact, while 38% said their organizations are well prepared. Deloitte attributed rising demand to expanded indications, growing consumer awareness and the drugs’ expanding role in obesity and diabetes management. The near-term cost effect introduces more volatility into medical loss ratios and actuarial forecasts, according to the report. Health systems face a different calculation, evaluating what expanded GLP-1 use means for demand across service lines tied to obesity-related interventions and chronic disease management.
5. Both sectors are pivoting from cost cutting to revenue growth. Among health system finance leaders, the share inclined toward revenue-led margin strategies rises from 31% over the prior two fiscal years to 50% over the next two. Among health plans, the share more than doubles, from 25% to 53%.Deloitte classified organizations as revenue-led when they allocated more than 55% of their margin strategy to revenue increases rather than cost reduction. The report cautioned that the pivot adds complexity, since revenue-led improvement requires growth in an environment where affordability, reimbursement, labor and capital pressures can limit the investments needed to deliver it. Outside of technology-enabled transformation, Deloitte found most health systems still emphasizing levers that reinforce the current operating model rather than reshaping future growth.
6. Workforce readiness is a margin variable, not just an operating one. Only 41% of surveyed finance leaders said their organizations are well prepared to manage workforce availability and burnout challenges, a constraint on transformation initiatives that require teams to adopt new ways of working while continuing to run the business. Deloitte cited prior research finding that health system cost and technology initiatives prioritizing clinician engagement are five times more likely to be rated effective by frontline clinicians.
Click here to access the Deloitte report.
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