Where 74 health system leaders are focused to prepare for 2025

Becker's asked C-suite executives from hospitals and health systems across the U.S. to share the areas they're focusing on for 2025.

The 74 executives featured in this article are all speaking at the Becker's Healthcare 15th Annual Meeting on April 28 - May 1, 2025, at the Hyatt Regency in Chicago.

To learn more about this event, click here.

If you would like to join as a speaker or a reviewer, contact Mariah Muhammad at mmuhammad@beckershealthcare.com or agendateam@beckershealthcare.com. 

For more information on sponsorship opportunities or vendor access-only badges, contact Jessica Cole at jcole@beckershealthcare.com.

As part of an ongoing series, Becker's is talking to healthcare leaders who will speak at our conference. The following are answers from our speakers at the event.

Question: What are the top headwinds you're preparing for in 2025?

Marty Sargeant. CEO of Keck Medicine of USC (Los Angeles): 

1. Uncertainty at national level
2. Continued erosion of margins necessary to fund: tech connectivity to at home care and key labor force: specialists and advanced providers
3. Cost of capacity

Uncertainty about legislative and executive action at the federal level is top of mind for most healthcare leaders. Keck Medical Center will weather any storm by staying true to our mission, vision and strategic direction with a major emphasis on investments in our current and future workforce. With teamwork and unity, we feel strongly about future successes.

The continued challenge, however, is razor-thin margins. Non-profit hospital operating margins nationally are hovering around 4% and are projected to stay low in 2025. Reimbursement increases are not keeping pace with increases in labor and supply costs. Finding resources for strategic investments, especially technology, has become increasingly difficult and isn’t likely to ease in 2025. Despite these challenges, the medical center has remained financially strong and is investing strategically in resources for our tertiary/quaternary patients, who comprise the majority of our patient population.

Shelly Schorer. CFO of California Division at CommonSpirit Health (Chicago): As we prepare for the top headwinds in 2025, we anticipate significant challenges related to cost containment and revenue cycle management. We will address rising inflationary costs through a rigorous approach to our expense management. Simultaneously, we will strengthen our revenue capture capabilities by optimizing billing processes, improving collections, and fostering strong relationships with payers.

Cliff A. Megerian, MD. CEO and Jane and Henry Meyer CEO Distinguished Chair at University Hospitals (Cleveland): One of our priorities is to work with the new administration, as well as our new state and local policymakers, to address the realities healthcare providers face. We must foster collaboration with policymakers to support sustainable healthcare delivery. Ensuring fair and prompt reimbursement for our services is essential. This isn’t just a financial issue — it’s about maintaining care standards, investing in innovation, and supporting our workforce. In addition, technological advancements are transforming care delivery. Embracing innovations like telemedicine and AI is essential, but we must also safeguard against cybersecurity risks. Patient trust depends on it.

Craig Kent, MD. CEO of UVA Health; Executive Vice President of Health Affairs at the University of Virginia (Charlottesville, Va.): Throughout 2024, UVA Health has exceeded regional and national retention benchmarks, and we feel confident in meeting our current clinical demands — even as patient volumes have grown dramatically. As we look forward to 2025, we remain focused on sustaining this momentum during a period of remarkable growth and increasing demand for UVA Health’s expert care. Over the past five years, our health system has experienced a 54% rise in the number of unique patients seeking its services. Since 2019, surgical procedures have increased by 65%, hospital admissions have risen by 62%, and emergency department visits have quadrupled. 

Even if we are well-staffed today, we recognize that maintaining this trajectory requires a steadfast commitment to recruiting, training, and retaining a highly skilled workforce. To support these efforts, we are expanding innovative workforce strategies, including programs like Earn While You Learn, enhancing retention through competitive compensation and benefits, and fostering career and leadership development through initiatives like the Health Leadership Institute. Together, these efforts ensure we are prepared to meet the needs of our patients today and into the future.

Marschall Runge, MD, PhD. Dean at the University of Michigan Medical School (Ann Arbor); Executive Vice President of Medical Affairs at University of Michigan; CEO of Michigan Medicine: Healthcare in 2025 faces unprecedented challenges, the most significant in my 40-year career. Two key issues stand out: 1) Cost pressures will dominate, with scrutiny on care models, high-cost drugs, and potential supply chain disruptions.; 2) AI-enabled care holds transformative potential, but success depends on gradual adoption rather than rushing in. These shifts are complex and demand thoughtful navigation — no simple fixes apply.

Robert Corona, DO, MBA. John B. Henry Professor of Pathology, SUNY Upstate Medical University (Syracuse, N.Y.); CEO of SUNY Upstate Medical University Hospital: Our major headwinds are related to capacity…both inpatient and ambulatory. Also we are struggling to recruit specialists in anesthesia, radiology and pediatric subspecialties. We continue to turn away approximately 7,500 transfer requests per year. We operate our hospitals (including our children’s hospital) at 110% capacity most of the time with some days reaching 120% capacity. Our emergency department volume and ambulance visits are increasing year by year. We often have 35-40 admitted 'boarders' in our ED at any one time. We are working to manage through by growing our ambulatory access, telehealth and mobile health offerings. We are also using new technologies to improve our throughput and operating room efficiencies.

Peter Banko. President and CEO of Baystate Health (Springfield, Mass.): In Western Massachusetts, Medicare and Medicaid will be a large and growing share of our community and patient base. These populations are already more than 70% of our revenue, with increasing value-based arrangements and the imperative to leverage very diverse care teams (physicians, nurses, navigators, and family members enabled by complex technology solutions). Care model transformation requires Baystate Health to impact four mutually reinforcing, integrated components — care offering, design target, delivery resources, and care design.

Pranavi Sreeramoju, MD. Former Vice President and Chief Quality Officer of Jefferson Health (Philadelphia): As we look ahead to 2025, several key challenges in the areas of quality, safety, and patient experience will shape the healthcare landscape. These include leadership transitions, financial constraints faced by health systems, and the evolving dynamics of patient trust. Health systems will need to adapt to significant changes proposed by the incoming government, particularly in relation to Medicare, Medicaid, and marketplace programs. Any adjustments to these programs are likely to have a direct impact on both health outcomes and patient satisfaction.

One emerging concern is the increasing number of patients opting to decline recommended vaccines. This trend, if it continues, could have serious implications for vaccine uptake and the prevention of vaccine-preventable infections, warranting close monitoring. Additionally, public trust in medicine and science is increasingly fragile, as patients struggle to distinguish between credible information and misinformation. Maintaining and rebuilding this trust will be essential to ensuring positive health outcomes and effective patient care in the years ahead.

Nicholas Nussbaum, MD. Director of Medical Affairs and Community Services, Adams Medical Group at Adams Health Network (Decatur, Ind.): One substantial headwind that is probably not part of most organizations' planning for 2025 is a decreased utilization of what I refer to as "deferrable/delayable, even if not avoidable" services. These would be things like routine labs for chronic illnesses, routine mammograms/colonoscopies, and even some surgeries such as joint replacements. This is not likely to be a system-driven decrease in utilization along the lines of 2020-21, this is much more likely to parallel the squeeze of 2008-10.  

For the record, that is not a prediction for a financial crisis and/or market meltdown — I'm not an economist, and frankly, history would suggest that even economists are terrible at such predictions.  I am referring to the fact that, in most parts of the country, from 2008-10, many patients avoided any/all medical services that they felt they could without suffering an immediate negative outcome.  This was driven by a handful of perspectives on their part, including but not limited to:

1. Economic uncertainty, and a keen desire to avoid any cost possible.
2. Employment uncertainty, and an unwillingness to miss work as a result (i.e., "I need to work while I can," or "I don't want to give my employer an excuse to fire me," etc.).
3. Lack of trust in their insurance coverage and/or company to cover even items that should be 100% covered such as preventive care, let alone items subject to deductibles, copays, coinsurance, etc.

The inflationary environment of the past few years has already brought issue #1 back into play, and I hear it from patients every day. Anyone following current events knows that #3 is front and center everywhere. The only ingredient missing has been #2, as the labor market has remained relatively robust. However, the wheel always turns, and expecting some softening of the labor market in 2025 is hardly an outlandish prediction. Given that I do not expect #1 or #3 to improve significantly in the next calendar year, I think we can expect a softening of demand for "deferrable and/or delayable" services in direct proportion to any downturn in the employment market.

