By Alexis Kayser

Healthcare Editor

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This is a preview of the May 21 edition of Access Health—Tap here to get this newsletter delivered straight to your inbox on Thursday mornings.

Good afternoon. CFOs are assuming a more strategic role in health system C-suites: advising on AI governance committees, forecasting the impact of Medicaid cuts, greenlighting more deals to gain safety through scale. And although we’ve been tracking that shift from bookkeeper to playmaker throughout the post-COVID years, finance leaders have been grappling with a newfound urgency throughout 2026.

Read More on Access Health Newsletter

This morning, I connected with Joe Kight, head of healthcare banking at U.S. Bank, to discuss the company’s new CFO Insights Report. Published earlier this month, the cross-industry survey included a sample of 120 health care finance leaders at companies generating at least $50 million in revenue.

The results were not surprising to Kight, who connects with health care treasurers, CFOs and CEOs day in and day out.

These leaders and their organizations “are being asked to modernize the future of health care while still managing through one of the most financially complex operating environments the industry has had in years,” he said.

“Coming out of COVID, it was really about cost management,” Kight continued. “It’s become more about transformation management.”

Exhibit A: Health care finance leaders ranked digital transformation as their second-highest priority in the U.S. Bank survey, coming in at 38 percent (10 percentage points higher than the scores for other industries). But 67 percent said that calculating the ROI of AI investments is “very challenging.”

Industry finance chiefs are tracking ROI on about 40 percent of AI implementations, and of those, only about 42 percent are generating a positive return.

Digital transformation is slow-moving and relatively opaque, but as health systems are pressured to become more efficient—from consumers, boards, workforces and even the federal government—they don’t have the avenue to opt out.

That’s one reason why mergers and acquisitions are on the rise, Kight said. Sixty-four percent of health care finance leaders say they are more likely to make acquisitions in the next 12 months—a higher share than in any other industry. At the same time, many health care organizations are also evaluating portfolio reshuffling strategies. Respondents expressed strong interest in bolt-on acquisitions and divestitures, with 57 percent and 56 percent, respectively, saying they’re likely to make those moves this year.

“The technology cost to do this modernization, to drive this efficiency, it's fairly significant,” Kight said, “and you need that scale to absorb those costs.”

We’ve seen more health system M&A in the past two years than in the previous 10, according to Kight, and it’s expected to keep going up.

Now, for a bit of good news. Despite the punishing conditions, more than three in five health care finance leaders maintain a positive three-year economic outlook—an optimism rate five percentage points higher than in the other industries U.S. Bank surveyed.

“The organizations that will thrive over the next five years will frankly be the ones that modernize their operations while preserving financial flexibility,” Kight said.

Read on to the Pulse Check section for more of our interview. And, as always, email your thoughts on today’s news to a.kayser@newsweek.com.

In Other News

Major health care headlines from the week

• CMS proposed **a major overhaul of Medicaid payment practices yesterday—**arguing that some state financing arrangements have pushed provider payments far above Medicare rates while shifting more costs onto federal taxpayers.

  • The agency says the proposed rule could save more than $775 billion over 10 years, including $510 billion in federal savings, by capping certain Medicaid managed care and fee-for-service payments closer to Medicare benchmarks.
  • The proposal targets state-directed payments (SDPs). CMS argues that these arrangements, often paired with provider taxes and intergovernmental transfers, have enabled states to draw down more federal Medicaid dollars without equivalent state spending—what Administrator Dr. Mehmet Oz called “misaligned payment incentives and opaque financing arrangements” in the May 20 news release.
  • CMS says SDP spending has expanded rapidly, growing from two states using the model in 2016 to 41 states today, with annual spending projected to nearly triple to $296 billion by 2034 if left unchecked.
  • Under the proposal, payment rates would generally be capped at 100 percent of Medicare rates in Medicaid expansion states and 110 percent in non-expansion states, while also introducing new national transparency and accountability standards.
  • CMS is seeking public comment on the proposed rule and its implementation. Read more here.

