Healthcare chief financial officers often say they are expected to be substantially involved in a broad range of enterprise decision-making, though many don’t believe they are appropriately equipped to contribute, according to a new Deloitte Center for Health Solutions survey report.
Issues in the realm of consumer affordability, access and patient experience strategy, for instance, are the chief examples of what Deloitte describes in its report as a CFO readiness gap. On these, 74% of surveyed CFOs said they are expected to be regularly or heavily involved, but only 41% of CFOs said they were well equipped to do so.
Similarly, three-quarters said they are expected to weigh in on mergers and acquisition-related decisions, but only 44% said they’re ready. Regarding care model transformations, 72% are expected to be involved, though only 47% feel appropriately equipped for the challenge.
These polled decision areas with the largest readiness gaps are among “the most consequential” that systems and plans are facing in the current healthcare landscape, Deloitte’s analysts noted in the report. They also land as CFOs reported both optimism and concern over margin improvement and pressures for the coming years.
“As financial pressure intensifies across the healthcare sector, decisions once viewed primarily through clinical, operational, or strategic lenses now can carry more direct economic implications, expanding the role finance is expected to play,” Deloitte analysts wrote in their report. “The readiness gap may, at its core, be a design gap: expectations for CFOs may have broadened beyond the organizational systems built to support them, leaving finance leaders expected to influence enterprise decisions faster than the surrounding infrastructure can evolve.”
Deloitte’s annual CFO survey reached 64 finance leaders at medium-to-large healthcare organizations, half of which were health systems ($1 billion revenue and up) and the other half health plans (500,000 or more members). Its other queried areas of enterprise decision-making included compliance governance (81% expected to weigh in, 59% well equipped to do so), enterprise strategy and long-term planning (72% and 50%), operating model and cost structure design (74% and 55%) and technology transformation (64% and 48%).
The report’s authors noted that many of the decision areas with the largest reported readiness gaps tend to involve major tradeoffs for an organization and cross-domain balance of different outcomes and priorities. CFOs are generally well positioned to connect those dots for their organization, they wrote, but getting finance leaders to that point will likely require structural changes.
“Many finance functions may have been built for a narrower remit, with data environments, reporting structures and operating models that predate the CFO’s expanded enterprise role,” the report reads. “Without corresponding changes to those systems, finance leaders may need to shape enterprise decisions without the information and support needed to influence them.”
To tackle the issue, Deloitte’s analysts suggested organizations redesign their finance operating models to focus on value creation, rather than simply providing functional oversight; create a decision-making infrastructure that gives finance leaders a more integrated view of the enterprise; and bolster governance to better reflect the areas in which finance is leading, co-owning, advising or challenging enterprise decisions.
Results from the annual survey were split into separate reports, which tackled margin expectations and AI investment alongside the issue of decision-making readiness.
On margins, nearly three in five respondents said their organization is aiming for two percentage points or greater margin improvement over the next two years. At the same time, 47% of respondents didn’t believe their organization is prepared to face the external and internal challenges that could pressure their performance—a “meaningful disconnect” between ambition and reality that Deloitte said will come down to top-to-bottom execution.
For AI, Deloitte found that 44% of CFOs considered to be “AI scalers” due to their broader deployment of the technology. Three-quarters of this group said they plan to increase investment in gen AI and agentic AI over the next 12 months, compared to 67% who haven’t met that level of adoption.
At the same time, just 18% of AI scalers said they are seeing mature financial attribution (consistent measurement of AI’s financial impact), compared with 31% of earlier-stage organizations. Still, AI scalers more often reported an expectation that the investments would break even within five years, more often expect higher revenue growth and more often estimated at least 5% annualized cost savings from their investments within one to two years.
“Investment is scaling and confidence in payback seems high. The focus now appears to be moving from adoption to accountability,” Deloitte wrote.