John Goodnow. CEO of Benefis Health System (Great Falls, Mont.): Top headwinds for 2025 at BHS: The challenge of remaining financially viable when your rate increases are far, far less than your inflation in the cost of doing business

At Benefis Health System over 75% of our patients are governmental payers, primarily Medicare and Medicaid but also Indian Health Services (Native American reservations) and Tri-Care (military base).

Having that high of a percentage of governmental payers (and that low of a percentage of commercial payers – approximately 20% at BHS) obviously makes the BHS financial picture much more challenging when compared to hospitals/health systems with higher percentages of commercial payers.

And, that ongoing problem gets further compounded when governmental rate increases are so much less than the inflation in our cost of doing business, as was the case in 2024, and as will also be the case for 2025. CMS rate increases for hospital inpatient and outpatient services are only 2.9% for 2025 (far less than our cost increases). To make matters worse, CMS coupled that with a proposed 2.83% rate decrease for physician payments (and the large majority of our physicians are employed). Further, commercial insurers are very much pushing back against rate increases, which further complicates the financial challenge. A pretty ugly picture.

 As an example of how rapidly our costs have escalated recently, from 2023 to 2024 our:

• Wage and salary costs increased 7.2%
• Benefits costs increased 6.7%
• And, when you add in contract (travelers, locums) labor, our overall staffing costs increased by 13.3%

And we, like everyone else, have also experienced significant inflation for non-staffing costs as well.

So, our top headwinds for 2025 are financial.

Sean Fadale, FACHE. President and CEO of Nathan Littauer Hospital and Nursing Home (Gloversville, N.Y.): Workforce – recruitment and retention of both clinical and support staff as well as providers has been at the top of our list for the past several years. 

Fiscal viability – as our cost of doing business has escalated dramatically, from supply costs, to the cost of employment has led to an environment when costs are greatly exceeding our revenues.  Couple this with payer challenges that negatively impact our revenue cycle. It creates an unsustainable environment to operate and it is critical we find ways to achieve better financial performance in the future.

Christine Larson, RN, BSN. Vice President of Medical Group Operations, North Wisconsin Area at Advocate Health (Charlotte, N.C.): The top headwinds I’m anticipating for 2025 include (in no particular order):

1. Keeping up with technology and AI needs will be a financial stress on the operating margin for most/all health systems, yet noting the importance from a work-life balance and efficiency perspective. 
2. Continued emphasis on value-based care, health equity, and access metrics will have the health systems scrambling to find unique and innovative ways to model care delivery and rethink how /where care is delivered. 
3. Senior leadership turnover trends including mergers/acquisitions will destabilize many health systems  throughout 2025 potentially. 
4. The sharing of healthcare related misinformation and social media influence on healthcare decisions. 
5. The scary trends related to maternity care delivery cessation in rural areas and the massive closures of outpatient pharmacies in rural communities and urban areas. 

Michael Dolan, MD. Chief Clinical Officer of Gundersen Region at Bellin and Gundersen Health System (La Crosse, Wis.): I think one of the difficult issues we are anticipating for 2025 is a continuing shortage of staff for the level of patient demand we are experiencing.  While we made some improvements in 2024, this is especially critical in certain physician areas. As a result, we continue to need assistance for physician staffing services to help us meet the demand. 

Dani Hackner, MD. Chief Clinical Officer of Southcoast Health System (New Bedford, Mass.): At Southcoast Health, against headwinds of provider shortages in healthcare as well as disruptions in the for-profit healthcare spaces, we are working diligently in community, not-for-profit care to improve patient access, improve collaboration among providers and staff, and to keep compassion at the fore. Despite these headwinds, we have been able to improve specialty and primary care access through recruitment, workflow efficiencies, and multidisciplinary teams. With other community providers we have leveraged our open medical staff model to partner in areas such as neighboring groups and systems, federally qualified healthcare centers, county-based public health, and even teaching and training. Our focus is on quality and empathy and how you demonstrate both in the care space helps to build resilience and overcome barriers. We believe the future for healthcare is healthy competition to drive quality, collaboration, and compassion.  

Lisa Hudnall. Executive Director of People Operations at UVA Physicians Group (Charlottesville, Va.): As an HR Professional in Healthcare, we foresee a few headwinds in the upcoming year.

1. Staffing Shortages: The healthcare industry is projected to experience substantial deficits in critical roles. For instance, the American College of Nursing anticipates a shortage of over 78,000 registered nurses by 2025, with an additional need for 29,200 advanced practice registered nurses by 2032. Similarly, a shortage of over 130,000 physicians is expected within the same timeframe.

2. Employee Retention and Engagement: Retaining skilled healthcare professionals is becoming increasingly challenging. Factors such as burnout, especially exacerbated by the COVID-19 pandemic, contribute to high turnover rates.

3. Evolving Employee Expectations: Healthcare workers are seeking more than just employment; they desire career growth, stability, and autonomy. We, as an HR department must adapt by offering flexible work policies, advanced collaboration tools, and initiatives that foster a sense of belonging.

4. Technological Integration: The rapid advancement of technology, including AI and telehealth, requires HR to ensure that staff are adequately trained and can adapt to new tools and systems.

 Addressing these challenges will require innovative strategies, such as:

• Implementing comprehensive workforce planning to anticipate and mitigate staffing shortages.
• Enhancing employee engagement through career development opportunities and wellness programs.
• Leveraging technology to streamline HR processes and support remote or flexible working arrangements.
• Ensuring continuous education and training to keep pace with technological and regulatory changes.

Jim Whitfill, MD. Senior Vice President and Chief Transformation Officer of HonorHealth (Scottsdale, Ariz.): We continue to see a tension between continued growth in our market that is driving increased demand for health services at a time when margins remain very tight. This puts increased stress on our staff who are trying to support this growth without adding FTEs. In addition, despite many vendors promising breakthroughs with AI, we have yet to see many real world impacts that justify the investments beyond one to two examples.

Ben Goodstein, MBA. Vice President and Chief Ambulatory Officer of Dayton (Ohio) Children's Hospital: At Dayton Children's, we are preparing for several significant challenges in 2025, each requiring thoughtful strategies and proactive leadership to mitigate their impact. These include:

1. Workforce Retention and Recruitment
   The competition for healthcare talent remains fierce, and retaining skilled employees and providers is critical to sustaining our high standards of care. Addressing burnout, enhancing engagement, and creating pathways for professional growth will be central to our efforts. We are committed to fostering a supportive and inclusive workplace culture while offering competitive benefits and opportunities for advancement.
2. Improving Patient Access to Specialty Care
   Demand for pediatric specialty services continues to grow, yet capacity limitations and logistical barriers persist. We are actively addressing these challenges by optimizing scheduling processes, expanding provider capacity, and exploring partnerships to reduce wait times and increase service availability, ensuring timely care for the children who need us most.
3. Mental Health Services Expansion
   The mental health crisis among children and adolescents remains a top priority, but it is met with systemic challenges, including limited resources, increasing patient volumes, and the complexity of coordinating care. We are focused on expanding our behavioral health programs, enhancing crisis management capabilities, and integrating mental health services within our primary and specialty care settings to meet this critical need.
4. Aligning Primary Care Networks
   Aligning primary care networks to create a seamless continuum of care for our patients is essential, but this requires significant collaboration and coordination with external providers and community partners. We are addressing this headwind by building stronger partnerships, standardizing care delivery models, and leveraging technology to improve communication and patient outcomes.
5. Financial and Operational Pressures
   Rising operational costs, reimbursement challenges, and uncertainties in healthcare policy pose ongoing financial pressures. We are focused on driving efficiency through process improvement, maximizing ROI on current investments, and exploring innovative revenue streams to ensure long-term financial stability.
6. Technological and Infrastructure Growth
   The growing demand for digital health solutions (including AI) and modernized infrastructure introduces the challenge of balancing rapid adoption with seamless integration into existing systems. Our focus will be on advancing telehealth, enhancing patient portals, and modernizing facilities to align with evolving patient and provider expectations.

These headwinds, while challenging, also present opportunities to innovate, strengthen our organization, and further our mission to improve the health of children in our community. Through strategic planning, collaboration, and a relentless focus on our priorities, we aim to not only navigate these challenges but emerge stronger and more capable of delivering exceptional care for the children we serve.

