TrustWorks On Call: You May Or May Not Be Fired

Behind the Headlines

Unpacking the forces driving healthcare's biggest stories.

1. FDA commissioner Dr. Marty Makary ousted.

On Tuesday May 12, Food and Drug Administration (FDA) commissioner Dr. Marty Markary resigned, following days of speculation that he was about to be dismissed because the White House saw him as a “rogue agent” on vapes, abortion pills, and certain drug approvals.
After it was reported last Friday that Dr. Makary would soon be fired, the FDA posted new enforcement guidelines on its website that would allow large tobacco companies to market flavored vapes again, ending an FDA policy that restricted them to selling only tobacco and menthol flavors.

TrustWorks Take: Dr. Makary’s ouster emerged out of a growing rift between the business-friendly and big-business-skeptical camps within the Trump administration and its supporters. The FDA is a focal point for this rift because the Make America Healthy Again (MAHA) movement’s skepticism toward “Big Pharma” clashes with the Trump administration’s desire to lower drug prices by speeding up drug approvals. Dr. Makary’s initial resistance to allowing more flavored vapes to hit the market, and his subsequent reversal in the hope of saving his job, illustrates this phenomenon. The pro-business faction appears to have won this round, although they were aided by pro-life activists frustrated with Dr. Makary over the FDA taking too long to publish a revised safety review of mifepristone, a drug used in medication abortions.

Secretary of Health and Human Services (HHS) Robert F. Kennedy Jr. described his healthcare leadership team of Dr. Makary, Dr. Jay Bhattacharya, and Dr. Mehmet Oz as “friends” who reportedly used Dr. Oz’s Florida home as a base for strategic planning and socializing during the transition between administrations. Despite their bonding, Secretary Kennedy reportedly "made this decision" to tell Dr. Makary to resign, and none of his other friends are expected to follow him out the door. However, we may end up looking back on Dr. Makary’s exit as part of a snowball effect. In addition to Dr. Makary, three of Trump’s cabinet appointees have been forced out in the last two months, repeating the pattern of significant leadership turnover that we saw in the middle of the first Trump administration.

2. Proposed WakeMed-Atrium merger sparks backlash.

State, municipal, and local leaders in North Carolina reacted negatively to the revelation that Raleigh, NC-based WakeMed Health and Charlotte, NC-based Atrium Health, part of the larger Advocate Health, had agreed to combine.
Despite the deal having been in the works for two years, the public only learned of it on Friday May 1, when the Wake County Board of Commissioners published its meeting agenda for the following Monday.
The commissioners were set to vote on changes to WakeMed’s articles of incorporation needed for the deal to move forward, but they opted to delay the vote by 90 days in response to public outcry.
If the Wake County Board of Commissioners approve the deal, it will still need sign off by North Carolina’s attorney general and the Federal Trade Commission.

TrustWorks Take: WakeMed CEO Donald Gintzig testified to the benefits of the proposed combination by pointing to the systems’ cultural fit, their opportunity to expand virtual and behavioral healthcare access in the state, and the $2B Atrium is willing to invest to improve WakeMed’s facilities. These valid points were undermined by the shady tactic of delaying the deal’s formal announcement until the morning after the Wake County commissioners were supposed to approve it. Gintzig explained correctly that “big strategic decisions don’t happen in the public realm,” but what he failed to account for is that nonprofit hospitals’ big strategic decisions require public engagement. If WakeMed and Atrium truly believe that their combination will benefit the community, their leaders should have announced the deal prior to local elected representatives’ only vote on the matter.

WakeMed and Atrium’s leaders likely feared and sought to avoid the backlash they ultimately inflamed because hospital mergers are once again facing rising scrutiny, particularly from state and local officials. It is easy to point the finger at hospital consolidation as the primary culprit for excessive healthcare cost growth because, when hospitals merge, prices usually increase and quality measures usually do not. Regulators have clearly gotten wise to this research finding. As two former Secretaries of North Carolina’s Department of Health and Human Services summarized in an op-ed posing pointed questions about this deal, “We are not arguing this merger cannot or should not happen. We are arguing that the bar for approval must be high, the commitments must be legally binding, and the process must be transparent.”

