For years, the instinct in healthcare leadership was to equate bigger with better: more beds, more service lines, more volume, more capabilities built and owned in-house.
Becker’s asked CEOs, CFOs, and clinical and supply chain leaders from hospitals, health systems and academic medical centers across the U.S. which once-core strategic assumption their team has fully let go of as that equation stopped holding up.
The answers point to a common thread: growth, ownership and scale are no longer treated as strategies in themselves. Leaders described moving away from chasing volume and instead evaluating every service line, partnership and investment against a harder question — does this genuinely strengthen long-term sustainability, or does it just add size? Many have also traded multi-year strategic plans for shorter, more adaptive planning cycles built to keep pace with shifting reimbursement, workforce and technology pressures.
Every executive featured in this article will speak on panels at Becker’s 14th Annual CEO + CFO Roundtable, taking place November 2-5, 2026, in Chicago. Attendees will have the opportunity to hear these and other health system leaders discuss the challenges shaping strategy for the year ahead, from financial sustainability and workforce retention to AI governance and rural healthcare access.
Registration is open now for the 14th Annual CEO + CFO Roundtable. Register here to secure your spot and join the conversation with the executives featured below.
If you would like to join as a speaker or a reviewer, please contact Mariah Muhammad at mmuhammad@beckershealthcare.com or agendateam@beckershealthcare.com.
For more information on sponsorship opportunities, please contact Jessica Cole at jcole@beckershealthcare.com.
Question: What once-core strategic assumption has your team fully abandoned?
Jeffrey P. Gold, MD. President of University of Nebraska System (Lincoln): The ability to make assumptions, plan for the future, and at the same time, to abandon assumptions in order to face future realities is key to all of healthcare, whether it is in the clinical standards that we practice, or the assumptions that we make concerning the business aspects. These assumptions are critically important to the long-term governance and operations but also to the day-to-day activities.
The application of advanced artificial intelligence to the delivery of healthcare, from both the clinical and the administrative perspective, cannot be underestimated as it will provide higher quality, more accessibility, and continue to control the escalating costs of access to quality care. The assumption that we chose to abandon was that all of this technology, both on premises and in the cloud, needed to come from third-party experienced vendors who had leadership positions in these areas. By assembling a dedicated and highly skilled team of software engineers in partnership with the clinical enterprise leaders, we have been able to build and deploy both small and large-scale clinical and administrative advanced artificial intelligence solutions to enhance the quality of care, enhance patient experience, and reduce administrative costs of delivering care in a large university-based academic medical center. The ability to successfully question long-held assumptions and to adjust course as needed will clearly define our future and hopefully keep the north star where it is today, or as we describe it, “serious medicine and extraordinary care.”
Albert L. Wright, Jr. President and CEO of West Virginia University Health System (Morgantown, W.Va.): I’m not sure we’ve abandoned a single core strategic assumption as much as we’ve challenged the notion that large health systems must move slowly. We’ve worked hard to create an entrepreneurial culture where leaders and employees are encouraged to move with purpose and determination and take calculated risks. Healthcare can often become overly cautious and process-driven, making it difficult to respond to changing markets and community needs. I want our leaders to have the confidence and authority to recognize an opportunity, make a decision, and act, even when they do not have perfect information. Some things we try will work extraordinarily well, and some may not, but we learn from both. I believe our ability to move with speed and an entrepreneurial mindset has become one of our greatest strategic advantages.
Nolan Chang, MD. Executive Vice President of Strategy, Corporate Development, and Finance at The Permanente Federation (Oakland, Calif.): We’ve abandoned the assumption that high-quality, value-based care must be anchored to traditional brick-and-mortar medical facilities and legacy administrative processes. Today, we’re bringing care directly into patients’ homes and remote environments through telehealth and remote monitoring, redefining “value” to include patient convenience alongside medical outcomes. We’re also using ambient AI tools to support clinical charting and provide real time updates during visits, helping physicians spend more time with patients and less time on paperwork while improving outcomes.
Redonda Miller, MD. President of The Johns Hopkins Hospital (Baltimore): Core Strategic Assumption: The hospital is the most dominant player in the healthcare continuum.
