Strategizing for 2026: What Health System Leaders Need to Know

Healthcare finance is at a critical crossroads. Rising patient responsibility dollars, evolving payer landscapes, and sustained pressure on operating margins are forcing health systems to rethink long-standing approaches to revenue risk. Patient payments now represent one of the most unpredictable components of hospital revenue, and traditional collection models are struggling to keep pace with changing patient expectations, complex legislation, and financial realities. As leaders look ahead, an important question emerges: what will financial success look like in 2026, and what steps must health systems take today to protect cash flow while maintaining access to care? This post explores the key trends affecting patient payments, the escalating impact of bad debt, and how solutions like BridgeMed can help health systems navigate this shifting terrain with greater confidence and financial stability.

The Shifting Landscape: Patient Responsibility Continues to Grow

Over the last decade, patient financial responsibility has increased steadily. High-deductible health plans, ongoing insurance churn, and increased out-of-pocket exposure are driving self-pay balances higher and making traditional revenue cycle approaches less effective. 

Industry data underscores the magnitude of this change. Patient balances after insurance have increased significantly in recent years, with high-balance accounts exceeding $7,500 nearly tripling between 2018 and 2022¹. True self-pay collection rates remain extremely low, as nearly 94% of true self-pay balances are ultimately categorized as bad debt or charity care². Hospitals collect only about 15 cents on the dollar for patient debts older than 120 days, while the cost to collect from patients is nearly four times higher than the cost of collecting from insurers.

Together, these trends are doing more than squeezing operating margins. They are increasing accounts receivable days, straining liquidity, and forcing health systems to reevaluate how they manage patient payment risk.

Bad Debt is a Growing Line Item on Hospital Financials

Bad debt, once viewed as a manageable portion of uncompensated care, is rising and posing a growing threat to the financial stability of many health systems.

Recent reporting shows that bad debt as a percentage of gross revenue has increased year over year, with median hospital bad debt growth approaching 2.9% in recent analyses³. Uncompensated care, which includes both bad debt and charity care, has created a substantial financial burden for hospitals, totaling more than $745 billion since 2000².

Patient behavior is also contributing to these challenges. Many patients delay or fail to pay due to confusion over medical bills or an inability to afford care, with 54% of patients reporting that they were surprised by the amount they owed².

These pressures are not theoretical or temporary. They directly affect daily cash flow, reduce forecasting accuracy, and elevate the importance of patient payment strategy in board-level financial planning.

Preparing for 2026: Provider Priorities

As health systems look ahead to 2026, several primacies are emerging as critical to financial sustainability.

1. Focus on Predictable Cash Flow

Margin pressure has made revenue volatility increasingly difficult to absorb. Many organizations are shifting their focus from gross patient accounts receivable to realized cash. Strategies that convert patient responsibility into guaranteed payment upfront can help stabilize financial performance and reduce reliance on uncertain collections.

2. Engage Patients Earlier in the Financial Journey

Financial engagement that begins before or at the point of care leads to better outcomes for both patients and providers. Identifying affordability challenges early allows health systems to offer clear, realistic payment options while balances are still manageable.

3. Expand Patient-Friendly Payment Options

Patients want flexibility, transparency, and affordability. Research shows that while a majority of patient balances remain uncollected, most providers still rely on internal payment plans that have high failure rates and require significant staff resources. Third-party financing options that are simple and patient-centric can improve payment rates without increasing administrative burden.

4. Shift Risk Rather Than Absorb It

Traditional payment plans keep the risk of nonpayment on the provider’s balance sheet. As patient responsibility continues to grow, more organizations are exploring non-recourse financing models that transfer repayment risk to a third party while ensuring patients are treated fairly.

Patient Payment Plans that Support Financial Resiliency 

BridgeMed’s non-recourse, interest-free financing model is designed to help health systems stabilize cash flow without shifting financial burden to patients or retaining repayment risk. Patients pay no interest and face no fees or penalties, removing common barriers to participation and supporting a more equitable financial experience.

For health systems, BridgeMed provides true non-recourse protection. All patients that apply are approved, and once enrolled, the provider receives payment within 48 hours–regardless of whether the patient completes repayment. BridgeMed assumes full repayment risk, which eliminates write-offs tied to patient default and improves revenue predictability.

This model also reduces operational complexity. Health systems are not required to manage ongoing payment plans, track patient repayments, or allocate staff time to collections related to financed balances. As a result, revenue cycle teams can focus on core priorities while improving overall financial performance.

The BridgeMed solution aligns financial stability with patient-centered care. Health systems can secure revenue at or near the time of service while offering patients a transparent, digitally-driven way to pay. As patient responsibility continues to grow, this balance will be essential for organizations preparing for the financial realities of 2026.

Building a Strong 2026 Revenue Strategy

The financial challenges facing health systems are unlikely to ease in 2026. Patient responsibility is expected to continue rising, and organizations that rely solely on traditional billing and collection methods will face mounting financial risk and greater revenue volatility.

Leaders who act now can reduce exposure to bad debt, strengthen cash flow predictability, and improve the patient financial experience at the same time. Interest-free, non-recourse financing solutions like BridgeMed provide a clear path forward by allowing health systems to secure revenue while offering patients transparent and affordable ways to pay.

Preparing for 2026 requires more than incremental changes. It demands a fundamental shift in how patient balances are managed and how financial risk is addressed across the organization.

Discover how BridgeMed can benefit both your patients and your healthcare organization with flexible, digitally-driven payment programs at www.mybridgemed.com.