Executive Summary
The healthcare environment is shifting fast enough that the difference between organizations that thrive and those that struggle may come down to whether their leadership teams have done the hard work of thinking ahead—before disruption forces their hand.
This guide was developed by the Strategy Catalyst team and field-tested with 50+ strategy leaders at the 2026 Strategy Catalyst Summit. Attendees workshopped plausible near-term scenarios across tables of peers, and the conversation was striking less for what people said than for what they admitted: most of their organizations were not actively preparing for any of them.
This guide is designed to change that.
The five scenarios cover a range of near-term policy and market shifts: site-neutral payment expansion, 340B margin restriction, value-based care acceleration, primary care fragmentation, and large-employer direct contracting. We chose these because they are credible, consequential, and frequently neglected in strategic planning. They are not predictions. They are pressure tests—paired with discussion questions and a facilitation guide—designed to move your team from a reactive posture to proactive strategy.
How to Use This Guide:
This guide is intended to be modular. Take what is useful, leave what isn't, and adapt it to your organization's context and priorities. The scenarios, discussion questions, and facilitation guide are designed to be copied into your own internal templates and used with whatever audience is most relevant, be that your executive team, strategy team, Board, or a cross-functional planning group. You do not need to use all five scenarios or all the discussion questions. Start with the scenarios most relevant to your organization and let the conversation tell you where to go next.
The goal is not to walk away with answers. It is to walk away with better questions and the internal alignment to act on them before circumstances make the decision for you.
The Five Scenarios
These five have been chosen to evaluate a variety of the most likely—and most impactful—near-term policy and market shifts. These are by no means the only possible plausible scenarios, but serve as a starting place for discussion. Feel free to edit and adjust them if additional elements or specifications would better suit your purposes.
Scenario 1: The End of the HOPD Premium
Congress passes legislation extending site-neutral payment policies beyond clinic visits to most outpatient procedures and service lines, including imaging, infusion, cardiac testing, and a broad range of ambulatory surgical procedures. Uniform Medicare rates now apply regardless of whether care is delivered in a hospital outpatient department, ambulatory surgery center, or physician’s office.
Within 18 months, major commercial insurers and Medicare Advantage plans adopt equivalent rate structures across their networks. The financial impact is structural and immediate, not cyclical, for health systems that have built hospital outpatient department infrastructure as a primary revenue driver and made significant capital commitments to ambulatory network expansion on HOPD-rate assumptions.