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

• Listen on Spotify

• Listen on Apple Podcasts

• 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.