Rae Woods (00:19):
From Advisory Board, we are bringing you a Radio Advisory, your weekly download on how to untangle healthcare's most pressing challenges. My name is Rachel Woods. You can call me Rae.

(00:31):
It probably won't surprise you that over the past few weeks, few months, Advisory Board has had a lot of conversations with healthcare leaders about the policy and economic environment. We've had one-on-one calls, we've had sit downs with executive teams and boards, and we even convened small group policy forums. Think something along the lines of a focus group. And all of these conversations are aimed at helping leaders hear and learn from each other.

(00:57):
We've compiled the candid experiences of more than 130 leaders to try to understand what they're doing to prepare for the seismic impact of all of the policies that are impacting healthcare business. And I would love to say that we walked away from these conversations with a universal approach that successfully positions an organization to conquer all of their challenges.

(01:20):
Unfortunately, that's not the case. The breadth of impact, frankly the variable starting place of each organization, means that we're living in a world beyond best practices. But there is still learning that can be done. What we can gain from these anonymized real-world examples is the ability to benchmark, to understand how others are approaching similar challenges, and to hopefully find community in how we as a healthcare industry move forward.

(01:49):
In this episode of Radio Advisory, I've invited Natalie Trebes and Chad Peltier, two researchers who've led our policy work at Advisory Board. They're going to talk to us about the takeaways from their recent policy conversations and what you, our listeners, should do next.

(02:05):
Hey, Natalie. Hey, Chad. Welcome to Radio Advisory.

Natalie Trebes (02:09):
Hi.

Chad Peltier (02:10):
Hey. Long time, first time.

Rae Woods (02:12):
Yes, welcome, welcome. I am going to start us off by doing the very difficult work of trying to rapidly summarize this moment in healthcare. So keep me honest. We've got direct funding cuts that are happening right now for hospitals and health systems. I'm thinking research cuts in particular. We're bracing for more cuts that are going to start in 2026 that are a result of the One Big Beautiful Bill Act.

(02:38):
We've got a volatile business environment that's not unique to healthcare. And there is potential for more change, more reforms, frankly aimed at some of the policies that practically speaking, keep a lot of hospitals and health systems afloat. I'm thinking 340B status. I'm thinking the inpatient business that cross-subsidizes everything else that hospitals and health systems do.

(02:59):
Did I get the highlights?

Chad Peltier (03:03):
I think you're missing changes to immigration and what that might do to the workforce. About a quarter of our physicians are foreign born. And if they're not coming to the US anymore, that's going to decrease the amount of physicians we have on hand and increase recruiting and retention costs.

Rae Woods (03:21):
I did miss that. And if I'm missing that, I have to believe that the health leaders who are listening to this podcast perhaps are also struggling to wrap their arms around this moment in healthcare.

(03:34):
As you speak with executives, do they understand how big of a deal all this change is?

Chad Peltier (03:41):
I don't think everyone has an understanding of how complicated this is going to be. All these different parts of healthcare are interconnected, so a change in one part is going to have these unknown ripple effects everywhere else.

(03:55):
So not healthcare leaders, not us, certainly not me. We can't predict how the One Big Beautiful Bill and other Trump administration changes are going to affect the healthcare landscape.

Natalie Trebes (04:08):
And it's not just the unpredictability of all of this, but a lot of leaders did tell us they feel like they don't know what will really actually manifest. And that's uncertainty number one. But it is also, as Chad mentioned, the interconnectedness. It is how are others in the market going to respond?

(04:29):
And so all of this together is so many moving pieces. It's a giant set of cuts to healthcare funding directly and indirectly. It is uncertainty about how those translate and actually are implemented. And it is uncertainty about strategic responses from competitors, partners, government more broadly.

Rae Woods (04:51):
That's exactly right. In response to all of the uncertainty that these executives are feeling, they're looking to try to understand what are other people doing next so they can understand what next move they should make. Or almost benchmark, where should I be compared to my peers?

