Editor’s note: This is a compilation of top pieces about the One Big Beautiful Bill published this year by Vizient and Kaufman Hall experts. Links to the full pieces can be found in each section.
The One Big Beautiful Bill (OBBB) represents a significant shift in the healthcare landscape, with far-reaching implications for hospitals and health systems. As new policy and reimbursement dynamics take shape, organizations are facing heightened financial pressure and operational complexity, underscoring the need for disciplined, forward-looking strategies.
In this environment, leaders must navigate uncertainty while continuing to deliver high-quality, accessible care. Success will depend on the ability to strengthen financial sustainability, adapt care delivery models, and build organizational resilience amid ongoing change.
To help organizations respond, Vizient has identified four strategic imperatives essential for navigating the One Big Beautiful Bill:
- Margin transformation: Moving beyond incremental cost reduction to improve structural efficiency and long-term sustainability.
- Care delivery realignment: Redesigning care models and resource deployment to better match evolving demand.
- Structural resilience: Building flexible operating models and partnerships that can adapt to changing reimbursement and market dynamics.
- Technological enablement: Leveraging analytics, automation and emerging technologies to improve visibility, productivity and performance.
Together, these imperatives provide a framework for health system leaders seeking to remain resilient and financially sustainable as the effects of the One Big Beautiful Bill continue to unfold. The perspectives that follow from Vizient and Kaufman Hall experts explore how organizations can apply these principles to navigate change and position themselves for long-term success.
Workforce redesign in an era of scarcity
Therese A. Fitzpatrick, Managing Director, Revenue & Operations Improvement, Kaufman Hall; Bonnie Proulx, Senior Vice President, Physician Enterprise Practice, Strategy & Business Transformation, Kaufman Hall; Christen Hunt, Senior Vice President, Kaufman Hall
Why it matters: OBBB’s indirect pressures on graduate medical education and state Medicaid financing collide with pre-existing shortages of physicians, nurses and direct-care workers. Many systems have expanded advanced practice providers (APPs), but role ambiguity, uneven transition-to-practice approaches and outdated productivity models mean higher spend without commensurate access gains. Meanwhile, AI tools (ambient documentation, automation) can return time to clinicians, but few organizations have workforce plans or regulatory frameworks that reflect tech-enabled capacity. In short, leaders can’t simply “hire their way out” — they must re-architect the team.
Strategies to consider:
- Map work to license and competency. Redesign service lines and clinics around explicit team-based workflows where MDs, APPs, RNs, pharmacists and care coordinators each have clear, measured responsibilities. Bake transition-to-practice and ongoing competency development into APP staffing models.
- Modernize staffing math. Update productivity benchmarks to reflect technology contributions (e.g., ambient dictation reducing indirect time). Establish governance for when tech substitutions are safe and how to count reclaimed hours.
- Deploy demand management. Use asynchronous visits, digital intake/self-service and navigation to smooth demand and free clinician capacity and measure the effects on access and total cost.
- Build the pipeline you need. Partner with academic programs and community organizations to expand training slots and grow direct-care roles; align compensation and career ladders to retention-critical segments.
Read the full article: From crisis to catalyst: Rethinking the healthcare workforce in the wake of the OBBB
Localize impact and act boldly with strategy and analytics
Brian Esser, Vice President, Intelligence, Vizient; Ryota Terada, Director, Intelligence, Vizient
Why it matters: OBBB’s second- and third-order effects won’t look the same in every market. Coverage shifts, payer behavior and site-neutral payment proposals create a moving target. That means static annual planning won’t cut it; organizations need an internal “flywheel” that fuses signal monitoring, scenario planning and real-time business/clinical performance tracking so leaders can pivot immediately. Zip-code-level coverage estimates (commercial, Medicare, Medicaid, Marketplace, uninsured) and clinical benchmarks should guide where to defend margins, where to grow and how to communicate priorities across the enterprise.
Strategies to consider:
- Act now. Don’t wait for perfect clarity. Develop localized, actionable tactics that can be applied with confidence across a variety of scenarios.
- Broaden focus. Evaluate clinical, operational and workforce implications — not just financial — across your System of CARE.
- Prioritize boldly. Meeting the challenges posed in the current landscape requires accelerated transformation and maximized systemness. Make strategic choices that reflect your mission and are grounded in the communities you serve.
- Communicate clearly. Ensure strategic intent is consistently shared across all levels.
