On June 5, 2025, the Nebraska High Value Network (NHVN) officially launched with 19 critical-access hospitals joining forces to strengthen healthcare delivery across rural communities. This collaborative network, organized by Cibolo Health, represents more than just a partnership—it's a strategic approach to ensuring sustainable, high-quality healthcare remains accessible in rural Nebraska.

The network's cornerstone is a clinically integrated network (CIN) that will serve nearly 300,000 patients while allowing each hospital to maintain its independence and community focus. For healthcare leaders like myself, this model offers a compelling path forward in an increasingly complex healthcare landscape.

The Congressional Budget Office's June 4, 2025 analysis of H.R. 1 (the "One Big Beautiful Bill Act") as passed by the House of Representatives provides stark confirmation of what rural health advocates feared, but the crisis may be far from over. The CBO projects that 16 million Americans would lose health insurance by 2034 under the House-passed bill, with rural communities bearing a disproportionate burden due to their heavy reliance on Medicaid and federally-funded programs. However, as the Senate now works on its version through budget reconciliation, early signals suggest senators may push for even deeper cuts, making the CBO's devastating projections a floor rather than a ceiling for potential coverage losses.

This escalating threat comes on top of the Trump Administration's FY 2026 HHS Budget, which would simultaneously eliminate critical rural health programs including Medicare Rural Hospital Flexibility Grants, State Offices of Rural Health, and the Rural Hospital Stabilization Program. Rural communities now face the unprecedented prospect of losing both federal support programs and insurance coverage that keeps rural hospitals financially viable, with the Senate potentially making an already catastrophic situation even worse.

The numbers from the House-passed bill tell a devastating story, but they represent only the beginning of potential damage. The CBO analysis reveals that 5.1 million people would lose insurance from baseline policy changes including premium tax credit expiration and new marketplace rules, while 10.9 million additional people would lose coverage from H.R. 1 provisions as passed by the House. Most alarming for rural America, 7.8 million of those losses come directly from Medicaid changes that will devastate communities already facing hospital closures and provider shortages. These numbers represent more than statistics—they represent rural families losing access to critical healthcare services in areas where alternatives simply don't exist. But as the Senate crafts its reconciliation bill, comments from senators suggest they may pursue even more aggressive cuts, potentially pushing coverage losses well beyond the CBO's already-catastrophic projections.

We stand at the threshold of a medical revolution. While the promise of personalized medicine has tantalized researchers for decades, we're finally seeing the convergence of technologies that can deliver on that promise at scale. Leading this charge is an unlikely partnership between a century-old Danish pharmaceutical company and cutting-edge quantum computing research—a collaboration that's rewriting the rules of drug discovery and patient care.

Novo Nordisk, best known for its diabetes treatments and the blockbuster obesity drug Wegovy, has quietly become one of the most innovative forces in computational medicine. Their recent breakthroughs offer a glimpse into a future where artificial intelligence doesn't just assist doctors—it fundamentally transforms how we understand, predict, and treat disease.

The Trump Administration released its fiscal year 2026 Department of Health and Human Services (HHS) Budget in Brief this week, presenting a complex picture for rural health funding. While some programs see continued support, several critical rural health initiatives face elimination under the proposed budget, creating a stark contradiction with commitments made by senators during recent confirmation hearings.

The budget includes $284 million for the Federal Office of Rural Health, with $145 million specifically allocated for the Rural Communities Opioid Response Program. This represents a significant investment in addressing the ongoing opioid crisis that has disproportionately impacted rural communities across America. However, the budget request lacks specific funding levels for most other rural health programs, leaving uncertainty around the future of many initiatives that rural communities depend on.

The proposed budget would eliminate several cornerstone rural health programs that have been vital to rural healthcare infrastructure. Medicare Rural Hospital Flexibility Grants, which have helped rural hospitals maintain critical access designation and improve quality of care, would be cut entirely. State Offices of Rural Health, essential coordination hubs that support rural health initiatives at the state level, also face elimination. The newer Rural Hospital Stabilization Program, designed to help struggling rural hospitals remain operational, would similarly be terminated. Additionally, 15 workforce programs that have traditionally helped address rural healthcare staffing shortages would be eliminated, though the fate of the Rural Residency Planning and Development Program remains unclear as it's uncertain whether this program is included among those slated for cuts.