(05:08):
And you, Natalie, you, Chad, and your team decided to help with some of that peer-to-peer benchmarking. I think your team convened over 130 healthcare executives across separate conversations, small group conversations, to discuss how they're responding to today's environment.

(05:28):
Now, don't worry. We are not going to put any of those leaders on blast. We are going to keep all of those conversations anonymous, but I do think it's helpful to share with our listeners at a high level who signed up for these conversations and what decisions they ultimately came to.

Natalie Trebes (05:43):
Yeah. We made a lot of promises about confidentiality here, so we are going to uphold that certainly. It's one of our most sacred values and more important than ever. It's been a series of conversations we've had one-on-one with clients. We've also convened focus groups, peer executive discussion forums to talk as small groups and letting executives share with each other in a really candid fashion. And that's what we want to give you some highlights from today.

(06:10):
But in general, in terms of who we've been talking to, it runs the gamut across the healthcare industry. We are still heavily focused on hospitals since they're the ones most affected immediately. We've talked with a lot of chief financial officers, chief operating officers, chief executive officers, and so on and so forth.

Chad Peltier (06:29):
We had leaders from single hospitals to leaders of big healthcare systems, expansion and non-expansion states, red states, blue states, representatives from every cut that you could make. We had plans, we had leaders from pharmacies, we had tech suppliers.

Natalie Trebes (06:47):
And we asked them who they most wanted to talk to and with, and who they wanted to collaborate and discuss with. And it was really interesting because there was a mix of folks who wanted to talk to as close a peer as possible, to leaders who wanted to better get inside of the head of others across the industry, sitting across from them at the table negotiating or within their communities trying to work towards similar goals.

(07:13):
And so, you're going to hear that from us a lot today. I'm sure it really varied across individuals. But everyone is yearning for understanding where everybody else in the industry is.

Rae Woods (07:24):
You've been having these conversations across the last several weeks, particularly in the time in which the One Big Beautiful Bill had passed the House, had not passed the Senate. It was certainly not law. That unique period of time where there was still a lot of uncertainty also revealed a lot about what is commanding these leaders' time and attention.

(07:45):
Not only are they trying to understand how everyone else is bracing for impact, but they're also directly engaging with the administration, with Congress, with the Hill. What did you learn about how leaders are thinking about working with Washington?

Chad Peltier (08:03):
I think some of them were struggling with politicians, sometimes lacking understanding of certain healthcare policies and the impact that it would have on their constituent states. For instance, three 40 B and MTALA were frequently referenced as misunderstood programs and how important they are and the impact it's going to have on hospital revenues and ability to sustain care.

Rae Woods (08:30):
And let's be clear, the healthcare industry is confusing. Healthcare business is confusing. And Natalie, I think you may have even said when we first sat down after the election and we were talking about what could come next, you referenced the fact that some folks in Congress who just were insiders in healthcare had since retired. They weren't there anymore.

(08:50):
And so there was just a lack of genuine in-depth healthcare business knowledge in Congress. And it seems that we're seeing the impact of that play out when it came to the advocacy around this law.

Natalie Trebes (09:03):
And there's also I think some maybe fatigue from Congress as we get away from some of that deep expertise. There is a blanket treatment of the industry as always being defensive, as always raising alarms against any change to healthcare. While at the same time in my entire career we've seen costs go up, access be challenging, quality be challenging.

(09:28):
And so the conversation and policy worlds has always been, are we getting enough bang for our buck? Effectively, but the sophistication around that conversation I think has waned in recent years. And so healthcare leaders in our conversations we're really starting to reconcile or account for the fact that they have been a part of this process by trying to just keep everything together and intact and not necessarily always engage with forward-looking reform.

Rae Woods (10:00):
There was obviously this peak moment of advocacy before the bill was signed into law. But we want to be clear, and the health leaders we spoke to were clear about this, too. That that advocacy doesn't end now that this piece of legislation has passed.