• Qualtrics acquired Press Ganey Forsta for $6.75 billion on Monday.

  • The deal created what Qualtrics is calling the “world's largest AI dataset for human experiential context ever assembled.”
  • Press Ganey’s measurement systems are used by more than 41,000 health care facilities. Qualtrics believes that by adding that dataset to its own, it can create AI systems that target the “experience gap,” or the gap between what consumers expect and what companies, realistically, can deliver.
  • “Nowhere is the experience gap more consequential than in health care,” said Qualtrics CEO Jason Maynard.

• Mark Cuban’s Cost Plus Drugs is partnering with TrumpRx, adding more than 500 generic drugs to the government's website.

  • Cuban joined Trump at the White House for Monday’s announcement, alongside officials from Amazon Pharmacy and GoodRx, who are also contributing to the platform. The partners said they are committed to lowering drug prices for consumers, and intend for this action to move the needle.
  • The Ozempic and Wegovy pills will be added to TrumpRx, along with the cholesterol medication atorvastatin, the blood thinner clopidogrel, high blood pressure treatment lisinopril and diabetes medication metformin. Various insulin injectors, migraine medications and asthma inhalers were also on the list.
  • Get the full story at Newsweek.

• Prior authorization requirements remain highly fragmented across major commercial insurers—with little consistency in which services require approval or what documentation is needed—according to a new research letter published in the Annals of Internal Medicine and covered by the AJMC.

  • Researchers analyzed public provider manuals from Aetna, Humana and UnitedHealthcare and found no overlap in the criteria insurers used to trigger or approve prior authorizations.
  • The variation was especially stark for medical and surgical services. Aetna relied on far fewer review criteria than UnitedHealthcare, while requirements like site-of-service reviews differed dramatically between payers. Aetna required them for more than 200 services, compared with just 11 for Humana and 33 for UnitedHealthcare.
  • While insurers have pledged to simplify electronic prior authorization workflows, the study found no evidence of broader standardization efforts across payers, and authors argued the “unexplained variation” in requirements deserves further scrutiny.

Pulse Check

Executive perspectives on key industry issues

...

Here’s a closer look at my discussion with Joe Kight, head of healthcare banking at U.S. Bank.

Editor’s Note: Responses have been lightly edited for length and clarity.

What stood out to you the most from this spring’s CFO Insights Report?

This is a really unique report for us. We've been doing it for a number of years now, so it's interesting to manage the trend lines and see what's changing from year to year.

I spend a lot of my time traveling the country, talking with CFOs, treasurers and CEOs, and the information that came out of the report is very similar to what I'm hearing out in the marketplace today.

One of the bigger things that I've seen is, today, [finance leaders and organizations] are being asked to modernize the future of health care while still managing through one of the most financially complex operating environments the industry has had in years. Coming out of COVID, it was really about cost management. It's become more about transformation management.

You see that coming through in the report—we're pulling a lot of data around [questions like,] how do you embed AI? How do you separate AI productivity from AI hype? How do you work through payment modernization?

And then there's this whole theme around M&A. Scale really matters. We're seeing that the technology cost to do this modernization, to drive this efficiency, is fairly significant. You need that scale to absorb those costs.

So, the report is telling us that health care is the leading industry in terms of evaluating M&A. And if we just talked specifically about the health care systems, that is absolutely correct. We're seeing many more partnerships—or outright mergers and acquisitions—come together to drive efficiencies, [to give these health systems] the ability to absorb some of these modernization and technology costs.

This is a very difficult reimbursement environment today, and on top of that, 2027 is coming with a whole host of legislative changes. Against that backdrop, you're seeing a lot of systems evaluate, “How do we better spread our fixed costs around?”

Which assets are actually generating the most interest right now on the M&A side?

There's definitely a realization that health care is becoming more ecosystem-driven. No organization can solve every operational and technological challenge alone.