At 2 AM in rural Montana, when a farmer suffers a heart attack and his wife frantically calls 911, the nearest hospital with cardiac care is 90 minutes away—if it's still open. This scenario is becoming increasingly common across rural America as healthcare infrastructure crumbles, and proposed Medicaid cuts threaten to accelerate the devastating trend.

The House's razor-thin 215–214 passage of the "One Big Beautiful Bill Act" has ignited a Senate reconciliation process that could strip approximately $750 billion from Medicaid over the next decade. The proposed changes include capped funding formulas and 80-hour monthly work mandates that health policy experts say would disproportionately impact rural communities where seasonal employment is common.

Rural America is already experiencing a healthcare crisis. Since 2010, more than 150 rural hospitals have closed their doors, leaving entire communities without local emergency care, obstetrics services, or specialized treatment. Each closure eliminates not just medical services but also jobs and economic stability in communities that can least afford the loss.

In rural areas, Medicaid serves as more than just another government program—it's an economic lifeline. The program covers nearly one in four non-elderly residents in these communities and serves as the primary revenue source keeping hospitals financially viable. These facilities operate on razor-thin margins where a late harvest season or unexpected flu outbreak can push them into bankruptcy.

Rural hospitals across America face a precarious financial situation, with nearly half operating in the red and hundreds vulnerable to closure. According to a comprehensive new report from the Chartis Center for Rural Health titled "Medicaid cuts would push rural hospitals—and care for rural communities—over the edge (link at bottom)," potential Medicaid cuts could devastate these vital healthcare institutions and the communities they serve.

The Chartis report, released in May 2025, provides alarming data about the current state of rural healthcare in America. An estimated 10.1 million people rely on Medicaid in rural hospital communities across the country. These individuals depend on their local hospitals for essential services, yet these same hospitals are increasingly operating on what Chartis describes as "the razor's edge" of financial sustainability.

Even without Medicaid cuts, rural healthcare's capacity is already tenuous. The Chartis analysis shows that nearly 50% of rural hospitals are operating in the red, 432 are vulnerable to closure, and many are discontinuing services just to keep their doors open. Recent budget reconciliation efforts on Capitol Hill have pushed potential Medicaid cuts into the spotlight, with the House Committee on Energy and Commerce tasked with finding $880 billion in savings over 10 years.

Many organizations unknowingly foster environments where speaking up is discouraged and conformity is enforced through fear. This phenomenon isn't isolated to a few problematic institutions—it represents a systemic challenge across the healthcare sector that undermines both organizational effectiveness and patient care.

A recent Harvard Business Review article by Hyunsun Park and Subra Tangirala titled "Why Employees Stay Silent When They See Warning Signs of a Problem" sheds light on this troubling dynamic. The researchers identify how organizations face two distinct types of threats: clear ones that trigger immediate action, and ambiguous ones that often go unaddressed. While clear threats—like a detected gas leak with alarming readings—prompt quick responses, ambiguous threats with mixed signals tend to slip through organizational cracks.

We're excited to welcome Jess Nuutinen back to our leadership series with her insightful exploration of the critical distinction between being a boss and being a leader. Following her previous contribution on shared governance, Jess now turns her analytical lens to the subtle yet profound differences that separate positional authority from true leadership. In "Boss vs. Leader: Understanding the Key Differences," she skillfully dissects how these contrasting approaches affect team dynamics, organizational culture, and long-term success. Jess's thoughtful examination of authority versus influence, task-orientation versus people-orientation, and control versus empowerment provides valuable guidance for healthcare professionals at every level. Her practical wisdom reminds us that effective leadership transcends titles and hierarchies—a timely message that complements our growing collection of leadership perspectives. As you read her compelling analysis, we invite you to reflect on your own leadership style and consider how you might incorporate more leadership qualities into your daily practice.

We're pleased to continue our leadership series with an enlightening contribution from Dan Swenson that challenges conventional notions of leadership. In "Transformative Leadership - Making a Meaningful Difference," Dan thoughtfully explores how true leadership transcends formal titles and hierarchies to focus on creating genuine impact. His perspective offers a refreshing counterpoint to authority-centric leadership models, emphasizing instead how service, compassion, and humility form the foundation of transformative leadership. Dan's insights are particularly relevant in healthcare settings, where leadership decisions directly affect patient outcomes and organizational culture. As Frontier Strategy Partners continues to showcase diverse leadership philosophies, Dan's emphasis on accessible leadership—available to everyone regardless of position—adds a valuable dimension to our ongoing conversation. His message that leadership is ultimately measured by positive impact rather than power aligns perfectly with our commitment to exploring leadership approaches that create lasting, meaningful change.

