BY: Jaime Caldwell. President – SFHHA

Each year, I set aside time to review what healthcare prognosticators are forecasting for the year ahead.  As we look toward 2026, the themes will feel familiar.  Still, they are worth revisiting, as their persistence underscores just how challenging—and consequential—the work of healthcare leadership remains.

In 2026, hospital administrators will continue to balance longstanding pressures with emerging trends, all while maintaining a sharp focus on patient care, financial sustainability, and technological advancement.  Below is a partial list of the issues most frequently cited as top priorities.

Patient Safety and Quality of Care

This area shows the greatest variability across forecasting reports.  While nearly every source ranks patient safety and quality within the top ten issues, its placement ranges from first to seventh.  On my own list, it will always rank first.

Ensuring high standards of care includes preventing medical errors, maintaining rigorous patient safety protocols, and improving outcomes through evidence-based practices and standardized care pathways.  Patient experience, satisfaction, and trust will also play a central role in hospital success, influencing everything from outcomes to reputation and financial performance.

Workforce Stability and Burnout

Consistently ranked as the second most pressing issue, workforce shortages remain a critical challenge.  The ongoing scarcity of nurses, physicians, and allied health professionals makes recruitment, retention, and training top priorities.

Hospitals are increasingly collaborating with regional educational institutions to address workforce gaps, though it remains unclear whether these efforts have meaningfully moved the needle.  Burnout—particularly among frontline staff—will continue to drive turnover, increase labor costs, and impact quality of care well into 2026.

Financial Sustainability and Cost Management

Hospitals will remain under intense pressure to improve efficiency while managing rising operational costs.  Inadequate reimbursement from Medicare and Medicaid, shifting payer mixes, and the growing number of uninsured patients will take center stage.

Administrators will focus on optimizing staffing models, reducing waste, negotiating better pricing for supplies, and strengthening revenue through managed care, reimbursement strategies, and strategic partnerships.  Financial viability will require both discipline and creativity.

Telemedicine and Digital Health Integration

Telemedicine will continue to reshape care delivery.  The challenge for administrators will be integrating virtual care in ways that maintain quality, continuity, and patient engagement.

As telehealth expands, data management, patient privacy, and cybersecurity will become even more critical.  Investments in digital infrastructure must keep pace with both innovation and risk.

Value-Based Care and Population Health Management

The importance of value-based care varies across forecasts.  While it ranks among the top five on my list, others place it lower.  Despite years of discussion, uncertainty remains about the direction and pace of value-based initiatives, particularly amid changes in federal leadership.

Population health management—improving outcomes for entire communities—will require advanced data analytics, cross-sector collaboration, and care models that extend beyond hospital walls.

Advancements in Medical Technology and Artificial Intelligence

I intended to limit this discussion to five issues, but this one cannot be overlooked.  Hospitals will increasingly adopt artificial intelligence to improve efficiency, diagnostics, and personalization of care.  From AI-driven clinical decision support to robotic surgery, technology investment will remain a strategic priority.

At the same time, administrators must address cybersecurity risks, infrastructure demands, and the ethical implications of AI, including patient consent, transparency, and appropriate reliance on algorithms.

In 2026, successful hospital administrators will be those who can thoughtfully balance these priorities while remaining steadfast in their commitment to high-quality, patient-centered care in a rapidly evolving healthcare landscape.



We recently heard that Florida Blue and Broward Health are having difficulties negotiating to a win-win. And, more recently, that Florida Blue and Memorial are also having similar challenges although they are still in the early stages of the process.

The recent news just happens to include Florida Blue but this process occurs between every insurer and healthcare providers as contracts do eventually end. So, what happens to all the players (physicians, hospitals, ancillary services, customers/patients, etc.) when the negotiators can’t see a clear pathway to a new contract?

When health insurers and healthcare providers cannot reach agreement on a new contract, the fallout can be far-reaching and disruptive—particularly for patients caught in the middle. These contract disputes, often centered on reimbursement rates, coverage conditions, and administrative terms, generate widespread uncertainty that affects access to care, financial planning, and continuity of treatment.

At the core of these disputes is a negotiation process between insurers and healthcare systems or physician groups about how much the insurer will pay for specific services. When negotiations stall or fail, the provider may exit the insurer’s network. This means patients who were once able to see their doctors or receive care at a preferred hospital under in-network rates are suddenly forced to choose between paying significantly higher out-of-pocket costs or finding a new provider—sometimes in the middle of ongoing treatment.

For patients, this uncertainty is not theoretical. They often receive notices that their provider may soon be out-of-network, without knowing whether a resolution will be reached before the deadline. In the meantime, patients with chronic conditions, cancer, or planned surgeries become anxious over whether they will need to delay care, find alternative providers, or absorb unexpected costs. Even temporary lapses in coverage agreements can result in canceled appointments, delayed procedures, and confusion about billing and required pre-authorizations.

