Insights
THMA's Weekly Essentials
Upcoming Events
Browse by Topics
Featured All-Access Insights
Podcasts
Priority Fog: The Gap Between Access Ambition and Execution
Listen to the episode on a streaming platform by clicking one of the links below:
THMA-Tegria research surveyed senior health system executives and interviewed Chief Financial Officers to understand how systems are defining, governing, and investing in access strategy. The headline finding: 82% now call access a strategic pillar, but most still can't solve basic appointment availability.
In this episode, Wes Adams, Managing Director of Industry Custom Services at THMA, walks us through where the alignment breaks down — from "priority fog" across the C-suite, to the fact that only 6% of systems involve finance in operationalizing access, to how tightening ROI timelines are reshaping where capital flows and where it doesn't.
Resources mentioned in this episode:
The Access-Driven Enterprise report from THMA and Tegria
THMA-Tegria webinar featuring executives from Emory, Sutter, and IU Health
Access as a Strategic Product case studies and webinar
Secret Shopping research webinars on urgent care and primary and specialty care access benchmarking
The Strategist in Brief: June 25, 2026
Listen to the episode on a streaming platform by clicking one of the links below:
The House Appropriations Committee voted unanimously to bar CMS from funding WISeR, its AI-enabled prior authorization pilot for traditional Medicare. But the model is still running in all six pilot states, and an identical defunding effort died last year.
While the defunding vote is meaningful, it’s unclear if the funding bill that the provision is attached to will become law. Other legislative efforts to stop the program via the Congressional Review Act are more likely to succeed.
Eli Lilly has followed through on threats to cut off 340B discount pricing for certain hospitals that won’t submit their underlying claims data, but the list of impacted providers is not public.
The drugmaker is targeting large health systems first, possibly to maximize publicity while limiting the impact on smaller and rural providers that garner more sympathy from policymakers.
AHA proposed a compromise that would create a federally-run clearinghouse for 340B data, but the idea hasn’t gained traction with Eli Lilly or HRSA. The federal agency’s efforts are likely focused instead on standing back up its proposed rebate pilot program that was halted by a federal court ruling in late December.
This week’s edition takes a special look at Nebraska Medicine’s National Quarantine Unit, which was recently used to monitor Americans exposed to hantavirus in a widely publicized cruise ship outbreak.
While the unit has also been used to handle patients exposed to Ebola and COVID, it went for nearly a decade without patients when it was first established in 2005. The program maintained executive support by reframing itself as a business continuity and workforce protection effort, not pandemic preparedness.
Nebraska Medicine’s experts work with other systems to assess their capabilities and right-size their preparedness rather than replicate the unit.
A new HHS OIG report found that the three largest Medicare Advantage insurers—UnitedHealth, Humana, and CVS Health—deny post-acute prior authorization requests far more often than peers.
CMS declined to commit to the report’s recommendations and has shown little appetite for heavy-handed regulation. On the other hand, the report could provide valuable evidence for an ongoing class-action lawsuit against UnitedHealth and bolster the case to lawmakers for reform.
The Strategist in Brief: June 11, 2026
Listen to the episode on a streaming platform by clicking one of the links below:
CMS is proposing broader caps on Medicaid state-directed payments—significantly broader than those outlined in last year’s budget reconciliation legislation—which would reduce federal healthcare spending by $510B over ten years.
The proposal would increase the financial impact of H.R. 1 (also known as OBBBA) by roughly one-third, forcing health systems to accelerate strategic plans to fill the financial hole with outpatient growth, AI savings, and other internal transformations.
Democratic lawmakers could try to reverse the cuts if they take control of Congress after the midterms, but advocacy efforts might be better targeted at the state level.
Discussions at a recent THMA forum showcased how chief physician executives are among strategy leaders' strongest allies for growth, but the issues they surface are architectural, not behavioral—requiring redesigning organizational structures rather than changing individual behavior.
Access stalls because compensation models reward keeping low-acuity patients on specialist schedules. Transforming the care model with greater APP reliance requires changing the comp model alongside it.
AI governance lags the pace of deployment because it was built to manage risk, not capture value. The fastest systems separate clinical AI (which needs rigorous review) from administrative AI (a faster lane).
Physician well-being is an organizational design problem deserving a dedicated C-suite owner. Efficiency gains can backfire unless there’s a clear answer for how recaptured physician time will be used.
This week’s featured graphic shows that the U.S. graduates 8.6 medical students for every 100,000 people—far below the OECD average of nearly 15.
A Commonwealth Fund report ties the gap to two upstream constraints: the highest medical tuition fees of any country in the analysis, and limited residency training positions.
Eli Lilly is threatening to cut off 340B discounts for hospitals that won't share claims data. Health systems that comply could face significant administrative burden while regulators stay on the sidelines.
Lilly says roughly 1,000 hospitals have refused while more than 2,300 have complied, and it is starting enforcement with the largest non-responders.
The data could let manufacturers eliminate duplicate discounts, quantify hospitals' contract-pharmacy spread, build the empirical case for narrowing 340B, and gain demand intelligence on high-value drugs.