Exceptional performance is rarely achieved through isolated initiatives or the heroic efforts of individuals. Instead, sustainable excellence requires a comprehensive management system that aligns people, processes, and strategic direction. Having observed this healthcare transformation effort, I've become convinced that the "three-legged stool" approach—integrating People, Process, and Plan—offers a powerful framework for healthcare organizations seeking to elevate performance across all dimensions.

We're excited to continue our leadership series with a compelling contribution from Kevin Stranberg of Stranberg and Associates. In this insightful piece, Kevin illuminates the often-overlooked yet essential role that non-clinical leadership plays in creating exceptional healthcare experiences. Building upon the shared governance principles explored in Jess Nuutinen's previous article, Kevin expertly demonstrates how non-clinical departments form crucial pillars in a healthcare organization's cultural foundation. His holistic perspective reminds us that exceptional patient care depends on every team member—from registration to housekeeping—working in concert toward a common mission. Kevin's thoughtful analysis of empowerment, collaboration, and accountability across departmental boundaries reflects his deep understanding of healthcare systems and organizational dynamics. We're confident his wisdom will provide valuable insights for leaders throughout your organization, regardless of their clinical or non-clinical roles.

Strong leadership in non-clinical departments of the healthcare system is essential to overall success.  Although most clinical departments generally have limited direct contact with patients, their efforts are important components of the overall culture of the organization.  Time and time again when patients are asked the question “did staff work together to care for you?” they include everyone they have come in contact with during their visit – registration, housekeeping, nutrition, patient financial to name a few.  As a leader of non-clinical staff, the focus of the work needs to be clear and important to every staff.  This focus centers on many of the same priorities listed by Jessica Nuutinen in the previous leadership article on Shared Governance – Empowering Healthcare Teams Through Collaborative Leadership for clinical staff leadership.

Rural hospitals face a perfect storm of challenges: aging populations, higher rates of chronic disease, lower reimbursement rates, and thinner operating margins. The Medicaid Directed Payment Program has emerged as a critical tool to ensure these essential healthcare facilities remain viable while improving care quality. Nebraska's recent implementation offers valuable insights into how these programs can transform rural healthcare delivery.

Directed payments, established by the Centers for Medicare & Medicaid Services (CMS) in 2016, allow states to require Medicaid managed care organizations (MCOs) to pay providers according to specific rates or methods. According to MACPAC (Medicaid and CHIP Payment and Access Commission), these payment arrangements can be used to establish minimum fee schedules, require participation in value-based payment arrangements, or implement uniform payment rate increases. Unlike traditional supplemental payments, which aren't allowed in managed care, directed payments must be tied to utilization and delivery of services under the managed care contract, distributed equally to specified providers, and advance at least one goal in the state's managed care quality strategy.

As a leader in rural healthcare, I can attest firsthand to the indispensable role the 340B Drug Pricing Program plays in maintaining healthcare access for our most vulnerable communities. For over 30 years, this program has served as a lifeline for rural and safety-net hospitals across America, allowing us to stretch limited resources and continue serving patients regardless of their ability to pay.

The 340B program represents a rare policy success: it costs taxpayers nothing while delivering tremendous value to communities in need. By requiring pharmaceutical manufacturers to provide discounts to qualifying hospitals in exchange for Medicaid and Medicare participation, the program helps offset the rising costs of medications that threaten to overwhelm our healthcare systems.

Rural hospitals operate on razor-thin margins. They serve communities with higher percentages of elderly, low-income, and uninsured patients, while facing all the challenges of attracting healthcare professionals to non-urban settings. The harsh reality is that without programs like 340B, many rural hospitals cannot survive.

Last week, my father-in-law passed away. As we all wrestle with and reflect on this loss, it’s hard not to think about the legacy he leaves behind – in the way he lived and the lasting impact he had on everyone around him.

