“The traditional hospital model is breaking. Even HCA — the fee-for-service king — is targeting 20:1 outpatient access points per hospital. Ascension sold 35+ hospitals, bought AmSurg for $4B, and is targeting 20% EBITDA margins. Emerging strategy = fewer hospitals, more density, ambulatory-first.”
By Blake Madden
I recently gave a keynote at the Health Plan Alliance Spring Forum on where healthcare is headed next. They were gracious (and crazy enough) to invite me out to riff on healthcare!
Here’s what I told a room full of health plan folks:
Bet 1: The AI Bot Wars are here. Providers are deploying AI in RCM and ambient documentation. Payers are catching up on prior auth. Coding-related denials are up 100%+ in 2 years. Both sides are arming up — but the real question is whether we’re entrenching misaligned incentives instead of fixing them.
Bet 2: Health System 2.0 is taking shape. The traditional hospital model is breaking. Even HCA — the fee-for-service king — is targeting 20:1 outpatient access points per hospital. Ascension sold 35+ hospitals, bought AmSurg for $4B, and is targeting 20% EBITDA margins. Emerging strategy = fewer hospitals, more density, ambulatory-first.
Bet 3: Drug distributors are vertically integrating fast. McKesson, Cencora, and Cardinal Health are writing blank checks for specialty physician practices to lock in 20-year drug distribution deals. This is a new capital partner competing directly with health systems for oncology and specialty service lines.
Bet 4: Healthcare is going direct.
• Baylor’s Levanto.
• Northwell’s 100K-life union deal.
• Henry Ford + Nomi Health.
• Mark Cuban’s regional direct contracting play.
The most sophisticated systems will run dual-track strategies — payer relationships for coverage, direct channels for better economics. More is happening behind the scenes
Bet 5: Consumerism is coming for primary care. Consumer use of AI chatbots for health info doubled from 16% to 32% in one year. ChatGPT, Gemini, and Perplexity all launched health offerings. This is Dr. Google with an action layer — and it could reshape local market referral patterns.
Bet 6: The Orchestration Era. Health systems want fewer vendors, not more. The tech is commoditizing. The real differentiator? Trust, expertise, and human partnership. The biggest unlock ahead is clinical AI, not just admin.
And the thing that doesn’t change: the need for humble, servant-hearted leadership in a time of massive uncertainty. The more things change, the more things stay the same. Healthcare is human, after all.