For decades, hospitals were the only option for acute care. As technology has become more advanced and people’s time more compressed, patients have placed greater emphasis on easy access and convenience. The days of patient willingness to drive long distances to an academic medical center for routine care are waning. Like many others, our health system is strengthening our hub and spoke model, with the academic medical center remaining at the center for complex acute care but with multiple “spokes” providing care at home, virtually, or in ambulatory clinics and surgery centers. This allows us to provide lower-acuity care in communities to facilitate easy access for patients. This also preserves capacity at The Johns Hopkins Hospital to meet the growing demand for complex care that can only be provided in an academic medical center setting, while ensuring that patients receive the right care at the right place at the right time to meet their specific healthcare needs.
Bradley C. Bond. CFO of University Hospitals (Cleveland): At University Hospitals, we’ve fully abandoned the once-core notion that growth depends on building or acquiring more and more brick-and-mortar hospitals, with private rooms for everyone as a strategy. While we will always provide the highest-quality care to patients in our hospitals, revolutionary advancements in medical technology have created a paradigm shift. They’ve prompted a move to increased care in outpatient settings, which now makes up most of our revenue. This is no small change, and it has necessarily caused us to think differently about how to operate our health system and make new and different decisions. For example, with reimbursement patterns shifting under the new realities of outpatient care, health systems like ours are challenged to transform at an ever-increasing pace. Our approach at UH is to continue operating differently: growing volumes where demand exists, improving productivity and staying disciplined about how we deploy resources.
Shelly Schorer. CFO of South Region at CommonSpirit Health (Chicago): The core strategic assumption my team has fully abandoned is the notion that there is only one path to success and margin health. We no longer believe that focusing solely on cost-cutting and basic operations is enough. As a CFO, I’ve realized that our role has evolved: we must be market-focused, experts in revenue cycle management, and keep a constant pulse on the latest technology. To succeed in today’s environment, we need to balance fiscal discipline with a much broader, multi-dimensional strategy.
Benjamin M. Schwartz, MD. President of Academic Delivery at Banner Health (Phoenix): We’ve fully abandoned the assumption that we have to build everything ourselves. For a long time, the instinct in healthcare research was to own every capability, develop every tool, and lead every discovery in-house. We’ve moved completely past that. Today, we believe the fastest path to helping patients is knowing which partners are the best in the world at what they do and building deep, strategic relationships with them. We partnered with the University of Arizona a decade ago to redefine academic medicine and healthcare delivery across the region, delivering an estimated $59 billion in economic impact to Arizona. This is made possible only because we stopped asking “can we do this alone?” and started asking “who’s the best partner to do this with?” That shift in mindset is precisely what allows Banner Health to move faster, reach further, and deliver more for the patients and communities we serve.
Peter D. Banko. President and CEO of Baystate Health (Springfield, Mass.): Our team must fully abandon our core strategic assumptions about our sacred investment strategies. We are having those robust discussions in the context of our shifting, turbulent reimbursement terrain and appetite for risk. Candidly, we are not quite there yet. We have made tremendous progress with strategic pivots with EHR and ERP investments with Oracle Health to enhance the caregiver experience, improve patient engagement, streamline administrative burdens, and optimize efficiencies. We have heavy lifting ahead to shift our precious capital dollars to “payvider” integration, care management, ambulatory, digital/virtual, and at home care.
Mark Sevco. President of Allegheny Health Network (Pittsburgh): At Allegheny Health Network, we have fully abandoned the assumption that volume expansion, particularly in high-cost acute care settings, can sustainably offset inflationary pressures. As part of Highmark Health, our integrated payer-provider model gives us the opportunity to take a fundamentally different approach: creating value across the entire health care continuum. That means expanding access in ambulatory and home-based settings, reducing avoidable admissions and readmissions, and aligning clinical workflows and incentives to lower the total cost of care. This direction is consistent with our broader strategy to improve outcomes and affordability together, rather than optimizing the payer and provider independently.
Affordability is essential, but our North Star is broader: operational excellence, easier access to care, outstanding clinical outcomes, and an exceptional patient experience. Our success will ultimately be measured by our ability to deliver all of those outcomes together while creating a more sustainable model of care.
