The healthcare industry is experiencing a dramatic shift in key competencies with the advent of new incentives and requirements, and new skills are needed to engineer the merger of clinical and financial priorities. Leaders must delegate risk management, case management, and medical informatics, among other priorities, while staying on course with strategic goals. Thinner margins mean that CEOs must take an active role in maintaining a healthy balance sheet. Top executives need to broaden their capabilities and serve as a bridge between clinical and financial priorities. While chief executives must provide the vision, they must also cultivate their own financial expertise while helming an executive team that is flexible and innovative in the face of rapid change, and that keeps financial self-sufficiency at the top of the priority list.