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The Strategist in Brief: October 9, 2025 · The Strategy Catalyst Dispatch

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  This is the strategist in brief.
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  For October 9th, 2025, the federal government shut down on October 1st after Congress failed to meet a funding deadline, the shutdown could last for multiple weeks with Senate lawmakers deadlocked over the extension of enhanced a CA marketplace.
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  Subsidies.
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  Disruptions for health systems include the expiration of telehealth, flexibilities, and hospital at home waivers.
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  A pause on certain supplemental Medicaid payment.
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  Federal agency furloughs.
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  If the enhanced a CA subsidies are not extended, nearly 4 million Americans could become uninsured.
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  The shutdown underscores the importance of proactive scenario planning, programmatic resilience, and open communication with patients and providers.
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  Moving on to our second story, UnitedHealth CVS and Humana are shrinking their Medicare advantage footprints by dozens of counties and CMS forecasts a fall in Medicare Advantage enrollment next year.
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  The major carriers are responding to rising utilization, following reimbursement and financial distress.
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  As the new version 28 reduction in Medicare rates goes fully into effect next year.
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  The retreat of major carriers could be a boon for regional plans that could be potential partners for health systems, but those plans are also dealing with their own financial struggles.
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  United Health's push to move members from PPO to HMO plans could disrupt continuity of care and create additional administrative frictions.
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  Moving on to our third story, Evolent Health has agreed to sell its a CO to Privia Health for$100 million.
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  The transaction highlights how some disruptors are leaning into distinct areas of specialization, privia, and value-based primary care, and evolent in value-based specialty care.
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  Privia offers independent physicians in alternative to health system employment, but several health systems have also partnered with the company to extend their reach in new markets.
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  And now our final story.
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  The American Medical Association, leading medical societies and nursing recruitment agencies are lobbying the Trump administration for exceptions to the new$100,000 fee for H one B Visa applications.
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  The fee threatens to make hiring new foreign trained physicians prohibitively expensive.
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  The greatest impact could be in central states where a higher share of physicians are H one B Visa holders.
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  That concludes this week's edition.
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  Be sure to check out the full version on the web@hmacademy.com.
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  Thanks for listening.