Key Questions for Boards In what ways can our board partner with management to prepare for changes in coverage eligibility and funding models—ensuring patients navigating Medicaid, Medicare, or ACA marketplace plans receive adequate guidance and support? What strategies should we adopt to better serve Medicaid populations—especially in rural and at-risk communities—given limited resources? What are the greatest opportunities to prioritize AI and automation investments to free staff capacity for supporting uninsured and underinsured patients? How will the bill’s provisions affect our financial projections, both short and long term, and what adjustments are needed in our strategic plan? To what extent might shifts in reimbursement and payer mix influence our current and future merger, acquisition, or partnership strategies? Which digital tools and patient engagement strategies will most effectively drive retention, loyalty, and long-term health outcomes?

As the One Big Beautiful Bill Act ushers in new policy directions, healthcare organizations are entering a pivotal moment—one that calls for strategic modernization, operational agility, and deeper collaboration across the healthcare ecosystem.

Rather than viewing this shift as a disruption, forward-thinking leaders are using it as a catalyst to reimagine their operating models, reconsider how systems are connected, and identify opportunities to better support patients. This article highlights five key actions for board members navigating this evolving landscape.

1. Help Patients Navigate Shifts in Coverage

The law imposes stricter work requirements for Medicaid and Affordable Care Act (ACA) marketplace plans, narrows Medicaid eligibility requirements, and limits coverage for certain non-citizens. The bill is expected to lead to an additional 10 million uninsured people by 2034, according to an estimate by the Congressional Budget Office.

As the law forces a change in eligibility and funding models over the next few years, healthcare organizations and their community partners will need to support patients through shifts in coverage, particularly those navigating Medicaid, Medicare, or ACA marketplace plans.

Key actions:

• Work with community partners to proactively engage patients about eligibility and assist with plan transitions.
• Encourage patients to evaluate their need for secondary coverage options, especially for Medicare populations.
• Invest in digital tools to engage patients about changes in coverage and connect them to enrollment resources.
• Support community workforce development to help patients retain coverage.

2. Reimagine Medicaid, Tribal, and Rural Health Strategies

The One Big Beautiful Bill also limits funding for Medicaid programs, in part by restricting taxes on providers and insurance companies that are a source for state Medicaid funding. As a result, provider organizations will need to rethink how they serve Medicaid populations—particularly in rural and at-risk areas. The law created a $50 billion Rural Health Transformation Program to support rural providers, but there are concerns it may not be enough to offset the impact of the cuts.

Key actions:

• Seek out private funding, tribal and charity partners, and value-based payer arrangements that support continued growth in services for low-income and at-risk populations.
• Develop a rural health strategy that includes community partnerships, telehealth services, remote patient monitoring, and creative staffing models that serve needs without adding to overhead costs.
• Collaborate with tribal leaders to offer tailored support and public health messaging.
• Use community health workers to assess needs carefully and facilitate effective allocation of limited funds.
• Consider how changes in Medicaid eligibility and enrollment may indirectly impact status and payments under the 340B Drug Pricing Program.

3. Prepare for the Future by Modernizing Operations

Health system boards should consider where AI and automation investments can be made quickly so that staff can be reallocated to handle the influx of uninsured and underinsured patients who will need help navigating coverage.

Financial projections may also need to change as a result of the bill’s key provisions and a major shift in payer mix. Leaders must evaluate the potential financial impact, both short-term and long-term, and adjust their strategic vision accordingly.

Key actions:

• Use AI and predictive analytics to map out various scenarios and support financial decision making.
• Invest in enhanced clinical documentation improvement (CDI) and utilization management/review processes to maximize reimbursement.
• Revisit staffing plans—consider supplementing onsite teams with off-shore/near-shore staff who can support an influx of patients who will need help navigating access and financial assistance.

4. Consider the Impact on M&A and Partnerships

The changing reimbursement landscape is likely to cause a shift in providers’ incentives for mergers, acquisitions, and partnerships. Health system boards should evaluate how current deals may be affected by the law’s changes and consider new acquisitions or partnerships to offset anticipated shifts in payer mix and patient demographics.