Pooja Vyas, DO. Vice President and Chief Medical Officer of Christian Hospital Northeast & Northwest Healthcare (St. Louis): Preparing for physician recruitment and staff onboarding. We are also focusing on sustaining our patient safety and quality metrics, along with our culture of safety and inclusion.

Matt Morton. Executive Director and Chief Information Security Officer of University of Chicago: The top headwinds for 2025 revolve around managing the increasing complexity of AI-driven threats, the rapid evolution of regulations surrounding AI and data privacy, and the challenge of securing hybrid and multi-cloud environments. The integration of generative AI into operations and its potential misuse will require robust monitoring and governance. Additionally, talent shortages in cybersecurity and the need to balance innovation with operational security will remain pressing issues. Preparing for these challenges requires adaptive strategies, strong partnerships, and investment in automation and advanced threat intelligence capabilities.

Stephen Rinaldi. Senior Vice President and Chief Revenue Officer of University of North Carolina Health Care System (Chapel Hill): While we face rising costs for labor and supplies, reimbursement rates have not changed to meet these ongoing pressures. Specifically, Medicare Advantage remains a significant headwind as plan sponsors consistently reimburse at rates lower than traditional fee for service Medicare. In the coming year, we will continue to work with our payer partners to ensure we have agreements that properly consider future inflation and performance targets. We must also do our part to embrace innovation, technology, and the many tools at our disposal to be as efficient as possible while delivering the quality care our patients expect and deserve.

Marc Perkins-Carrillo, MSN, RN. Chief Nursing Informatics Officer of Moffitt Cancer Center (Tampa, Fla.): As the CNIO and director of clinical informatics, I anticipate several significant challenges in 2025. The rapid pace of technological advancements, particularly in areas such as Gen AI and digital front door initiatives, presents both substantial opportunities and intricate challenges. These technologies demand meticulous planning, strategic implementation, and continuous evolution to integrate seamlessly into our healthcare systems and improve outcomes in patient care.

Regulatory and policy changes also represent a considerable hurdle. The evolving landscape of healthcare regulations and policies requires vigilant navigation. Preparing for potential policy shifts and ensuring compliance with new regulations will be essential to maintain operational efficiency and prevent disruptions. This will involve staying abreast of legislative developments and actively engaging in policy discussions to advocate for favorable outcomes.

Financial sustainability is another critical issue we must address. Achieving long-term financial stability for healthcare organizations will necessitate strategic planning and efficient resource allocation. This includes optimizing our budgetary practices, exploring innovative funding opportunities, and implementing cost-saving measures without compromising the quality of care.

Andrew Buffenbarger, EdD. Chief Compliance Officer of Kirby Medical Center (Monticello, Ill.): We are preparing for growth in a few service lines over the coming three years, so 2025 is focused on construction and strategic planning.

Gian Varbaro, MD. Vice President of Ambulatory Services and Chief Medical Officer at Bergen New Bridge Medical Center (Paramus, N.J.): I think the payer environment will be the top headwind in 2025. Both decreasing reimbursement as there is a greater movement to Medicare Advantage combined with the possibility of decreased Medicaid funding is concerning for a safety net hospital like ours. We will be looking to start new programs and diversify our patients and programs in order to counter this, but it has to be forefront in our thinking.

Dave Alexander, MBA. CFO of Penn Medicine at Home (Philadelphia): The Home Infusion, Home Health and Home Hospice industry is facing several significant headwinds in 2025. Here are few:

1. Regulatory and Payment Pressures – in Home Health related to the expansion of value based purchasing and electronic visit verification, which will place increased scrutiny over quality and outcomes, requiring investments in compliance and analytics. In Home Infusion, potential changes to 340B program could make therapies less affordable and lead to fewer patients being served.
2. Shifts in Payer Dynamics – as Medicare Advantage continues to grow its market share, at home providers must navigate increasingly stringent prior authorization requirements and negotiate with aggressive payers.
3. Labor Constraints – a persistent shortage of skilled nurses and therapists, coupled with competition from higher-paying healthcare settings, is likely to continue to strain staffing capacity and exasperate wage rate pressures.
4. Demographic and Demand Pressures – labor constraints could restrict our ability to meet the increasing demand for at home healthcare services.
5. Competitive Threats – from investments by large national payers in the home health industry represents significant competitive threats. These payers are leveraging their expansive resources, integrated models, and data- driven capabilities.

Vi-Anne Antrum. Senior Vice President and Chief Nursing Officer of Cone Health (Greensboro, N.C): Some of the top headwinds we are facing at Cone Health include inflation in expenses, like labor, supplies, and pharmaceuticals that are outpacing reimbursement, the war for talent remains swift, and our state is considering the removal of CON protections. There are not enough community based resources to care for our strictly behavioral and IDD populations. Our health system is one part of the equation and partnership is needed from a variety of stakeholders to collectively solve these issues. I know that we are stronger together when we partner with our community, policymakers, and payers to serve those relying on us. We will have the added benefit of being part of Risant Health in 2025 and I am excited about that! These headwinds are not unique to Cone Health and many not-for-profit health systems are facing similar situations.

Sowmya Viswanathan. Chief Physician Executive of BayCare Health System (Clearwater, Fla.): At BayCare Health System, we are excited to welcome a new year! As part of BayCare's ongoing commitment, we will be expanding our academic focus on graduate medical education (GME) and research. This will include adding more than 650 residents by 2029. This takes a total team effort to recruit and maintain world-class physicians who will be teaching the next generation of doctors. BayCare will continue to navigate the national physician shortages and other headwinds including physician integration and alignment strategies.

BayCare Health System is West Central Florida's leading provider at the forefront of clinical innovation.

Darrell Bodnar. CIO of North Country Healthcare (Whitefield, N.H.): As CIO of North Country Healthcare, I’m focused on several key challenges as we head into 2025. One of the biggest is making sure we’re getting the most out of our technology investments. This includes improving EHR usability, rolling out tools like ambient voice technology, and supporting staff to integrate these solutions into their workflows. We’re also looking at how AI can help us work smarter — whether it’s through better clinical decision support, financial modeling, or improving operations.

Financial sustainability is another major focus. Managing vendor performance and helping our teams use tools and information to make better financial decisions will be critical as we move into 2025. Finally, I’m leading a culture change initiative to better align our teams with our goals as a system. This means encouraging collaboration, improving communication, and helping leaders and staff connect with our shared vision. These efforts will position us to meet the challenges ahead and keep moving forward as well as to be able to pivot to the changes that are sure to come in 2025. It’s always an exciting time to be in healthcare!!

Bill Pack. CFO of Conway (Ark.) Regional Health System: Hospitals face a variety of headwinds as they prepare for 2025, many of which stem from ongoing challenges in healthcare delivery, finance, and workforce management.

Key challenges include:

Financial Pressures

• Reimbursement challenges: Declining Medicare and Medicaid reimbursements, coupled with shifts toward value-based care, create financial uncertainty.
• Cost inflation: Rising expenses for labor, supplies, and pharmaceuticals outpacing revenue growth, tightening margins.

Regulatory and compliance/IT security

• CMS and payer mandates: Adapting to changes in federal regulations, such as quality reporting requirements and interoperability standards.
• Cybersecurity: Compliance with stricter data protection laws and managing the risk of ransomware attacks.

Shifts in Care Delivery Models

• Outpatient and care: The migration of care to outpatient settings, especially surgical procedures once done as inpatient resulting in the same cost, but lower reimbursement.

Hospitals, like Conway Regional Health System, must strategically navigate these headwinds, balancing immediate challenges with long-term planning for sustainability and growth.

Chad Konchak. System Assistant Vice President of Data Analytics at Endeavor Health (Evanston, Ill.): As the leader of analytics for a large integrated healthcare delivery system I am very excited for the next year, however, we do face some significant challenges. One major headwind is the integration of diverse data sources, as the critical data we need to answer complex questions or build meaningful metrics / analytics tools often resides in fragmented systems that are difficult to integrate. This is especially true for Endeavor Health that is still early in our journey to integrate the three legacy EMR platforms into a single instance. The other major hurdle is navigating the pace of advancement around AI and ensuring that my staff has the time to upskill and support these new initiatives and we are supporting the training, governance, and educating for all our impacted employees around this exciting new space.