HRSA has so far declined to block the policy despite AHA pressure to declare the policy unlawful.
A federal judge's ruling for Clover Health—ordering CMS to recalculate its MA star rating after finding 20 measures were improperly included—reframes a routine scoring dispute as a challenge to CMS's authority over how Medicare Advantage quality is measured.
If the reasoning survives appeal, it could force the program to drop measures CMS still relies on, creating exposure for health systems running provider-sponsored health plans.
The Strategist in Brief: May 28, 2026
Listen to the episode on a streaming platform by clicking one of the links below:
The cautious habits that shaped healthcare's first wave of AI adoption are increasingly working against health systems, and a new playbook is emerging from those navigating the shift in real time. Four hard truths now shape AI strategy for 2026:
You must deploy AI faster than feels safe. Legacy governance designed for episodic, bespoke review can't keep up with a portfolio of dozens of tools that update every few months. The fix isn't less rigor but proportional rigor—tiered review, pre-agreed decision rights, and standardized intake.
Your "human in the loop" is disappearing. Volume, speed, and automation bias have eroded the assumption that human review inherently protects against AI error. The work is shifting from supervising every action to designing systems where autonomy is safe by default: defining what AI can do independently, what it must escalate, and what it will never do, even when it could.
Soft ROI is no longer enough. Federal cuts, margin compression, and capital scrutiny have reset executive expectations. Most organizations see value but struggle to convert it into dollars, because the operational mechanism connecting AI to financial impact was never designed.
Ad hoc monitoring will not scale. As AI becomes enterprise infrastructure, oversight needs its own infrastructure to match. Leading systems are moving from bespoke supervision to industrialized oversight—Sutter Health's centralized platform approach to imaging AI and UW Health's tiered governance model both treat monitoring as lifecycle management rather than a favor clinicians perform on the side of their desks.
A new rule finalized by CMS will overhaul the ACA marketplaces by expanding access to high deductible “catastrophic” plans and by allowing insurers to offer non-standard plans with different levels of cost sharing.
A combination of projected enrollment losses and thinner benefit designs will pressure both payer mix and patient collections for health systems.
While the Trump administration isn’t looking to repeal the ACA altogether, the full set of changes points towards a more conservative vision of healthcare coverage that partly resembles the pre-ACA status quo for individual insurance.
This week's featured graphic tracks a fragile recovery in health system operating margins through Q1 2026—climbing from a median of -0.6% in January to 0.4% in March.
While revenue has rebounded, an accelerating trend in uncompensated care is worth watching over the longer term.
CMS issued a six-month moratorium on Medicare enrollment for new home health and hospice providers as part of its broader fraud crackdown.
Existing providers aren't affected, but the policy could temporarily block ownership changes and prevent suspected operators from crossing state lines to evade enforcement.
Health systems aren't the direct target, but the moratorium could complicate discharge planning and shrink post-acute options. That could have knock-on effects for length-of-stay costs, value-based arrangements, and Hospital-at-Home or SNF-at-Home models.
Videos
From Front Door to Last Mile: Aligning Patient Acquisition, Provider Availability, and Care Affordability
Health systems have invested heavily in digital access —online scheduling, intake, and self-service. Yet, access strategies often fail to convert demand into visits and payments. A new national study, The Cost of Confusion in Healthcare, makes the stakes clear: 38% of patients find it difficult to identify the right provider and location for their needs, and 50% of patients say they've cut back on care because of cost.
This session explores how Emory Healthcare is redesigning the patient journey to enhance ideal matching with provider availability, and how affordability best practices close the "last mile" of access: moving patients from acquisition to affordable action so matches become completed care, not lost visits. Speakers will share practical patterns, from diagnosing where matches break down to surfacing affordability at scheduling to reduce friction, improve conversion, and protect revenue.
Winning in TEAM: The Operating Model for Sustainable Performance
The CMS Transforming Episode Accountability Model (TEAM) represents more than a new bundled payment program. It signals a broader shift toward accountability for cost, quality, care coordination, and performance across the continuum. For health systems, success in TEAM will require far more than regulatory readiness. It will require a new operating model. In this session, THMA and Navvis will explore how AdventHealth and Inova are approaching TEAM as a catalyst for enterprise transformation.
The discussion focused on the capabilities needed to succeed in episode-based care, including physician alignment, post-acute strategy, clinical pathway standardization, care management, analytics, and cross-continuum collaboration. During this 60-minutes session, attendees will gain practical insights into how organizations can use the model's first-year upside-only structure to build sustainable capabilities that improve financial performance, strengthen care delivery, and prepare for the future of value-based care.
THMA Spring 2026 COO Post Forum Debrief
In this session, you'll hear what leading health system COOs discussed during our Spring 2026 in-person gathering in Dallas, TX — and we'll share our perspective on the key themes and what they mean for industry organizations that work with them.
THMA Spring 2026 CPE Post Forum Debrief
In this session, you'll hear what leading health system Chief Physician Executives discussed during our Spring 2026 in-person gathering in Dallas, TX — and we'll share our perspective on the key themes and what they mean for industry organizations that work with them.