Key actions:

• Map potential deals to specific operating model gaps and vulnerabilities under the new law, such as service lines, digital infrastructure, or expertise in serving at-risk populations.
• Evaluate divestment options or turnaround strategies for assets that may become unsustainable as a result of the law.
• For deals that have already closed, consider how post-M&A integration strategies may need to change as a result of the new law.

5. Enhance the Consumer Experience to Improve Retention

As coverage dynamics shift, patient retention becomes even more critical. Even as the bill tightens provider resources, many will continue to be at risk under value-based care plans that require them to keep patients engaged and in good health. Organizations that invest in convenience and strengthen their digital front door will win patients’ loyalty and deliver personalized care.

Key actions:

• Expand self-service platforms for registration, scheduling, and payments to simplify access and make it easy for patients to manage their care.
• Review consumer analytics to identify pain points and tailor engagement strategies.
• Evaluate service line strategy to prioritize long-term outcomes and avoid losing patients to competitors.

A New Chapter in Healthcare Policy

The One Big Beautiful Bill Act signals the next chapter in healthcare policy—one that will require leaders to realign resources, modernize operations, and get closer to the patients they serve. Organizations that act with urgency—planning thoughtfully and adapting swiftly—will be best positioned to lead in this new era.

TGI thanks Timothy Kinney, Partner and Payer/Provider Practice Leader, Guidehouse, for contributing this article. He can be reached at timothy.kinney@guidehouse.com.

TGI: How should healthcare leaders approach innovation to better understand and respond to patient and community needs?

Dr. G: Where a lot of innovation has gone wrong is when we don’t really understand the consumer experience. As I’ve said in previous TGI articles and presentations, the consumer experience is also very much the physician experience—they can’t be separated. You cannot improve one without directly impacting the other. Ultimately, consumers are there to see their doctor. And what they value most in that encounter is time, empathy, and the assurance that they are being heard. They want a knowledgeable physician who can deliver the right diagnosis and treatment plan, personalized to their needs. So, when looking at ways to innovate, it’s about ensuring the patient is happy while also enabling the doctor to do their job well.

One of the best places to start with consumer experience is by addressing physician burnout. Much of the technology that was intended to help doctors has instead slowed them down and is partly responsible for the disgruntled consumer experience. For example, many patients say doctors don’t look them in the eye or have real conversations like they used to.

The lowest-hanging fruit in healthcare right now is fixing documentation and electronic health record issues. These are significant contributors to physician burnout, and with today’s ambient AI technologies, they are very possible to solve. In the next five years, this could change the game—allowing doctors to truly look patients in the eye again. At the same time, clinical decision support will enable physicians to personalize diagnoses and treatment plans. We are getting closer, but the most important thing to understand about innovation and consumer experience is that it is tied to the physician experience in a very tangible way.

TGI: What kinds of innovations do you believe organizations should be talking about now that they aren’t?

Dr. G: Being visionary in healthcare is actually about keeping things simple because we don't have some of the basic building blocks in place. When people talk about what AI can do, the conversation often jumps to eliminating doctors and nurses. Why? Because they are expensive, burned out, and there are shortages. But that is not what consumers want. They do not want an experience with no humans. This is life-and-death work: surgery, delivering babies, and managing diabetes and hypertension. Getting a new diagnosis is scary, and in those moments people want compassion and a human touch. They don't want to feel like a number on an assembly line.

When you ask patients why they keep coming back—even if wait times are long or office staff are rude—the answer is simple: they trust their doctor. If it were an AI robot, that bond wouldn’t be the same. Maybe one day this will be reality, but I don’t think it’s happening in this lifetime because the consumer isn’t ready for it.

And beyond that, with innovations like this, there is so much we don’t know. Are we really willing to gamble with patient care when there are other dysfunctions—like prior authorization and documentation—that are not only simpler to fix but far less risky? Those are the areas where innovation can make a safe, immediate difference while we are still learning about the bigger, riskier technologies. Also, it’s important to be mindful that innovation isn’t just technology. There are so many other ways to innovate.