Deborah Visconi. President and CEO of Bergen New Bridge Medical Center (Paramus, N.J.): We’ve abandoned the idea that we can run a hospital the way we did five or 10 years ago and expect it to work. The needs of our community are changing too quickly, and the financial pressures on safety-net hospitals are too significant. At Bergen New Bridge, we’ve had to become much more willing to challenge the way we’ve always done things, whether that means expanding services, looking at partnerships differently, investing in technology, or finding new ways to use the resources we already have. We’ve also stopped looking at our mission and financial sustainability as competing priorities. For us, they are inseparable. If we want to continue being there for the people who need us most, we have to be financially strong enough to do it. The biggest shift has been moving from protecting what we have to thinking much more boldly about what our community will need from us next.
Rick E. Smith. CEO of Troy Regional Medical Center (Troy, Ala.): Here at Troy Regional, we’ve abandoned the assumption that survival means doing more. Sometimes the most strategic decision is to stop doing something ourselves and build a better partnership around it. We have begun to focus on core, essential service lines and dropped those services that are not fully maximized, or we are not the top service in the area. Case in point, our ENT service line was premier in the area for years until the retirement of our local provider. We tried to back fill with another experienced ENT provider, but the service continued to deteriorate to the point that my senior team recommended to our board that we exit the service. Referrals are now sent to another provider in a neighboring community for care. The losses that we were seeing have dropped and we have repurposed the ENT clinic to accommodate a primary care provider who is very respected and very loyal to our facility.
George Mikitarian. President and CEO of Parrish Medical Center (Titusville, Fla.): We’ve given up believing that healthcare people actually care about healthcare costs.
Kurt Koczent, RN. Executive Vice President and Chief Operating Officer of UR Thompson Health (Canandaigua, N.Y.): One core strategic assumption we’ve abandoned is the idea that a health system’s job is to provide services and wait for patients to access them. Today, we actively manage population health across our network. We review care gaps monthly and department level associates proactively reach out to patients who may be due for imaging, mammography, lab work, colonoscopies, or other recommended services. Our teams help patients schedule care at a time that’s convenient for them, and they also work to close documentation gaps when services have already been completed elsewhere but are not reflected in the medical record. We’ve shifted from managing individual encounters to actively managing the health of a population. That improves patient outcomes, increases access to needed care, and helps support both practice-level and health system performance.
John M. Fogarty. President, Beth Israel Deaconess Hospital–Needham (Mass.): While it is important to keep all potential assumptions” near the table” not “on the table”, a core assumption that we have moved away from operationally is the concept of long term strategic planning. Clearly, good vision and strategy are essential, but a planning horizon that extends beyond three to five years in today’s dynamic market is of limited value. We’ve found that focus on the nearer term two to five year time horizon allows the organization to be more nimble and responsive to shifting market conditions and community needs.
Timothy Collins, EdD. CEO of UCR Health (Riverside, Calif.): We have abandoned the assumption that growth requires ownership. Historically, organizations have equated their growth strategies with “owning more” – more practices, facilities and services. In a region as large and medically underserved as the Inland Empire, we believe the better strategy is integration rather than ownership. Our focus is building a connected network that brings together UCR Health, independent community physicians, and healthcare organizations around coordinated care, shared infrastructure, quality, and access. We do not want to replace the providers who have cared for our communities for decades; we want to connect and strengthen them while filling critical gaps in care. Instead of asking, “What do we need to own?” we are asking, “What does our region need, and how can we best bring the right capabilities together?” We are making an important shift toward building a healthcare ecosystem centered on the patient and the community.
Melvin Price, DPM. President and CEO of MCR Health (Bradenton, Fla.): One strategic assumption we have fully abandoned at MCR Health is that access exists simply because a service is available. As an FQHC, we have always been committed to providing high-quality care regardless of a patient’s ability to pay, but we have learned that opening the doors of a health center is not enough. Transportation, geography, awareness, trust and other barriers can still keep people from getting the care they need. That has pushed us to think differently about how we show up in the communities we serve, through stronger community partnerships, outreach, mobile services, technology and new models of care that bring MCR closer to our patients. We are shifting from expecting communities to find their way to healthcare to asking how healthcare can better find its way to them. For MCR, sustainable growth and better outcomes will come from earning trust, removing barriers and becoming an even more connected part of the communities we serve.
Christine Schuster, RN. President and CEO of Emerson Health (Concord, Mass.): One core strategic assumption we have fully abandoned is that a health system must own every capability it needs to serve its community.