Girish N. Nadkarni, MD. Director, The Charles Bronfman Institute of Personalized Medicine and System Chief of Division of Data-Driven and Digital Medicine (D3M), The Irene and Dr. Arthur Fishberg Professor of Medicine at The Icahn School of Medicine, Mount Sinai and the Mount Sinai Health System (New York City): The top headwinds I am preparing for in 2025

• Navigating the rapidly evolving regulatory landscape for AI in healthcare, particularly around its ethical use and integration into clinical workflows.
• Addressing clinician burnout while ensuring technology adoption remains user-centric is critical.
• Ensuring equitable access to AI-driven innovations across diverse patient populations will be a key focus, as disparities could widen if not proactively addressed.

William Munley. Market Administrator of Southeast Administration at Shriner's Children's (Greenville, S.C.): At Shriners Children’s Greenville, we are not preparing for headwinds in 2025; rather, we are planning on riding a strong tailwind into the new year.

We just implemented a new, dynamic strategic plan, and we are very excited about the future.

We are focused on providing the best pediatric orthopedic care to more kids in the right places with more value. To do this, we are setting our marketing strategies around four areas: awareness, education, access, and affordability.

We have always been known for quality care and patient satisfaction, but we have set even higher standards for excellence, outcomes, growth, and patient engagement. Furthermore, we treat all patients regardless of ability to pay.

Through telehealth agreements and physician satellite clinic space, we have had success this year partnering with other healthcare systems. We have concentrated on not only serving our commercial and managed care patients, but also focused on FQHCs, rural hospitals, critical access hospitals, urgent care centers, and school screenings.

Through an initiative called Shriners Children’s Access Navigator (SCAN), we have been able to engage with over 225 new providers as referral sources in our catchment area of South Carolina, North Carolina, Alabama, Florida, Georgia, Tennessee and Virginia.

However, our boundaries are not limited to just these seven states. Over the past few  years, we have served patients from 38 states and 34 foreign countries and territories – making us a global destination center.

Diane Lynn. Assistant Vice President of Global Health Care at Advocate Health (Charlotte, N.C.): One of the top priorities will be improving and increasing access to care. That encompasses improvement in the existing care models but also leaning into the development of alternate care models that allow for greater access to care; this includes enhanced virtual health opportunities, robust hospital at home models and other innovative solutions. 

Roxanna Gapstur, PhD, RN. President and CEO of WellSpan Health (York, Pa.): In 2025, workforce challenges will remain one of the greatest headwinds. With a shrinking labor pool and evolving expectations, the need to attract and retain talent is more critical than ever. We’re focused on upskilling and promoting from within. We're also creating partnerships with local institutions for new pipelines of skilled professionals. From advanced training programs to collaboration with schools and universities, we’re elevating our workforce to keep pace with new demands. By investing in our teams and embracing innovative pathways, we’re ensuring a steady flow of talent equipped to thrive in an increasingly complex environment.

Mark D. Townsend, MD. Chief Clinical Digital Ventures Officer of Bon Secours Mercy Health (Cincinnati): As we lean into the headwinds of 2025, we continue to prepare for 1. downward pressure from payers that constrain the care of our patients and our communities. We are 2. doubling down on using digital-ventures to help us address staffing challenges by ‘working smarter’ to empower the workflows of our caregivers, and to improve access for our patients! We are also using digital-ventures to 3. augment and improve our cybersecurity infrastructure.  Here’s to 2025, and happy New Year to all!

Margaret Larkins-Pettigrew, MD. Senior Vice President and Chief Clinical Diversity Equity Inclusion Officer of Highmark Health Allegheny Health Network (Pittsburgh); Professor and Chair Ob/Gyn of Drexel University School of Medicine (Philadelphia): As a corporate clinical and academic leader, there are several headwinds that my primary employers and affiliates must prepare for. First of all, a big concern is how will we continue to provide high quality services and resources and low cost care to all of our stakeholders if there are major changes in our Medicare / Medicaid compensation/reimbursements, ACA and CHIP programs. We need to prepare for the upcoming economic changes that are sure to have a significant impact on how we’re able to best serve our communities. 

Secondly, from a social, ethical and moral perspective on total healthcare for women, we must be prepared to advocate for and defend women's rights to live and to choose. Significant restrictions on abortion access will lead this country on a pathway backwards, where women will die from preventable causes. 

Thirdly, we must also maintain cultural humility when it comes to how we provide care for communities classified as "the other," including people with disabilities, LGBTQIA+ community, African-Americans and people of color and veterans — when the targeted programs and resources that have previously protected, supported and served these groups are on the chopping block to be eliminated.

Wayne Gillis. President and CEO of Rehoboth McKinley Christian Health Care Services (Gallup, N.M.): Malpractice - New Mexico has recently had some unprecedented judgements over the last few months that have set the bar very high. This is causing most insurance companies to not offer coverage in New Mexico all together due to the extreme risk.

Fully integrated telehealth programs that give the right specialty access to rule communities which is a significant barrier to providing effective comprehensive care locally.

Provider recruitment for both family practice and internal medicine providers.

William Kumprey. Assistant Chief Medical Officer of Emergency Medicine at ThedaCare (Neenah, Wis.): As an emergency medicine physician, our teams will be focused on continuing to keep care local in 2025, providing the best experience possible for our patients and families. To meet the needs of communities, ThedaCare is creating two new health campuses which are expected to open in 2025. Both hospitals will have emergency care, inpatient beds, and 24/7 coverage with board-certified emergency medicine physicians.

Specifically, in the emergency department, we are excited to invest in technology across all locations which will allow our teams to properly staff the EDs, and manage increasing volumes and acuity. For example, we are adjusting our workflows and rooming processes. We are also using AI solutions that can help reduce administrative workload of clinicians through automatic documentation platforms. At ThedaCare, we promise to make health care easier. To meet patients where they are, and decrease wait times, we are prepared to utilize virtual ED telemedicine when needed. Initiatives such as this can help improve the experience from both sides – for patients and care teams. Our system's continued dedication to putting patients first will be enhanced with digital and technological advancements.

We also look forward to supporting our physicians through best practices and innovative resiliency strategies. It’s important that we understand the challenges team members are facing. ThedaCare has launched a new peer support program which provides structure and specialized training to clinicians so they can support their colleagues after adverse events or professionally stressful circumstances. 

All physicians, nurses, and advanced practice clinicians have the opportunity to participate. The sessions focus on listening and support from a place of shared understanding. Through programs such as this peer support program, we can problem-solve together, empowering team members in improvement efforts to ensure they feel supported and engaged. This will allow physicians and teams to continue providing high-quality care for those we serve. As we empower each person to live their best life through wellness, prediction, prevention and healing, we also have the opportunity to support our care teams in meaningful and impactful ways so that we can continue delivering comprehensive care when our patients have more urgent needs. 

D. Richelle Heldwein, MPH. Chief Risk and Compliance Officer of St Johns Health (Jackson, Wyo.): As we close out 2024 and look to 2025 we continue to see the uphill battle of an ever aging population and shortage of providers and staff to care for them. With this also comes a payer mix that shifts much of our commercially insured patients into governmental programs that are lower paying programs for hospitals. This makes already strained margins even tighter. Add the need to pay more to recruit key clinical staff and it makes for a pretty stiff headwind in keeping an independent community hospital in the black. This affects the ability to purchase new equipment and stay on the cutting edge of technology for quality care of our patients as well as impacting access to care. Our strategic focus of access to care is helping us see these needs and gear up to meet the challenges that 2025 brings.

Mayank Shah, MD. Vice President and Chief Medical Officer of Advocate Condell Medical Center, Advocate Health (Charlotte, N.C.): From a hospital and health system perspective, there are several anticipated headwinds in 2025. Perhaps the biggest is the regulatory uncertainty, there are waivers and programs that are due for renewal in 24-25. With change in administrative direction, it is unclear the future of these waivers. As a system, we continue to work through scenarios of creating stability in programs and benefits despite regulatory changes.

Second headwind for consideration is continued financial pressures with growing denials and reimbursement challenges balanced with needed community and technology advancements for efficiency. To plan the future,  hospitals and systems need to invest capital into technology and programs. However, low financial margins, continue to stress the ability for future investments.  Many systems continue to have dual short term and long-term strategies for financial sustainability.

Finally, the healthcare market is pivoting towards more private equity and venture capital investments looking for returns. This shift of ownership often compromises indigent and underserved care. The non-for-profits in the market end up taking the brunt of this payer mix which continuously constrains the financial health of the organization. The anticipated complexity is that an increase in volumes of patient care requires upended staffing with reducing reimbursements to cover the costs.