3. Medicare to test $50 GLP-1 prescriptions.

The Centers for Medicare and Medicaid Services (CMS) announced that eligible Medicare beneficiaries will be able to receive GLP-1 prescriptions for weight loss with a $50 monthly copay, in a pilot program running from July 1, 2026 to December 31, 2027.
The Medicare GLP-1 Bridge program will allow Medicare Part D enrollees, after receiving prior authorization through a central system contracted to Humana, to obtain certain GLP-1 prescriptions, including various doses and delivery mechanisms, for a flat fee that does not count toward their plan’s cost-sharing limits.

TrustWorks Take: Medicare has traditionally excluded weight-loss drugs from Part D coverage, but now the over 17M Medicare beneficiaries who are overweight or obese could be eligible to get these drugs for at least $100 cheaper than cash-pay prices. (GLP-1 prescriptions for other treatments besides weight loss are not eligible for the Bridge program.) CMS is running this expensive, but time-limited, pilot program to learn what happens when people are given access to a variety of affordable GLP-1 drugs. CMS will use this utilization and cost data to redesign a program it is developing with Medicare Part D plan sponsors (i.e. private insurers) to share the costs of Medicare covering GLP-1 drugs for weight loss. The voluntary model it initially proposed has been indefinitely delayed because no insurers agreed to participate.

Beyond the Whiteboard

Visualizing key trends from the healthcare industry

The Future Value of Hospital Mergers
Hospital merger activity hit a 15-year low in 2025, as an uncertain policy environment following the inauguration of President Trump caused many health systems to delay major strategic decisions. However, even with more regulatory clarity, health system M&A activity is unlikely to return to pre-COVID levels for an important structural reason: the most attractive mergers have already happened. From 2010 to 2025, over 1,300 hospital M&A transactions were announced, ranging from single-hospital acquisitions to billion-dollar megamergers. Over that period, the number of hospitals affiliated with health systems rose from 56 to 69 percent, including 80 percent of urban hospitals and a majority of rural hospitals. Acquiring systems pursued the highest-performing independent hospitals and strategically compatible smaller systems first. The remaining M&A candidates are more likely to involve distressed assets or potentially unnavigable regulatory hurdles.

As hospital independence declined, local hospital markets became more concentrated, with over two thirds of metropolitan areas served by three or fewer health systems in 2024; one in five markets is controlled entirely by a single health system. We know that health systems with greater market concentration charge higher prices, leading federal antitrust regulators to ramp up scrutiny of proposed deals. Regulators still expect health systems to advance toward value, however, just not through scale. Instead, systems are expected to look inward, focus on operational efficiencies, and unlock the full promise of the scale they have already achieved but not fully integrated.

Dialing In

Sharing insights from our work with clients

The (Statistical) Insignificance of Management Consulting
A health system CEO we are working with emailed me this JAMA study that has been making the rounds, perfunctorily asking me, “thoughts?” The study found “no evidence” that the use of management consultants by nonprofit hospitals produces any measurable, statistically significant benefit to anyone (besides the consulting firm). Although comparing TrustWorks to Deloitte or Accenture (the two highest-paid firms in the study) is like comparing a craft brewery to Anheuser-Busch, your entire industry summing up to a very expensive “no effect” still demands explanation.

I replied that hiring a management consultant is like going to a therapist. You have a problem which may not be well defined, so you bring in an outside expert to diagnose it and help you change your behavior. If you receive an accurate diagnosis but fail to make life-improving changes, did you or your therapist fail? In our line of work, executing solutions is almost always more difficult than identifying problems, and we are not always brought in to do both. Additionally, the returns on our strategy and governance work (where my personal passions lie) have a longer horizon and can be more amorphous. The best results happen when a hospital, already committed to changing its ways, forms a long-lasting relationship with a consulting firm to see through systemic improvement from identification through implementation. But similar to how some people may see more benefit from a gym membership than a therapist, some providers would be better off hiring more nurses rather than paying a consultant to tell them whether they can afford to hire more nurses.

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You May or May Not Be Fired