Insights

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We’ve just wrapped up our Strategy Catalyst Summit, where we had the pleasure of seeing more than 75 of our members in person for two days of networking and high-level strategic discussion. Stay tuned for a summary of our favorite insights in a future edition.

• The American Medical Association is replacing bundled maternity payments with a new set of itemized codes, a change that will shift reimbursement from cost-conscious delivery units to more comprehensive outpatient services.

  • Medicaid will likely adopt the changes first, impacting rural and safety-net providers. Many commercial plans might continue to use value-based bundled payments.

  • Redirecting reimbursement to OB specialists and supplemental services could improve the workforce pipeline in the long term, but the new codes will also create new administrative burdens for these providers.

• We’ve assembled an expert panel of health system strategy leaders to help set our research agenda and supplement our insights throughout the year. To introduce our CSO Advisory Council, we asked each of them to talk about “what keeps them up at night” in their role.

  • Answers included state and federal policy changes, the rapid pace of technological change, modernizing core platforms, and separating the signal from the noise.

• Our featured graphic showcases the results of a THMA survey that asked senior executives across a variety of roles about their health system’s access strategy.

  • The vast majority of systems are investing in telehealth and centralized scheduling. Fewer systems are investing in self-service portals, and less than half of systems say they’re modernizing contact centers—possibly due to cost constraints.

• This week’s research recap looks at our favorite insights from two recent case studies detailing how health systems can leverage consumer segmentation to achieve operating model discipline.

  • Behavioral research can often uncover critical gaps between clinical assumptions and real patient perspectives.

  • Turning consumer insights into differentiated service offerings can unlock new levels of operational efficiency and patient engagement.

  • Segmentation needs to be embedded in governance, infrastructure, and multi-year strategy to maximize effectiveness.

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In this episode, we share highlights from a recent Strategy Catalyst webinar where Liz Jones, Research Director, walked strategy leaders through three disruptors reshaping service lines in 2026 and tested a few intentionally provocative predictions. We cover why payvider M&A slowdowns don't mean reduced threat, what the PE retreat from care delivery means for acquisition timing, and why distributors—the disruptor that worried this group least—might deserve more attention.

Want to hear the full discussion, including the polls and live Q&A? Access the complete webinar recording on our website here. And for a deeper dive on the Cencora-One Oncology deal referenced in this episode, read our analysis in The Strategist here and check out our disruptor response guide here.

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• Humana closed its acquisition of the Florida-based primary care chain MaxHealth, one of the largest such deals since CVS’s purchase of Oak Street Health in 2023.

  • With MA reimbursement falling behind utilization trends, payviders like Humana and UnitedHealth are leaning further into owned provider assets that might steer downstream volumes away from health systems in competitive markets.

  • If health systems don’t acquire the care delivery assets that private equity firms are looking to unload, payers might swoop in instead.

• The Trump administration is appealing a federal court ruling that struck down a Biden-era regulation expanding what merging companies need to disclose to the FTC.

  • The appeal signals that the more aggressive antitrust posture that began under the previous administration still retains some bipartisan support.

  • If the new merger rules are rolled back, a more permissive legal environment for M&A could give growing health systems and financially distressed hospitals more strategic options.

  • Larger health systems tend to attract more media and antitrust scrutiny, but they also have cheaper access to capital for strategic transformation.

• In a 6-3 ruling, the Supreme Court struck down President Trump’s sweeping emergency tariff rates. This week’s featured graphic breaks down the alternative legal authorities that the administration is drawing on to replace them with new tariffs.

• CMS unveiled surprisingly low rates for its new ACCESS model, a voluntary alternative payment model for chronic conditions like high blood pressure, diabetes, and depression.

  • Third-party analysts say the ACCESS rates are significantly lower than the equivalent fee-for-service rates under traditional Medicare, spurring speculation that the new model will only be feasible for startups that replace human clinicians with AI-guided care.

• CVS launched a new GLP-1 drug access service that lets employers decide how much they want to subsidize out-of-pocket costs for their employees.

  • High prescription drug costs remain a top employer concern, and health systems with provider-sponsored commercial plans should consider matching similar features.

  • Health system-sponsored weight management programs might not be able to compete on cost with virtual-only alternatives pushed by payers.

Listen to the episode on a streaming platform by clicking one of the links below:

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• The Trump administration is scrapping its proposed 340B rebate pilot just weeks after a federal court issued a temporary block on procedural grounds.

  • If the administration revives the pilot, it has agreed to go through a new rulemaking process with advance notice and public comment.

• This edition’s Key Market Dive looks at the latest quarterly and full-year earnings reports across the healthcare sector.

  • HCA’s strong results showcase not only its ability to leverage scale to control costs, but also its disciplined approach to capital spending and systemness.

  • Payers with exposure to MA like UnitedHealth and Elevance continue to face a mismatch between utilization and reimbursement trends, while commercially focused payers with value-based capabilities like Cigna are thriving.

  • Amazon’s plan to spend nearly $200B of its capital on AI-related investments is spooking investors, but the company might be able to find further synergies with its healthcare segment.

