Insight #1: Federal public funding reductions will bring a generational rollback of safety net coverage

A landmark law, along with sweeping regulations, is pulling back federal subsidization of healthcare through stricter eligibility and reduced funding levers. Reductions in essential community access financing will bring significant increases in uninsured patients and uncompensated care for providers.

Insight #2: Compounding rural hospital pressures will spill over onto regional capacity challenges and disrupt referral patterns

Rural hospitals are facing survival threats through rising costs and shrinking reimbursement. Local rural access closures may shift pressure to nearby hospitals and destabilize community healthcare ecosystems. But these potential ripple effects are also spurring regional partnership models.

Insight #3: Community retail pharmacies are quietly disappearing, threatening local “front door” mechanisms for care management

Financial strain and changing consumer habits are accelerating retail pharmacy closures, which signal a structural shift that will reshape local access to care and may worsen outcomes. E-commerce and health system pharmacies are stepping into the gaps, but their unique approaches will leave some community care functions unfulfilled, especially in rural areas.

Insight #4: Unique margin pressures on academic medicine will prompt mission contraction and competitive growth strategies

Margin erosion and research funding cuts threaten the stability of the academic medical center (AMC) business model. AMC pursuits for sustainable margins will likely have ripple effects that will be felt across the care ecosystem, as they may reduce mission-oriented services, intensify traditional service competition, and leave gaps in education and research that no other entity is positioned to fill.

Insight #5: A perfect storm of medical spending headwinds continue the cost spike for purchasers and challenge traditional tools

Purchasers are facing extreme pressure from unrelenting medical spending increases. Both rapid and gradual structural shifts to utilization are colliding with greater patient uptake of specialty services, a broadening treatment portfolio, and escalating reimbursement pursuits by providers. Health plans are caught in the middle as strained providers seek higher rates for survival, employer price tolerance is in question, and traditional cost management tactics bring diminishing returns.

Insight #6: PBMs’ rollout of holistic GLP-1 management solutions are an inversion of drug management dynamics with health plans

Rising drug spend, largely driven by GLP-1 utilization, is outpacing traditional cost management tactics. The costliness and complexity of the expanding specialty drug market is leading payers to turn to specialized vendors not just for drug purchasing, but also for comprehensive management strategies with wraparound patient engagement support. These programs may be a step toward delegating risk management to vendors for targeted conditions.

Insight #7: Behavioral health tech platforms are now entrenched intermediaries that can impose care outcomes standards

Behavioral health utilization has skyrocketed in the wake of the pandemic, as the expansion of telehealth significantly improved access. But purchasers are grappling with ambiguity about defining appropriate, quality care in behavioral health. Third-party platforms are in an ideal position between health plans and clinicians to wield their scale and technology to impose measurement-based care standards and secure more definitive outcomes.

Insight #8: Variable copay plans aim to steer members at the service level, potentially altering future network contracting dynamics

Variable copay plans are finally gaining employer interest as employers seek any innovation to bend the cost curve. These plans aim to go beyond traditional copay tiering to expose consumers to prices that better represent the clinical value, quality, and cost of a service. Increased adoption of these plans could have a profound impact on traditional network contracting if service-specific rate nuances become more essential than organization-level averages.

Insight #9: The clinical workforce is structurally compromised, with compounding staff experience challenges that intersect with complex patient demands

Years of trauma, burnout, and under-resourcing have left the clinical workforce in a fragile state. Clinician shortages are projected to get worse, while patient needs grow more complex and consumer expectations evolve. Provider organizations must confront the disconnect between enterprise strategy and frontline reality, redesigning roles, investing in retention, and rebuilding trust to ensure sustainable, high-quality care delivery.

Insight #10: Growing patient dissatisfaction and distrust limits clinician influence and fosters conditions for external platforms to thrive

Patient trust and experience are eroding at an alarming pace, disrupting the bedrock patient-physician relationship. As patients grow increasingly frustrated, they turn to external sources — including social media, chatbots, and direct-to-consumer services — to meet their perceived healthcare needs. Traditional healthcare leaders must evolve to accommodate, rather than reject, these revealed preferences, without compromising quality.

Insight #11: Drug wholesalers expand their reach over care delivery through specialty physician group acquisitions

Though other corporate acquisitions of medical groups have seemingly cooled, pharmaceutical wholesaler conglomerates are quietly shaking up the physician alignment landscape. Acquisitions of physician groups in high-cost specialties highlight a strategic shift that increases pharmaceutical wholesalers’ control of drugs across the care continuum — and positions them as potential competition for incumbent stakeholders.

Insight #12: AI and automation are reshaping healthcare workflows — and redefining who holds operational power

As cost pressures mount and technology capabilities accelerate, AI and automation tools are no longer peripheral, they are embedded into the core of healthcare operations. These tools are transforming workflows, both to streamline existing tasks and to enable entirely new capabilities — from predictive decision support to real-time billing adjudication. Organizations must confront their growing dependencies and rethink their governance approach in this new era of integrated vendors.

Core assumptions about how healthcare businesses operate are unraveling. We’re seeing a retrenchment of responsibility for safety net access, shared ownership over purchaser spend management with niche experts, and a sprawling array of advisors influencing what treatment options are available and appealing.

Today’s shifts represent an evolution in control over care delivery, diffusing from traditional incumbents to many different groups. As industry players exert new power, purchaser and patient expectations will evolve and new (or exacerbated) service gaps will emerge.

In this context, regional leaders must set a clear course for their organization that accounts for changing business dynamics — alongside their true internal strengths and the context of their community partners and competitors. Executives need to make explicit decisions about the services their organizations will lead, when to share the work with other partners, and what services no longer make sense to offer in their markets.

Ultimately, no healthcare business exists in a vacuum, and the spillover effects of today’s changing dynamics will ensure that community fates are bound together.