Strategic Growth Opportunities in an H.R.1 World
Learn where and how to grow in a landscape of rising uninsured populations and mounting financial pressures.
H.R.1 is set to reshape the healthcare landscape, creating turbulence that will test even the strongest provider organizations. While most headlines highlight the upcoming challenges—and they are real—a more nuanced picture is springing up from conversations with healthcare leaders across the country.
Financially sound systems, especially in non-Medicaid expansion states, are treating this moment not as a period to retreat, but as a chance to reposition. For them, the defining question isn’t whether to grow, but how to do so strategically amid new financial pressures.
For boards and executive teams willing to think outside the box, H.R.1 may prove less a storm to weather than an opening to gain ground while others retrench.
This article draws on insights from a recent Coker webinar exploring how healthcare organizations can pursue strategic growth opportunities under H.R.1.
Rethinking Growth Fundamentals
Organizations that cling to traditional growth playbooks as H.R.1 looms risk being outmaneuvered by those willing to rethink the fundamentals. To grow smarter, not just bigger, leaders are focusing on these levers:
Value over volume. Instead of chasing patient volume across all service lines, successful systems will double down on high-value areas where they’re truly differentiated. Where are your margins strongest? Where is your clinical reputation unassailable? That’s where strategic investment should flow to create financial resiliency that can weather policy storms and competitive pressure.
Modular over linear expansion. With capital costs soaring, few organizations can justify large-scale campus expansions. Instead, systems are looking to expand their ambulatory presence through micro-hospitals, freestanding emergency departments, and strategically placed outpatient centers, growing geographic reach without the crushing capital burden. With modular expansion, you can test markets more quickly, deploy services faster, and adjust footprint based on real-world performance rather than betting everything on projects with decade-long payback periods.
Partnership Over Ownership
“We need to be thinking differently about how we strategically partner with other organizations and entities throughout the care journey, rather than assuming we need to own every asset along the way.”
Perhaps the biggest mindset shift required under H.R.1 is letting go of the belief that success depends on owning every asset along the care continuum. Strategic partnerships can often create more value and support faster expansion than trying to build and own everything in-house.
Partnership models might include:
- Physician alignment vehicles: Joint ventures or co-management structures that drive shared gains in high-margin service lines without employment models that strain balance sheets.
- Rural and community health partnerships: Collaborations that extend market reach into underserved areas where full ownership isn’t financially sustainable.
- Shared services models: Models that allow organizations to scale capabilities across broader geographies, reducing redundancy and cost while extending beyond organizational boundaries.
- Dedicated provider networks: Network agreements that expand access and referral pathways without the capital burden of physical expansion.
The organizations most likely to thrive in the months and years ahead aren’t necessarily the ones that own the most; they’ll be the ones that orchestrate care most effectively.
Technology as a Growth Enabler
Access challenges are coming. The workforce shortage isn’t going away. Despite all the hype around telehealth, digital front doors, and remote patient monitoring, real adoption still hasn’t caught up to the promise these tools hold. H.R.1’s pressures will separate the talkers from the doers.
This is no longer about innovation for innovation’s sake. It’s about using technology to guard against access challenges while maintaining margin. Telehealth can expand market reach and meet demand well beyond traditional service areas, while remote patient monitoring brings care directly into patients’ homes, creating both clinical value and new revenue streams.
The real differentiator is not who adopts these tools, but who scales them strategically. Organizations that move past pilots and point solutions toward scaled, coordinated deployment are expected to see the most meaningful impact when access challenges start to come down the line.
Playing Offense Under H.R.1
So what does offensive strategy look like in the H.R.1 world? If you’re well-positioned, this is your moment for growth. As smaller competitors pull back, expansion opportunities are expected to emerge. Strategic acquisitions may come within reach at attractive valuations, and market share gains are possible for those with both capital and conviction.
“What I’m seeing is a bifurcation among systems. Those that are financially strong, in non-Medicaid expansion states, are actually exploring expansion opportunities right now. It’s not all doom and gloom. There are real opportunities for growth for organizations that are well positioned to take advantage of them.”
If you’re among the organizations that need to shore up fundamentals first, offense looks different but is still possible. It means being ruthlessly strategic about where you compete, building partnerships instead of going it alone, and using technology to extend capabilities without extending costs proportionally.
The Road Ahead
The market divide we’re seeing is likely to widen under H.R.1. Organizations that can move from defense to strategic offense, even in turbulent times, stand to capture growth and reinforce their market position. Those that stick to traditional playbooks or default to purely defensive moves risk being left behind. The question is: which side of the divide will you be on?
What to Do Next
📘 Read our latest resources to explore insights on strategic planning, growth, and performance improvement
💼 Explore our advisory services to see how we help healthcare organizations navigate change and pursue sustainable growth
📅 Talk to a Coker consultant to discuss how H.R.1 may impact your organization’s growth strategy
