7 things CEOs told Becker's this year that signal where healthcare should go

Healthcare's future isn't shaped by sweeping policy changes or shiny new tech alone — it's in the choices and priorities of the leaders running the systems today. 

The CEOs at the helm of health systems often reveal where the industry is headed, not always with flashy declarations, but through candid remarks and actions they make every day. This year, those insights spanned some of the most pressing issues in healthcare. From the realities of a payer mix dominated by government reimbursements to rethinking workforce development, access and what it means to lead, leaders' perspectives can offer a clear window into what's to come.

Here are seven key takeaways from conversations with health system CEOs throughout this past year that point to the challenges — and opportunities — likely to continue shaping 2025.

1. "I think we have a math problem in healthcare." – Kevin Mahoney, CEO of University of Pennsylvania Health System

"Medicare for all, Medicare for none — the debate goes on and on. While we're talking about it, we're becoming a single-payer system," Mr. Mahoney said at the Becker's Annual Meeting.

When Mr. Mahoney began his tenure with Penn Medicine in 1996, its payer mix was approximately 60% commercial and 40% governmental reimbursement. Today, it has flipped to nearly 63% government-paid, or as he put it, "government underpaid." This shift highlights a critical funding challenge for the six-hospital system, with hundreds of outpatient locations, where 60% of profit margins go to research, 25% to health system capital and 15% to education.

The "math problem" Mr. Mahoney refers to extends beyond finances, reflecting broader demographic shifts that will deepen funding strains. By 2030, all baby boomers will be 65 or older, doubling the Medicare-eligible population to nearly 70 million from 2000 levels. These shifts underscore the inevitability of governmental payer dominance, which health systems must navigate without the possibility of reversing aging trends.

"As a healthcare system, we have significant demographic trends that we have to face up to. You can't change your payer mix; people aren't going to get younger," Mr. Mahoney said. His remarks point to the urgency for innovative models to sustain care amid aging populations and constrained funding.

2. "People talk about the workforce shortage of the future. There's only a workforce shortage of the future if you don't do anything today." — Michael Dowling, President and CEO of Northwell Health 

Mr. Dowling shared this thought when talking to Becker's in January about the new partnership between the health system, Bloomberg Philanthropies and New York City Public Schools to develop a healthcare-focused high school, which will open in 2025 in Queens. Northwell is one of 13 health systems participating in the $250 million initiative from Bloomberg, in which health systems partner with public school systems in urban and rural areas to create a high school with specialized healthcare curriculum, work-based learning and opportunities for graduates to move directly into high-demand healthcare jobs. 

As the largest healthcare provider and private employer in New York, Northwell already reaches nearly 100,000 students annually through its existing educational programs. It has a lengthy and growing list of educational partnerships, scholarships and internships. 

Mr. Dowling's remarks underscore an essential truth: the workforce challenges of tomorrow cannot be solved with short-term fixes. Strong workforces are not built on high signing bonuses, aggressive recruitment tactics, or reliance on AI-driven efficiencies alone. Instead, they are forged by leaders with a vision for the future who invest in upstream solutions, build inclusive partnerships and develop pipelines for talent that may not yield immediate results. Importantly, this leadership extends beyond building workforces for one's own organization. It is about contributing to a broader healthcare ecosystem, creating opportunities for individuals who may not work directly for your system but will help sustain the industry as a whole.

"Begin thinking more broadly about the role you should have," Mr. Dowling said. "Don't think narrowly about what you do inside your organization. Think about how you can influence and become a change agent for other institutions to be involved in education outside your organization." 

This work is personal for Mr. Dowling. He was the first person in his family to attend college, graduating from University College Cork in Ireland while working up to 120 hours per week in odd jobs to fund his tuition. He immigrated to the United States in the 1970s and has led Northwell since 2002, but his firsthand experiences with poverty, classism and unequal access to opportunity continue to shape his approach to leadership and health. 

"When I was a kid myself and wanted to go to college, I didn't have any exposure to these things. When I went to college, my eyes were opened to the possibilities," Mr. Dowling said. "That's what we give these kids. There's no limit to what these kids can do if you open up the possibility for them."

