HMA Insights: Your source for healthcare news, ideas and analysis.
HMA Insights – including our new podcast – puts the vast depth of HMA’s expertise at your fingertips, helping you stay informed about the latest healthcare trends and topics. Below, you can easily search based on your topic of interest to find useful information from our podcast, blogs, webinars, case studies, reports and more.
Why healthcare strategy is needed more than ever in times of rapid change
When thinking about strategy, most organizations have a strategic plan. But with the amount of change being thrust upon the healthcare industry, no one could have predicted the current landscape even one year ago.
The strategy function at a healthcare organization generates strategic plans, identifies growth initiatives and validates them. A core responsibility is monitoring the information and policies that inform those hypotheses. The best organizations are able to stay focused on their overall goals while keeping track of, adapting, and changing as new information surfaces.
The high pace of change related to technology, policy, and regulation, requires continual monitoring and reassessment. Not every healthcare organization has the competencies to track and manage these changes, and entities frequently come to HMA to either validate assumptions that are the basis of their plans, or to outsource components of the analysis or the implementation.
Organizations generally have a good handle on certain elements, including their own assets and competencies, the strength of relationships with their partners, and hopefully an understanding of what their customers want. But in times of rapid change, consultants can support monitoring external market factors and turbulence on the policy and regulatory front. They can assess changes on the technology side as well, including ways to integrate AI and other digital technologies to enable care delivery. Organizations see the potential for policy changes to disrupt the way they are doing business, but may need outside validation to ultimately communicate and operationalize new approaches within their business.
If your organization is struggling to turn strategy into action, our experts are available to help you lay a clear path to positive results. Whether you are focused on payments, healthcare delivery, government policy, behavioral health, life sciences, Medicare, Medicaid, or Managed Care, our HMA experts are ready to partner with you, from initial strategy-setting through implementation.
Rebecca Nielsen and Alex Rich, co-leaders of HMA’s Strategy and Transformation practice, have been supporting healthcare strategies in an ever-changing environment defined by constant disruption from AI, shifting regulatory policies, and financial strain. With so much change in the air now, many strategic plans are outdated before they ever get implemented. In this episode of Vital Viewpoints on Healthcare, they expose the blind spots that sabotage even the most well-crafted strategies and offer a grounded look at what actually works when change is the only constant. They unpack the challenge of the 5-year strategic plan and the risk of trying to do everything at once, explaining why real-time information sharing may be your most overlooked leadership tool. If your organization is struggling to turn strategy into action, this is the clarity you’ve been waiting for.
In the current policy environment, we anticipate increased consolidation in various subsectors due to financial and regulatory headwinds. Organizations can take intentional steps pre- and post-integration to realize cost synergies.
HMA Strategy & Transformation consultants advise organizations in their integration activities, and find it valuable to conduct the following sequence of steps:
Map the operating model pre-close to understand organizational structure, systems, contracts, and key processes across both entities.
Identify risks and quick wins before close—including staffing gaps, system incompatibilities, or duplicative vendors.
Design a Day 1 plan to keep operations stable, align communication, and ensure continuity for staff, patients, and partners.
Stand up integration teams post-close to drive workstreams across finance, IT, HR, and clinical operations with clear timelines and ownership.
Track synergies and milestones to measure progress, course-correct where needed, and deliver the operational and financial goals of the deal.
A thorough, objective mapping is recommended, to investigate whether to cultivate in-house capabilities or maintain vendor relationships. Considerations include in-house capacity, contracted rates, and the flexibilities and risks associated with outsourcing. We recommend identifying favorable terms in existing vendor contracts that can be leveraged in enterprise-wide contracts.
Although there are internal and external pressures to move aggressively towards transaction deadlines, ensuring that appropriate pre- and post-close activities take place is key.
Ready to transform your organization?
Whether you are focused on payments, healthcare delivery, government policy, behavioral health, life sciences, Medicare, Medicaid, or Managed Care, our HMA experts are ready to partner with you, from initial strategy-setting through implementation.
Alex Rich is an experienced business transformation leader with extensive expertise designing and deploying strategic programs that produce meaningful results. … Read more
Achieving financial resilience in a time of turbulence
Healthcare business leaders face significant policy and regulatory headwinds. Ensuring that your organization is financially resilient to weather the storm should be a priority. Achieving financial resilience enables leaders to preserve core functions and staff. We’ve found that indirect costs are often overlooked and undermanaged and represent an opportunity to build margin (think overhead and administrative costs such as vendor spend).
HMA can help identify cost savings
We find it useful to conduct the following sequence of steps:
Review / categorize all vendor spend to find areas with unnecessary costs, overlapping services, or outdated pricing.
Analyze contracts line -by -line to identify where terms can be improved or where the scope no longer fits current needs.
Stack rank initiatives by risk levels and speed.
