Insights

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• CMS walked back its initial proposal for a flat MA rate increase and instead finalized a 2.48% payment bump.

  • The increase between the initial and final proposal follows a familiar pattern and highlights the strength of the payer lobby. But the reprieve might only be temporary if CMS goes forward next year with a proposed update to their risk adjustment model.

  • Reduced supplemental benefits have slowed the growth of MA relative to traditional Medicare, but the Trump administration is exploring ways to continue increasing its share, including automatic enrollment.

  • Changes to the star rating system will boost payments to plans that succeed on core clinical quality metrics, but the removal of metrics related to appeal timeliness and outcomes could let payers get away with aggressive prior authorization tactics.

• A new study in JAMA finds that AI scribes reduce clinicians’ EHR times, but a claim that they also increase the volume of visits deserves careful scrutiny.

  • Reducing EHR time can also help providers avoid workforce burnout and boost retention, which might not be captured in existing measures of AI scribe ROI.

• Anthropic has developed a new AI model called Claude Mythos with capabilities that could significantly enhance cyberattacks. The company is withholding it from public release over safety concerns.

  • Anthropic is working with major tech companies like Amazon, Apple, Google, and Microsoft to harden their systems with the help of the unreleased model. The company estimates that rival firms could develop models with similar capabilities in as little as 6 months.

  • The fragmented and custom-built software that health systems rely on could be particularly vulnerable to AI-assisted cyberattacks, and health systems could find themselves paying large sums to security vendors to reduce the risk of devastating outages.

• At a recent public meeting, MedPAC presented study findings that the association between MA penetration and all-payer margins was consistently near zero across multiple sensitivity analyses.

  • Without more granular MA-specific data, the analysis may not isolate MA's true effect on health system margins—but that won't stop it from being held up as proof that MA pays enough.

  • Health systems could push federal policymakers to make better data available, following the example of states like California and Oregon.

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• Sutter Health and Allina Health have signed a letter of intent to form a combined system with 39 hospitals and 18K aligned physicians.

  • The 1,500-mile gap between the systems raises questions about systemness and governance, but there are opportunities for synergy in technology innovation, IT, RCM, and purchasing.

  • Diversifying across state lines to form a system with national scale can help diversify policy and market risks.

• On a panel at HIMSS26, CMS administrator Mehmet Oz and other administration officials expressed interest in introducing AI agents to Medicare that could help beneficiaries find providers or select plans.

  • Seniors might not trust AI, but that might not matter if these services and recommendations are pushed on them.

  • Unlike patients, AI navigator agents might not care so much about nonprofit health systems’ brand halo. We’ve raised similar concerns in the past about navigator services for commercial plans like UnitedHealthcare’s Surest.

  • Greater use of AI to detect Medicare fraud could root out bad actors, but false positives could create operational and reputational headaches for providers and health systems inadvertently caught in the crossfire.

• More than 75 strategy team members from 49 health systems joined us at last month’s Strategy Catalyst Summit in Arlington, Va. For this edition’s Key Market Dive, we’re digging deeper into four of our favorite insights and highlights from the sessions.

  • New AI deployments are making a visible impact on key strategic challenges like physician burnout and revenue capture, but they’re also demanding an increasing share of IT and transformation budgets. Strategy teams need to take on big picture questions about governance and vendor selection and can’t simply leave this work up to their IT teams.

  • In a hands-on demo showcasing how platforms like ChatGPT and Claude can be used for strategy work, we saw a wide range of AI fluency among participants. As these tools become more and more capable, strategy teams looking to transform their systems’ AI prowess would be wise to lead by example.

  • In another session, attendees discussed how reframing service line rationalization as a distribution problem can generate more organizational buy-in and sharpen thinking.

  • Stress testing different hypothetical market and policy scenarios can help strategy teams move from a reactive mindset to a more proactive approach in their strategic planning.

• This week’s featured graphic compares responses to THMA’s annual CXO priorities survey across a variety of executive roles.

  • Compared to other roles, CSOs are less focused on revenue capture and more focused on strengthening the workforce.

  • Executives across nearly every role are increasing their focus on AI.