In today’s environment, trying to build and operate everything independently is neither financially sustainable nor necessarily best for patients. We now focus on what we must do exceptionally well ourselves and where the right partnership can bring greater expertise, scale, technology, or access to our community.
That shift has required us to become more intentional about partnerships and less focused on ownership as the measure of success. Whether we are working with an academic medical center, physician organization, or specialized service provider, the goal is the same: expand access, improve quality, and keep care close to home while protecting long-term financial sustainability.
For us, remaining independent does not mean operating in isolation. It means having the flexibility to choose the right partners and design arrangements that benefit our patients, our organization, and the broader healthcare system.
Bradley R. Hipp. Vice President and CFO of Tucson (Ariz.) Medical Center: One strategic assumption we’ve deliberately moved away from is the belief that growth alone will solve financial and operational challenges. The healthcare landscape has fundamentally changed, and at TMC Health, we’ve recognized that long-term sustainability requires a relentless focus on operational excellence, workforce productivity, affordability, and value creation.
Across healthcare, there was a period when increasing volumes, expanding services, and adding facilities were often viewed as the primary path to long-term sustainability. While growth remains important, we’ve learned that growth without the right operational foundation can amplify challenges.
Today, we evaluate growth opportunities differently. Rather than asking, “Will this increase volume?” we ask, “Will this improve access, quality, affordability, and the health of our community while strengthening our long-term sustainability?” Growth remains important, but sustainable value creation for our patients and community is now the primary objective.
That shift has led us to focus on sustainable performance and invest more heavily in physician integration, ambulatory growth, digital capabilities, population health, and data-driven decision-making. We are just as disciplined about productivity, access, quality, workforce engagement, and affordability as we are about expansion. We evaluate investments through the lens of measurable value for patients, providers, and the communities we serve rather than simply increasing size or scale.
Our strategy is focused on building an integrated system that meets patients where they are. That includes expanding access through TMCOne, investing in ambulatory services, strengthening our physician network, improving care coordination, and leveraging digital tools and analytics to proactively manage health.
This evolution has strengthened our organization. We continue to pursue strategic growth opportunities, but with greater emphasis on execution, accountability, and ensuring every initiative advances our mission while creating long-term value.
The future of healthcare is increasingly about keeping people healthy, connected, and receiving the right care in the right setting. Our success will be defined not by how many patients are in our beds, but by how effectively we improve the health and experience of the communities we serve across Southern Arizona.
Steve Davis. CEO of Cincinnati Children’s Hospital: We have moved away from the assumption that a traditional five-year strategic plan can keep pace with the environment in which we operate. In healthcare, the pace of change across AI, federal research policy, payer dynamics and workforce expectations now requires a more adaptive approach. Instead of relying on a fixed planning cycle, we use continuous, component-level strategy refreshes that allow specific domains to evolve at the cadence the environment demands. Our research strategy illustrates this approach. Our core commitment to breakthrough discovery remains constant, while the ways we prioritize, resource and accelerate that work must evolve as science, technology and funding opportunities change.
David Hernandez. CFO of HHM Health (Dallas): One strategic assumption we’ve fully abandoned is that FQHCs should only pursue growth within the traditional boundaries of the FQHC model. Too often, safety-net organizations, not just FQHCs, allow resource limitations to define what they believe is possible. We’ve taken a different approach. We still operate with limited resources, but we’ve stopped assuming those limitations should drive our strategy.
That mindset has led us to explore physician practice acquisitions, expand into service lines that are uncommon among community health centers in our region, and pursue opportunities and partnerships that create new sources of revenue while expanding access for patients. None of this is easy. Every new venture requires some level of capital, leadership focus, and a willingness to navigate uncertainty. Some initiatives deliver exactly what we hoped for, while others require us to adjust course quickly. We’ve become comfortable with the idea that not every strategic decision will be a home run. Our goal is to build an organization that can sustain and grow its mission through strong clinic operations, allowing us to expand access and continue serving our communities for the long term. For us, self-sustainability is what makes the mission possible.
Robert Wiehe. Senior Vice President and Chief Operating Officer of UC Health (Cincinnati): We stopped believing that access is only a capacity problem.
We’re an academic health system, so for a long time the answer to a wait time was to recruit another physician or find more clinic space. Sometimes that’s still the right answer and we still do it. But when we dug into our own data, what we found was mostly waste in the classic sense. Templates built years ago for a practice that no longer exists. Return visits scheduled out of habit. New patients waiting behind slots that were never going to fill. We had been treating a patient flow issue like a supply problem.