However, these challenges and headwinds also generate an opportunity for innovation and thought leadership. We are excited at Advocate to be leading the charge in redefining health care for all.

Victoria Regan, MD. Vice President of Women's and Children's Service Line at Memorial Hermann Health System (Houston): One of the greatest headwinds we anticipate in 2025 is the ongoing decline in the number of pediatric specialists and subspecialists with a lower proportion of medical school graduates selecting pediatrics as a specialty. Additionally, pediatric providers will continue to face a growing population of children with serious mental health concerns and limited resources to care for them, leading to longer patient stays in general pediatric beds until a behavioral health placement can be found. At Memorial Hermann, we are working to meet these challenges and more by identifying opportunities for innovation and partnerships to help us meet pediatric needs within our health system, schools, and communities.

Sandra Scott, MD. Interim CEO of One Brooklyn Health (N.Y.): With each new year, the healthcare landscape evolves, presenting challenges that require One Brooklyn Health to respond with strategic focus and innovative solutions. Inflation and rising capital costs make disciplined spending and operational efficiency more essential than ever. Workforce challenges also remain a priority as we navigate labor shortages, rising wages, and the critical need to support and retain our talented team — the backbone of our organization.

On the policy front, shifting reimbursement regulations will demand agility while preserving our commitment to delivering high-quality, patient-centered care. Meanwhile, the rapid advancements and implementation in AI offer transformative opportunities to enhance patient outcomes but also bring challenges that require significant investments, robust data security, seamless interoperability, and ethical oversight. By addressing these issues proactively, we will position ourselves to thrive in 2025 in our dynamic and complex healthcare environment.

Naydu Lucas, DNP. Interim Chief Nursing Officer of SouthEast Alaska Regional Health Consortium (Juneau): The key challenges include economic pressures, labor issues, and workforce well-being.

Economic pressures are impacting the healthcare system as a whole. Frontline leaders are feeling the strain of needing to reduce costs and generate revenue while remaining accountable for providing the best and safest care to patients with limited resources.

The workforce remains unstable in many sectors, with staffing shortages across all disciplines in hospitals still posing a significant concern. Healthcare organizations are competing for the same pool of employees, leading to a challenging and inequitable labor market, particularly in rural communities.

Employee well-being, both physical and mental, is crucial in any industry. Ongoing economic pressures, the influence of social media, and widespread burnout are affecting overall well-being. These factors further exacerbate labor shortages and increase costs.

These issues are interconnected and interrelated, and they must be addressed simultaneously and comprehensively.

Lucy Bucher, DO. Associate Vice President of Clinical Affairs at OhioHealth O'Bleness Hospital (Athens): I am an OB/GYN and an important part of my clinical practice is education, affirmation, and advocacy for my patients so they can understand what's happening, why it's happening and what (if anything) they can do. I have meaningful conversations with my patients and take time to talk through any concerns and questions they may have. No one should be scared to reach out to their doctor; we’re here to help people make informed decisions about their health and well-being.

At a more macro level, as the clinical affairs leader of our community hospital, I carry this guiding principle into our clinical planning at OhioHealth O’Bleness. I am always thinking about how our institution can continue building trust with patients and our community, and how we can keep as much care local as possible. It’s incredibly important for patients and family members to have a trusted source of medical information and medical care, not just their individual provider but also the systems and institutions that support the providers. 

At OhioHealth O’Bleness Hospital, we partner with our larger OhioHealth Clinical Enterprise, as well as local and regional partners to understand and address the healthcare barriers in our community. This includes initiatives such as mobile clinics in maternity desert counties, robust multidisciplinary care for substance use disorder, participation in community health educational events, and collaborative care plans between local providers and subspecialists at tertiary care centers. This ensures that patients have a local partner and advocate in their care who can help them navigate when they might need more complex needs that require higher level care.

Moving into 2025 for me means digging deeper to understand how advancements in care and therapies, increasing complexity of disease states, and systemic barriers intersect to impact the health of my friends and neighbors — and then looking to find ways I can lessen the burden of healing and seeking wellness for my community.

Ryan Younger. Vice President of Marketing at Virtua Health (Marlton, N.J.): Time will continue to be a highly valued commodity. Healthcare organizations must lean on marketers to create personalized content that provides real value to people. It must be highly relevant and timely. As we connect with people during their decision-making journeys, we must also create personalized experiences in terms of frictionless access and convenience. Marketers have the skillsets and technical platforms to address these headwinds in consumerism. We are preparing by leveraging tools that allow us to enhance targeting capabilities and enhance privacy features at the same time. This combination leads to higher trust and long-term relationships with people. It is an exciting time to be in healthcare marketing and make an impact.

Ebrahim Barkoudah, MD. System Chief and Regional Chief Medical Officer of Baystate Health (Springfield, Mass.): As a system chief and regional chief medical officer, I am acutely aware of the significant headwinds facing healthcare in 2025. The landscape is complex, with intertwining challenges that demand strategic foresight and innovative solutions. Based on current industry data and trends, here are the key metrics shaping our healthcare environment:

• In 2025, healthcare costs are expected to increase by 6.7%, approximately 2.2x faster than general inflation rates, while hospital operating margins remain thin at 1-2%. Nearly 52% of U.S. hospitals are projected to operate at a loss, largely due to labor costs increasing 8-12% and supply chain expenses rising 4-7%.
• Physician burnout affects 63% of healthcare clinicians and care providers, costing health systems an estimated $4.6 billion annually through reduced productivity, increased turnover (which costs $250,000-$1 million per physician replacement), and higher medical error rates. This represents a 22% increase in burnout levels compared to pre-pandemic figures.
• Value-based care adoption is accelerating, with 42% of healthcare revenue expected to come from value-based arrangements by 2025, up from 15% in 2022. Organizations implementing these models have shown 15-20% reductions in total cost of care and 25-30% decreases in hospital readmissions, for example. We need to aim for a universal adoption of value-based care. 
• Healthcare technology investments are projected to reach $24.3 billion in 2025, with particular focus on AI/ML solutions (expected to grow 48% YoY), interoperable EMR platforms (projected $8.8 billion market), and virtual care delivery systems that can reduce care delivery costs by 15-30% while maintaining or improving clinical outcomes.

Navigating these challenges requires a balanced approach that prioritizes financial sustainability, clinician well-being, and technological advancement while maintaining our core focus on delivering high-quality patient care. Success in 2025 will depend on our ability to innovate, adapt, and implement data-driven solutions across all aspects of healthcare delivery.

Richard Isaacs, MD. Dean, Senior Vice-President of Medical Affairs, and Chief Academic Officer of California Northstate University College of Medicine (Elk Grove): As healthcare leaders, we are navigating a tumultuous landscape as we approach 2025 — one that requires resilience, creativity, and steadfast commitment. Here are three critical challenges we must confront:

1. Rising costs: Healthcare expenses are escalating at an unprecedented rate, with inflation, prescription drug prices, and labor costs all contributing to this trend. These may be the highest cost increases we have seen in over a decade. Rising costs are affecting everything from patient access to affordable quality care and insurance enrollment. We must seek innovative solutions that maintain the quality of care while addressing these financial pressures. 

Given these challenges, physicians and healthcare providers will need to participate in healthcare advocacy at the state and federal levels. 

2. Cybersecurity threats: In our increasingly digital world, safeguarding patient data is not only a technical necessity but also a moral imperative. The frequency and sophistication of cyberattacks are on the rise, compelling us to remain vigilant and proactive in protecting sensitive information.

3. Workforce Challenges: Our teams are facing significant strain due to burnout and staff shortages, particularly as patient demand surges in emergency departments and hospitals. It is essential that we prioritize recruitment, retention, and mental health support to preserve physician, nurse and staff strength and morale of our workforce.

Together, we can address these challenges and continue to provide exceptional care to our communities. 

Ngozi Ezike, MD. President and CEO of Sinai Chicago: As the largest private safety net health system in Illinois, we perennially face financial headwinds. We are heavily dependent upon government payers with nearly two-thirds of our patients utilizing Medicaid. And we don't turn anyone away and end up providing more than $50 million each year in uncompensated care for those without healthcare coverage. In the end, the math simply doesn't work to make us whole and we end up losing money every year. 