3. "Mental health is very much something that every single one of us experiences. It's not somebody else's problem, it's our problem." — Elizabeth Wako, MD, President and CEO of Swedish Health Services

Behavioral and mental healthcare continued to align more closely with physical and medical healthcare in 2024, a shift that is needed, warranted but also challenging in some ways for the leaders who run legacy health systems in which mental healthcare was traditionally more siloed. This is what makes perspectives like that of Dr. Wako all the more orienting.

Dr. Wako was appointed to the top position of Swedish, a five-hospital system based in Seattle, in 2023. She began working as a registered nurse caring for psychiatric patients, an experience that left her with a firsthand understanding of the needs, care gaps and judgments endured in the specialty. She spent time in the home health setting, inpatient involuntary hospital medicine, and the group home setting with patients who had behavioral health needs and were experiencing homelessness.

"The more we pretend like mental health is its own special disease, the more we'll be unable to treat mental health," she shared with Becker's at its 14th Annual Meeting.

She advocates for expanded access points, increased reimbursement for services and the integration of mental health resources within primary care settings. Dr. Wako also sees the integration of mental and primary care as critical to address needs in a manageable way, and the system is working to expand primary care and embed mental health resources within all primary care clinics. 

"That's a goal that I think all of us should have: you should be able to see your primary care provider have an assessment done, an evaluation made, and then a direct transfer to a mental health professional to be able to start having that conversation with you," Dr. Wako said. 

As a leader with a large platform, Dr. Wako is intentional in how she communicates about mental health and strongly rejects the notion that it exists in isolation. She employs the metaphor of a wave when describing mental health needs. Whether a sine wave or an ocean wave, mental health exists on a continuum, she insists.

"You could be at the top of the wave or sit at the bottom of the wave, but there's always a wave," she said in a Becker's Healthcare podcast. "Sometimes you are drawn back deep into the ocean — kind of the dark depth of the oceans. Sometimes you're resting in the sunlight on the white sands. The wave, however, is always moving. It's always coming in and it's always going out. So I would say accepting that mental health is normal and it's our human plight — that's half the battle of managing mental health. It's normal."

4. "Old-school M&A is dead." – Rod Hochman, MD, President and CEO of Providence

Providence is not focusing on acquiring hospitals, Dr. Hochman said at Becker's 12th Annual CEO+CFO Roundtable. "We don't think that's what the future of health and healthcare is going," he added.

His comments came as hospital M&A activity increased in late 2024, driven in part by divestitures of Steward Health Care. The pandemic and immediate post-pandemic years brought on different flavors of hospital M&A, including cross-regional mergers. At least half a dozen hospital deals were called off or unwound in 2024, too, with some dissolved after FTC intervention. 

As Providence transitions leadership to COO Erik Wexler, Dr. Hochman's pivot reflects a broader realization: the future of healthcare integration may emphasize partnerships and collaborations over traditional acquisitions. The focus will likely shift toward networked care models and shared capabilities to address cost pressures and patient expectations without overextending systems financially.

5. "There's some people that talk about 'the comeback.' And to that, some people say: 'We never left.'" — Bob Riney, CEO of Henry Ford Health

2024 marked a high for CEO turnover across all industries. This rate of change only makes leaders like Mr. Riney stand out more

Mr. Riney began working at Henry Ford in 1978 as a college student, drawn to its business principles and complexity. He has since grown with the organization through three distinct chapters: from leading human relations as CHRO, to mastering operations as COO, and now guiding the entire system as president and CEO.

Just as Mr. Riney's career evolved, so too has Henry Ford Health and its hometown, Detroit. Together, they offer a compelling reminder that "comebacks" often appear sudden only to those who haven't been paying attention. While disruptors and tech-centric innovators often steal the spotlight, Mr. Riney's story highlights the real power of leaders and organizations that embrace their history, lean into their culture and values, and strive to emulate their own best versions rather than mimicking others. 

