Insights

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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.

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• At this year’s JPM, health system presentations were focused on disciplined execution, strategic simplification, and missions grounded in financial realities.

  • New technologies are accelerating the shift towards more proactive, longitudinal care models.

  • Health systems are streamlining patient journeys, internal processes, and vendor ecosystems. Portfolio rationalization is proving essential for investor confidence.

  • Technology leaders are prioritizing core tech infrastructure over flashy novelties and point solutions.

• Congressional leaders have attached a bipartisan package of healthcare reforms to this week’s “must pass” government funding legislation. An impasse over immigration enforcement funding could delay passage.

  • The package includes new limits on PBM practices, extensions of key programs like Hospital-at-Home and telehealth flexibilities, and a new billing requirement for off-campus HOPDs.

  • Overall, the provisions are mostly positive for health systems. A larger, more comprehensive site neutral payment reform is unlikely this year, but policymakers are still chipping away at the issue.

• At a recent Strategy Catalyst webinar, health system leaders debated three provocative claims about payviders, PE, and distributors.

  • Most attendees agreed that payviders will exert leverage through benefit design and referral control rather than outright ownership. However, payers might lack the network density to execute this strategy in some markets.

  • The vast majority agreed that health systems don’t necessarily need to outbid PE for physician assets if they can just outlast them instead.

  • The virtual room was split on the competitive threat posed by distributors like Cencora, McKesson, and Cardinal Health.

• Zarminali Pediatrics raised $110M to expand its multispecialty platform to several new markets, including Chicago, Milwaukee and Dallas.

  • Health systems might be able to partner with Zarminali in an “embrace-and-extend” model that still refers acute and complex cases to the hospital setting. Other systems might see the firm a new competitor for care volumes, workforce talent, and patient relationships.

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Women in midlife are the highest healthcare spenders on the managed care side and women use healthcare more than men, even when you take obstetrics out. In this episode of The Strategy Catalyst Dispatch, Kathleen McHugh, AVP of Corporate Strategy, and Jennifer Todd, VP of the Women's Service Line at Memorial Hermann walk us through the business case for investing in women's health, why they partnered with digital health start-up MIDI Health to address the gap in menopause care rather than build in-house, and the outcomes they've seen two years in, including record employee benefit adoption and a steady flow of referrals back to Memorial Hermann for care.

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In this episode of The Strategy Catalyst Dispatch, we explore a commonly cited theme in strategic plans that rarely gets commensurate investment: culture transformation.

Wellstar Health System's Chief Strategy Officer Matt Terry joined us to talk about how his system has positioned culture as a strategic pillar to make it visible, measurable, and fundable alongside other enterprise priorities.

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

Join Kathy Davies, Director of Clinical Documentation Integrity (CDI) at OSF HealthCare, and Priti Shah, SVP of Product Management at Waystar, to uncover how OSF strategically transformed their CDI program. This session demonstrates how purposeful leadership, cross-functional collaboration, and AI-powered innovation deliver meaningful improvements in documentation quality, coding accuracy, and financial performance. They reveal practical approaches you can use now to modernize workflows, eliminate departmental silos, and create sustainable change to improve patient outcomes and organizational value.

Sustaining health impact initiatives amid financial constraints requires demonstrating clear value propositions that support health system margins, yet the challenge of building scalable models remains. This roundtable explores innovative approaches that drive health system sustainability, including building FQHC partnerships and comprehensive care networks that close the gap on rural health access & outcomes.