Negotiate directly with vendors to lower rates, adjust service levels, or consolidate under better pricing structures.
Monitor results and vendor performance to ensure savings hold over time and services stay aligned with operational needs.
In assessing indirect costs, we visually depict areas of cost reduction by risk of disruption to support client decision-making. There is often a locus of opportunity that can be trimmed with little or no impact to the core business.
As you prepare to batten the hatches, consider assessing indirect costs. Even if the storm isn’t fierce, conducting this work will give you improved real options for optimal decision-making.
Ready to transform your organization?
Whether you are focused on payments, healthcare delivery, government policy, behavioral health, life sciences, Medicare, Medicaid, or Managed Care, our HMA experts are ready to partner with you, from initial strategy-setting through implementation.
Alex Rich is an experienced business transformation leader with extensive expertise designing and deploying strategic programs that produce meaningful results. … Read more
This week, our In Focus section focuses on a March 12, 2025, announcement from the Centers for Medicare & Medicaid Services (CMS) regarding CMS Innovation Center programs under the new Administration. After reviewing the Innovation Center’s model portfolio, CMS has elected to discontinue four models ahead of their original end dates: Maryland Total Cost of Care (TCOC), Primary Care First (PCF), End-Stage Renal Disease (ESRD) Treatment Choices (ETC), and Making Care Primary (MCP). The agency also intends to downsize the Integrated Care for Kids Model (InCK) and forgo the launch of two drug pricing initiatives. According to the announcement, CMS appears to be moving forward with other Innovation Center models, but signaled upcoming modifications to models to align with Administration priorities as well as new model announcements.
The following is a discussion of CMS’s announcement and what it may signal about the agency’s commitment to value-based care, key takeaways regarding the four terminated models, and how stakeholders should be preparing to engage with the Innovation Center on current or future models while we await additional details.
CMS’s Strategic Decision
As part of CMS’s recent announcement about the model terminations, the agency reaffirmed its support for testing models that reduce program spending while maintaining or improving quality of care. Furthermore, the Innovation Center “plans to announce a new strategy based on guiding principles to make Americans healthier by preventing disease through evidence-based practices, empowering people with information to make better decisions, and driving choice and competition.” These statements should be seen as a commitment to using the Innovation Center to test new approaches to delivering care but with an expectation that the models will need to demonstrate significant cost and quality improvements as outlined in its statutory authority. According to CMS, the cancellation of these models is projected to save an estimated $750 million.
Because CMS said it may modify additional models in the future, it is reasonable to expect those changes will focus on achieving a higher level of savings or to see savings earlier in the demonstration, as well as aligning model design with the priorities of this Administration. The potential modifications could have an impact on the number of model participants, length of model testing, and financial arrangements, especially with regard to risk and quality improvement approaches.
Models Ending
CMS Innovation Center models are time-limited pilots meant to help the agency test which types of interventions lead to cost savings and improved quality and, if successful, can be scaled on a nationwide basis. These models are evaluated regularly, and CMS has the authority to modify or terminate models if they fall short of the statutory criteria.
The four models the agency plans to terminate are ending for various reasons (e.g., underwhelming performance, forthcoming replacement by successor model, etc.) and, as stated above, the decision should not be seen as a retreat from value-based care, but rather as a signal regarding Administration priorities for Innovation Center models. For example, despite terminating PCF and MCP prior to their original end dates, CMS reaffirmed its support for primary care as a “foundational component of the Center’s strategy” and that future primary care payment reforms will focus on approaches that produce savings. CMS also noted that ending these models early offers an opportunity to move beneficiaries into more permanent programs, such as the Medicare Shared Savings Program (MSSP)—CMS’ flagship accountable care initiative—even going so far as to direct readers to the MSSP’s calendar year 2026 application.
CMS plans to advise current model participants of other options for advanced primary care payment before the models conclude by December 31, 2025. Table 1 presents information on the models scheduled for early termination.
Table 1: Models Ending by December 31, 2025
In addition, the agency is considering options to reduce the size of the InCK model and will no longer pursue the Medicare Two Dollar Drug List and Accelerating Clinical Evidence models. The latter two initiatives were included in a Biden Executive Order on drug pricing and were not implemented. Notably, CMS did not end another drug pricing Innovation Center model, Cell and Gene Therapy Access (CGT) Model.
Innovation Center’s New Strategic Plan
CMS also announced that it will soon release its new vision for the Innovation Center, based on principles designed to improve Americans’ health through evidence-based practices, empower individuals with decision-making information, and drive competition.
This vision will set the direction for future value-based care initiatives and reflect the leadership changes within CMS, including the anticipated confirmation of Mehmet Oz, MD, as CMS Administrator and the appointment of Abe Sutton, as the new Director of the Innovation Center. Mr. Sutton’s experience with value-based care—especially during his time as an advisor to then Department of Health and Services Secretary Alex Azar under the first Trump Administration and his subsequent private sector leadership of value-based companies—positions him to play a key role in shaping CMS’s future efforts.