In 2025, we're focusing on finding ways to fill the gaps so we can get to financial stability while continuing to provide the charity care needed in our communities. It's not going to be easy, especially with city and state budget challenges looming and a good deal of uncertainty about healthcare policy pivots with a new administration. So, we need to look creatively at new philanthropy channels, partnerships with better resourced systems along with ongoing efforts to be as efficient and cost-effective as possible. These are difficult needles to thread, but our leaders and caregivers are committed to our mission that healthcare is a right for all.

Tabitha Hapeman, DNP, APRN, RN. Enterprise Director of Utilization Management and Clinical Appeals at WVU Medicine (Morgantown, W.Va.): No one, or very few people, in healthcare would say that the process of receiving authorizations or payment is getting easier. Healthcare providers and payers continue to be diametrically opposed, and bureaucratic burdens continue to increase. A primary cause for concern is the continued proliferation of Medicare Advantage products. The administrative burden and increasing costs necessary to get paid requires providers to be strategic and innovative. Challenging the status quo, leveraging automation, and fiercely fighting for appropriate payment will become even more pressing goals in 2025. 

Stacy Bentil, DNP, MSN, RN. Director of Nursing at State of Connecticut (Hartford): Nurse leaders should anticipate several key challenges in 2025 as healthcare systems evolve. Here are the top headwinds I feel they should prepare for:

1. Workforce shortages and retention

• Why it matters: Burnout, retirements, and the limited supply of new nurses threaten care quality and safety.
• Preparation: Enhance recruitment, retention, and engagement strategies, including mentorship, flexible work arrangements, and wellness programs.

2. Healthcare technology integration

• Why it matters: Advanced technologies like AI and telehealth are transforming care delivery, but adoption challenges remain.
• Preparation: Invest in staff training, data governance, and seamless technology integration into clinical workflows.

3. Regulatory and policy changes

• Why it matters: Reimbursement shifts, new value-based care metrics, and compliance requirements demand proactive adaptation.
• Preparation: Stay ahead of changes, build compliance systems, and advocate for nurse leadership in policymaking.

4. Health equity and social determinants of health 

• Why it matters: Disparities in outcomes and access to care remain significant barriers to achieving equity.
• Preparation: Lead initiatives in culturally competent care, SDOH assessment, and community partnerships.

5. Mental health and well-being

• Why it matters: Rising mental health needs among staff and patients affect organizational stability and care outcomes.
• Preparation: Provide resilience training, peer support programs, and integrated mental health resources for both staff and patients.

By prioritizing these areas, nurse leaders can tackle the most critical challenges while fostering resilience and innovation in their organizations.

Nick Sturgeon. Vice President and Chief Information Security Officer of Community Health Network (Indianapolis): Several headwinds are emerging, particularly in health IT and cybersecurity. One major concern is the growing focus on AI by state and federal regulatory agencies, which could significantly impact how AI is utilized in patient care and IT environments. For example, the recent guidance from HHS/OCR on web tracking technologies has already created considerable challenges for healthcare organizations. If similar restrictive measures are applied to AI technologies, the consequences could be far more severe.

Additionally, ongoing challenges include the scarcity of skilled talent and the increasing frequency of third-party supplier attacks, both of which continue to pose substantial risks to the sector.

Sandra Johnson. Vice President and Chief Revenue Officer of MedStar Health (Columbia, Md.): Finding automation or AI that can assist with the numerous tasks we have within the revenue cycle which we are increasingly not able to find staff to complete. There is a manual alternative to each of these tasks, but we no longer have an excess of staff to complete them. We need systems, automation, and AI to assist us.

Jen Moore. Vice President of Payer Relations and Payment Innovation at MaineHealth (Portland): In 2025, workforce challenges and the rising costs of contract labor will remain significant obstacles for healthcare systems. These challenges are particularly acute in long-term care facilities, where limited capacity will persist, driving longer patient stays. Concurrently, increased utilization rates will strain value-based contract performance, further impacting hospital margins. These financial pressures are compounded by payers exerting greater influence through tactics such as tougher contract negotiations, higher rates of claims denials, and steering patients toward lower-cost care settings. In this environment, hospitals must adopt adaptive strategies, with revenue diversification emerging as a critical element for survival and long-term sustainability.

Kenneth Altman, MD, PhD. Chair of Department of Otolaryngology, Head and Neck Surgery, Professor at Geisinger Health System (Danville, Pa.): The post-COVID fallout, generational shift and financial pressures continue to shake-up our mission. Unprecedented hospital and practice closures or consolidations create additional headwinds for access to care. Also, patients are increasingly educated and there’s greater interest in real-time electronic communication with their physicians, so it seems we’re facing our greatest challenge. Access to quality care will need to be met with dramatically different approaches, and 2025 will likely be our greatest opportunity to embrace and apply the powerful new computational tools. It will be an amazing ride.

Steve Purves. President and CEO of Valleywise Health (Phoenix): At Valleywise Health, Arizona's leading public teaching hospital and safety net system of care, we're continuing to look for new ways to overcome labor challenges to ensure we provide top quality care. We have significantly reduced our use of contract labor by recruiting and retaining staff across the organization, including behavioral health. We're also keenly aware of payer mix shifts leading to a higher number of uninsured patients and closely watching policy changes from a new presidential administration. Finally, cyber threats from bad actors are a constant threat to any healthcare organization, and we're taking steps to protect our systems. 

Daniel Hoody, MD. Chief Physician and Chief Medical Officer at Sanford Health of Northern Minnesota (Bemidji): We are focused on innovative approaches and partnerships in the year ahead that will strengthen access, quality and sustainability, especially in rural areas where challenges are more pronounced. The privilege of serving patients in one of the poorest and most geographically isolated regions of Minnesota is a responsibility we do not take for granted. 

There is a maldistribution of healthcare providers in Minnesota. The majority practice in urban areas of the state. While 8% of Minnesota’s population lives in isolated rural towns, only 4% of providers practice in these areas. To add to this challenge, more than one third of rural providers in Minnesota plan to leave the workforce in the next 5 years or less. Overall, Minnesota ranks in the bottom half of states for primary care and physician availability. Additionally, in 2030, one quarter of residents living in rural Minnesota counties are projected to be 65 years of age or older and will have increased healthcare needs. 

This problem, while challenging, is not unsolvable. Expanding exposure to physician training programs in rural areas is key to filling gaps in care. Rural graduate medical education rotations, particularly in non-primary care specialties, can substantially increase the percentage of residency graduates who choose to practice in rural Minnesota. We look forward to building a stronger healthcare workforce of tomorrow to ensure we can meet the needs of our communities for generations to come.

Veronica T. Mallett, MD. System Senior Vice President and Chief Administrative Officer, More in Common Alliance at CommonSpirit Health (Chicago); Professor at Morehouse School of Medicine (Atlanta): Both at CommonSpirit and Morehouse Healthcare we are preparing for continued challenges with denials and payers not paying legitimate claims.

In addition, concern is rising on what if any changes will the new administration make to the exchange market place.

Lastly with the anti DEI, “anti woke” spirit coursing through states increasing health inequalities and further lack of representation in the healthcare workforce will likely be persistent challenges.

Zeshan Anwar. System Chief Hospital Medicine of The Guthrie Clinic (Sayre, Pa.): Recruitment and retention of providers of both primary care as well as specialties will be one of the challenges rural healthcare will continue to face in 2025. Similarly, rising inflation and increasing supply cost continue to pose a threat to organizations 'bottom-line.'

We will also have to tackle the pressure of decreasing payor’s reimbursements in 2025.

Patricia McClure-Chessier, MBA, MPA. Chief of Operations, Patient Safety and Strategy at Streamwood (Ill.) Behavioral Healthcare Hospital: Our healthcare system is preparing and bracing for several headwinds in 2025. Delayed payment from insurance companies is one of the major headwinds in our healthcare system, as it disrupts cash flow in the organization. Another headwind will be, if there are new, complex, regulatory requirements in the upcoming year, it could significantly impact operations, resources, and the environment. SBHS top headwind in 2025, is the implementation of an electronic health record, and the challenges that go along with the conversion. Clinicians will have to adjust and adapt, to the new method, of how documentation and data will be captured and collected in our healthcare system. The biggest obstacle regarding the conversion to an EHR, is for all clinicians to embrace technology and accept their learning curves.

