Protecting access amid funding cuts

Wes Campbell and Sasha Preble

The U.S. healthcare system has long relied on the government to grant a baseline subsidy to private providers, making it financially viable for them to create a collective safety net, effectively underwriting community health as a public good. That safety net goes beyond coverage to include access to care (both rural and urban), the role of academic medical centers, and the impact of pharmacy. But new federal policies, most notably the One Big Beautiful Bill Act (OBBBA), will create a generational rollback of this safety net and the funding sources that support it.

With Social Security and Medicare essentially untouchable during legislative negotiations, Medicaid shouldered the majority of the cuts in the form of stricter eligibility requirements and overall reductions in funding.  These reductions will bring significant increases in uninsured (or underinsured) patients — and uncompensated care for providers.

Healthcare providers cannot solve this issue alone. Responding to these reductions will require partnerships with community organizations and local market support systems. Moreover, healthcare and non-healthcare providers must come together to address the needs of underserved community members. Healthcare leaders must define what part of the problem they own and address root cause issues in the process.

In a new webinar on Jan. 8 at 1 p.m. ET, we’ll take a deep dive into:

• The repercussions of rolling back the collective safety net.
• How this will compound existing pressures to rural systems and the regional and community providers that surround them.
• Why the impact on urban patients and providers shouldn’t be overlooked.

We will then unpack what it will take from all of us to create a patchwork system that works for both the people who need care and the organizations who deliver it.

Managing spend amid rising costs

Jocelyn Herrington and Vikas Garg

A perfect storm of medical spending continues to drive up costs for purchasers, challenging traditional management tools like prior authorization and referral requirements. These cost increases are fueled by structural shifts in utilization, greater uptake of specialty services, and providers seeking higher reimbursements. Health plans find themselves caught between strained providers, price-sensitive employers, and diminishing returns from old cost-control tactics.

Beyond costs, the landscape of care decisions is rapidly evolving. Behavioral health utilization has skyrocketed post-pandemic, thanks to expanded telehealth access. Yet, defining quality care in this space remains ambiguous for purchasers. This void is being filled by entrenched behavioral health tech platforms that are now positioned to impose measurement-based care standards and drive more definitive outcomes. Simultaneously, variable copay plans are gaining traction among employers desperate to bend the cost curve. These plans aim to steer members at the service level by exposing them to prices reflecting clinical value, quality, and cost. Such innovations could profoundly alter future network contracting dynamics, making service-specific rates more crucial than broad organizational averages.

Join us for a webinar on Jan. 15 at 1 p.m. ET, where we’ll continue the discussion on:

• How spend management is evolving.
• How expanding treatment options, intensifying health needs, and shifting demand behaviors are reshaping financial strategies for healthcare organizations.

Shaping care decisions amid diffusing influence

Rae Woods, Morghen Philippi, and Carol Chouinard

The traditional way care decisions are made is undergoing a profound transformation. Clinicians are no longer the primary decision-makers, maintaining close relationships with patients but exercising significant autonomy.  Today’s healthcare consumers have higher expectations for their experience, but they don’t trust the traditional system to follow through. Rising dissatisfaction and declining trust coupled with new advisors ranging from social media to the latest chatbot influence which treatments are viable and appealing. Clinicians have their own new advisors, as vendors and AI companies embed their protocols into clinical workflows.

For providers, this perceived loss of authority can create defensiveness, which risks pushing patients further away toward new sources of information and treatment. Healthcare providers must acknowledge that patients often have valid reasons for feeling discarded or ignored by the healthcare system, and that the structure of traditional care delivery, with its long wait times and 15-minute appointments, has opened the door for patients to explore unconventional sources for advice and opinions. Simply put: The first step to combatting distrust and misinformation is understanding and accepting the healthcare system’s role in it. The next step is working to earn back patients’ trust.

AI is the elephant in the room when we talk about new care decision-makers. It can be part of the problem or part of the solution, but it is not a savior on its own. Healthcare leaders cannot assume that the tech can simply be changed to influence patients in a certain direction. AI that works for patients and providers requires clinician involvement in the design and implementation stages. Provider expertise is essential to ensure generative AI systems can offer patients information that aligns with the care delivery options that are best for them.

In our forthcoming webinar on Feb. 5 at 1 p.m. ET, we will:

• Explore the forces that are changing patient decision-making.
• Investigate the emergence of new direct-to-consumer options.
• Provide actionable insights and practical guidance for navigating this rapidly changing landscape.