Becker's Hospital Review

6 CEO / STRATEGY Why Trinity Health is embracing a 'beginner's mindset,' per its CEO By Alan Condon W ith hospital margins under significant strain and coverage headwinds mounting — from Medicaid cuts to the looming expiration of ACA subsidies — Livonia, Mich.- based Trinity Health is reshaping its strategy for the years ahead. Under CEO Mike Slubowski, the faith-based nonprofit is ramping up ambulatory care, home-based services and its older adult care offerings, including its Program of All-inclusive Care for the Elderly (PACE). e health system's growth and transformation goals aim to close a widening financial gap and ensure access to care for vulnerable and underserved populations. A $1.5 billion gap — and the plan to close it Mr. Slubowski does not sugarcoat the challenge. "A lot of the damage has already been done with the [One Big Beautiful Bill Act], with the reduction in Medicaid enrollment, as well as the death by 1,000 cuts that keep happening with Medicare payment," he said. "We've identified a $1.5 billion gap annually for us to close, and that's excluding what may happen with ACA subsidies. e good news is we saw this coming … and have been developing plans on both the cost and the revenue side to close that $1.5 billion gap, which is on top of the gap we have to close every year between inflation and payment increases of over a billion dollars." at projection is a substantial risk tied to funding changes. Trinity Health estimates the impending Medicaid cuts will inflict a $1.5 billion blow across its 92 hospitals. On average, Medicaid covers 20% of the patients Trinity Health serves — with some communities at 25%. For its nursing homes and long-term care facilities, Medicaid is oen the predominant form of coverage. To address this challenge, the system in the spring launched Repositioning Trinity Health, a sweeping initiative to transform its cost structure, revenue model and care delivery approach. "ere's been a lot of great, creative work happening across our ministry — work that requires both radical thinking and what we call a 'beginner's mindset,'" Mr. Slubowski said. e mindset he emphasized is pushing leaders across the health system to think differently, question legacy models and ask: "If we were starting from scratch, how would we deliver the best care and be a transforming presence in our communities?" at mindset shi is helping Trinity Health streamline care where possible, redesign core processes and reducing costs to remain a strong, sustainable ministry for the communities it serves across 27 states. "e reality is, with reductions in Medicaid and potentially ACA subsidies, more people will become uninsured — and many will end up in our emergency departments," he said. "So, we're building processes to better meet people at the ED door and redirect them when possible — through urgent care, primary care, or more efficient inpatient throughput. We're also working on improving payment plans to make care more affordable, and we've focused on the pricing of shoppable services like imaging, making sure we don't apply hospital-based pricing models to outpatient care. "We're confident we can get there, but it's not easy." Betting on outpatient, ambulatory and home‑based growth At the core of Trinity Health's new strategy: growth not in inpatient beds but in lower-cost, higher-volume settings. "Of our seven strategic priorities, the four we're really focused on are growth, exceptional member experience, exceptional colleague experience and transformation," Mr. Slubowski said. Growth is not about building more hospitals. Instead, it is about expanding ambulatory and outpatient services, and scaling home-based care and PACE. ose areas have been growing at a steady 8% to 10% annually, with plans to accelerate. "We're actually the largest not-for-profit PACE provider in the country [and second-largest overall], and we've moved into markets where we don't operate hospitals or physician groups," Mr. Slubowski said. "We know how to do it well and can partner with others to expand that work." Getting smarter — and leaner — with 'transformation' He emphasized that "transformation" is more than a buzzword at Trinity Health; it is a full-scale operating model overhaul. As part of the Repositioning plan, the system is reengineering clinical workflows, embracing technology and rethinking where and how care is delivered. Even in the AI space, Trinity Health is cautious yet deliberate. "ere are a bazillion vendors out there trying to sell us the next cool thing in AI, but we're taking a more grounded approach," he said. Rather than chasing every new vendor, the health system is leveraging its core systems. By spring 2026, it expects to be the largest single-instance user of Epic in the country, and aims to benefit from the company's AI capabilities across its ministries. "We want to maximize that value before we go out and buy new tools," he said. is conservative, platform-first approach may pay dividends as cost discipline and operational efficiency become increasingly essential in the current landscape. Financial strength and smarter capital deployment "ere are a bazillion vendors out there trying to sell us the next cool thing in AI, but we're taking a more grounded approach." — Mike Slubowski, President and CEO, Trinity Health

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