It's no secret that health systems are building more ambulatory/outpatient centers. That is a very real trend [as systems are] trying to provide the best care they can in the best channel possible, whether that's the lowest-cost channel or just the channel that's most appropriate for that particular patient.

You're also seeing health care leaders look for partners that can help them operate more efficiently. From a banking perspective, banks are not just trying to provide capital anymore. [We are] really shifting to help [health care organizations] through that modernization, through rethinking this technology change that they're going through right now.

That’s where you're seeing a lot of these health systems start to look at mid-sized or smaller systems. Maybe they pick up certain doctor groups or physician practice management groups that align with existing specialties in their broader build out. From a geography perspective, you're also seeing areas where there are obviously tailwinds from a demographic shift.

We've seen more M&A in health systems in the last two years than we had seen in the previous 10 years.

You mentioned that technology is driving this need for partnership. Has the urgency around modernization picked up over the past year, or has it been a consistent slow burn?

During the COVID years, health systems really focused on stabilization. Obviously during that period, health systems saw labor costs skyrocket. That's one of their biggest margin pressures, and that comes through in our survey as well. Labor costs—and how they are spread—are front and center all the time. They show up in every conversation that I’m having.

So this modernization is really a byproduct of the health systems stabilizing through COVID. They're obviously trying to focus on the reimbursement environment, trying to better understand the legislative changes that are coming through in 2027. And you've also seen the rise of some very big EHR platforms that are moving the needle in the marketplace. They're very expensive build-outs, but they drive quite a bit of efficiency through those health care organizations.

When you've got an environment where the health system feels stabilized, but labor costs are elevated—they're not rising as much as they did, but they are not coming down either —they're absolutely seeing that margin pressure. The byproduct of that is this huge focus on creating efficiencies through modernization.

There is an expectation now from patients that they have the same sort of experience when they're interfacing with the with the health care systems that they have when using Uber or DoorDash. Trying to meet the patient's expectations around a great experience—from when they walk in the door, to the care they receive, to how their billing is handled—has absolutely taken center stage. It's trying to reduce checks. It’s trying to create a system that doesn't just provide you data, but actually creates information that you can make decisions on; there are so many transactions and moving parts within health systems that you can have a lot of data, but no information.

It’s not just payment or treasury modernization; it's also [about] examining their liquidity, because in health care today, liquidity equals flexibility. Organizations with stronger cash flow are simply better positioned to invest, recruit and adapt.

The report also found that more than half of health care finance leaders are eyeing divestitures. What sorts of assets are they shedding, or planning to shed?

For a lot of health systems that explore divestitures, it's really examining [whether an asset] fits in their core competencies. If it's not something that they think they can scale and really be meaningful at, they're absolutely going to explore that [divestiture] so that they can reinvest into the core business.

There was a time when a lot of the health systems were trying to stand up their own health plans, and you've seen a little bit of retracement on that. You have to have fairly large scale to make that business work, and if you don't have that scale, if you don't have the ability to spread those costs around, they become very costly to you.

It's a good practice for leaders to make sure that they're not just chasing growth for the sake of growth. Pre-COVID, the reimbursement pressures weren’t as relevant as they are today. You could chase growth, and you could really just try to expand.

COVID made it clear that health systems need to be very efficient at what they do. And now, with the rise of technology post-pandemic, all of these health systems are taking a look at their portfolio of offerings and trying to decide what really works for them.

Looking ahead to the next 12 to 24 months, which types of organizations do you expect to be the most financially resilient? What are they doing differently?

The ones that are really thinking about liquidity, creating flexibility around their capital structure, having a robust set of people within the organization that are examining, “Do we have the right capital stack today to create the most amount of flexibility going forward?”

The organizations that are taking the most proactive approach to liquidity management and have the wherewithal to embrace the technology changes—taking an aggressive approach to modernizing their end-to-end treasury platforms to help protect margins and remain financially strong—are the ones that are going to be very well-positioned in the future.