Now when a chair or a service line leader comes to the system asking for more, the first question is what we’ve done with what we already have. We review the template utilization first. Sometimes that’s a less satisfying answer than a hire, but many times it’s the one that changes what a patient experiences.
Marty Mann. Senior Vice President and Chief Development Officer of Lifepoint Health (Brentwood, Tenn.): Within my team specifically, and even the broader Lifepoint organization, we’ve moved away from the assumption that being a large integrated health system means we should build and own every capability ourselves. Scale is valuable, but it does not automatically make us the subject matter expert in every area required to operate and grow a complex healthcare organization. Increasingly, we are asking where our team members create unique value and where the right external partner can bring deeper expertise, greater speed or broadened capacity that would take significant time and resources to develop internally.
At the same time, we recognize that partnership works both ways. Lifepoint has developed deep expertise across acute care, rehabilitation and behavioral health that creates opportunities for us to serve as the strategic partner to other health systems looking to strengthen or expand those capabilities. That requires being disciplined about our core competencies, understanding where we can benefit from the strengths of others, and being equally intentional about where our expertise can create value with health systems across the country. The goal is to pair complementary strengths in pursuit of shared goals. In that sense, partnership has become both a strategic capability and an important avenue for growth.
Surendra Khera, MD. President of Cleveland Clinic Florida Accountable Care Organization; Vice Chief of Primary Care Institute, Florida Market at Cleveland Clinic: We abandoned the assumption that primary care is defined by a place, a set of hours or access to a single clinician as opposed to a team.
For decades, primary care was built around a familiar construct: a patient visits their physician, in a clinic, during traditional business hours.
We still believe deeply in the longitudinal patient-PCP relationship. The PCP remains the anchor. But we no longer believe preserving that relationship means every episode of care must wait for or be delivered by that individual physician.
Our clinical access teams helped us separate continuity from exclusivity. Physicians and APPs working as an integrated primary care team can provide timely care for immediate needs while preserving the patient’s longitudinal relationship with their PCP. Access to the team can actually protect continuity with the physician.
We have challenged two other traditional boundaries as well.
Time: Primary care doesn’t have to end at 5 PM. We are extending access into early mornings and late evenings with excellent adoptions by the patient .
Place: Primary care doesn’t exist only inside the brick-and-mortar clinic. A second, largely invisible clinic has emerged alongside it, what I call the digital clinic. Nationally, patient portal messaging increased 153% between 2020 and 2025. Symptoms, results, refills, advice and care coordination increasingly arrive digitally, and that work can no longer simply be absorbed around a full day of scheduled visits. A special team based approach consisting of medical assistants, nurses, pharmacists, APPs and physicians is being built in parallel to and surrounding our physical primary care entities to manage the digital workload.
So the strategic assumption we abandoned is bigger than extended hours, team-based care or digital medicine.
Primary care is no longer simply a place patients visit, during certain hours, to see one clinician. It is an access system , longitudinal and team-based, physicians and APP enabled, physical and digital , built around when, where and how patients need us.
Matt Fry. President and CEO of Freeman Health System (Joplin, Mo.): One assumption we’ve fully abandoned is that operational efficiency and patient-centeredness are competing priorities. More often than not, the things that frustrate patients frustrate our teams as well. We’ve learned that reducing friction, improving access, and simplifying the healthcare experience leads to better outcomes for everyone. As a nonprofit hospital, our mission starts with patients, which means we’re increasingly willing to challenge long-standing processes. After all, “we’ve always done it that way” is rarely a compelling strategy.
Rob Chestnut. Senior Vice President and CFO of LMH Health (Lawrence, Kan.): We have abandoned our core strategic assumption about commercial payers. Our assumption had traditionally been that reimbursement and denial patterns were fairly predictable year-over-year. This created an ability to have solid long-term revenue forecasts. We now incorporate much more variability into these forecasts since payers have proven to be much more unpredictable on a real-time basis.
J. Stephen Jones, MD. President and CEO of Inova (Fairfax, Va.): One strategic assumption I no longer believe is that organizational strength naturally follows scale.
