Article
The system CFO in 2035 will occupy one of the most consequential roles in any organization: a nexus of finance, operations, risk, and strategy. While historically the CFO was known primarily as the guardian of the ledger, the pressures of reimbursement compression, rising uninsured volumes, and out-of-network leakage demand that today’s CFO be much more. The question is no longer “How do we maintain margin?” but “How do we transform the enterprise?”
Between now and 2035, the CFO must evolve from back-office sentinel to chief integrator of mission and margin, balancing liquidity, growth, access, and resilience for the long view.
As reimbursement declines and cost pressures intensify, margin protection becomes an operational exercise. The CFO is being drawn into throughput, care site mix optimization, workforce productivity, supply chain redesign, and capacity alignment. In many systems, the CFO already acts as a de facto COO—particularly when finance leads operational initiatives.
The provocative thrust: Is the CFO of 2035 the architect of care delivery efficiency? If so, then CEOs must reexamine their assumptions about succession planning: perhaps the operator is not the only—or even the most natural—successor.
Traditionally, treasury is about preserving stability. In the future, it must be about creating optionality. Healthcare CFOs must deploy capital into new care models, digital platforms, joint ventures, ambulatory expansions, and social determinants partnerships. With capital cost rising and philanthropy plateauing, the CFO’s ability to manage debt, liquidity, and investment becomes a strategic differentiator.
The challenge: Can a CFO pivot from capital preservation to capital creation? Can they see the balance sheet not as constraint, but as a living instrument of growth?
The risk agenda in healthcare has shifted: no longer limited to downside protection, it must become a core engine of enterprise value. The modern CFO must fuse enterprise risk and strategic planning—anticipating payer disruptions, workforce exodus, cyber threats, denial risk, and macroeconomic shocks.
Key questions:
In this paradigm, the CFO becomes the chief risk architect—designing growth that embeds resilience.
By 2035, the CFO will need to shift from reacting to pressure, to anticipating disruption—shaping consumer access models, defining network dynamics, and enabling digital-first health systems. Their analytics, scenario modeling, and capital decisions will determine whether a system offsets external revenue erosion or falls behind.
As health systems seek diversification—retail clinics, risk-bearing contracts, tech-enabled care—the CFO’s voice moves from “balancer” to catalyst: guiding how the enterprise adapts.
If the CFO by 2035 is driving operational performance, shaping enterprise strategy, and managing cumulative risk, then the natural question is not “Can the CFO succeed the CEO?” but rather: “Why not?”
In a sector where financial literacy, systems thinking, and strategic agility define survival, the CFO may be uniquely positioned to lead the next transformation—perhaps even as CEO successor.
Between now and 2035, the evolving CFO must:
In 2035, the health system CFO will sit at the heart of mission and margin. The systems that succeed will be those where the CFO sees across silos – and leads decisively from that vantage.
Sarah Eames leads the Russell Reynolds Associates’ Global Healthcare Services practice. She is based in New York.
Amy Saddington leads the Russell Reynolds Associates’ Healthcare Services North America practice. She is based in Dallas.
Ben Grover is a senior member of Russell Reynolds Associate’s Healthcare Services practice. He is based in Chicago.
Tiffany Yam is a member of Russell Reynolds Associates’ Healthcare Commercial Strategy and Insights team. She is based in New York.
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