Four pressures redefining health system strategy

By Ryan Shepherd, EVP, Care Alliance, GE HealthCare

Across the country, health systems are facing a familiar set of pressures: advancing precise and preventive care, sustaining access, supporting a strained workforce, and protecting financial resilience.

In conversations with leadership teams, I hear a consistent theme: these pressures rarely show up alone. They increasingly intersect, amplify one another, and make enterprise decisions harder to separate.

This matters because many transformation efforts still tackle these challenges one at a time. However, a workforce challenge quickly becomes an access challenge. Access constraints become growth constraints. Cost pressure limits the ability to invest and slows down modernization efforts, making all three harder to solve.

Precision care is no longer optional

This isn’t a niche clinical ambition anymore. It’s a broader enterprise expectation as leaders look for growth tied to quality, early intervention, and personalized care pathways.

That shift is reinforced by the continued expansion of value-based care. Around 14 percent of U.S. healthcare payments are now tied to capitated risk, up from 7 percent in 2021¹, More than 60 percent of healthcare organizations have increased value-based care participation in 2026.¹

Precision care is still about clinical excellence, but it’s now also tied to enterprise performance, reimbursement, and a shift to more proactive, coordinated care.

Workforce strain is a core operational constraint

Workforce capacity is one of the clearest strategic constraints facing health systems today. Nearly 60 percent of healthcare industry leaders cite workforce challenges, such as shortages, retention, and upskilling, as a top strategic concern.²

Organizations continue to face clinician shortages and burnout, while clinicians also manage growing cognitive overload as data increases in volume and complexity. What this means day to day is clinicians are being asked to do more but with less time and more complexity.

This isn’t just about workforce satisfaction and retention. It’s a broader performance issue. When labor constraints put more strain on teams, the effects ripple across throughput, access and both patient and staff experience, as well as the pace of transformation.

When workforce strategy isn’t aligned with operations and technology, organizations struggle to build lasting, reliable capacity.

Access is about more than just the health system’s footprint

For many systems, patient access is about more than geography. It’s shaped by how care is distributed across sites. It shows up in how quickly patients can move through pathways, and it depends on how effectively health systems move care into settings that are more convenient, efficient, and sustainable.

Outpatient volumes are projected to grow 18 percent over the next decade, with outpatient surgery expected to rise 20 percent.³ The bigger shift is where care is delivered, pushing health systems to rethink how they expand access beyond the hospital.

This becomes even more pronounced in higher-acuity specialties: Outpatient cardiovascular and neuroscience volumes are projected to increase by 25 percent and 23 percent, respectively, over the next decade.⁴

As outpatient demand rises, leading systems are proactively reassessing network design, service line growth initiatives, how capacity is used and the economics of care delivery across a distributed system.

The more complex question is how to transform the enterprise to meet that demand: how best to build an operating model that is sustainable, alongside a comprehensive technology deployment strategy and a consistent experience across sites of care.

Financial pressure ties everything together

Even where hospital performance has improved, the underlying economics remain tight. Median hospital operating margins reached 4.4 percent in early 2025, up from 2.5 percent in 2023⁵, but they remain under pressure. Reimbursement continues to lag inflation. From 2022 to 2024, Medicare net inpatient payment rates didn’t keep pace with inflation, rising just 5.1 percent compared to 14.1 percent overall.⁶

This gap helps explain why everything is more connected: costs, access, workforce, growth, and the pace of modernization. Systems are being asked to preserve flexibility, fund transformation, protect margins, and improve performance without adding unsustainable complexity.

This underscores the drive for resilient and integrated operating models that support growth, access, and clinical performance at the same time.

What comes next is likely to reward integration, not silos

Many executive teams are asking a structural question: How do you respond to all four pressures in a way that is coordinated, scalable, and financially sustainable?

Health systems that continue addressing these pressures separately may struggle to create capacity, sustain access, and fund modernization at the pace the market demands. I explore this management challenge further in a related piece: Enterprise agility starts with reducing fragmentation.

What comes next in healthcare strategy will depend on how well organizations connect clinical ambition, workforce realities, patient access, technology deployment and financial sustainability into a single, enterprise-wide path forward.
  

To learn more about how Care Alliances can support and accelerate enterprise alignment, explore Care Alliances here.

Continue your reading:

• Enterprise agility starts with reducing fragmentation by Ryan Shepherd, EVP, Care Alliance, GE HealthCare
• Navigating Complexity—The hidden costs of adopting healthcare technologies at scale
• The Power of Integration—How connected people, processes and technology unlock new value for health systems

References

1. Optum, “Value-Based Care Statistics and Facts,” 2026.
2. Deloitte, 2025 U.S. Health Care Outlook (2025).
3. “Outpatient Volumes Projected to Grow,” Becker’s Hospital Review.
4. Kaufman Hall, “Outpatient Volume Projections,” 2025.
5. “Hospital Operating Margins Improve,” Becker’s Hospital Review.
6. American Hospital Association, “Medicare Payment Rates Compared to Inflation,” 2024.