Don’t get me wrong. I’m a strong believer in growth and absolutely believe some minimum scale matters in healthcare. We actively push organic growth and very selectively acquire capabilities, including high-fit physician practices. Yet, we intentionally support and align with physician practices without prioritizing employment or merger.
This, however, is not why Modern Healthcare recently named Inova #3 among large health systems, or why Press Ganey named Inova “2025 Health System of the Year.” Inova’s strength comes from focusing on excellence. It comes from earning trust, attracting great people, delivering great outcomes, and building a culture that people want to be part of. Those are hard to do, and even harder to merge or acquire.
Martha Henley. CEO of Unity Medical Center (Manchester, Tenn.): For most of my career, the unspoken rule was that a real hospital offers everything. If you did not have the service, you were somehow a lesser hospital, and small facilities stretched themselves thin trying to keep up with that definition. We have let that go completely.
What replaced it is a harder question. Not what could we offer, but what does this community actually need from us, and where can we be genuinely good rather than barely adequate. Home health is the clearest example. We had it years ago and let it go, and when the question of restarting it came back around, we looked at the market and decided against it. The need was already being met. If we had gone back in, we would not have been filling a gap, we would have been pulling volume from agencies already serving those patients.
That is the shift. Every service line now has to earn its place before we commit people and capital to it, and sometimes the honest answer is that someone else is already doing it, and doing it well. We say no more often, and we say it earlier, which is uncomfortable, but it is the reason we can invest well in the few things that matter most here.
Timothy Layman, DNP, MSN, RN. President and Chief Administrative Officer of St. Mary’s Hospital, Hospital Sisters Health System (Decatur, Ill.): One once-core strategic assumption we have fully abandoned is that growth in healthcare is primarily about adding volume — more beds, more services, more providers, and more physical capacity.
Today, we recognize that sustainable growth is about creating the right capacity, in the right place, with the right technology and workforce, while improving access, quality, experience, and financial performance. In a smaller community hospital, simply adding services or capacity without understanding demand, consumer behavior, workforce realities, and the economics can actually make the organization less sustainable.
We have shifted from a “build it and they will come” mentality to a “build what the community needs, prove the value, and make it exceptionally accessible” strategy. That means leveraging partnerships, virtual care, advanced technology, AI, ambulatory strategies, and regional relationships rather than assuming every capability has to be built internally. The biggest change in thinking is that technology and intelligence can create capacity just as effectively as bricks and mortar. Our goal is no longer to be the biggest hospital in the market — it is to be the smartest, most accessible, highest-value hospital for the patients and community we serve.
Craig Cheifetz, MD. President of Primary Care Service Line of Inova Health System (Fairfax, Va.): One traditional core strategic assumption we are moving away from is that patients will come to us on our terms at a traditional clinic location, during traditional hours, through traditional scheduling pathways. At Inova we are building a primary care system that meets patients where they are, making access simpler, more convenient, and more responsive to their needs. We are expanding access through new care locations, enhanced digital capabilities, more flexible scheduling options, and innovative care delivery models. Rather than asking patients to navigate a complex healthcare system, we are redesigning the system around the patient experience. This shift allows us to reach more individuals earlier, strengthen continuity of care, and improve health outcomes across the communities we serve. Our focus is to create a seamless, connected access ecosystem that makes high-quality primary care available whenever and wherever patients need it.
John W. Wood II. CEO of Sugar Land Rehabilitation Hospital, PAM Health (Enola, Pa.): In healthcare, we have moved away from the idea that culture, engagement, and retention are functions of the human resource team. HR is an integral part of all three; however, it takes focus and buy-in from all leaders for the organization to be successful. The culture of an organization is its personality that everyone experiences when they walk through the doors. Patients, families, employees, vendors, providers, and contractors are all influenced by the culture of an organization. I spend a lot of time interacting with various healthcare organizations and I can quickly tell if the culture is positive or negative. Successful healthcare organizations have a contagious positive culture that transcends all departments, not just HR.
