Preparing for 2026 Business Intelligence as a Strategic Planning Tool. Week 1: What 2025 Taught Us
- Cale Queen
- Nov 17
- 5 min read
If 2025 taught any of us anything, it’s this:
You’re not struggling because you’re doing something wrong.
You’re struggling because the healthcare environment is changing faster than your systems can adapt.
This year was a stress test — and stress tests reveal the truth. Here’s what 2025 made unmistakably clear.
1. Staffing Was the #1 Instability — But Not for the Reason Most People Think
Staffing challenges shaped 2025, but the deeper cause wasn’t simply the labor market.
National data show:
73% of practices reported moderate to severe staffing shortages (MGMA).
Clinical and front-office turnover increased 28% year-over-year (AMA).
The U.S. faces a projected 86,000-physician shortage by 2036 (AAMC).
But clinics with clearer workflows, defined roles, and less rework remained far more stable than clinics with the same headcount but higher operational friction.
Fix the system, and your team can succeed.
2. Payer Pressure Quietly Eroded Margin — And Downcoding Made It Worse
2025 brought a level of payer friction that many clinics had never experienced before.
Across the industry, practices saw higher denial rates, more prior authorizations, narrower Medicare Advantage networks, greater documentation demands, and lower effective reimbursement.
But one trend had an outsized impact: the rise of systematic downcoding.
Why it happened:
MA plans faced tighter financial pressure.
Medicare Advantage Star Rating changes reduced bonus revenue.
Payers expanded automated claim-editing tools.
AI-driven audit models were deployed.
Insurers shifted cost control to the claim level.
How it affected clinics:
A single level-down may only reduce a claim by $25–$55, but across a year:
A few per day → tens of thousands lost.
Many per day → six figures gone.
What clinics can do:
Track downcoding.
Identify payer and code patterns.
Use templated appeals.
Request written policies.
Negotiate lookbacks.
Reevaluate payer contracts.
Your 2026 takeaway: Payer behavior changed. Your strategy must change with it. That requires Business Intelligence.
3. Access Became the New Battleground
Patients didn’t just want appointments — they wanted care that fit their lives.
In 2025, the rules of patient behavior shifted more than most clinics realized.
National surveys and claims data pointed to a consistent pattern:
patients prioritized speed of access over physician continuity
appointment availability became a leading driver of patient retention
retail clinics filled gaps traditional practices couldn’t
virtual-first competitors captured younger adults and working families
callback delays became a top source of online complaints
clinics with rigid templates lost patients to those with flexible scheduling
Patients weren’t leaving because the care was poor. They were leaving because the experience didn’t match their daily life.
In a marketplace where clinical quality is high across the board, your ability to offer timely access determines whether you gain or lose patients.
Clinics that adapted their access model saw:
higher patient retention
improved schedule density
fewer no-shows
stronger financial performance
better staff utilization
What Clinics Can Do:
Access is no longer an operational issue — it’s a competitive one. Understanding your access patterns is the key to success.
When are patients trying to be seen?
How long are they waiting?
Where do you have bottlenecks?
Where is demand exceeding capacity?
How many patients didn’t schedule because the first available was too far out?
If clinics want to grow in 2026, improving access isn’t optional. It’s the battleground where growth will be won or lost.
4. Patient Complexity Increased Across All Age Groups
If staffing issues shaped 2025 from the inside, patient complexity shaped it from the outside.
National trends showed:
More chronic disease at Medicare entry (CDC).
Rising obesity, hypertension, diabetes, and depression among younger adults (CDC MMWR).
More patients with multiple, interacting conditions across all cohorts.
Higher behavioral health needs layered onto routine medical care.
But the clinics hit hardest weren’t the ones with the sickest patients — they were the ones without systems built for this new level of complexity.
Operational research shows:
Complex visits run longer
Documentation expands
Care coordination multiplies
Portal messages increase
Medication management becomes heavier
Clinics didn’t just get busier — they got more clinically intense, and the workload spread across every part of the day.
What Clinics Can Do:
You can’t build a strategy around a simpler patient population that no longer exists. Business Intelligence helps you see where complexity is growing, how it affects capacity, and what adjustments your clinic must make next year.
5. Technology Improved Capabilities — and Increased Workload
2025 delivered more tools than any prior year — but also more alerts, more clicks, more fragmentation, and more rework.
Technology expanded rapidly in 2025, but far less of it translated into usable improvements for clinics.
National and industry trends showed:
More EHR features, alerts, and clicks across major systems
Growing use of AI tools, but inconsistent workflow fit
Higher portal message volume driven by ease of access
More fragmented data streams across platforms
Increased documentation expectations layered onto clinicians
Technology enhanced what was already functioning — but it did not provide new solutions for clinics with underlying workflow friction.
What Clinics Can Do
Business Intelligence helps you determine which tools genuinely support your workflows—and which ones will increase the burden next year.
6. Strategic Blind Spots Became Harder to Ignore
Even high-performing clinics saw declining confidence in their decisions throughout 2025.
Key drivers included:
Assumptions aging faster than expected
Unpredictable payer behavior, including downcoding
Poor visibility into demand and capacity trends
Reports providing data, not direction
External changes outpacing annual planning cycles
Clinics weren’t failing due to lack of effort — they were operating without a clear view of what was changing and what mattered most.
What Clinics Can Do Today:
Business Intelligence closes these blind spots by giving clinics clarity on trends, priorities, and next actions.
7. Clinics That Thrived Did One Thing Differently
The clinics that performed best in 2025 weren’t the biggest — they were the most adaptive.
Industry analysis consistently found:
Frequent trend reviews instead of annual strategy checks
Early correction of small problems before they became structural
Clearer role definitions leading to lower turnover
Reduced rework through focused process improvement
Access improvements aligned with patient expectations
They didn’t predict the year — they responded to it with discipline and visibility.
What Clinics Can Do Today:
Business Intelligence enables adaptability by showing clinics when to adjust, why to adjust, and how to adjust.
What This Means as We Begin Planning for 2026
Reduce rework before hiring.
Redesign access intentionally.
Monitor payer behavior.
Adopt technology with purpose.
Plan for rising patient complexity.
Use monthly intelligence reviews.
Build a strategy system, not a strategy document.
Business Intelligence is what makes all of this possible.
Your clinic doesn’t need more data for 2026 — it needs Business Intelligence. Let’s show you how.
Get a free one-week dashboard review, where we analyze your existing data, identify your biggest opportunities, and give you a clear, actionable plan for the year ahead.
➡ Register for an Upcoming Lunch & Learn (Clarksville/Nashville)
Next Week — Week 2: “The 2026 Landscape: What’s Coming (And What We Need to Prepare For)”
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