"Cities, no matter how thriving they are at any one time, go through life cycles," Mr. Riney said. "Having a long-term view and knowing that you can work through the ugly parts of cycles and rise again is something that's really important. It's true of leadership and it's true of organizations."

Home to 633,218, Detroit is a testament to the vulnerabilities of single-industry economies and the power of reinvention 11 years after its $18 billion bankruptcy. Against this backdrop of urban renewal, Henry Ford Health is writing its own transformation story. The system, which admitted its first patients in 1915 as Ford Motor Co. celebrated its millionth Model T, has grown into a $12 billion enterprise. Its latest chapter, a joint venture with Ascension Michigan, reestablishes it as the Detroit area's largest health system by net patient revenue.

Leading a health system won't be any easier in 2025 than it was in 2024. Mr. Riney exemplifies the kind of leadership healthcare needs: loyal, humble, thoughtful and guided by a bigger vision. The COVID-19 pandemic saw a number of CEOs postpone job changes; it shouldn't take a crisis for loyalty and commitment to be celebrated. In 2025, watch for those who stay the course, even during the toughest cycles. 

6. "The first thing I look at every morning is the system dashboard showing every metric across all performance criteria in our health system." — Howard Chrisman, MD, CEO of Northwestern Medicine 

"I can tell you OR start times at NM Kishwaukee and patient lag time for our dermatology clinic in downtown Chicago," Dr. Chrisman told Becker's this past summer shortly after marking his first year in the top role.

Dr. Chrisman's operational focus isn't only due to his time spent as COO of the academic health system before assuming the CEO role in 2023. It also reflects how access is not an issue delegated to other senior leaders: It is very much a CEO issue headed into 2025 as wait times climb across the U.S. The average wait time for the third next available appointment across 11 medical specialties in 23 U.S. metro areas is 38 days, starkly contrasting with the traditional 14-day benchmark.

"As a new leader, you want to set the tone and the culture. When I reach out to physician leaders, I get it. I'm still seeing patients. My start time isn't there sometimes, for a variety of reasons. So when I call them, it's like, 'I've noticed your physicians are wonderfully productive, they're busy, but the lag time is 70 days. How can I help?'" 

Northwestern Medicine contains the 943-bed Northwestern Memorial Hospital, situated in the heart of downtown Chicago. The system's reach has expanded throughout the city and Northern Illinois in the past decade, and it continues to grow with plans to open a 120,000-square-foot advanced outpatient care center in the city's Bronzeville neighborhood on the South Side in 2025.

Throughout the year, CEOs remarked to Becker's that it should not take a well-connected relationship to healthcare to receive timely appointments or access into health systems. Dr. Chrisman's remarks and steady concern about access into Northwestern Medicine signal that even for leaders at large integrated systems with talented executive teams, access today is just as meaningful as an organization's 10-year strategic plan. 

7. "You have to really enjoy it, and you have to like people. This is a people business. If you don't like people, you shouldn't be in this business." — Peter Fine, Former CEO of Banner Health

The remark, while simple on its face, serves as a profound reminder in an industry that often emphasizes strategic planning, M&A, financial acumen and clinical expertise over foundational people skills. Yet, as Mr. Fine underscored in his career-end interview with Becker's, the connective tissue between these domains must be a genuine love for people. This is especially the case as AI continues to expand its role in healthcare operations, care delivery and workflows. 

His perspective offers valuable guidance not only for aspiring leaders but also for the boards and teams responsible for identifying and appointing them. Strong interpersonal skills and a genuine love for people will differentiate leaders capable of navigating both the complexities of the job and the rapid integration of new technologies.

"The combination of liking people, working with people and recognizing how difficult this business is and that it requires a passion for complexity and a high tolerance for ambiguity — you can do very well and survive very well if you understand those things and behave like you understand those things," he said.

Mr. Fine led Phoenix-based Banner Health as president and CEO since 2000, transforming it into the largest private employer in Arizona. Under his leadership, the system expanded to operate in six states, encompassing 33 acute-care hospitals, 50 urgent care locations, hundreds of clinics, an academic division and 55,000 employees. His successor, Amy Perry, now serves as CEO after serving as president of the system.

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