Every year, Cedar brings together a group of senior healthcare finance leaders for our Financial Leadership Council — a unique community where some of the most experienced CFOs and revenue cycle executives in the country come together to speak honestly about what’s working, what’s breaking, and what comes next.
This year, we convened nearly 50 leaders from across the country. And if I had to summarize the mood in one phrase, it would be this: realism with resolve.
Everyone in the room recognizes how hard this moment is. Margins are shrinking, policy is volatile, and affordability has become the defining pressure point for patients and providers alike. Yet what struck me most was the shared sense of purpose. Despite all the headwinds, these leaders are not just trying to survive — they’re trying to build something better.
Here’s what we learned.
1. Leadership means embracing multiple truths at once
The leaders who are thriving in today’s environment aren’t choosing between compassion and discipline, or innovation and stewardship. They’re doing both.
Several CFOs spoke candidly about the pressures that make “either/or” thinking tempting — shrinking margins, increasing labor costs, and volatile payers. When the spreadsheets don’t balance, every decision feels zero-sum. But those finding a way forward are being explicit about those trade-offs, linking decisions back to mission, and aligning teams around shared values. As one leader put it, “long-term value follows values.”
Across the discussion, executives emphasized the need to manage competing realities instead of collapsing them into false choices: protecting margins and protecting people, automating workflows and strengthening human connection, investing in AI and supporting workforce stability. These aren’t opposing goals — they reinforce each other.
There was also a sense of cautious optimism about the economy. Many leaders viewed AI as a deflationary force, one that could improve efficiency and help build long-term financial sustainability. Attendees shared real-world examples, from using automation to free teams for higher-value work, to reinvesting savings in patient needs, and maintaining stability amid payer volatility and operational uncertainty.
The takeaway: meaningful progress isn’t about sweeping transformation. It’s about deliberate, measurable actions backed by leaders willing to take principled risks — because in this environment, standing still is the bigger gamble.
2. Success is being redefined — from transactions to trust
In the past, healthcare finance success was measured by metrics like cost to collect, denial rates, or revenue cycle efficiency. Those still matter. But the most forward-thinking systems are expanding the definition of success: how well do we connect patients to the care and resources they need?
Leaders described a clear shift in mindset: trust is the new currency in healthcare. Financial performance and patient experience are no longer separate conversations — they’re two sides of the same equation. When patients don’t understand their bills or lose trust in the system, they delay care, default on payments, and disengage entirely. That erodes both population health and financial stability.
One-third of Americans still avoid care because they can’t afford it, and the average cost of a family health insurance plan is now $27,000. Finance leaders see that as a business risk, not just a social one. Many are rebuilding trust through practical steps — simplifying statements, improving price transparency, and using digital communication to guide patients through complex coverage decisions.
Policy instability only heightens the urgency. With Medicaid changes on the horizon, leaders are no longer waiting for federal clarity — partnering with community organizations, investing in eligibility automation, and deploying tech to keep patients enrolled and connected. Incremental, tech-driven preparation has become a genuine competitive advantage.
AI is also reshaping the conversation. The question is no longer whether to use it, but how to use it responsibly. Several leaders described using agentic AI to assist staff and patients — for example, automating eligibility checks or suggesting next best actions — allowing teams to focus on high-impact, human interactions instead of administrative churn. It won’t be the best algorithm that wins, but the organizations that use AI and technology to bring trust back.
3. Affordability is now a growth strategy
Affordability used to be a patient-experience issue. Now it’s a strategic one. Since 2010, median household income has grown by about 22%, while deductibles have climbed more than 200%. For millions of Americans that fall into the ALICE population — Asset Limited, Income Constrained, Employed — one unexpected medical bill can destabilize everything.
Leaders spoke about affordability as a core driver of patient loyalty, system solvency, and long-term growth, calling for a paradigm shift: moving from systems that treat all patients the same to systems designed for individual realities.
This next chapter in healthcare finance is defined by navigation — anticipating barriers, offering alternate paths, and guiding patients toward affordable care before a crisis occurs. In this model, success depends on becoming a trusted guide, helping patients move through a complex system with empathy, accuracy, and proactive support.
Some systems are already building digital safety nets to prevent coverage loss before it happens — integrating Medicaid enrollment, financial counseling, and community support into front-end workflows. These efforts aren’t charity; they’re long-term investments in patient retention and community health.
The larger shift underway is toward what many called the Navigation Era of healthcare — one where the system doesn’t just react to affordability barriers but anticipates them, guiding patients toward sustainable care before crisis hits.
The bottom line
What I took away from this year’s Financial Leadership Council is that healthcare finance is entering a new chapter, one defined not by cost-cutting, but by connection.
The leaders who will thrive are those who can see both sides of every equation: mission and margin, empathy and efficiency, innovation and trust. They’re the ones building organizations that don’t just survive policy shifts and economic pressure, but use them as catalysts for progress.
If this year’s conversations are any indication, the future of healthcare finance won’t be decided by who can do more with less — it will be shaped by who can do more for people.
Author bio:
Florian Otto, MD, PhD, Co-founder and Chief Executive Officer, Cedar
An accomplished entrepreneur and former physician, Florian now drives growth and sets overall direction across all facets of Cedar’s operations. Prior to founding Cedar, Florian was an executive at Zocdoc where he drove the commercial adoption of the platform. Florian also founded a daily deal company in Brazil (ClubeUrbano) that was eventually acquired by Groupon. After the acquisition, he became Chief Executive Officer of Groupon Brazil, growing the company to one of Groupon’s top three international markets. Florian began his business career as a strategy consultant at McKinsey & Company within their healthcare practice. Florian holds a M.D., D.D.S. and PhD from the University of Freiburg, Germany.
Photo: Sergey Khakimullin, Getty Images
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