Natalie Trebes (10:16):
Yeah, that's right. We were talking with these leaders at a moment, as you said, in between when the House bill had passed. The Senate had not yet finalized their version. And so there was uncertainty, but everyone was very clear-eyed about the fact that even though the final bill would be giving us some guidelines and the boundaries effectively of where we're headed, that is not the end of the road and there is still certainly the state implementation.

(10:42):
We've got lots to talk about over the next several years around how that varies from state to state, how states are putting these provisions into effect, how HHS is overseeing that. But you're also going to see continued advocacy. Still trying to engage with Congress and state legislatures about the implementation, about pulling some of these provisions back, potentially repealing pieces of it. You're going to see lawsuits cropping up to try to mitigate some of this impact.

(11:09):
And so, it does leave leaders with this question of what is really here to stay? What is really changing? Versus what can I ignore because it might not actually come to pass? And everyone has a totally different opinion on that depending on who they are, what their experiences are, where they sit.

Rae Woods (11:28):
And there are, of course, so many questions. But there were some conclusions that these leaders came to, like the conclusion that you're going to have to continue to not just advocate for change that will benefit you, but also do some education and teaching on some of these, especially the very complicated parts of healthcare, like 340B status like EMTALA. That leaders are going to need to be very careful at tracking the impact and the effect of policy changes on their business, on their patients, on their community. And that tracking needs to start now.

(12:00):
And by the way, that tracking is not going to be easy, especially with to your point, Chad, one policy change can create almost this change of impact. It's why we like to refer to healthcare business as an ecosystem. I'm going to hold true to the anonymous comments that these leaders made, but we did pull a couple of quotes that we're just going to leave blinded.

(12:22):
One leader told us that, "Current policies are baked into the healthcare business ecosystem, and right now we are in equilibrium. But if you disturb one, the entire system is impacted."

(12:37):
And that speaks to the long-term ripple effects that policy decisions can have on the entire industry. So let's actually name some of those ripple effects. There are some known impacts that leaders are bracing themselves for. I'm thinking impacts to Medicaid, to Medicare, and the marketplace. Can you top line those impacts for us?

Natalie Trebes (12:55):
Overall, I think the biggest things we'll see in some form or another is reduction in insured individuals, so who has insurance coverage. And just overall reductions in reimbursement rates. All of that together is hard on the industry and hard on healthcare, but the uninsurance will probably mean you see some conditions go untreated that potentially can lead to ED visits and crowding. And that it's difficult for those who need it, it's difficult for the providers who are delivering that care and not compensated for it, and it's difficult for those who need access to the ED for other reasons.

(13:32):
You've got probably a reduction in more, what we would call, elective procedures. That's obviously a debated term, but things like joint replacements, which are high margin and often something you see in the commercial population and the Medicare population as we start to reduce reimbursement.

(13:51):
The other piece that I think is going unnoticed, and this is in that vein of things that Congress might act on or not, is Medicare sequestration. And we won't get into all the details of that, but effectively the increase in the deficit of this lot triggers cuts to Medicare automatically. So there's going to be a 4% reduction every year unless Congress does something separately.

(14:14):
And so I have heard some leaders say they assume that this will get taken care of. I have heard others say they need to be baking this into their strategic plans now. And ultimately that just tightens up the margin environment for Medicare across the board.

Rae Woods (14:29):
And these are the big headline known or expected things to happen, but there are also ripple effects that still have uncertainty around how much they will hit, when they will hit, how significant those impacts will be.

(14:43):
I'm thinking immigration, like you mentioned, Chad, tariff volatility, what's happening with HHS and delayed approvals. There's also a third bucket, which are the things that we truly don't know or what's truly unappreciated, under-acknowledged. What might those ripple effects be?

Natalie Trebes (15:03):
I think one is probably what happens with 340B. There's everything from if you reduce the number of patients that an organization is seeing that are on Medicaid, you might be changing your status designation that allows you to access 340B discounts as a designated entity.