TGI: What about innovation regarding social media, for example, linking technology and education to better meet patients where they are?

Dr. G: Social media is where people are getting their healthcare information and looking for experts. But your experts—your faculty and staff—are not there. They are missing the eyes of the consumer. And it’s no longer just about competing with the doctor or hospital down the street. Now, you are up against Dr. TikTok and influencers pushing supplements and home genetic kits in lieu of an appointment at your facility.

It’s not that the staff are not on social media—many are. And they often view it as a way to build business. But hospitals have traditionally shunned social media, even asking staff not to mention their facility, usually because of liability concerns. But the staff remain the heartbeat of the hospital and your biggest asset.

If you do have social media all-stars at your organization, flip the narrative. Encourage them to mention the hospital. Ask, “Can you lead a workshop? Can you inspire 10 more people in your department to join in?” Then pay them for their time and give them support from the hospital’s PR and marketing teams. Partner with them, align them on messaging, and respect them as trusted ambassadors for your brand.

Developing a Social Media Strategy Identify doctors, nurses, and other staff who are natural influencers or strong communicators. Collaborate with them as part of your content strategy—connect them with PR/marketing and align on messaging and goals. Review metrics to measure impact, such as whether trust in the hospital increases or if patient visits rise. Have a plan for monitoring social media to ensure staff content is accurate and aligned with organizational values. Provide training and support so staff feel confident representing the hospital online—covering compliance, brand voice, and best practices.

TGI: Let’s bring back the connection to trust. How do you look at innovation and trust in the same sentence when it comes to strategy, technology, engagement, and marketing? Who in the healthcare organization should be using these words together, and how does this intersect with consumer and physician experience?

Dr. G: Whenever you are changing something, transparency is absolutely critical. We probably learned that the hard way with the rollout of electronic health records, where transparency wasn’t always prioritized. I also think a “crawl, walk, run” approach is best. Some hospitals just flipped the power switch all at once, and the result was too dramatic.

It’s also important to get active input from the staff and patients. Whether that's through committees, surveys, or another structured process, you need a way to capture feedback along the way. Half of trust is also acknowledging: “I may not know everything. This is my best shot at something new, but I’ll learn and adjust as we go.” Leaving room for continued feedback from doctors, nurses, staff, patients, and everyone affected allows you to anticipate those issues and alleviate pressure points early.

Finally, governance is critical—especially with AI. We need to be intentional about ensuring new technologies serve underserved communities and are applied in an ethically responsible way.

TGI: Innovation is often seen as an operational responsibility, but board leadership can play a pivotal role in driving it. How can hospital boards more actively champion innovation?

Dr. G: Innovation is a team sport. The board should help oversee innovation, while the C-suite executes it—from the Chief Information Officer and Chief Technology Officer to the Chief Marketing Officer to the Chief Medical Officer—with the CEO setting clear innovation goals and focus areas. It comes from the top, but it requires the whole team.

For the board, the first step is prioritization. Ask the right questions: What are our innovation priorities? Do we have buy in from all stakeholders, including staff and patients? Boards also play a key role in making it safe to fail. That doesn’t mean ignoring risk or tolerating reckless mistakes, but rather creating an environment where calculated risks are encouraged.

There should be an appetite for experimentation—a willingness to move five steps forward, occasionally step two back, and then go seven steps forward again. True innovation requires agility, transparency, and thoughtful risk management. When boards provide that safety and guidance, organizations can innovate with confidence.

Key Board Takeaways Review how you talk about community impact. Ensure it’s not overly reliant on numbers but instead is a comprehensive story rooted in patient impact. Identify clinical opinion leaders. Work with leaders at all levels and the marketing and communications team to find those unique spokespeople and storytellers. Equip them with specific information. Arm them with key facts, projects that may not be well known, community initiatives, etc. Activate them. Accept the risk of turning them loose. Consider even assigning them specific work, such as, “Have these 10 conversations.” Give them license to be themselves while also asking them to represent the organization. Circle back. Turn this process into a feedback loop. Come back to hear how the conversations went, and measure impact and reach. Then reconvene, review, refine, and do it all again.

