Alignment Before Acceleration: Why Regulatory Changes and New CMS Programs Require Leadership Operating from One Shared Truth
- Rebecca Bonds
- 16 hours ago
- 3 min read
In a previous Insight, we introduced the idea of siloed truths — not silos of work, but silos of understanding.
Different leaders, all working hard, yet each operating from their own interpretation of “what’s really happening,” “what matters most,” and “where responsibility lives.”
Individually, those truths may each feel reasonable.
Collectively, they quietly fracture leadership alignment.
For years, healthcare organizations have been able to function — sometimes even succeed — in that environment. Lag in reimbursement, retrospective reporting, and policy cycles provided cushion. Variation could be debated. Ownership could be softened. Progress could move “just fast enough”.
That cushion is disappearing.
CMS Is No Longer Experimenting Quietly
We are entering a period where regulatory expectations, new CMS programs, and evolving reimbursement models are no longer “interesting initiatives.” They are structural bets on the future of U.S. healthcare.
These shifts signal something deeper than compliance:
Quality is shifting from retrospective reporting
to in-line operational behavior
Care coordination is shifting from
program activity to organizational responsibility
Accountability is shifting from
departmental effort to leadership capability
Healthcare is being asked to perform differently — not explain differently.
Participation in CMS programs is no longer a strategic choice. It is becoming an operating environment.
Organizations that struggle in the next era will not fail because:
the model was unfair
the technology wasn’t ready
or the workforce didn’t care
They will fail because leadership alignment could not sustain execution across boundaries.
That is not a technology problem.
That is a leadership operating model problem.
HFMA Quietly Confirmed What Many Leaders Already Know
Recently, HFMA published findings that healthcare executives feel underprepared for what lies ahead, particularly around AI readiness, financial stability, and governance expectations.
What stood out most was not anxiety — it was honesty.
Executives openly acknowledged:
The current operating model is under strain
Old leadership constructs will not carry the future
Collaboration pressures are increasing
Reality is not negotiable
One HFMA contributor said it plainly:
“This is what it feels like when the model starts breaking down. Financial pressures are mounting — and reality is not negotiable.”
That perspective matters because it comes from the financial leadership side of healthcare — not technology evangelists, not innovation narrators. Finance leaders aren’t calling for more pilots, more platforms, or more energy. They’re calling for alignment, coherence, and disciplined leadership capacity.
When CFOs, CIOs, CMOs, and Strategy Officers all acknowledge growing complexity — alignment stops being philosophical. It becomes essential infrastructure.
Technology Will Not Hide Misalignment Anymore
For a long time, organizational misalignment could live in latency:
Report cycles
Performance lag
Interpretive debates
Post-hoc explanations
But in the future:
AI will surface issues instantly
APIs will expose variability in real time
Data will eliminate deniability
Without alignment:
AI becomes surveillance instead of support
Signals trigger defensiveness instead of correction
Care coordination becomes “everyone’s job” — and therefore no one’s
Failure will occur not because organizations are incapable — but because leadership has never been required to operate this coherently before.
Now it is. Not through pressure – but through reality.
Why Leadership Alignment Must Precede Everything Else
This shift is not anti-technology.
It is anti-premature technology.
Once alignment exists:
technology accelerates capability rather than compensating for dysfunction
AI becomes an enabler rather than a burden
governance strengthens clarity rather than constraining leaders
Alignment is not about control.
It is about coherence.
It is about leadership operating from one shared truth — not agreement on everything, but alignment on:
What we believe about where we are
What we are accountable for
How we will behave in execution
Without this foundation, CMS programs feel punitive.
With it, they become achievable.
A Hopeful Reality
There is a quiet, stabilizing truth here:
Survival in the next era of healthcare is not dependent on how many tools you buy, how aggressively you deploy AI, or how loudly you proclaim innovation.
It depends on:
Whether your leadership team can operate from one truth
Whether alignment is cultural rather than episodic
Whether accountability is shared, not diffused
That restores agency to leaders.
This is not something being done to healthcare.
This is an invitation to build the discipline we have always said healthcare deserves.
And that work begins at the executive table.
Coming Next
In our next Insight, we will look beyond compliance and capability — and explore why so many healthcare transformations fail, and why it is rarely due to leadership failure, but rather system design, incentive structures, and misaligned governance cultures.
Because alignment is not just wise.
It is protective.
And it may be the most valuable leadership discipline healthcare develops in the next decade.