Rae Woods (15:21):
Wait, wait, hold on. Let's stick to this for a moment, because this I think really speaks to what I mean when I say ripple effects. Changes to 340B. Were not a part of this legislation, but what you're saying is that hospitals and health systems might still have an impact to their 340B status because of what happens with Medicaid. That's precisely what we mean by the unknown ripple effects in this ecosystem as we brace for what is the biggest healthcare legislation since the Affordable Care Act.

Natalie Trebes (15:49):
That's exactly right. And then the other piece of the Affordable Care Act, the marketplaces, I think one of the big ripple effects we'll see there is overall affordability decreasing. So premium prices increasing and we're already seeing insurers filing higher rates, expecting that they're going to have spillover costs accruing to them. And that having some healthy people who were getting tax-deductible assistance with premiums leaving the marketplace is going to potentially make it riskier and therefore more expensive to cover on a per capita basis.

(16:23):
So that is a spillover for everyone who's staying in the marketplace in addition to those who are losing their insurance.

Rae Woods (16:30):
And we could spend hours talking about these ripple effects. You could have spent hours just interrogating the problem with these health leaders. But I want to move us to action, because that's really what these health leaders are craving.

(16:43):
I have a simple question to ask that probably has a very complex answer. What did you actually learn about the moves that healthcare leaders are making in response to these challenges?

Natalie Trebes (16:56):
You're not going to be surprised when I say they're all over the place. And that is not just in terms of what are the moves, but it's also the degree of how proactive versus reactive the leaders are thinking, right?

(17:11):
We have heard some say they really are trying to plan for multiple scenarios and wait until they have a little bit more of an indication of where things are headed. We have heard others say they're already charting that future course that they want to head towards. I think that depends on their market context, but also their financial position and resourcing and their own mission and their own culture at their organizations. And that varies across the board.

(17:40):
We know everyone wants to take care of their patients and be an important source of vital healthcare for their community. Whether they're doing that at a loss and whether they are trying to patch together the absolute safety net or whether they're trying to find more of a niche and focus on something a little more specialized, is a general range of things that we are seeing and hearing. And that'll depend on so many different factors.

Rae Woods (18:06):
So is it correct to say then that there are no universal best practices? There's no common approach that leaders are taking today.

Chad Peltier (18:17):
I think that's right. There's a full spectrum of responses that people are taking. And unfortunately, if you're looking for a simple recommendation, they go across the board of leaning risk-taking versus being extremely conservative.

(18:33):
And the fact that there's this widespread of proposed strategies means there isn't the clear, simple, or correct answer.

Natalie Trebes (18:41):
I would differentiate the strategic direction from day-to-day operations, which we know is everyone's number one through 10 priority right now. Which is how do I make sure that I am as efficient as I possibly can be? How do I make sure that I have patient throughput moving as quickly as possible? I'm maintaining access. I'm working with different partners in my community to find stabilization options and follow up care, and so on and so forth.

(19:09):
Care variation, reduction, the length of stay, all of those buzzwords that we've been talking about for ages, I think, have catapulted to the top of everyone's priority list to get done as fast as possible. And this is honestly a time where the urgency can be helpful to organizations to make moves towards the things they know they should have been doing, and it's hard to get everybody appeased and on the same page. Now you can put things into action, and we heard that from several leaders.

Rae Woods (19:38):
I appreciate the differentiation between operational excellence in the playbook that we know and that health leaders know they need to execute on versus the strategic decisions that folks have to make.

(19:51):
That said, we know that the margin pressure is going to be remarkable and just making things more efficient is only going to take organization so far, right? At some point, leaders are going to have to make difficult decisions. They're going to have to make difficult trade-offs that ultimately mean cutting things.

(20:11):
I actually want to pause and read another quote from these conversations that I think perfectly highlights the tension that we're seeing. "We don't want to just have a strong balance sheet but be strategically bankrupt."

(20:25):
How are leaders thinking about the tension between just being efficient enough to keep the lights on versus being able to act on their strategic priorities?