Lacy Heiberger. Chief of Practice Innovation, UVA Physicians Group (Charlottesville, Va.): The physician groups at UVA Health continue to experience common pressures of the industry, including doing more with less. We see clinician shortages across many provider types, decreasing or weakening reimbursement schedules, an increased need for access to care, and variability in service line volumes that comes with natural disasters, pandemics or other circumstances beyond our control. While we face these headwinds, we also must expand our capabilities in a multitude of areas — regulatory reporting, addressing health equity issues, investing in technology, integrating new service lines, enhancing patient satisfaction, and maintaining high-quality care across thousands of performance measures. Our recipe for success will prioritize good partnerships, robust data sharing, and direct clinical support models. 

Tamara M. Campbell, MD, PsyD. Executive Director of VHA Office of Mental Health at U.S. Department of Veterans Affairs (Washington, D.C.): Veterans Affairs is the largest integrated healthcare system in the United States. We are providing more care to more Veterans than ever before. Within the past decade we’ve seen a 92% increase in Veterans receiving mental health services. We have very high VA trust scores and anticipate Veterans will continue to seek VA mental health services. Keeping up with the demand given the mental health provider shortages across the country will require collaborative efforts across our clinical and administrative services, ensuring everyone is utilizing the stepped care model where we meet Veterans in the right place at the right time for the right treatment.

Debra Fields. Executive Vice President and Chief Transformation Officer at City of Hope (Duarte, Calif.): In 2025, our objectives are clear: To expand access to advanced cancer care and accelerate the delivery of breakthrough cures to patients. Among the top challenges to accomplishing these objectives are growing healthcare workforce shortages and escalating costs of care and research.

In the year ahead, we will be working to mitigate these challenges so we can move ahead with strong initiatives that support our communities and our patients. A primary focus will be anticipating the highest areas of talent demand and proactively filling critical roles with exceptionally skilled professionals. To do this right, we are very aware of the importance of sustaining the organization as a great place to work that attracts and retains top talent. We will be ensuring our team is well-supported, engaged,  and motivated to fulfill our mission and values.

Additionally, we will remain agile, constantly willing to re-examine our organizational effectiveness, prioritizing processes and systems that are pivotal for delivering on our objectives. This means investing in the mission-focused initiatives that matter most –activities that save lives by speeding the delivery of breakthrough research and ensuring more patients receive our advanced cancer treatments and cures.

Frances Kelly, PhD, MSN. Assistant Chief Nursing Officer of USA Health, Children’s and Women’s Hospital (Mobile, Ala.): There are several headwinds our leadership team is preparing for in 2025, including keeping our team members safe and engaged, assessing and growing nurse leader competencies, and partnering to manage expenses.

Healthcare team members experience more non-fatal workplace violence incidents than team members from any other industry. According to Medscape's 2024 Nurse Career Satisfaction Report, over 75% of participating nurses reported experiencing verbal and physical abuse from patients in the prior year. 

Our own healthcare team has experienced an increase in verbal and physical abuse from patients as well. The Joint Commission requires leaders to adopt a 'zero tolerance' for workplace violence of any kind. In its General Duty Clause, OSHA requires employers to provide a place of employment 'free from recognizable hazards that are causing or likely to cause death or serious harm.' While we do have a zero-tolerance policy,  we are working to strengthen existing mechanisms to recognize and respond to actual or potential verbal or physical abuse from patients, families, or visitors. 

Nurse leaders are faced with many challenges, including balancing multiple, often competing priorities, while ensuring patient care is safe and effective. 

These challenges can feel even more overwhelming for new or inexperienced nurse leaders. Our senior nursing leadership team is focused on improving the competencies of our nurse leaders using the AONL nurse competencies as a framework to assess existing competencies and create development plans for areas identified as needing improvement. Improving nurse leader competencies will facilitate meeting goals and objectives, not the least of which is creating a healthy work environment and retain top talent.

In order for our health system to grow and evolve to meet the changing needs of our community, we must effectively manage our expenses. While our team has maintained a robust focus on providing safe and effective patient care, we recognize that care be provided as efficiently as possible. Our team will focus on ways to optimize productivity while providing outstanding care and service to our patients and our community.

Todd Schaffer, MD. President and CEO, Bismarck Region, Sanford Health (Sioux Falls, S.D.): At Sanford Bismarck, our team of providers, clinicians, nurses and support staff are vital to ensuring the patients and communities we serve have access to world-class care close to home. Our number one, two and three priorities for the year ahead are focused on our workforce. This includes bringing in new talent and building a pipeline for the future as well as retaining our people who carry out our mission every day. 

North Dakota is expected to have a shortage of as many as 500 physicians by 2025. Meanwhile, one-third of the physicians in the state are nearing retirement, and 30% of North Dakotans will be over age 60 by the year 2030. The bottom line: We have a supply/demand challenge. We do not have enough providers to meet the increasing healthcare demands in our region, which can lead to difficulties accessing care and worse health outcomes. This is unacceptable, and that’s why we’re focused on doing all we can to strengthen our rural healthcare workforce. This includes fostering a strong culture, harnessing technology and supporting the well-being of our caregivers. 

We also have a comprehensive and multifaceted strategy to build our workforce of the future. To proactively address the anticipated shortage of providers, we have made an unprecedented expansion in our graduate medical education programs to bring clinical expertise, resources and subspecialties to the upper rural Midwest. 

Next year, we’re excited to launch an internal medicine residency in Bismarck. Additionally, we have strong partnerships with accredited colleges and universities to provide students with clinical and research training sites. The institutions we collaborate with include the University of North Dakota, Bismarck State College, the University of Mary and North Dakota State University School of Nursing. International recruitment of nurses is supplemental to our local talent pipeline strategy. Since 2021, we have welcomed nearly 200 internationally educated nurses in Bismarck, and we look forward to having approximately 30 more internationally educated nurses join our teams next year. 

We remain committed to advancing access to care and improving health outcomes for the patients we serve. In 2023, we began an expansion project to add 36 hospital beds to the Sanford Medical Center in Bismarck. The project is expected to be completed in 2025 and will increase our capacity to care for patients.

The future health of our communities rests on our ability to attract and develop highly trained clinicians and employees. We will continue to prioritize initiatives to support the caregivers we need today and cultivate the workforce we know we will need tomorrow.

Tracea R. Saraliev. Board Member of Dominican Hospital Santa Cruz (Calif.); Board Member, PIH Health: The biggest headwinds facing healthcare for 2025 are:

1. Financial struggles leading to consolidation –  In 2024 Kauffman Hall reported that around 40% of hospitals are still losing money despite improved average industry margins from 0.3% to 3.8% due to rising costs for labor, drugs, and supplies, alongside workforce challenges and growing administrative burdens.  The growing divide between health systems that are struggling vs. those that are thriving due to market positioning, payer mix, and geographic wage differentials will continue to drive consolidation and M&A in the industry. 
2. Cybersecurity attacks impacting business continuity and financial performance - Nearly 400 healthcare cyberattacks were reported thus far in 2024 including data theft crimes involving patient data and ransomware attacks crippling business continuity and already struggling health system financials. I forecast that this trend will continue until the necessary investments in IT infrastructure are made to shore up security at the industry and national level.   
3. Staffing shortages creating operating pressures - Health systems struggled in 2024 to recruit and retain workers resulting in more shortages.  These shortages will be exacerbated at all levels in 2025 by factors such as an aging workforce, high burnout rates due to pandemic stress, increased demand for care from an aging population, inflationary wage pressures, and financial pressures on healthcare facilities.
4. Political changes increasing consumer power - The Trump healthcare administration including RFK Jr. and Dr. Oz will bring increased transparency to consumers about healthcare and their choices. I see this particularly impacting pharmaceutical companies and the way they interact with health systems, providers and patients. I anticipate that there will be additional requirements for testing, disclosures, liability reserves, and restrictions on how pharmaceutical companies go to market and sell their drugs. I also predict enhancements being made to Medicare particularly in the areas of home-care and telehealth to ease the demand for care for the baby boomers continuing to shift healthcare to the home. Finally, I envision a shift towards Medicare Advantage from Medicare to increase choices for the >65 years old population.  