Health systems have a lot of fixed costs, and when you have a structure [like that,] scale really matters. You have to be able to spread those fixed costs around. Otherwise you're going to continue to see increasing margin pressures.

Nonprofit systems focused on delivering the best possible patient care still have to operate as sophisticated financial entities, and they have embraced the rigors around that.

These health systems are not publicly traded companies reporting quarterly earnings, but they still have to demonstrate financial viability. Many of the rating agencies are constantly looking at health systems’ leverage profiles and overall financial standing.

We’ve absolutely seen borrowing costs show up as a focal point in our survey. The 10-year Treasury is trading around 4.4 percent today—higher than many expected. At the same time, there’s ongoing debate around whether the Fed will cut or increase rates, while inflation remains very sticky. Energy costs are still elevated, and there’s the added backdrop of geopolitical risk.

Then you pile on AI, which is one of those areas where [finance leaders] have to separate productivity from hype and make sure they’re not chasing something that could be obsolete in 12 to 24 months. It’s changing that rapidly. I have a lot of people ask me, “Joe, can you tell us what the bank is doing with AI? What are you seeing in the industry? Which areas have the most momentum?” It varies, and the answer today may be different from the answer tomorrow.

I would argue that in one of the most financially-complex environments that they can operate through, flexibility absolutely is going to matter. And I think health care finance has become one of the most strategic seats in the C-suite. They have to use as much information as they can to make decisions that are difficult at best.

I've heard that a lot from chief digital and technology officers, too. What used to be a three-to-five-year plan might now be a one-to-two-year plan at most, because it's difficult to look further into the future given the pace of tech evolution. Is that something you're hearing from the CFO side as well?

Yeah, absolutely. There's great reason to pay attention to it, because they're frankly being asked by many of their stakeholders, all the time, “What are you doing, what are you seeing, what are you hearing?”

And they are, as an industry, trying to get their arms around what's really going to move the needle. Obviously, the early adoption pieces are going to be around chatbots, ambient listening in the clinician rooms to create better quality of life. But getting into modernizing the workflows, driving efficiencies...that used to take maybe four to six people to do. Now, maybe you could do it through AI, and that's very much in focus right now.

Technology is changing so rapidly that all organizations are trying to figure out where the puck is going, not where the puck is at today.

C-Suite Shuffles

Where health care leaders are coming and going

• Health Secretary Robert F. Kennedy Jr. has fired the co-chairs of the U.S. Preventive Services Task Force, Axios reported on Wednesday.

  • Kennedy told the two leaders—Dr. John Wong, a professor and primary care physician at Tufts University, and Dr. Esa Davis, a professor and family medicine physician at the University of Maryland—that their appointments would be terminated immediately, in letters dated May 11.
  • The letters said that the decision was not related to performance, but was a “step to help protect the Task Force and preserve confidence in the continuity and durability of its work.”
  • HHS postponed the last several meetings of the Task Force, according to Axios. There are currently eight active members on the panel.

• Shakeeb Akhter is the new chief digital officer at Memorial Sloan Kettering Cancer Center, based in New York City.

  • He joins the cancer center from Children’s Hospital of Philadelphia, where he served as chief digital and information officer.

• The American Medical Association tapped Dr. John Wigneswaran as chief operating officer, effective June 1.

  • Wigneswaran, known as “Dr. Wig,” has an extensive resume with experience at some of the largest health care companies in the nation. Most recently, he was the chief clinical officer at UnitedHealth Group, serving from June 2024 until this month.
  • Dr. Wig previously held the chief medical officer titles at Walmart, Express Scripts and DaVita Kidney Care. He currently serves on the boards of the American Diabetes Association, the National Kidney Foundation and the Milken Institute, according to his LinkedIn profile.

This is a preview of the May 21 edition of Access Health—Tap here to get this newsletter delivered straight to your inbox on Thursday mornings.

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