Chad Peltier (20:36):
Unfortunately, what we heard from leaders is a broad spectrum of responses indicating that there's no clear or correct answer. Some people are being extremely conservative about future investments and they're just focused on efficiencies and cost-cutting. Others are trying to develop new revenue streams so they're not as reliant on government payment for healthcare.

Rae Woods (20:59):
Meaning maybe on one end they're guarding against this idea of becoming strategically bankrupt, right? Using this short moment in time before some of the big cuts hit to make more investments. Like I'm thinking, we've heard from leaders we're taking this time to invest more in ambulatory care in the anticipation of site neutral payments to come.

(21:20):
But there are still some folks that are bracing for the financial impact. These are the conservative moves. How far are those conservative moves going?

Chad Peltier (21:31):
Those in tough financial spots are being extremely conservative. They're considering cutting their staffing, which is potentially a short-term win for their profitability, for their costs. But unfortunately that's a long-term loss. You're going to have to hire people back again if you want to grow. That's then going to be recruiting and retention costs that are long-term negatives for your organization.

Natalie Trebes (21:56):
It's actually, when you take a step back, reflective of the position that systems have been in for a while now, which is that they know they need to transform for where care is shifting, for how demographics are evolving, for more ambulatory and drug-based therapy. But that's not yet what makes them money. And so balancing that proactive investment has been difficult for them.

(22:23):
Now we're in this position where they may see overnight what makes them money really getting ripped back, but they haven't yet been able to invest towards the future. And so it's even more damaging to the future to do those layoffs now. But it's so hard to get there. And I don't want anyone to think that this is an easy situation, and the answer is just hold your nose and don't do the layoffs. That is really complicated. I don't want to pretend otherwise.

Rae Woods (24:12):
What about the revenue side? I understand that people are bracing for impact. They're making these difficult decisions when it comes to something like layoffs, when it comes to pulling back on their strategic priorities. But I have to believe there are listeners that are thinking, hold on, I can make up for this. I can make bigger investments. I can run that volume campaign. I can get more hips and knees in.

(24:33):
Is that something that folks told you they believe is a viable strategy?

Natalie Trebes (24:37):
I will say, we did hear a lot of leaders talk about how they are pivoting even harder towards trying to partner with employers, trying to attract commercial covered lives for procedures.

(24:51):
That is not necessarily a new thing I think we've heard in healthcare leaders strategy. I think the challenge is with everyone talking like that, it is going to become even more of a zero-sum game or honestly negative-sum game is I think increasingly a way to think about this.

(25:10):
Because employers are not going to be isolated from all of the impacts here. We are not going to be able to just shift all of the costs over to employers and have them make this up when they've been seeing honestly double-digit increases in premiums for the last several years. And they too are desperate to not have their costs increased.

Rae Woods (25:30):
There's also just so many volumes to win, right? Everyone can do the operational excellence stuff. Everybody can focus on CVR. Everyone can focus on RevCycle. But if one health system wins that volume, that means the other system didn't.

Natalie Trebes (25:44):
Right/

Chad Peltier (25:45):
And to secure it, you're probably going to have to offer something unique which costs you money. Or offer discounted prices for your customer, which means you're making less revenue than you would otherwise.

(25:57):
The seeking commercial strategy would work great if it was one provider per state doing it. But when there's multiple providers in the same location competing, no one's going to win.

Rae Woods (26:07):
So there's not enough revenue for everyone to capture, to boost their way out of this. Some folks are willing to take pretty bold action when it comes to cutting back on the cost side. And those might be the right business moves, but here's what I'm concerned about. That the quote/unquote "strategy" is actually just survival. It's just survive at all costs, and that creates a real tension between being financially sustainable and being able to provide services for your community. Right?

(26:42):
The classic margin versus mission. I want to be blunt. Did the leaders that you spoke to believe that they would be able to maintain all of the services that help meet the needs of the community given this financial pressure?

Natalie Trebes (26:58):
No, absolutely not. A single person told us that they felt that they were going to be able to maintain every single service that they currently offered.

Rae Woods (27:07):
Wow. Not a single one in 130 conversations. Chad, keep me honest.

