Section Summary
Health system strategy, operations, and service line leaders from across the U.S. assessed 14 service lines and evaluated each on its role in the system, margin performance, mission importance, and current strategic posture. What is a clear tension: health systems have largely aligned around the importance of ambulatory care, yet many leaders' biggest investment regrets stem from not moving into ambulatory and ASC settings soon enough. We call this the Ambulatory Paradox.
This section is from Strategy Catalyst's report—Service Line Portfolio Strategy in 2026: Where Health Systems Are Growing; How They Are Rationalizing; and What Leaders Regret the Most. Access the report overview on the executive summary page, a breakdown of survey demographics, and Findings 1-3 in Section 1: The Valuation Paradox and Findings 4 and 5 in Section 2: The Rationalization Paradox.
Key Section III Findings
Finding 6: Past regrets vs. future priorities
Top investment regrets (35%) concern site-of-care decisions, most often being late to the ambulatory transition. Underinvestment regrets outnumber overinvestment regrets, suggesting that the main story is opportunity cost.
Finding 7: Current vulnerabilities vs. anticipated responses
Ambulatory surgery, cardiology, gastroenterology, and orthopedics are anticipated to be the most vulnerable to near-term market share loss and are being prioritized for ambulatory expansion over the next 2-3 years.
Finding 8: Multiple lines vs. unified direction
No single service line stands out for the largest expected change by 2028. Among the top five, 44% of responses name ambulatory and ASC infrastructure as the largest driver of change.