Expert calls highlight a mixed utilization backdrop amongst rising crosscurrents

Research evidence excerpt

Expert calls highlight a mixed utilization backdrop amongst rising crosscurrents

IdeaMand state-directed payments (SDPs) contribute >$100mn annually. and an expansion

in participation beyond traditional safety-net providers was highlighted. The

medium-term outlook appears favorable given the stair-step structure that

ultimately settles around 110% of Medicare, but CMS litigation, retroactive rule

changes, and shifting legislative priorities can quickly turn these programs from

tailwind to headwind.

Site-of-care shift is reshaping volume mix, preserving patient activity but

pressuring reimbursement mix. The large national system emphasized that

patients are not necessarily being lost, but care is migrating away from traditional

hospital settings, with hospital surgeries moving to ASCs and ED demand shifting to

urgent care or extended-hours clinics. The system has 15 ASCs and is looking to

expand through acquisitions and selective de novo builds. The South Florida health

system saw a similar outpatient migration, with on-campus ED visits declining while

off-campus ED visits rose 21%, consistent with its strategy to decompress hospital

EDs and expand outpatient access points. ASC volumes were the main soft spot,

down ~5% due partly to lost physicians, partner disruption, and one ASC closure,

but the broader strategy remains oriented around outpatient diagnostics, urgent

care, ASCs, and centers of excellence.

AI and technology investments are increasingly tied to cost efficiency, staffing

productivity, and margin protection. The large national system is evaluating

automation as part of its broader mitigation plan to help offset expected 2027-2028

pressures (OBBBA), including reducing headcount needs in manual workflows such