Top Considerations for Not-for-Profit Health Systems 2026
Navigating investment, innovation, and governance in a complex operating environment.
As we enter 2026, the outlook for not-for-profit health systems appears stable overall, with improvement expected in patient volumes and cash flow generation. However, elevated cost pressures, regulatory and political uncertainty, cybersecurity risk, and demographic headwinds continue to challenge health system leaders.
Investment markets add another layer of complexity. While macroeconomic conditions have remained resilient, concerns around labor market softening, tariff-related risks, elevated equity market concentration, and historically tight credit spreads persist.
In Top considerations for not-for-profit health systems in 2026, we outline key themes intended to support fiduciaries as they evaluate risks and opportunities across operating pools, healthcare innovation programs, governance models, and affiliated benefit and insurance plans.
We explore how health systems are approaching:
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Operating poolsManaging liquidity amid uncertainty, maintaining rebalancing discipline, and adapting equity and fixed income exposures in a changing rate and market concentration environment.
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Healthcare innovation
Evaluating artificial intelligence and other technologies as both clinical and financial return drivers, with a focus on scalability, valuation discipline, and governance. -
Governance
Aligning investment service models with operating challenges, including cost pressures, resource constraints, and potential M&A activity. -
Multi-portfolio considerations
Curated insights for defined benefit and defined contribution retirement plans, captive insurers, and provider-sponsored health plans.
As health systems move into 2026, stability is improving, but uncertainty around costs, policy, and markets remains elevated. That combination makes disciplined liquidity management, diversification, and governance more important than ever for preserving balance sheet strength.
2026 top considerations for healthcare systems
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As a partner to your portfolio, we look beyond any single perspective to pursue outcomes that address today’s investment challenges and, importantly, prepare our clients for the future. Our specialist healthcare team works alongside organizations in the elements of their investment program where we can truly add value, allowing organizations to focus on delivering high-quality care, developing innovative services and transforming healthcare in the communities they serve.
To discover how we partner with healthcare organizations, from research and advice to investment solutions including Alternatives, portfolio construction, and OCIO, contact one of our specialists.