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Before UW Health and UnityPoint-Meriter were strategic partners, they were in court against each other. Now, UW Health's COO wonders whether their joint operating agreement has been more successful than a full merger would have been.

In this episode of The Strategy Catalyst Dispatch, Dr. Peter Newcomer, SVP and Chief Operating Officer at UW Health, walks us through how two organizations that used to compete built a financially aligned, strategically coordinated partnership — without merging. We dig into how the JOA with UnityPoint-Meriter helped UW Health address capacity constraints, delay a major capital build by years, and create a shared patient flow system.

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

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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.

Listen to our debrief of The Health Management Academy's Spring 2026 Chief Financial Officer (CFO) Forum. In our debrief, we shared what these executives discussed with their peers, including what CFOs are working on right now.

Health system executives face two critical imperatives: improving patient experience and brand loyalty while identifying new revenue streams to offset losses from the One Big Beautiful Bill Act starting in 2026. This exclusive webinar connects these challenges to a powerful solution—the $29 billion premium healthcare market that most systems have overlooked.

Leaders from UC Irvine's Samueli Integrative Health Institute and University Hospitals share their vision and experience scaling their concierge offerings. They demonstrate how membership-based models create new access points that drive brand loyalty, attract commercial volume, and generate sustainable revenue. Additionally, the panel provides insight on how to accelerate premium offerings through innovative partnerships—proving premium care can be deployed without major capital investment.

Attendees will learn from peers who have quantified the tangible opportunity in premium healthcare, gaining practical insights into partnership models and proven strategies for delivering the convenient experiences today's patients expect—while building competitive advantage and new revenue streams essential for long-term financial resilience.

Speakers:

• Kelly Brennan, Chief Operating Officer, University of California Irvine Susan Samueli Integrative Health Institute

• Andrew Moleski, Director of Administration and Business Development, UH Premier Services

• Aasim Saeed, MD, MPA, CEO and Founder, Amenities Health

The demand for providers is quickly outpacing the supply - creating significant patient access issues that lead to leakage, burnout, and quality challenges. As recruitment timelines stretch and labor costs escalate, 80% of health systems remain trapped in a cycle of short-term fixes—relying on expensive contract labor and shift incentives.

Structural silos, insufficient or outdated data, and rapid changes in provider expectations have created a workforce storm that short-term fixes alone cannot weather. Hear an exclusive conversation with leading health system clinical and innovation executives that have embraced new workforce planning models that integrate novel, real-time market data; incorporate expertise across finance and operations; and leverage new tools, models, and processes to modernize their workforce planning.

The gap between clinician expectations and health system capabilities is widening. This webinar provides the blueprint for health system leaders to move from "business as usual" to a data-first strategy that secures both the workforce and the bottom line.

Read The Velocity Gap: Why Retrospective Staffing is Failing Modern Medicine

Read The Intelligence Imperative

Speakers:

• Amir H. Barzin, DO, MS, Chief Operating Officer, UNC Health

• Christopher M. Coburn, Chief Innovation Officer, Mass General Brigham

• Charlie Lougheed, Chief Executive Officer, Axuall

Healthcare organizations increasingly cite access as a top strategic priority, yet despite growing investment in digital front doors, telehealth, and AI-enabled tools, many struggle to translate these initiatives into meaningful improvements in access, satisfaction, and return on investment. A key challenge is not lack of technology, but misalignment across governance, operations, and strategy—resulting in fragmented execution and underwhelming results.

This panel brings together healthcare executives and research insights from the Access-Driven Enterprise, a collaborative study conducted by THMA and Tegria. The initiative examines how leading health systems are reimagining enterprise IT and organizational strategy around access, combining THMA's proprietary executive research with Tegria's digital transformation expertise.

Panelists share insights on how leading health systems are achieving meaningful access transformation. The discussion examines the strategic decisions, organizational changes, and implementation approaches that separate successful initiatives from those that underdeliver.

Read the Access Driven Enterprise Report.

Speakers:

• Haley Bolton, Vice President, Access Performance Management, Emory Healthcare

• Jeremy Rogers, Vice President, Digital Marketing and Experience, Indiana University Health

• Andrew Smith, Vice President, Patient Access, Sutter Health

• Steve Nilson, Acting Managing Director (Access and Experience), Tegria