Today’s health system CEOs don’t just view advocacy as part of their leadership roles. They see this work as essential to the future of healthcare delivery and the industry as a whole.
Becker’s connected with Barry Arbuckle, PhD, president and CEO of Fountain Valley, Calif.-based MemorialCare; Carl Armato, president and CEO of Winston-Salem, N.C.-based Novant Health; and Bill Gassen, president and CEO of Sioux Falls, S.D.-based Sanford Health, to discuss the tools or forums they are using to influence lawmakers.
They also discussed how they are engaging state and federal policy levers and shared examples of operational decisions influenced by policy positioning.
CEOs’ role in shaping policy
Healthcare CEOs have long played a role in shaping policy, but today’s leaders are intensifying their advocacy in response to increasing industry pressures.
“It’s the CEO’s responsibility to take a lead role in that,” said Dr. Arbuckle. “Members of Congress, and certainly members of the administration — whether at the state or federal level — are responsive when they hear from the people leading the organizations that their regulations impact.”
In-person meetings with lawmakers — or their staff — are especially effective, he said.
“I often tell colleagues that if you’re scheduled to meet with a member of Congress but end up with a staffer because the legislator was held up in a vote, that’s OK,” Dr. Arbuckle said. “Frankly, and this isn’t a criticism, healthcare staffers often know the issues more deeply. You can actually have a more informed and lively discussion.”
He added that real-world data and examples are in high demand.
“Those examples are valuable. And when you can provide reliable, third-party research — not just anecdotes or one-off horror stories — that evidence is powerful and appreciated,” he said.
Mr. Gassen echoed the importance of front-line insights, emphasizing that advocacy is an extension of leadership, especially for rural systems such as Sanford Health.
“Today’s healthcare CEO must be informed, engaged and solutions-focused on the policy issues shaping the future of care. Our role extends beyond leading an organization — we must be visible advocates who tell the story of rural hospitals and emphasize how essential they are to the health and vitality of communities.”
He sees advocacy as directly tied to Sanford’s mission — and most impactful when relationship-driven and community-centered.
“It must be intentional, relationship-driven and grounded in stewardship for the communities we serve,” he said. “This is even more important in a dynamic environment where policy shifts and economic pressures challenge providers, and communities are looking for reliable leadership.”
He also stressed the value of optimism and credibility in these efforts.
“Thought leadership is an important part of how we contribute, and it has helped strengthen Sanford Health’s national credibility,” Mr. Gassen said. “We’ve used our voice to elevate the needs of rural communities and highlight the impact of policies that matter — including telehealth flexibilities, enhanced premium tax credits and the 340B program. We’ve also shared how strategic system combinations can expand access and accelerate innovation in rural regions.”
He added that CEOs are uniquely positioned to connect legislative goals with on-the-ground care.
“Bring forward real solutions, bridge the gap between policy and day-to-day care and work in partnership with federal elected officials, policymakers and peers to scale models that strengthen rural healthcare. I view advocacy as part of the job — elevating the needs of caregivers, patients and communities and helping advance innovative care models that position the entire sector for long-term success.”
Tools or forums to influence lawmakers
The CEOs outlined several forums and strategies for engaging policymakers.
Mr. Armato pointed to Novant Health’s involvement with the American Hospital Association, The Academy Advisors and the North Carolina Healthcare Association on issues such as affordability, rural access and workforce development.
Novant has also created a clinician-led Center for Public Policy Solutions, which contributes to policy debates by publishing white papers on issues like annual checkup policies and sepsis treatment criteria.
Dr. Arbuckle, while recognizing the value of sector-specific trade groups, said cross-sector collaboration can yield even greater impact. He cited his work with California’s Integrated Healthcare Association and the Healthcare Leadership Council at the national level.
“So when IHA advances a concept, it has cross-sector support,” Dr. Arbuckle said. “At the federal level, I work with the Healthcare Leadership Council, and I serve on its executive committee.”
He added that a unified message from a diverse group carries more weight with lawmakers.
“Where we agree — those aligned priorities — are incredibly powerful,” Dr. Arbuckle said. “Legislators and members of the administration take notice when a cross-sector group is unified. It signals that the issue isn’t about one sector’s self-interest.”
At Sanford, Mr. Gassen said advocacy is grounded in long-term relationships with state and federal officials. He highlighted the $50 billion Rural Health Transformation Program, a federal initiative aiming to bolster care in rural regions, as an example of where such partnerships matter.
“We applaud CMS for launching the Rural Health Transformation Program — a significant investment in expanding access, improving long-term sustainability and supporting the communities who need it most,” Mr. Gassen said.
Sanford also works closely with the AHA and other national groups to share rural perspectives and promote innovation.
“Through the AHA, we share operational and on-the-ground perspectives, elevate innovative rural care models and help shape national conversations around access, workforce and innovation,” he said.
Engaging state and federal policy levers
Health systems increasingly recognize the importance of working at both the state and federal levels.
“California has been very active for decades,” Dr. Arbuckle said, noting his advisory role with the state’s Office of Health Care Affordability. “They’re actively trying to control the trajectory of healthcare costs.”
That office has frequently sought MemorialCare’s input on care models and payment structures.
At the federal level, Dr. Arbuckle shared how a conversation about telehealth reimbursement with the Congressional Budget Office evolved after initial concerns about cost projections.
After MemorialCare and other systems were blocked from sharing internal data due to conflicts, Epic founder Judy Faulkner stepped in.
“She said, ‘Barry, I can fix this.’ … She ran the analysis nationally and shared it with CBO, and they changed the scoring model,” Dr. Arbuckle said.
Mr. Armato also highlighted Novant’s federal engagement, including recent testimony before the U.S. House Ways and Means Subcommittee on Health, which focused on the role of value-based care and care coordination.
Mr. Gassen emphasized Sanford’s dual-level engagement as well — from collaborating with governors and health departments to participating in national roundtables and policy development sessions.
“Our responsibility is to stay engaged at both levels. Each plays a distinct but complementary role in advancing rural healthcare.”
How policy is shaping operations
Health system leaders are not just engaging policymakers — they are adjusting their strategies in response to regulatory shifts.
“As an integrated nonprofit health system, Novant Health has always operated with the expectation that we will not be fully reimbursed for the care we provide, yet we remain committed to investing in access and innovation,” Mr. Armato said.
To that end, Novant is expanding ambulatory care and alternative sites to control costs and improve convenience.
Dr. Arbuckle is focused on how FDA drug approval standards affect system spending. He pointed to Wegovy’s approval based on relative risk reduction, raising concerns about the absence of absolute risk and cost-effectiveness data.
Mr. Gassen said Sanford’s virtual care program demonstrates how policy and operations intersect. Today, the system offers virtual care across 78 specialties and 93 locations. Two-thirds of virtual care patients live more than 30 miles from a major medical center, and each visit saves an average of 176 miles in travel.
He cited the Sanford Roger Maris Cancer Center in Fargo, N.D., as an example of this impact.
“We are also expanding infusion pharmacy services at nearby satellite clinics, increasing access to advanced therapies, including CAR T-cell therapy,” he said. “These advancements are possible because of federal telehealth flexibilities. The result is a scalable model that brings advanced, complex care closer to home — and sets the standard for the next generation of rural care delivery.”