We all leave a legacy whether we intend to or not. It's about the impression we make on the people in our lives, the values we demonstrate daily, and how we're remembered when we're gone. My father-in-law never set out to create a legacy. He was just living his life according to what he valued. Yet, in doing so, he left behind powerful lessons about what matters most.

In our continuing leadership blog series, we're pleased to feature Jess Nuutinen's insightful exploration of shared governance—a cornerstone concept in modern healthcare leadership. Jess brings a wealth of experience to this topic, offering a thoughtful analysis of how collaborative decision-making transforms healthcare organizations. As Frontier Strategy Partners continues to examine diverse leadership approaches, Jess's perspective highlights how distributing authority and responsibility across all levels of healthcare professionals creates more resilient, innovative, and patient-centered organizations. Her practical framework for implementing shared governance reflects our commitment to providing actionable leadership strategies that can be applied across various healthcare settings. Join us as Jess illuminates this powerful approach that bridges the gap between frontline caregivers and organizational leadership.

Shared governance is a vital framework in health care and nursing that promotes collaboration, accountability, and empowerment among nursing staff and other health care professionals. By fostering a participative decision-making process, shared governance allows nurses to have an active role in shaping policies, procedures, and practices that directly impact patient care and workplace dynamics.

Organizations face unprecedented challenges that demand focused strategic responses. Yet many healthcare institutions struggle with strategic clarity—developing plans that are unwieldy, difficult to communicate, and even harder to implement effectively. The A3 methodology offers a powerful solution to this common challenge.

Originally developed by Toyota as part of their lean management system, the A3 approach has found remarkable resonance in healthcare settings. Taking its name from the international paper size (11x17 inches) that serves as its canvas, this methodology constrains strategic documentation to a single page—forcing clarity, precision, and prioritization.

Delivering sustainable results requires more than just setting broad organizational targets. True success comes from creating a comprehensive system where every aspect of the hospital, from executive leadership to individual departments, aligns its efforts with a unified purpose. At the heart of this alignment lies a structured approach to goal setting that ensures the organization moves forward cohesively toward its mission and vision.

The strategic pillar framework offers healthcare organizations a powerful methodology to measure success across critical operational areas. By organizing goals around five foundational pillars—Quality, Workforce, Patient Satisfaction, Finance, and Community—hospitals create clear pathways for improvement while ensuring that priorities cascade effectively throughout all levels of the organization.

Communication stands as the foundational element that shapes organizational culture and drives employee engagement. Far beyond the simple exchange of information, strategic communication serves as the invisible architecture that aligns teams, builds trust, and propels organizations toward their goals.

Successful organizational communication hinges on three critical dimensions: the message content, the delivery mode, and the target audience. When these elements are strategically aligned, communication transforms from a mundane operational function into a powerful catalyst for organizational cohesion and performance.

We're delighted to launch our leadership blog series featuring unique insights from across our talented team at Frontier Strategy Partners. Craig Saylor kicks off the series with his thought-provoking piece on "Essential Leadership Tools" - a compelling exploration of intentional leadership practices that challenge conventional approaches. Drawing from his extensive experience, Craig offers valuable perspectives on mission-driven leadership, fact-based decision-making, team empowerment, and achieving meaningful work-life balance. His practical wisdom sets the perfect tone for this series, demonstrating the caliber of insights you can expect in the weeks ahead. Craig's ability to distill complex leadership principles into actionable strategies exemplifies why he's such a valued voice in our organization and the healthcare leadership community. We hope you'll find his observations as inspiring and applicable as we do.

Physician recruitment has become more than a matter of filling positions—it's about creating meaningful connections between talented healers and the communities they serve.

At its core, physician recruitment tells a deeply human story. It's about professionals who have dedicated their lives to healing, searching not just for a place to practice, but a place to belong. Healthcare organizations must recognize that beyond competitive salaries and cutting-edge facilities, physicians seek environments where they can make meaningful contributions, grow professionally, and find fulfillment in their calling.

Many physicians carry memories of environments where they were “put on a high-speed treadmill and forgotten” (actual quote from a previous Physician I recruited regarding the culture of his/her prior employment)—their insights overlooked, their concerns minimized, their growth stunted. These experiences profoundly shape what they seek in new opportunities: workplaces where their voices matter, their expertise is valued beyond clinical skills, and they can actively shape the future of patient care.