Read the full article: OBBB and beyond: Drive strategy with localized insights
Payer–provider relationships: From hard resets to radical collaboration
Joyjit Saha Choudhury, Managing Director, Strategy and Business Transformation, Kaufman Hall; John Poziemski, Managing Director, Consulting Innovation Leader, Kaufman Hall
Why it matters: With rising uninsured risk and fragile margins on both sides, many markets are stuck in zero-sum negotiations — or “hard resets” featuring brinkmanship, non-renewals and out-of-network standoffs. AI-driven arms races in prior auth and claims intensify friction, while employers eye alternatives like ICHRAs. Yet shared exposure to OBBB’s economics creates an opening for payer–provider models that pursue both growth and margin.
Strategies to consider:
- Build “radical collaboration” structures. Pursue joint ventures, advanced value-based constructs and shared operating platforms with governance and transparent information-sharing. Focus early wins on avoidable utilization, access/throughput and total cost of care within a carefully crafted, mutually beneficial financial framework.
- Align incentives to the local reality. As national plans exit unprofitable lines/markets, leverage regional payers who must grow locally; co-design products and steerage that sustain volume and margin for both parties.
- Use AI to reduce administrative friction. Collaborate with payers on automation that streamlines prior authorization and claims processes, improves transparency and protects patient experience.
Read the full article: Rethinking payer–provider relationships after the One Big Beautiful Bill: Where will the money come from?
Financial planning: Use time wisely, not passively
Gavin McDermott, Managing Director, Financial Planning & Data Analytics, Kaufman Hall; Gordy Sofyanos, Managing Director, Financial Planning & Data Analytics, Kaufman Hall
Why it matters: Unlike COVID-19’s overnight shock, OBBB’s biggest provider impacts (e.g., Medicaid eligibility/financing changes) ramp in 2026-2027. That runway is a gift — if you use it. Enterprise financial trajectories will diverge by payer mix and state policy, so scenario-based planning with boards and operators should begin now, with clear operating/credit targets and capital plans that can flex.
Strategies to consider:
- Have a plan and know what financial success is for your organization. Organizations cannot afford to “fly blind” amid looming threats to reimbursement. Remember that risks are unique to each organization: There are no one-size-fits-all scenarios.
- Define “financial success” explicitly. Establish guardrails (days cash on hand, debt metrics, margin targets) and connect them to decision rights for timing capital, hiring or program expansion.
- Re-prioritize capital. Re-sequence or resize projects based on ROI, affordability and strategic fit, and consider partnerships where balance sheet capacity is constrained.
- Don’t put too much focus on the worst-case scenario. A range of outcomes should be considered and realistic future scenarios should be used to pressure test current strategies and identify alternative strategies. Scenario planning should not paralyze an organization’s decision making.
- Remain nimble. Scenarios may need to evolve between now and the implementation of the OBBB’s health policy provisions.
Read the full article: Planning for the One Big Beautiful Bill’s financial impacts on hospitals
Expense management and supply chain: Build structural resilience now
Blaine Douglas, SVP/GM, Indirect Spend & Purchased Services, Vizient; Dan Kistner, SVP/GM, Category Management & Strategic Programs, Vizient
Why it matters: As coverage declines and bad debt rises unevenly across markets, C-suite teams must lock in hard-wired discipline while aligning expense strategy to enterprise growth (e.g., specialty pharmacy) and ambulatory shifts. Ambulatory sites can boost margins — but only if supply chain models fit their lean, high-turnover reality. And AI, applied with guardrails, can surface variation, standardize products and remove waste at scale.
Strategies to consider:
- Systematize cost optimization. Standardize products, tighten utilization controls and improve upstream documentation and recordkeeping to support clean claims and accurate reimbursement. Pair initiatives with monitoring to sustain gains.
- Fuse expense strategy to growth. Tie supply and pharmacy strategies to enterprise priorities (e.g., specialty pharmacy margin) and build long-term vendor partnerships that create mutual value — not just price cuts.
- Right-size ambulatory operations. Redesign perioperative flow, preference items and pharmacy logistics for ASC-style throughput and same-day turns; anticipate potential site-neutral dynamics.
- Use AI with governance. Apply AI to identify variation, guide formularies/standard work and automate procurement and processing — backstopped by clinical, finance and IT oversight.
Read the full article: The One Big Beautiful Bill and 5 key takeaways for expense management