• Payer stocks plummeted more than 20% after CMS gave notice that next year’s MA rate increase will be essentially flat.

  • The agency is also moving to exclude chart reviews without follow-up care from their risk adjustment model. For-profit plans that effectively gamed the system will face a larger hit to their revenues.

  • Health systems might prefer to work with the regional nonprofits and BCBS plans that are now taking market share from the national for-profits. But the changes could also shutter provider-sponsored plans that can’t absorb a margin hit in the current environment.

• ChenMed is no longer widely prescribing GLP-1 medications to its members for weight loss, citing unintended side effects like muscle loss and increased falls.

  • ChenMed’s focus on a single patient type—seniors on MA—allows them to tailor their approach and make a more compelling value-based pitch to payers.

  • Health system-sponsored weight management programs might consider similar moves, but a shift away from GLP-1s might disappoint younger consumers who specifically join these programs to obtain prescriptions.

• MSK disruptor Sword Health is acquiring rival Kaia Health in a $285M deal that will consolidate their customer bases.

  • In addition to greater scale, the acquisition might help Sword care for patients with a wider range of conditions, making their app-enabled service more attractive to employers.

• This week’s featured graphic takes a comprehensive look at contract disputes between payers and providers that spill out into public view.

  • Unsustainable economics and eroding negotiating leverage are making private compromises harder to reach, leaving patients in limbo for weeks, months, or even years.

In today's environment, volatility is the norm. Health systems face margin fragility, rising expenses, consumer affordability challenges, policy disruptions, payer retrenchment, and rapid site-of-care shifts that are reshaping strategic footing. This session unpacks those pressures — helping you understand the assumptions health systems are rethinking. We then focus on the levers that will define health system success, including asset-light growth models, operational efficiency that unlocks capacity and revenue, and workforce modernization aligned with AI-enabled productivity. Grounded in the latest Academy data, member conversations, and market sensing, this session equips you with a sharper read on where health systems are headed in 2026 and how to align your commercial strategy accordingly.

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Capacity constraints and reimbursement pressures are pushing health systems to question long-held assumptions about how access should be designed and delivered. In this Strategy Catalyst roundtable, leaders from Cleveland Clinic and Inova Health shared how their organizations are re-envisioning what "right level, right place, and right time" actually looks like in practice.

Building on our Access as a Strategic Product research series, this session featured Dr. Marianne Sumego, Director of Shared Medical Appointments at Cleveland Clinic, and Michelle Vassallo, Vice President of Clinical Operations at Inova Health. Both leaders presented their organizations' access initiatives and discussed how they've worked to unlock capacity without adding headcount, get buy-in from skeptical providers and leadership, prove value when ROI is hard to quantify, and sustain momentum over time.

The conversation also explored how systems can leverage what they already have in place, how to persevere when access work takes years to build, and what's next on the horizon as reimbursement rules and patient expectations continue to shift. Attendees had the opportunity to ask questions and share their own access challenges with the panelists and peer leaders.

Volatility has become a defining characteristic of the healthcare landscape. Health systems are navigating margin fragility, rising expenses, consumer affordability challenges, policy disruption, payer retrenchment, and rapid site-of-care shifts that are reshaping strategic footing across the industry.

This session explores what organizational resilience looks like in this new reality—and how leaders can move beyond reactive cost management toward a more durable model of competitiveness. The discussion centers on the strategic and operational levers that are redefining success in a highly disrupted market.

Grounded in the latest Academy data and industry insights, this session equips executives to make disciplined, high-impact strategic choices that align growth, operations, and workforce transformation around a cohesive vision.

The central takeaway: resilience is no longer about weathering disruption—it is about using disruption as a catalyst for reinvention. Organizations that embrace this mindset are better positioned to lead in 2026 and beyond.

Nursing executives are navigating unprecedented workforce complexity: persistent talent shortages, intensifying margin pressure, and the critical need to balance workforce flexibility with financial viability. Staffing challenges and premium labor costs rank among the top five priorities for nursing leaders, alongside increasing difficulty maintaining competitive employer status. Finance leaders reinforce this urgency—over 90% identify cost containment as their primary focus, while 73% are actively planning reductions in travel nurse expenditures.

The imperative is unmistakable: CNOs are positioned to champion internal workforce optimization through strategic improvements in efficiency, productivity, and engagement.

This session combines data-driven insights from The Health Management Academy with practical CNO expertise to examine the workforce imperatives that will shape health systems in 2026:

• Strategies to close critical staffing gaps

• Changing perspectives on agency relationships

• Competitive employer positioning in today's market

• Approaches to margin management and cost optimization

For the full deck, click here.

Speakers

• Scott Estep, MBOE, RN, CSSBB, System Vice President, Nursing Operations & Capacity Management, OhioHealth

• Jessica Potts, DNP, Vice President of Workforce Strategy and Operations, SSM Health

• Courtney Green, MSN, RN, NE-BC, Senior Vice President of Nurse & Staff, QGenda

• Naj Khan, Associate Director, The Health Management Academy