It would be a mistake for healthcare leaders to interpret the passage of the One Big Beautiful Bill as an outlier—a one-off event unique to our strained political climate, something that “won’t happen again.”

But it was not an anomaly. It was a warning buzzer. And healthcare leaders can take action today to answer the alarm.

The bill passed despite the most dire warnings from healthcare leaders—“Hospitals will close! People will die!”—and regardless of deep opposition from voters across the political spectrum. As late as last April, national consumer research from Jarrard’s Market Research & Insights found that nearly two-thirds of Americans opposed cutting Medicaid, and a full two-thirds supported continuing ACA subsidies.

The passage of the legislation despite strident healthcare voices and negative public sentiment dramatically exposes the deterioration of the political influence of healthcare organizations, traditionally an unassailable bastion.

Whether the legislation ultimately hurts your organization a little or a lot and whether your margins today are non-existent or pushing double digits, it’s the inability for healthcare to leverage political strength, or to even summon the power to wield, that was revealed this summer.

This erosion isn’t new, but it’s been put in stark relief with the One Big Beautiful Bill. Even though the public didn’t want the cuts, that didn’t necessarily mean they were flocking to hospitals’ aid in the push against the bill. Because, make no mistake, the public is skeptical. Earlier this year, a Jarrard consumer trust survey found that seven in 10 U.S. adults say hospitals prioritize profits over patients.

What can healthcare do to begin to reinvigorate trust—and through trust, successfully pursue necessary change? There are many answers, but two steps are clear:

1. Reframe and leverage the community benefit most hospitals provide today. These services have great political strength, yet many organizations do not fully capitalize on their merits.
2. Engage and activate the clinical workforce. When it comes to shoring up public trust, professionals who wear white coats to work are far stronger voices than people in business suits.

Reframe Community Impact: It’s Not Just Math

“Community benefit” is also a hot topic these days. Scrutiny from lawmakers and activists about whether not-for-profit health systems “deserve” or do enough to earn their tax-exempt status has ramped up in recent years. In fact, while nine in 10 consumers say that providing community benefit is important, only four in 10 say hospitals provide enough of it, according to recent Jarrard research.

We asked about specific elements of community benefit—ranging from charity care and Medicare to community clinics, food and nutrition support, and research funding—and whether hospitals provide sufficiently in those areas. Statistical analysis then identified which elements drive perceptions that non-profit hospitals do enough to justify their tax-exempt status. The most influential? Financial assistance, training clinicians, helping with transportation to appointments, and providing health education all contribute directly to that perception at a national level.

And many hospitals are carrying out these aspects of community benefit well—consumers often just aren’t aware of their efforts. March 2025 NRC Market Insights data show that 82 percent of U.S. adults—four in five—know only “a little” or “nothing” about hospital and health system community work beyond the bedside.

Even more significant is that talking about more elements of community benefit is multiplicative, not additive. The more facets of work leaders can showcase, the greater the effect. It’s 1+1=3.

The other problem is that the conversation about community benefit has become too academic. It is a regulatory term somewhat loosely defined by the IRS that applies only to non-profits. Yet, there’s enough wiggle room in the definition that provider organizations and critics can—and very much do—argue over what counts as community benefit. It’s about the math. But, unlike tangible action and stories, the math doesn’t resonate with the public.

Furthermore, some of the most significant forces pushing against hospital finances—Medicare and Medicaid funding—don’t resonate with the public, either. The survey showed that Medicare and Medicaid shortfalls land flat when it comes to driving support for tax-exempt status.

With all this in mind, provider organizations would be well served to reframe and expand the idea of community benefit to “community impact.” The numbers should be viewed as an outgrowth of the mission and purpose. Instead of zeroing in on what is reported in the 990, the focus should be on the impact the work—all of it—has on patient lives. An added benefit: even investor-owned providers can use this approach to talk about how they are fulfilling the mission of care. The reality is, while the survey asked about “community benefit,” the public isn’t sorting through the IRS Website to understand the concept. For most people, it is instead a proxy for “How is my local hospital giving back to my family, friends, and neighbors?”

