PLAYBOOK

Protecting patient care through coverage disruption

A healthcare executive’s playbook for the 2026–2028 planning cycle

The upcoming planning cycle will bring more coverage churn, more eligibility denials and more pressure on uncompensated care. Hospitals don’t have to choose between financial discipline and clinical service delivery.

Drawing on frontline insights from Ensemble’s payer strategy and patient access work with leading health systems, this playbook shares practical strategies to identify coverage risk earlier, connect patients to assistance and reduce avoidable self-pay.

Inside the playbook:

Reimbursement pressures to plan through 2028, from H.R. 1 and Medicaid redeterminations to work requirements and ACA subsidy reductions.
4 budgeting priorities to pressure-test assumptions, recalibrate reserves and reassess service line exposure.
3 frontline strategies to protect patient access and reduce coverage-related revenue leakage, from at-risk coverage support to repeat non-emergent ED management.

Use the playbook to prepare earlier, protect margin and support patients before coverage gaps become harder to resolve.

Inside the playbook:

Use the playbook to prepare earlier, protect margin and support patients before coverage gaps become harder to resolve.