How are You Going to Pivot?

Everyone in health care is stunned by the breadth and blinding speed of disruption during the first months of the 2nd Trump administration. Many are disheartened and dismayed, some are protesting, many have lost funding. More disruption looms under Project 2025's plan for health care reform.(1) 

With “fail fast” disruption comes opportunities. The editors of Lancet critique the carelessness with which vital systems have been dismantled, but – being clear-minded – they see an opportunity to rebuild global health better than it has been.(2)

PwC believes that new rules of governance will generally lead to:

• Federalism, with a libertarian thread,

• Free market and self-determination ideology, and

• Preference for privatization over public health for societal contracts.(3)

Towards these ends, PwC proffers some no-risk strategy adjustments, while McKinsey extols consumer-centric health care.(4)

Is now your organization’s opportunity to move towards consumer-centric health care? What would that pivot look like, how would you protect and achieve your organization’s goals? Do you have to change your mission, or just your methods? Most important, how will you make payroll and a profit - week after week after week? 

If this sounds like your situation, consider this brief SWOTT analysis. 

Strengths

• The need for whole health services and the dedication of providers to health ecology and patient well-being remain strong.
• Federal initiatives like the Make America Healthy Again Commission may bolster these services, strengthening business models for improving access to healthy food.(5) 
• Shifts in governance will transfer decision-making power and fiscal control to states and the private sector, empowering individuals, employers and their communities. 

Weaknesses

• Changes in governance will create uncertainty and require health care networks to pivot toward a business model that closely collaborates with community resources and addresses health related social needs. 
• Physicians seeking to take part in such a coalition will need to spend scarce time developing working relationships with the stakeholders. 
• Employers, accustomed to 3rd party workforce wellness vendors are inured low-cost but minimally effective telephonic and internet-based wellness services, challenging community-based health hubs to prove their value to business leaders.

Opportunities

• The move toward privatization will give employers the opportunity to configure a community-oriented benefit package designed to meet the needs of their employees and dependents, rather than defaulting to retiree-based models like Medicare. 
• Collaboration among whole health providers, employers, and community organizations can create effective, locally-focused services, emphasizing team-based care, telehealth and technologies to address lifestyle and health related health issues – so-called “upstream factors – that underlie common chronic diseases.

Threats

• Well-funded telehealth vendors are able to use telehealth technology to provide generic services, but won’t be able to customize their offerings to match community culture and built environment.
• Successful community health hubs will need to invest in locally-based health teams allied with primary care practices to address chronic disease causes and preserve local wealth.

Key risks include:

• Failing to be a first-mover, 
• Implementing an incomplete plan, and
• Competing vendors of low-cost internet-based services. 

Tactics

Implementation requires:

• Lifestyle and community-based intervention protocols tailored to population needs,
• A solid pro forma to gain leadership approval,
• Evidence-based data management systems for patient-facing health services, and
• Networking tools to integrate services into a cohesive social network.

Those seeking to build a locally-oriented health hub should look to organizations like the Kellyn Foundation, in eastern Pennsylvania, for a paradigm on how to provide access to healthy food, health living education and lifestyle medicine services.

In conclusion, the public health sector has historically led preventive services, especially for lower socio-economic populations. Businesses that seriously invest in worker well-being outperform the market, because thriving employees make for a thriving company.(6) Now is a good time to pivot to a consumer-centric, community health hub – a coalition of employers, community-based whole health providers and primary care practices – in a business model that delivers health and well-being services to your whole community.

If you’re inspired by this vision, check out the TrueNorth platform. Sustainable Health Systems has the tools and expertise to help you make your pivot. 

Citations

1. Severino R. Chapter 14, Department of health and human services, in Mandate for Leadership: the conservative promise. Project 2025. https://www.project2025.org/policy/

2. The Lancet. The demise of USAID: time to rethink foreign aid? Lancet, March 22, 2025;405(10483): 951. doi: 10.1016/S0140-6736(25)00556-2

3. Hunzinger G., et al. President Donald J. Trump’s healthcare agenda: flexibility and choice, fiscal conservatism, public health reform and deregulation. PwC’s Health Policy and Intelligence Institute. February, 2025. https://www.pwc.com/us/en/industries/health-industries/library/election-2024-trump-health-agenda.html

4. Cordina J, et al. Engaging the evolving US healthcare consumer and improving business performance. McKinsey & Co., published online, March, 2025. https://www.mckinsey.com/industries/healthcare/our-insights/engaging-the-evolving-us-healthcare-consumer-and-improving-business-performance

5. Trump DJ. Establishing the President’s Make America Healthy Again Commission. The White House, Feb. 13, 2025. https://www.whitehouse.gov/presidential-actions/2025/02/establishing-the-presidents-make-america-healthy-again-commission/

6. Goetzel RZ, et al. The stock performance of C. Everett Koop Award winners compared with the Standard & Poor's 500 Index. J Occup Environ Med 2016; 58(1):p 9-15.  DOI: 10.1097/JOM.0000000000000632

All sites accessed 04/09/25