From a financial standpoint, out-of-network care is significantly more expensive for patients. Deductibles, coinsurance, and copays are higher, and insurers may not cover services at all, particularly if deemed non-emergency. For families already managing tight healthcare budgets, these disruptions can cause real financial strain. In some cases, patients face surprise medical bills for services they assumed were covered.

Healthcare providers also feel the pressure. They may experience patient attrition, staffing disruptions, and loss of revenue, especially if a large portion of their patient base comes from the impacted insurer. Meanwhile, insurers also risk losing members to competitors if the disruption frustrates patients. The public nature of these disputes, often played out in the media or through direct communications with members/patients, can damage the reputations of both parties.

At a systems level, these disputes highlight deeper structural tensions in the healthcare market, where rising costs, administrative complexity, and profit margins all influence contracting decisions. The lack of transparency in negotiations further compounds patient confusion and fosters mistrust in the system as a whole.

Ultimately, when providers and insurers fail to reach timely agreements, it is patients who bear the brunt of the uncertainty. Policymakers and regulators have an opportunity to promote more patient-centered solutions—such as standardized dispute resolution timelines, expanded continuity-of-care protections, and greater transparency about in-network status during negotiations. Until then, contract disputes will continue to create instability in a system where stability and access are most needed.

The good news is that these contract negotiations usually lead to an acceptable win-win for both the contracting partners and results in restoration of relationships between the member/patient and their favored providers. Throughout this negotiation process, both of the contracting partners are well aware that the process is disruptive to their members and patients and teams on both sides work diligently in an attempt to find a solution that works for everyone.

So, until we find a better way to pay for healthcare, this is the process that we all have to endure. Just be aware that all the parties are working for you.



From Tom Murphy at the Associated Press, “Top U.S. health insurers vow prior authorization reform.” [Sun-Sentinel, June 24] Quoted from the article, “Insurers said Monday that they will standardize electronic prior authorization by the end of next year to help speed up the process. They will reduce the scope of claims subject to medical prior authorization, and they will honor the preapprovals of a previous insurer for a window of time after someone switches plans.” We will see.

Medical prior authorizations, while intended as a cost-control measure, often prove detrimental to patients, leading to delayed care, worsened health outcomes, and increased administrative burdens (cost) that interfere with the patient-provider relationship. At its core, prior authorization (PA) requires healthcare providers to obtain approval from a patient’s insurance company before delivering certain medications, tests, or treatments. Though insurers argue this process ensures appropriate use of services and prevents unnecessary spending, in practice it frequently results in harmful delays and denials that compromise timely care.

And, with the repositories of “big data” being at insurance companies, surely analysis of that data shows that these changes can be safely and effectively implemented. So, why does it take a year?

One of the immediate negative impacts of prior authorization is treatment delay. According to surveys by the American Medical Association (AMA), a significant number of physicians report that PAs have led to delays in patient care, sometimes exceeding several days or even weeks. [The AMA views prior authorization as an overused, costly, inefficient, and opaque process that often leads to patient care delays and potentially adverse events.] These delays can be critical, especially for patients with chronic or progressive illnesses. For example, in cases involving cancer, heart disease, or mental health conditions, even short delays in initiating treatment can worsen prognosis or lead to complications that might have been preventable with prompt intervention.

Moreover, many prior authorization requirements are not based on the latest clinical guidelines or patient-specific information. This creates a system where insurers second-guess providers’ judgment, despite not having the same level of direct patient insight. In some cases, patients are denied treatments that their physicians consider medically necessary, forcing patients to either forgo care or switch to less effective alternatives. This can have both health and psychological consequences, eroding trust in the healthcare system and leaving patients feeling powerless in decisions about their own care.

The administrative burden of prior authorizations also affects patients indirectly. Physicians and clinical staff must often spend hours navigating complex and inconsistent requirements, diverting time and attention away from direct patient care. This not only contributes to provider burnout but also limits the capacity of clinics—especially those in underserved areas—to efficiently manage high patient volumes. For smaller practices, the resources required to manage PA requests can be prohibitive, further contributing to disparities in access and continuity of care.

Additionally, prior authorizations can disproportionately affect vulnerable populations, such as the elderly, low-income individuals, or those with limited health literacy. These patients may struggle to understand or contest denials, and they may lack the financial flexibility to pay out-of-pocket while appeals are pending. This often leads to treatment abandonment or reliance on emergency services, which are both more costly and less effective than preventive or early-stage care.

In recent years, there has been increasing advocacy from medical societies, patient rights groups, and even bipartisan legislators to reform or streamline the PA process. Proposals include electronic prior authorization systems, standardized forms, and “gold card” programs that exempt high-performing providers from routine reviews. While some insurers have taken steps toward such changes, progress has been uneven and slow.

With elections looming, what we have witnessed is growing unrest by the insured about this antiquated process. After the recent death of UnitedHealthcare CEO Brian Thompson, we saw the frustration manifest and we also saw an election year issue come into focus. Is legislation that is more stringent in the works? [“Dr. Mehmet Oz called the practice “a pox on the system” that hikes administrative costs during his Senate confirmation hearing in March to lead the Centers for Medicare and Medicaid Services.] It is time for the healthcare system to reduce one of its expensive barriers to appropriate care.



