Alexandra Criscione, Director, BDC Advisors If you are a health system CFO, you are likely being asked a harder question than you were five years ago. Not simply: “Can we get the payer renewal done?” But: “Will this renewal sustain the enterprise?” That is a different question. And it requires a different way of thinking. For years, traditional renewal strategies assumed a relatively stable environment: predictable labor costs, manageable inflation, modest annual rate movemen

Peter Attwater, Managing Director Health systems continue to pursue mergers, acquisitions, and member substitutions to expand access, enhance capabilities, and achieve scale that reduces administrative and fixed costs. While organizations devote substantial effort to evaluating potential partners, conducting due diligence, and preparing for Day 1, far fewer apply the same level of discipline to what happens afterward. In our work across the country, we see a common pattern: o

Shawn Fitzgibbon, Managing Director, BDC Advisors 2026 is shaping up to be one of the most financially volatile years health systems have faced in over a decade. A convergence of policy changes, enrollment disruption, and rising employer-sponsored insurance costs is poised to materially increase revenue risk, bad debt, and patient affordability challenges — often faster than organizations can react. For health system leaders, the question is no longer whether these pressures

Peter Attwater, Managing Director AMCs are at a pivotal moment in their evolution. To sustain their tripartite mission of clinical care, research, and education, leaders must proactively embrace mergers and acquisitions as a strategic necessity. It is essential to move beyond traditional growth models and recognize that M&A offers a faster, more cost-effective path to expanding capacity, protecting academic and research missions, and reinforcing the safety net for vulnerable

Alexandra Criscione, Director Jamie Hanrahan, Principal Health systems often assume that owning a health plan will automatically drive margin, market control, or population health success. But the truth is more complex. A provider-sponsored health plan can be a powerful strategic lever or a costly distraction, depending on how clearly it’s aligned with health system goals. Why This Matters Now Healthcare margins are thin, payers are consolidating, and capital is scarce. Every