L.E.K. Consulting's U.S. Health System Survey Reveals a Growing Gap Between Financially Strong and Struggling Health Systems

Health System Executives Share Strategies Around AI Adoption and Changes to Operating Models to Address Growing Capacity Constraints, Financial Pressures & Policy Shifts

BOSTON, May 27, 2026 /PRNewswire/ -- U.S. health systems are under mounting pressure—financial, operational and regulatory—and the gap between those best positioned to weather the storm and those struggling to stay afloat is growing, according to L.E.K. Consulting's 2025-2026 U.S. Health System Survey of hospital and health system executives.

There's a clear split in financial health across U.S. health systems. Half of executives report that their organization's financial position is solid or strong, while the other half describe their position as constrained or at high risk. This divide is reinforced by liquidity exposure: more than half of respondents report holding fewer than 180 days of cash on hand.

Expectations for the future reflect the same divergence. Nearly 60% of financially strong systems expect operating margins to improve over the next three years, while nearly 60% of constrained systems expect margins to fall. Notably, the proportion of all systems expecting margins to decrease more than doubled compared to 2024.

"The financial divide across U.S. health systems is increasingly clear, as is the risk that those that are more pressured will fall further behind," said Frazer Dorey, Managing Director at global strategy consultancy L.E.K. Consulting. "Both groups face similar headwinds, but do not have ready access to the same strategies and tools to respond, so must be selective."

Policy Uncertainty at the Forefront

Among the most pressing concerns is the impact of federal policy change. More than half of respondents believe the impact of Medicaid and ACA enrollment changes, 340B program reform and supply chain challenges will be significant for their organizations.

Leaders are already taking action. In response to Medicaid and ACA enrollment losses, they're reprioritizing service lines and seeking strategic partnerships. For 340B, hospitals are modeling financial scenarios and reevaluating contract pharmacy arrangements. To address supply chain challenges, they're renegotiating contracts, consolidating purchasing, shifting sourcing, and building forward-buy inventory reserves.

"What's different in this cycle is not any single policy shift, but how changes in Medicaid coverage, 340B economics, and supply chain dynamics interact," said Rozy Vig, Managing Director at L.E.K. "The systems that proactively assess these interdependencies and build flexibility into their service mix, cost structure and partnerships will be better positioned to manage the downstream impact, protect financial resilience, and drive sustained growth."

Access and Capacity: A Sector-Wide Crisis

More than 90% of health system executives report significant patient access and capacity challenges—a near-universal finding that underscores the issue. The most common barriers include referral handoff breakdowns, ineffective patient outreach and limited capacity. On the capacity side, staff shortages and constrained physical infrastructure—beds, operating rooms and procedural space—are the most acute bottlenecks.

To improve access, health systems are deploying care navigation tools (49%), testing new delivery models such as mobile clinics (38%), and using data analytics and patient risk profiles to target those most likely to benefit from care (38%). Hiring and retaining staff remain the most cited priorities to ease capacity constraints. But adding staff alone is not enough, as nearly 40% are also redesigning workflows and schedules to improve throughput, while more than a third are shifting appropriate care to ambulatory and lower-acuity settings.

Investment Strategies: AI, Specialty Pharmacy and Precision Medicine

Despite financial constraints, strategic investment continues, particularly among progressive systems with stronger balance sheets. AI is moving from pilot to application across clinical and operational functions. Specialty pharmacy and ambulatory infusion services are growing as high-value diversification plays, and a smaller but notable cohort of systems is advancing precision medicine and clinical research to differentiate and open new revenue streams.

For the MedTech industry, survey findings signal a constrained but stable customer base. Most hospitals expect medical supply and device spending to grow at roughly 2%–4% annually—a modest pace that reflects discipline. Innovation demand is increasingly concentrated among larger, more progressive systems with the scale and coordination to adopt and integrate new technologies.

"Clinical performance alone is no longer sufficient for MedTech," said Nathalie Allan, Managing Director at L.E.K. "Providers are increasingly asking suppliers to be active partners in gaining clinical, economic and operational efficiencies. The companies that can credibly deliver on all three will have a meaningful edge."

About L.E.K. Consulting
L.E.K. Consulting is a premier global strategy consulting firm that partners with clients to solve their most critical business challenges and deliver high-impact outcomes. We bring deep industry expertise and rigorous, evidence-based insight to global corporations, growth companies, and private equity investors, helping them turn strategy into action. Founded more than 40 years ago, L.E.K. now operates across 27 offices worldwide. Learn more at lek.com.

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SOURCE L.E.K. Consulting