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In this episode of The Strategy Catalyst Dispatch, Dennis Thé, Vice President of Strategy and Business Development at Children's Health System of Texas, walks us through how the leading pediatric system in North Texas decides where to grow.

Children's Health serves about one million patients a year across two campuses and is building a $5 billion campus in partnership with UT Southwestern. Dennis explains what makes pediatric growth decisions different from adult ones, why the system evaluates growth across its full portfolio rather than site by site, how that thinking led them to move their inpatient rehab unit from Dallas to Plano and convert the freed-up capacity into NICU beds, and how community need shaped the services at the Redbird Specialty Center south of Dallas.

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• Health system leaders at The Health Management Academy’s Fall 2026 CEO Forum discussed the policy pressures and financial realities that are forcing systems to rethink business as usual.

  • Affordability was a major theme. CEOs discussed how policymakers sometimes frame the debate around the price of a single service, not the total cost of care.

  • Limited ED and inpatient bed capacity is pushing some systems to make greater use of value-based care strategies. Mandatory CMS payment models and direct-to-employer offerings are accelerating the trend.

  • CEOs worry that stacking too many AI point solutions will make overall workflows less efficient, even if each individual use case has a positive return on investment.

  • Labor costs are pushing systems to reimagine how care is delivered, but CEOs say culture and clinician training remain major obstacles.

• HRSA named ten drugmakers and 21 high-cost drugs for its reworked 340B rebate pilot, set to launch January 1. Drugs eligible for the pilot account for less than 5.5% of 340B purchases, but a successful rollout could pave the way for a broader shift away from upfront discounts.

  • The AHA and other provider groups have once again sued to block the pilot, arguing annual administrative costs could top $1B, nearly double HRSA’s $537M estimate.

  • In other 340B news, a growing number of health systems are suing CVS, alleging the company withheld nearly $300M in 340B savings.

• Five Democratic governors asked HHS to delay the January 1 deadline for Medicaid work requirements, citing new frailty definitions and verification rules that states say they can’t implement in time.

  • Medicaid coverage losses will build gradually through 2027, with a different timeline in each state depending on the specifics of implementation.

• This week’s featured graphic tracks the recovery in health system operating margins, with new data from Strata Decision Technology.

  • After dipping below zero early in the year, the median health system margin climbed to 0.7% in June. That’s still below the 1.0%–1.5% range seen throughout much of the second half of 2025.

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

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• This week’s Key Market Dive looks at the landscape for musculoskeletal care, one of the largest service lines facing one of the most rapid transitions to outpatient settings.

  • Multiple forces are reshaping the market: digital MSK platforms and benefit networks capture and steer patients upstream, ASCs siphon off profitable routine procedures midstream, and PE-backed platforms consolidate the full orthopedic value chain.

  • Digital MSK leaders Hinge Health and Sword Health are expanding their platforms into GI care and behavioral health, leveraging their existing relationships with employers and health plans.

• Our featured graphic showcases data from The Health Management Academy’s 2026 AI Use Case Benchmarking Survey Report, which surveyed 52 health systems.

  • Health systems that have deployed more than a dozen AI use cases report a positive ROI in most cases where ROI can be measured, suggesting that returns hold up even as AI portfolios grow.

• Ascension is selling its ownership stake in an Arizona-based Medicaid plan called Mercy Care to Aetna for an undisclosed amount.

  • Mercy Care has massive revenues and dual-eligible enrollees, but also has a margin of less than one percent. Aetna has enough scale to take on that financial risk in an uncertain policy environment.

• Counsel Health will join CMS's ACCESS Model with Oura as its preferred wearable partner, offering no-cost chronic care to eligible Medicare beneficiaries starting in early 2027.

  • ACCESS's low rates, which many digital health companies passed on, work for Counsel because its AI-first care model is cheap to run and Oura's 5 million paid members give it low-cost patient acquisition.