To answer that question—and push back against the finger-pointing—leaders must first move away from touting the hard-earned and impressive numbers. Those big numbers are real, and important, but they don’t resonate. What the public does connect with are stories about the people who received charity care. It’s a mindset shift, and it’s one in which a good marketing and communications team can help drive.

That starts with collecting stories about the work taking place inside the hospital and externally in the community. Just as a marketing team would for a service line or a specialty center, connect the dots of those anecdotes and turn them into a single, cohesive story that shows who the organization is. The more elements of community impact that are brought together, the greater the effect on public perception.

This may be uncomfortable because it could involve stories about things that cost the organization money and lead to losses, not financial gains. Yet driving awareness creates indirect—but meaningful—ROI through the support, trust, and credibility it will bring.

Activate Your Workforce

Armed with a solid story, healthcare leaders need to get the word out. That starts in the hallways. Healthcare has problems and the workforce has answers—and the confidence to help.

Another recent Jarrard survey asked over 1,000 nurses, doctors, and other clinical staff what they think about issues facing them and the industry today. Two questions lie at the heart of the survey:

1. Please indicate whether you agree or disagree with the following statement: “My organization involves me and my colleagues in finding productive ways to respond to the major challenges facing healthcare?”

2. Regardless of whether you think your organization involves you, how much do you think you as an individual can drive positive change related to the major challenges facing healthcare?

The workforce is a mass of energy and ideas, coiled, waiting, and looking for a place to be unleashed. Healthcare workers also have more credibility and political capital today than large institutions like hospitals and health systems. What could be better than for leaders to thoughtfully unleash that energy and use that capital to solve the myriad challenges organizations face.

Having a strong, cohesive story that relies on the human touch instead of numbers will work in a hospital’s favor here as well. Healthcare workers don’t want to hear about the numbers either. Let’s be honest, they already think they are not getting paid enough. They are driven by mission, though. When asked, “caring for patients” and variations on that theme were far and away the most common reasons they give for loving their job and staying in healthcare.

There is a belief among the workforce that they can make a difference. They believe in themselves. And despite declines in trust across the board, nurses (89 percent) and doctors (82 percent) continue to be the most trusted healthcare voices, according to other Jarrard research from April 2025.

Truth be told, the investment to engage the workforce costs in both time and attention. Yet, we see today that the lack of investment in building internal support has hurt the provider space.

Leaders can take a two-tiered approach to such engagement: broad and targeted.

• Broad means everyone—all 500 or 10,000 employees. Ask for feedback, hold listening sessions and town halls, and survey them for new insights into what’s working and what they are worried about. Then, provide them with clear answers and ways they can be involved.
• Targeted pertains to five to 20 core messengers across the organization. They may be individuals who already have a persona and following, or those with a unique perspective who have been flying under the radar. Leadership can work with them to develop that unified community impact story and provide them the time, resources, and encouragement to take it out to the community.

This tiered approach means that no matter what is happening with an organization, there are individuals whom leaders can bring into the fold and send out as ambassadors.

The tools are all right there for every healthcare organization; the work is happening and the people who can best speak to it are ready. It’s up to savvy leaders to put the pieces together to build something amazing.

A Final Note

This should all feel good—bringing everyone together for a common goal and collaborative problem-solving. It should be encouraging and empowering for leadership teams and boards right along with nurses and doctors to know that they can manifest positive change at both the micro and macro levels. They have the minds, motivation, and political power to tap to get things done.

After all, people are the reason this work exists in the first place. Finances and business and policy are necessary, but recentering on the human side of healthcare is a positive stimulant in the midst of a very difficult moment that’s left the industry with hard choices.

This isn’t the last time, but healthcare can learn from the hard political lessons of 2025.

TGI thanks David Jarrard, Chairman, Jarrard Inc. Executive Committee, for contributing this article. He can be reached at djarrard@jarrardinc.com.