Shane Strum. President and CEO of Broward Health (Fort Lauderdale, Fla.); President and CEO of Memorial Healthcare System: For years, the operating assumption was that two public hospital systems serving the same community had to compete rather than collaborate. Broward County is the only county in Florida with two public hospital systems, and 18 months ago we decided that wasn’t serving the 2 million people who live here, so we chose to work together instead. No one else can say what we’re saying now: a pediatric ecosystem partnership with Nicklaus Children’s Health System that’s already made landmark pediatric heart procedures possible at Broward Health for the first time in its 90-year history, an oncology collaboration bringing higher-level cancer care into Broward Health, a free rideshare program helping expectant mothers make it to their appointments, and specialists patients used to have to leave the county to see. When two systems stop duplicating and start coordinating, families get better care closer to home. That’s the kind of change worth building on.
Steven Blair, MD. President and CEO of Sutter North Medical Group (Sacramento, Calif.): For a long time, our compensation model was built almost entirely around production: dollar-per-RVU with tiered upside tied to MGMA percentile ranking. That structure served us well when volume and throughput were the metrics that mattered most, but it’s no longer the lever we want pulling hardest as our market shifts. Our growing participation in MSSP, and the prospect of new commercial risk-based and managed-care lives, means more of our revenue is now tied to how well we manage a population, not just how many patients we see. MA penetration is still catching up in our footprint outside Sacramento given our rural geography, so this transition is being driven primarily by MSSP and commercial VBC arrangements rather than Medicare Advantage. As a result, we’re redesigning incentives to reward completeness of care and quality outcomes rather than pure volume. Just as important, we’re intentionally designing this so clinicians aren’t simply trading one productivity treadmill for another; the goal is to support a sustainable, balanced practice life while still meeting value-based targets. Digital tools are central to making that possible: from ambient documentation to care-gap identification, we’re using it to help clinicians meet VBC goals without adding hours to their day. In short, we’re moving from paying for volume to paying for value, and using technology to make that shift financially and personally sustainable for our physicians.
Kristopher Doan. President of Augusta Medical Group at Augusta Health (Fishersville, Va.): The majority of my leadership career has been spent in the physician enterprise side of a health system. And early in my career, we acquired private practices with the strategic assumption that we could simply “do it better.” We could scale resources better, we had a more favorable position when negotiating commercial rates or prices for supplies, and we could provide you, acquired physician, with an environment where you didn’t need to worry about all of the business aspects of healthcare – just worry about what you trained to do, your passion…just see patients.
Fast-forward to today, and while a large health system certainly can create some economies of scale, the assumption that we don’t need physicians engaged in the business aspects is woefully inaccurate. I have completely abandoned that mindset when I am talking with physicians to join our organization. I absolutely want physicians on the team who are engaged in understanding how they impact the business side of healthcare. Certainly some aren’t passionate about the business side, and that why they choose to work for a health system and not go into private practice; but when I have a group of physicians and APPs who are engaged in the healthcare economics of their practice it performs at such a higher level than the days when I used to tell them “we don’t need you involved in the business.”
Naveen Mehrotra, MD. President of Medical Staff at Saint Peter’s HealthCare System (New Brunswick, N.J.): Once-core strategic assumption we’ve moved away is the idea that growth or innovation, by itself, equals progress.
Earlier, we used to believe that if we added more locations, more people, more technology, or more capabilities, the organization would naturally become stronger.
However, what experience has taught us is that innovation or an increase in the scale may not necessarily solve problems; it actually may magnify them. Scale amplifies what you do well, but it also amplifies what you don’t do well.
So, our thinking today is different. Before we scale up something, we ask: Is the process repeatable? Will the experience be consistent? Will it improve outcomes for the patients we serve? And will our team be able to sustain it over time?
We’ve moved from a mindset of “build and grow first” to “design it right, prove it works, and then scale it.”
That shift has probably been one of the most important changes in how we think strategically as an organization and as leaders.
Brad Bivens. CFO of Parkside Psychiatric Hospital & Clinic (Tulsa, Okla.): One strategic assumption we have abandoned at Parkside is that growth alone will solve operational and financial challenges. In behavioral health, demand for services is significant, but adding volume without addressing underlying processes, staffing models and reimbursement can actually compound inefficiencies. We have shifted our focus toward becoming more disciplined about how we use our existing resources. Matching staffing to patient demand, improving revenue cycle performance, evaluating service lines based on both mission and sustainability, and using technology and automation to reduce administrative burden. That has also meant being willing to rethink long-standing processes simply because “that’s how we’ve always done it.” Our goal is no longer growth for the sake of growth, but building a more efficient and financially sustainable organization that allows us to serve patients for the long term.
