C-Suite Checklist 2025: Ten Actions for Health System Leaders in Times of Uncertainty

Navigating the complexities of the current political and economic landscape will require health system executives to be proactive, strategic and resilient. There are risks to both reacting too quickly and not being ready to act quickly enough. Informed by our work both with and within leading health systems around the country, we propose a ten-point checklist to help leaders navigate during this time of uncertainty.

Choppy Waters

The administration has issued Executive Orders and federal agencies have taken actions with significant implications for health systems, including related to the delivery of care (), , and . On the horizon, we anticipate the following:

• Cuts to federally-funded insurance programs and loosening of consumer protections: Congress is and loosen consumer protections on marketplace and employer-sponsored plans, putting pressure on revenues and increasing costs.
• Reduced government reimbursement for clinical services: Targets include 340B coverage, site of service policies, directed payments and physician fee schedules.
• : We expect a push to make Medicare Advantage (MA) the default Medicare program, leading to more revenue cycle friction for health systems.
• Immigration Policies: Limiting legal immigration will negatively impact the workforce.
• National Institutes of Health (NIH) Shakeup: With and the NIH reorganization, we expect shifts to research priorities and funding availability.
• Tariffs: Expected to increase medical and pharmaceutical supply costs.

The Administration’s approach to health care is likely to also create opportunities for forward-looking health systems, including:

• Service development, such as enhancing primary care, chronic conditions, nutrition and food as medicine programs, related to the “.
• M&A or other partnership activity, given anticipated .
• Reduced administrative costs if regulatory reporting burdens eased.
• AI innovation, thanks to the Administration’s goals of EO  

Managing a health system, let alone making investment decisions for new programs, technology or capital expenditures, against a backdrop of policy uncertainty and capital market turmoil likely feels daunting. This ten-point checklist can help leaders set a positive direction for their employees, patients and communities.

Ten-Point Checklist for Health System Executives in Uncertain Times

1. Prioritize Expenditures and Investments and Engage in Scenario Planning: Conserving cash will be a “no regrets” move. Some initiatives that pen out under current reimbursement models may not do so under proposed policy changes. Effective scenario planning will blend a strong understanding of the policy issues and the political landscape with sophisticated financial modeling. It will also require a 360-degree view of operations to weigh the potential downstream impacts of any service reductions. And it will require the fortitude to make trade-offs.  

2. Refresh Governance Model: There is a risk for leaders to overreact to the unpredictability of federal policy, which would be disruptive and costly. We believe that in such a time, it is critical for organizations to become more intentional about their governance so as not to lose sight of their core mission and commitment to patients. Management will be forced to make difficult operating decisions. Having the right governance model—composition, structure and decision-making mechanisms—will be more important than ever. Refreshing governance provides an opportunity for boards and leadership teams to reaffirm the organization’s mission, vision and values, including important commitments to the community, such as improving access, reducing variation in outcomes and enhancing the wellbeing of populations.  

3. Focus on High-Reliability Operations: Tools proven to improve both quality and efficiency include:

1. Rationalizing services across sites of care into centers of excellence;
2. Renewing focus on foundational quality metrics;
3. Implementing or strengthening a “7-Day Hospital” model to open capacity and ensure high reliability care around the clock;
4. Using digital tools to manage patients in lower acuity settings—including through hospital-at-home programs on the inpatient side and virtual care programs for outpatient services. 

In our experience, health systems can make significant quality and efficiency gains using any one of a variety of methodologies (Lean, Six Sigma, IHI, a Baldrige Journey and others); the main differentiator is leadership commitment and follow through, a culture of continuous improvement and staff training.

4. Sharpen Contracting Strategies: The aging population and anticipated policies favoring MA argue for a sharper focus on MA performance, risk contracting, partnership and network strategies. Significant untapped opportunities exist in MA value-based contracts as plans have added broader incentives for quality performance and annual wellness visits. Concentrating on in-system utilization within all contracting networks can also drive revenue growth without extensive investment. Given likely government policy support for private company enablers, health systems may consider new partnerships to offset value-based risk and improve performance. Some systems may want to restructure current insurance offerings to deliver better balance sheet performance.  

5. Engage in Enterprise Risk Management (ERM): Cybersecurity, operational disruptions and regulatory compliance – are just a few of the growing challenges requiring careful management. A common barrier to managing risk is rigid organizational silos. ERM models break down these silos and find ways for organizations to see and manage existing and emerging risks more clearly.

6. Harness the Power of AI: Early applications of AI are expected to help address physician burnout, streamline administrative processes, advance evidence-based medicine and drive more accurate and faster diagnoses. For these benefits to materialize, health systems must have their technology stacks, data systems and workflows in order. Now is a good time to do the hard blocking and tackling of modernizing the technology infrastructure and laying out an and .

7. Align Research Priorities and Strengthen Industry Partnerships: A strategic review of the research portfolio will position academic health systems to adapt to the changing funding environment—including an emphasis on chronic disease. Developing more robust industry partnerships and commercialization strategies will help organizations tap into private sector support for impacted research programs.

8. Leverage “MAHA” Alignment: Health systems will want to identify and develop areas of alignment with the new administration’s health agenda. One prime example is the focus on chronic conditions. Many systems have already partnered with community organizations on food as medicine and healthy living initiatives. As the Administration clarifies its agenda and action plan, additional opportunities to further this work will emerge. An early example could be eliminating ultra-processed foods from hospital meals, cafeterias and campuses. Another could be investing in primary care, which is often historically under-resourced but remains a critical asset in managing chronic conditions and an important entry point into the system of care for patients. Finally, organizations may want to use this moment to pursue to address previously unmet community health needs. 

9. Consider Merger and Acquisition Opportunities: With a potentially more supportive regulatory environment for partnerships and anticipated financial headwinds, health systems may want to consider opportunities for scale through M&A, when circumstances merit. We recommend that health systems pursue M&A strategically, with the intent of developing an integrated system of care centered around community health needs, rather than purely a growth lens. Historically, results have been mixed in terms of achieving the economies of scale anticipated through M&A and state regulators are increasingly skeptical of the benefits. Organizations should be very intentional about clearly articulating the opportunities for cost savings, as well as the chance to improve quality and access to care in the community. 

10. Engage Policymakers at Both Federal and State Level: Advocating with state lawmakers to support the preservation of Medicaid funding and subsidies for the Marketplace is essential. Protecting the workforce—for instance by supporting exemptions or protections for immigrants who work in health care—is also an important advocacy priority.

The Leadership Imperative

Employees are worried about their future and the future of the organization. Communities are anxious about cuts to public health and the instability of hospitals in their region. Institutional leadership is needed now more than ever and developing a clear and compelling communication plan will help provide encouragement and support to all stakeholders while reassuring them that the organization will not lose its focus from its core mission: taking great care of patients and improving the health of the community. By following this ten-point checklist, C-Suite leaders can better position their organizations to take thoughtful, timely, mission-aligned and market-responsive actions.

About Manatt Health

Manatt Health is a multidisciplinary professional services firm with a broad range of integrated legal, consulting, policy and advocacy capabilities.

Combining legal excellence, sophisticated strategy insights and deep analytic capabilities, Manatt is well-poised to address the complex needs of clients across the health care system.

For more information, please reach out to Naomi Newman () or Doug Brown ().

Acknowledgements: The authors would like to thank colleagues Jared Augenstein, Ebone Carrington, Tom Enders, Seth Frazier and Thomas Robertson for their review and input.