Margin Pressures, and Payer Tensions: Inside Becker’s CFO Roundtable

At the Becker’s CEO + CFO Roundtable in Chicago last week, healthcare finance leaders gathered for candid conversations about the industry’s most urgent pressures – and the path forward. 

Across panel discussions and hallway conversations, CFOs discussed the relentless squeeze of rising costs and uncertain reimbursement, the uneven promise of AI and the need for new models of collaboration. 

While concerns ran deep, the tone was constructive. Healthcare CFOs, COOs and CEOs alike are seeking ways to turn pressure into progress. 

Here are the common themes that permeated this year’s Becker’s conversations.

1. CFOs face intensifying margin pressures and payer uncertainty

CFOs said payer dynamics continue to be the most complex and consequential financial challenge they face. From Medicaid expansion states to large urban systems, leaders described vastly different payer mixes and margins. For rural hospitals, Medicaid and Medicare may account for the majority of revenue; for others, commercial payer negotiations are the pain point. 

Several CFOs cited the growing complexity of pre-authorizations and claims denials, as payers increasingly use AI-driven automation to identify disputes. Hospital finance leaders are deploying analytics and automation to fight data with data, streamlining denials, improving compliance and accelerating cash flow. 

Underlying it all is the uncertainty of federal and state funding, particularly around supplemental payments and the 340B drug pricing program. One of the most well-attended sessions focused on 340B program cuts, with many leaders voicing concern that reduced funding could jeopardize the uncompensated care currently supported by those savings. 

2. Technology investment demands proof of financial return

Across discussions, technology emerged as both a catalyst for efficiency and a source of new cost pressures. CFOs spoke about the need to modernize outdated systems while proving a clear ROI for every investment. 

The most common focus areas were revenue cycle automation, specifically in pre-authorization, claims management and coding. Leaders discussed using AI to identify documentation gaps, accelerate reimbursement and reduce manual workload. One CFO noted, “Payers are using AI to their advantage. We need to use it to ours.” 

To make that possible, organizations are rethinking data infrastructure, standardizing and cleaning claims data to make it usable for predictive analytics and AI. Several executives emphasized that AI is only as strong as the data beneath it – a reminder that data quality and standardization are foundational, not optional.

3. Workforce shortages are limiting access to care

CFOs agreed that workforce shortages are now one of the biggest constraints on expanding care access. Hospitals are competing for limited clinical talent even as labor costs continue to rise. 

Several leaders tied these staffing gaps directly to access-to-care challenges, especially in rural and underserved communities. As one CFO observed, “It’s not just about hiring; it’s about whether we can even keep our doors open in some service lines.” 

To preserve and expand access amid financial and staffing constraints, health systems are exploring new care delivery models, from ambulatory expansion and outpatient surgery centers to telehealth partnerships. The shift to outpatient and community-based sites was a recurring theme, viewed as essential for both patient convenience and long-term cost control. 

4. AI adoption is measured, practical and data-dependent

AI was everywhere at Becker’s, but the conversations were grounded in reality. CFOs and CIOs agreed that governance and defined use cases are essential. The most immediate success stories are coming from ambient listening tools that automate clinical documentation, giving providers back valuable time while improving note accuracy. 

Beyond the clinical setting, CFOs see potential in AI-driven automation for administrative workflows such as coding, scheduling and revenue cycle optimization. But they emphasized the need to move deliberately, start small – standardize first and then scale. 

The consensus: AI’s role in healthcare will depend less on hype and more on data readiness, workforce training and ethical oversight. 

5. Collaboration is becoming a strategy for resilience

With rising costs and staffing challenges threatening margins, CFOs are re-examining how and where their organizations compete. Several described exploring partnerships or shared-service models with neighboring systems to consolidate service lines or expand access more efficiently. 

This cooperative mindset extends beyond healthcare-to-healthcare partnerships. A number of leaders discussed engaging with academic institutions and industry partners to advance research, digital transformation and workforce education, particularly as academic medical centers face steep federal funding cuts for research programs. 

As one executive put it, “We can’t do everything alone anymore. The question isn’t whether to partner, it’s how to do it smartly.” 

6. Finance leaders are turning pressure into progress

Despite the financial strain, the conversations at Becker’s reflected a determination to move forward. CFOs are embracing technology with greater discipline, investing in analytics to regain leverage in payer negotiations and rethinking care models to balance mission and margin. 

A common theme across every conversation: data, discipline and trust. CFOs are uniting clinical, operational and financial priorities under a single goal: building resilient organizations that can weather uncertainty while improving care. 

What’s next for healthcare finance 

At the Becker’s CEO + CFO Roundtable, one message came through clearly: healthcare finance is changing fast. Margin pressures and payer tensions continue to influence every CFO decision, yet leaders are finding ways to adapt, building progress through focus and collaboration. 
 
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