Chad Peltier (27:14):
Yeah, so referencing the spectrum of responses and strategies again, we got an extreme response was someone trying to maintain all their services?

Rae Woods (27:25):
Wait, hold on. We're going to say that again. It was an extreme business goal to try to maintain all services?

Chad Peltier (27:32):
To try to maintain. Yes. And it wasn't most people saying that it. It was one specific organization doing their best to hold on because they recognize they're a community hospital and their patients don't have many other options to seek care.

Natalie Trebes (27:47):
I think it's important to note that we are getting in the territory of, for some of these organizations, of what is the point of existing if they do not provide that kind of care to their community. And so rather than shrink themselves down to a clinic that only focuses on... Basically shrinking themselves down into an ambulatory surgery center and getting rid of everything else so that they can exist as an organization with their name. They are going to try their best to scrap it together and maintain what they can for as long as they can and they'll see where that takes them.

Rae Woods (28:28):
I'm having flashbacks to some of the most important research that, frankly my co-host Abby, led last year, which was all about what hospital and health system growth would look like. And the big insight and takeaway from that research is that the very definition of growth had changed. And that it was no longer about getting bigger to be bigger. It was no longer even about top line growth. It was about sustainability. But sustainability is very different than survival.

(29:00):
Survival is just do you exist and is your name still on a plaque on the wall, even if it's just an ambulatory surgery center? Sustainability was a very different goal, which is that first of all, you are financially sound, but you're also still able to meet the specific strategic and mission oriented goals of your organization, and it no longer sounds like sustainability is an option for all hospitals and health systems.

(29:26):
My question is do we know what kinds of organizations fall into the "we just have to survive" camp versus the sustainability camp?

Chad Peltier (29:38):
The community hospitals and rural health care centers, those are the ones that are hoping to survive. They don't think sustainability is really going to be an option for them. They're all about survival at this point.

Rae Woods (29:55):
Was anyone hopeful? Positive?

Natalie Trebes (29:59):
I think there was a lot of hope in the talent in the organizations and hope in the coming together as an organization, as a culture, as a community. I don't think anybody was necessarily feeling great about the position that they're headed towards, but they certainly feel a number of them felt very strong about the partners that they had. And again, I think I said this before, but the urgency of the orientation to meet this moment.

(30:32):
And so many of these leaders are so focused on the patients in their community. It's a buzzword that I have heard thrown out a lot of different times in my career here of saying we want to meet the patients where they are. It's always abstract. And this time felt like the most tangible, specific concern I'd ever heard for the patient's well-being in communities that is remarkably different than what I've heard from more of a business lens in the past. This truly feels like existential. We are here to serve patients.

Chad Peltier (31:08):
So one of the providers we spoke with summarized this pretty well and said, "We have to change the mindset from how do you afford to offer this service to how do you afford not to offer it?"

Rae Woods (31:20):
And look, this is a healthcare business. Podcasts, Advisory Board, is a healthcare business research firm. But there's clearly this moment where if no one we are speaking to thinks that they can continue to provide all of their services, that they're really trying to come together as multiple hospitals and health systems, as coalitions across different parts of healthcare, to try to figure out what does healthcare's next act look like?

(31:46):
And there is no way to do that without further engagement with the government. How are leaders thinking about the next phase of healthcare reform?

Natalie Trebes (31:58):
One of the most interesting conversations we had was around, I would describe it as humility, from the industry about where we go next. And there was a recognition that the healthcare industry has really been defensive when it comes to health policy. So a lot of pushback anytime there is any potential change to reimbursement, structures, coverage reform, all of these pieces. There's just a knee-jerk, have-to-hold-on to the financial situation that you're in because it's already so hard.

(32:31):
And we are of a relatively large health system talked about how the industry has not offered any real compromises on how move forward on health reform to get more affordability across the nation. And that part of the reason we are in this position where healthcare is the big ticket item for Congress to cut when they're looking for trillions of dollars of savings is because we have set up these structures over time that accrue all of that.