Recently, I have had the opportunity to read several articles where authors have put on their “future” glasses and talked about healthcare from that perspective. I thought that I would synthesize all their hard works and create my own future!

By 2050, healthcare will be transformed by advances in technology, data integration, and personalized medicine. Care delivery will shift from hospital-centric models to decentralized, patient-focused systems. Smart homes equipped with health monitoring devices will enable early detection of diseases, allowing many conditions to be remotely managed. Artificial intelligence (AI) will play a critical role in diagnostics, treatment planning, and even robotic surgery, enhancing precision and reducing human error.

Genomics and biotechnology will usher in an era of hyper-personalized medicine, with treatments tailored to an individual’s genetic makeup, lifestyle, and environment. Chronic conditions like diabetes and heart disease will be more effectively managed—or even prevented—through predictive analytics and real-time data from wearable devices. Mental health care will become more integrated into primary care, with digital platforms offering therapy, monitoring, and support.

The healthcare workforce will evolve alongside these changes. Clinicians will work more collaboratively with data scientists, engineers, and AI systems. Virtual reality and simulation will be standard tools in medical education and surgical training, while telemedicine will be a default mode of care for routine consultations.

Equity will remain a central challenge. While affluent populations may benefit most from high-tech advances, health systems will be pressed to ensure that rural, elderly, and underserved communities are not left behind. Regulatory frameworks will have to adapt quickly to protect patient privacy while enabling data-sharing across systems.

By 2050, healthcare will likely be more proactive than reactive, more data-driven than intuition-based, and more personalized than ever before. The result could be longer, healthier lives—but only if technology is harnessed equitably and sustainably.

In these pictures of the future, I am uncomfortable about who will be benefiting from these advances. I feel reasonably confident that one of the ways to reduce overall healthcare cost is to provide and encourage people to get primary/preventive care. Preventive care that leads to avoidance of more serious illnesses requiring hospital admissions will be lessened (per capita). The only way we can do that is to ensure that quality, affordable healthcare insurance/program is available and that those eligible are encouraged to take advantage of that care.

Over the next few years, I look forward to seeing this view of the future unfold.



Mental health is an integral component of overall well-being, yet it has historically been treated as separate—or even secondary—to physical health. In reality, a holistic approach to healthcare must include mental health services to ensure comprehensive treatment and improved outcomes. The story of Robert F. Kennedy Jr. (RFK Jr.) underscores this point, as his own health challenges highlight the complex relationship between mental and physical health, as well as the need for integrated care.

RFK Jr. has openly discussed his struggles with addiction, particularly with heroin and other substances during his younger years. As a member of the prominent Kennedy family, his challenges with substance abuse reflect both personal struggles and the broader issue of addiction in society. He has also shared his battles with neurological and autoimmune conditions, including spasmodic dysphonia, a rare disorder that affects the voice and is linked to the nervous system. [Spasmodic dysphonia is a voice disorder. It causes involuntary spasms in the muscles of the voice box or larynx. This causes the voice to break and have a tight, strained, or strangled sound. Spasmodic dysphonia can cause problems ranging from trouble saying a word or two to being not able to talk at all.] His health struggles exemplify how chronic conditions often carry significant mental and emotional burdens, including anxiety, depression, and stress. Without proper mental health care, these issues can exacerbate physical symptoms, hinder treatment adherence, and diminish quality of life.

This interplay between mind and body is well documented in medical research. According to the National Institute of Mental Health (NIMH), individuals with chronic physical illnesses are more likely to experience mental health disorders, and vice versa. For example, stress-related conditions can contribute to cardiovascular disease, while untreated depression can lead to poor management of diabetes and other chronic conditions. Despite this, mental health services remain underfunded and often inaccessible to those who need them most.

The healthcare system must recognize mental health as a fundamental part of the care continuum. This means integrating mental health screenings into primary care, ensuring parity in insurance coverage, and expanding access to behavioral health specialists in hospitals and community settings. Policymakers and healthcare leaders must also address the stigma surrounding mental health, which prevents many from seeking necessary care.

RFK Jr.’s experiences serve as a reminder that health is not merely the absence of disease but the presence of balance—physical, mental, and emotional. RFK Jr.’s experience with addiction highlights the struggles that many individuals, even those from privileged backgrounds, can face.

His story aligns with broader conversations about addiction being a disease rather than a moral failing, emphasizing the need for access to treatment and compassionate approaches to recovery. By prioritizing mental health within the broader healthcare framework (mainstreaming mental health), we can move toward a more holistic, patient-centered approach that benefits individuals and communities alike.

Let’s hope that RFK Jr. remembers his own mental health challenges as he creates his own legacy as the Secretary of the Department of Health and Human Services.