Luis Taveras, PhD. Senior Vice President and Chief Information Officer of Jefferson Health (Philadelphia): Cybersecurity: I'm dedicated to fortifying our enterprise against cyber threats. By staying ahead of the curve with cutting-edge technologies, we are well-equipped to protect our operations and ensure the safety of our patients from threats from cyber criminals.

• Operational excellence and value creation: Our ongoing investments in IT solutions are transforming our operations. These advancements empower our clinicians to deliver exceptional patient care and achieve outstanding results. As the IT department, our mission is to maximize the benefits of these innovative solutions.
• Modernizing applications and technology environments: We are focused on creating a future-ready healthcare system and university. By modernizing our infrastructure and streamlining our applications, we are paving the way for an environment where data drives excellence and efficiency.

Matthew Ducsik. Associate Vice President of Providence Clinical Institutes at Providence (Renton, Wash.): The top headwinds that my team is preparing for is the complexity of whole person care. Populations like heart failure, dementia, cardiovascular disease, and complex pregnancies do not respond to a one-size-fits-all approach. Successful strategies must acknowledge social determinants of health, co-morbidities, and cultural norms, and necessitate a person-centric, multidisciplinary approach. This is easy to talk about and much more difficult to execute because it requires caregivers to communicate and collaborate across vertical teams and across the care continuum. Providence is leveraging digital health solutions to help facilitate effective identification of patients and better communication across care teams.

Tiffany Lawrence. President and CEO, Fargo Region, Sanford Health (Sioux Falls, S.D.): Sustainable access to care in rural communities is one of the most significant challenges we are focused on solving. It is a distinct privilege to serve as the Fargo region’s leading healthcare provider and North Dakota’s largest employer. Looking to 2025, we have a comprehensive, multi-pronged strategy in place to proactively address rural healthcare workforce challenges.

We understand the unique barriers our communities face in accessing behavioral healthcare. More than 90% of the counties in North Dakota are federally designated as mental health provider shortage areas. Two-thirds of those facing mental health challenges go untreated. Virtual care bridges that gap and reduces stigma. Our new self-scheduling tool in MyChart allows patients to make these appointments without a referral – improving access when it’s needed most. We also launched a virtual behavioral health program in critical access hospitals in our region. ER providers can now connect with specialists in under an hour, improving care and reducing the time a patient in a mental health crisis spends in the emergency department. 

Sanford Medical Center Fargo is the largest teaching hospital in North Dakota, providing clinical training for hundreds of students and medical residents. In 2025, we are excited to launch a surgical critical care fellowship and in 2026 a cardiology fellowship, which is part of our broader system strategy to expand graduate medical education programs. One of the biggest predictors of where a physician chooses to practice is where he or she trains. The best way to recruit and keep physicians in our communities is to grow our own. We are also focused on recruiting physicians in other high-need specialties. 

In North Dakota, our nursing shortage is compounded by a low unemployment rate. We have strong partnerships with local nursing schools and universities and are focused on building a stronger pipeline of nurses across the upper rural Midwest but, unfortunately, even with expansion of programs many nursing schools are also facing a shortage of faculty, particularly in rural areas like North Dakota, where just half the nurses we need are graduating annually. Welcoming internationally educated nurses to our team is a common-sense approach to help fill this gap. Since early 2021, we have hired nearly 300 internationally educated nurses in Fargo. We expect to welcome a total of more than 500 internationally educated nurses in Fargo by 2026. Our goal is to retain these nurses long-term — these nurses sign a three-year commitment and most bring their families with them. This is an integral part of our workforce strategy, streamlining the immigration system for healthcare workers can help us tap into a global talent pool and bolster our rural workforce. 

We will continue to prioritize investments in advanced technology to meet our patients’ needs in an evolving healthcare landscape, bring world-class care close to home and improve health outcomes. We are excited to positively shape the future of rural care delivery. 

Judy Ducsik. Executive Director of Providence Central Division Heart Institute (Renton, Wash.): While our organization continues to focus on operational optimization to improve access to care, reduce health disparities, improve costs, and ease the way for patients with chronic illness, the headwinds of 2025 are turning into hurricanes that challenge the ability to equalize healthcare delivery. The first challenge is preparing to lead in a union environment like we have never seen before. Some might argue that this is a means to build fairness and equity into our workforce; however, the path to get there is unforgiving and rugged for all involved. Empathy and understanding each other are key, and building a culture of trust and value is essential to long-term success. The second challenge is the frequent inability to meet contractual terms with longstanding payors in our regions. Our patients experience immense disruption in their care plans and, in some cases, have to start from square one if they can’t afford to have out-of-network care or if they have been on waitlists for specialists. Additionally, the administrative burden for our care teams becomes two-fold as they now must help navigate patients through these changes. Therefore, we will enter 2025 with strength, dignity, respect, and a get-it-done attitude.

Andrea Turner, JD. CEO of Harbor UCLA (Torrance, Calif.): In 2025, the top foreseen headwinds are:

1. Cost containment and reducing waste while balancing the needs of our patients and community at large with an equity lens.
2. Navigating new regulations and insurance denials
3. Competing for strong talent and retaining
4. Building capacity within primary care clinics
5. A.I. and its impact along with strong ethical guardrails.

David Verinder, MBA. President and CEO of Sarasota (Fla.) Memorial Health Care System: 2025 will be another exciting and challenging year for Sarasota Memorial, as we break ground on our third acute-care hospital, introduce a new, integrated IT platform and continue expanding services and facilities to meet the needs of our growing and aging population. Our greatest opportunities and challenges in the year ahead, not necessarily in this order, include: (1) Maintaining our historically strong financial and operational performance while investing hundreds of millions into new facilities, technologies and services; (2) safeguarding our systems and supporting our team members while we transition over 80 standalone and integrated applications into Epic’s fully integrated electronic health records system; and (3) recruiting and retaining top tier providers (during a persistent, nationwide healthcare worker shortage) to continue expanding and providing safe, high quality care to our patients.

Elissa Charbonneau, DO, MS. Chief Medical Officer of Encompass Health (Birmingham, Ala.): We are excited to explore new technologies to assist in our mission to provide patients with the best rehabilitative care as they recover from serious injuries and illnesses. Additional resources to reduce the amount of time our clinicians spend doing non-patient care activities are also on our agenda.

Maria Ansari, MD. Executive Director and CEO of The Permanente Medical Group; President and CEO of Mid-Atlantic Permanente Group; and Co-CEO of The Permanente Federation (Oakland, Calif.): As we look to 2025, we know that physician shortages will be a critical issue. In fact, the American Medical Association projects a deficit of up to 86,000 physicians by 2036. We’re seeing an increase in demand for health care services, particularly as we experience a growing aging population, while at the same time many physicians are choosing to retire early or leave medicine due to burnout. Permanente Medicine’s physician-led, value-based care model is a promising solution that allows physicians to practice evidence-based medicine, where doctors make medical decisions with their patients. Our model of care encourages collaboration between physicians, health plans, and hospitals to prioritize patient care. We are also combating physician burnout through a variety of ways. To help alleviate administrative burden, we recently introduced ambient scribe technology to over 24,000 physicians.

Alex Barkan, MD. Vice Chairman and Surgery Director of Bariatrics at Richmond University Hospital (Staten Island, N.Y.): The head winds for 2025 will include continued issues for access to care for the bariatric surgical patient with insurance denials and appeals, hospital financial well-being in terms of ability for capital purchases to keep up with technology. Does survival of independent hospitals without big institution support depend on private equity as the only option?

Kim Meeker, BSN, RN. Vice President of Patient Care Services and Chief Nursing Officer at Henry Ford Wyandotte (Mich.) Hospital: As a chief nursing officer, I recognize that 2025 presents a unique set of challenges for the acute healthcare market. One of the most pressing headwinds we face is the persistent national nursing shortage, which continues to strain the workforce and impact patient care. Additionally, the rising costs of healthcare delivery, driven by inflation and increased demand for services, will require us to continue to innovate in our operational efficiencies. 

We must also navigate the evolving landscape of regulatory changes and reimbursement models that could further complicate our financial stability. Mental health issues, exacerbated by the lack of national resources to care for these patients, will necessitate a more integrated approach to care, placing additional demands on our nursing staff. Finally, we must remain vigilant in our efforts to enhance patient safety and quality outcomes amidst the growing prevalence of healthcare-associated infections and other adverse events.  I’m very happy to work in an organization that recognizes the importance of all these issues and excels in their performance in addressing each.