(32:57):
And so the industry needs to start leaning into more proactive avenues towards health reform that are more sustainable for the nation as a whole, which means potentially making some compromises individually, but working together more holistically as an industry.

Rae Woods (33:13):
It also feels like a very big change in what healthcare advocacy looks like. I'll be honest, a lot of advocacy has been very protectionistic.

Natalie Trebes (33:20):
Yes.

Rae Woods (33:21):
It's just how do I prevent hits from hitting my business or my part of the organization? And it's clear that that model isn't resonating. It isn't working.

Natalie Trebes (33:34):
And I think that comes back to what Chad was talking about before, around a lot of legislators don't necessarily understand how things work. And so-

Rae Woods (33:44):
Yes.

Natalie Trebes (33:45):
... it's not just education on the mechanisms of policy that's needed. It's education on how the overall healthcare ecosystem functions and how day-to-day operations rely on contributions from all across the industry, how patient throughput involves health plans and hospitals and post-acute care facilities. No one is an island in healthcare is how we need to be thinking about that.

Rae Woods (34:12):
What you're describing is an enormous shift in the industry's historical posture. If I can give one last quote from these conversations, it's that a leader said that, "We've always lobbied to prevent things from being taken away from us instead of being able to offer something to give up. We need to work together as an industry to look at what to fix, what we can give up to make healthcare more sustainable."

(34:36):
If that's the goal, if that's part of the next chapter, what do healthcare leaders need to do right now?

Chad Peltier (34:45):
So one of our takeaways is that we don't want the healthcare system to be viewed as the industry that cried wolf. A lot of leaders in the healthcare organizations and legislators are claiming that the One Big Beautiful Bill Act is going to do a lot of damage. People will go without care, people will die, hospitals will close.

(35:05):
While all that may be true, if you're going to make these claims that are that big and important, you better have the data to back it up. So healthcare leaders need to start tracking all the data they have available to them so they can start making an evidence-based argument a year or two down the road.

(35:23):
So start getting your benchmarks now and then over time, you need to be looking at how sick are people when they come in the future? Do they get less care? Can they not make payments? Do the hospitals have thinner margins?

Natalie Trebes (35:36):
Yeah. And what are those indicators that you already are tracking that you can just go ahead and make a plan for your pre and post analysis that's relative to the changes happening right now?

Rae Woods (35:49):
Final question. Are you going to convene more folks for these kinds of focus groups?

Natalie Trebes (35:55):
Yes. We have heard from leaders that participated in that they actually would like to have more of them, but longer. And so we are going to be putting together more of a workshop for a select group of leaders who would like to engage further, and we are open to your ideas and opinions.

(36:16):
We would love to hear whether that's leaning more towards the operational efficiency side of things, more towards the strategic planning ambitions, or even into the advocacy space.

Rae Woods (36:30):
Well, that means more to come from you, Natalie, and you, Chad. But for now, thank you for coming on Radio Advisory.

Natalie Trebes (36:36):
Thanks for having us.

Chad Peltier (36:36):
Thanks for having us.

Rae Woods (36:43):
I'm going to be blunt with you all. This is a tough moment for healthcare. In fact, it's a bit of a moment of reckoning, a time to assess how we as an industry can move forward. But if there's one thing you take away from this conversation, it's that you are not doing it alone.

(37:00):
You can always get in touch with us, and we are going to be convening more of these conversations and focus groups across the fall. If you're interested in being a part of one of those conversations, just send us an email. We're at podcasts@advisory.com because remember as always, we are here to help.

(37:42):
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(37:49):
Radio Advisory is a production of Advisory Board. This episode was produced by me, Rae Woods, as well as Abby Burns, Chloe Bakst, and Atticus Raasch. The episode was edited by Katy Anderson with technical support provided by Dan Tayag, Chris Phelps, and Joe Shrum. Additional support was provided by Leanne Elston and Erin Collins. Special thanks to Lindsay Paul.

(38:11):
We'll see you next week.