Stakeholder Considerations
Stakeholders have several critical operational decisions and strategic considerations to address, including:
Transition Support. Participants in the models scheduled to end must assess their options for sustaining certain components of the payment models without Innovation Center support. This effort will require strategic, operational, and financial analyses to make informed decisions.
Evaluation of Other Programs. While the Innovation Center has signaled its intentions of announcing new models, participants should not wait to evaluate options. The Administration plans to prioritize permanent payment programs and will continue to support the MSSP as CMS’s permanent model for accountable care organizations (ACOs). Stakeholders interested in participating in the MSSP in 2026 must act quickly to assess their organizational readiness, conduct financial modeling of their potential benchmark and performance, evaluate potential partners, and prepare for the application process. Both existing and new ACOs should be exploring their strategies and infrastructures to optimize performance.
Adapting to Changes in Existing Models. While CMS discontinued select models, it is likely the agency will make additional changes to the Center’s continuing models. These revisions likely will reflect President Trump’s executive actions and policy priorities. With the increased focus on cost savings, CMS may choose to spend fewer resources on model implementation, including participant support and model engagement.
Policy and Market Intelligence. Monitoring the dynamic federal policy landscape and seeking strategic advisory support can help stakeholders navigate and inform potential future federal and state alternative payment model opportunities. Stakeholders should expect that existing and potential new models may have stricter requirements and higher expectations for financial risk. Providers, states, insurers, and other interested stakeholders should monitor public and private sector developments to understand the landscape and evolving opportunities.
Connect with Us
Health Management Associates, Inc. (HMA), is home to alternative payment model experts that can assist stakeholders in responding to changes in Innovation Center models and the agency’s approaches and to help prepare for participation in future model opportunities. Additionally, HMA produces a weekly briefing focused on public and private sector VBP-related news. To learn more about how HMA can support your organization’s federal engagement and innovation strategy, contact our experts below.
Through a new collaboration with Stanford University’s Emergence Program, HMA’s Strategy & Transformation practice aims to foster innovation in Medicaid and public healthcare. This collaboration seeks to support a new generation of public health innovators, focusing on transformative approaches to healthcare payment, policy, and delivery.
Kyle Murphy and R.J. Briscione presenting.
Kyle Murphy and R.J. Briscione of HMA’s Strategy & Transformation Practice will mentor early-stage companies, deliver guest lectures on the U.S. public healthcare system, and co-develop thought leadership pieces with Stanford faculty and students at Stanford Emergence Program.
This multi-faceted collaboration is designed to provide real-world insights to aspiring healthcare entrepreneurs aiming to improve public health outcomes and equity.
Prof. Narges Baniasadi, who is the founder and executive director of Emergence program says: “We are excited about our growing collaboration with HMA team to catalyze the translation of academic research to impactful innovations for public health and to educate budding entrepreneurs on ways they can scale their impact through working with the public sector.”
Dr. Narges Baniasadi oversees this new initiative that strives to 1) catalyze impact entrepreneurship to address systemic challenges in the health of our society and planet and 2) shift the culture of the innovation ecosystem to be more mission-driven and inclusive. At the core of Emergence is its mission to inspire, educate, and support the next generation of innovators to improve societal and planetary health through impact entrepreneurship.
Early in January, HMA’s Strategy & Transformation Practice will also participate in the Stanford Mussallem Center for Biodesign’s implementation bootcamp for its 2024-25 cohort of Innovation Fellows. Murphy and Briscione will focus on expanding the Innovation Fellows’ understanding of Medicaid and assessing its viability as a go-to-market strategy for innovative solutions. Since 2001, Stanford Biodesign has educated and empowered aspiring and experienced innovators interested in improving healthcare with technology innovation through fellowships, graduate and undergraduate courses, faculty training, and executive education.
To date, the center has trained 219 Innovation Fellows through a 10-month program where they learn to identify and screen important unmet health needs, invent technology-based solutions to address the most promising ones (including medical devices, diagnostics, digital health, drug delivery, and biotechnology solutions), and prepare to implement them into patient care. The Strategy & Transformation Practice brings valuable experience to this collaboration, having previously worked with companies that have emerged from Biodesign trainee projects.
This collaboration elevates HMA’s position within the innovation ecosystem and prepares founders to build and scale products designed for Medicaid populations. By bridging the gap between evidence-based research and practical implementation, this effort has the potential to drive changes in public healthcare policy and delivery, generate the development of cost-effective healthcare solutions, and improve healthcare access for vulnerable populations. As HMA continues to lead in healthcare consulting,supporting the Emergence Program and Stanford Biodesign reinforces its commitment to fostering innovation and improving public health outcomes across the country.
