As health systems shift from short-term recovery to long-term durability, two experienced CFOs share what strategy and mindset shifts are the right ingredients for baking in sustainable financial resilience.
What does it take for health systems to be financially resilient in today’s market? In the latest episode of HealthLeaders’ The Winning Edge, two CFOs examine what it takes to foster real financial resilience when industry pressures mount.
Two CFOs, Brad Hipp, vice president and CFO of Tucson Medical Center (TMC) and Rob Tonkinson, senior vice president and CFO of Centra Health, share their hard-earned industry experience and leadership insights around what strategies, disciplines, and mindset shifts come into play when building financial resilience in healthcare.
Governance should help organizations make decisions, not create more meetings, says this health system CEO.
KEY TAKEAWAYS
Governance creates momentum when leaders establish ownership and define when critical decisions need to be made.
Delaying difficult decisions can slow transformation and leave organizations struggling to execute strategic priorities.
In this episode of HL Shorts, Diana Richardson, president and CEO of Merrimack Health, explains why enterprise transformation depends on effective governance, starting with timely decision-making and giving leaders clarity during periods of change.
Hospital and health system executives at the HealthLeaders CEO Exchange prioritized growth and governance for a changing healthcare landscape.
KEY TAKEAWAYS
Hospital CEOs are investing in ambulatory care through integrated access points and strategic partnerships that expand services outside the hospital campus.
Leaders are standardizing enterprise functions where it creates value while preserving local decision-making so hospitals can respond to the needs of their communities.
Leadership continuity and succession planning are vital as organizations prepare for a future that looks considerably different than the past.
The HealthLeaders CEO Exchange offered a window into how hospital and health system leaders are viewing strategy during a time of unavoidable industry transformation.
Across two days of roundtable discussions in Avon, Colorado, executives shared approaches for remolding their organizations around care models that emphasize access, leadership structures that give local teams room to execute, and partnerships that create value for patients and communities.
Here’s a look at the conversations that took place and what they mean for the immediate future of hospital decision-making.
Growth follows the patient
Ambulatory care strategy has become imperative for providers wanting to grow in the current environment in which care isn’t bound by the hospital’s four walls.
Several CEOs spoke about creating integrated care sites that combine primary care with behavioral health, dental services, rehabilitation, and optometry. Others discussed hybrid emergency department and urgent care facilities that simplify access for patients who are unsure where to seek treatment. Mobile care services and virtual specialty were also highlighted as organizations look for ways to expand access across urban and rural markets.
One executive described an approach that challenged years of competition between neighboring organizations.
“Historically, the CEOs hated each other,” the executive said. “When she and I both became CEOs, within six months of each other, we were like, ‘Let’s start a different path.'”
The relationship led to a shared walk-in clinic that has since become a wider ambulatory strategy across the region. The model increased access, generated revenue for both organizations, and strengthened relationships with community leaders, according to the executive.
Another participant described their organization’s philosophy as “no wrong door,” with patients entering the system through whichever service best fits their needs while gaining access to additional care during the same visit.
The discussion reflected how executives are focusing on bringing care closer to patients through flexible access points that improve convenience and support long-term financial performance.
Balancing scale and local leadership
As health systems continue to grow, CEOs are rethinking ways to preserve decision-making close to the communities they serve.
Executives at the Exchange described centralizing functions such as marketing and revenue cycle while allowing local leaders to shape implementation based on market conditions. Several attendees said enterprise standards provide direction, though each hospital requires flexibility to address its workforce and patient population.
One executive summarized their philosophy in three words: “Implementation is local.”
That perspective echoed an earlier discussion on systemness, where leaders debated which functions benefit from standardization and which remain stronger when managed locally. Participants acknowledged that scale can improve efficiency, though additional layers of governance can also slow decisions and weaken ties to the community.
Accountability starts with setting clear expectations for local leaders and sharing what works across the organization.
Leadership evolves with the organization
Roundtables at the Exchange also revealed how leadership expectations continue to change.
Executives spoke about building stronger relationships across finance, operations, and clinical teams through greater transparency and more frequent collaboration. Several described spending time with frontline employees and creating environments where staff feel comfortable raising concerns. Those efforts, participants said, strengthen trust and improve execution.
Leadership continuity also emerged as an important advantage. Executives said longer CEO tenures help strengthen relationships with physicians, employees, community organizations, and elected officials while giving strategic initiatives time to mature.
When change does happen, internal succession planning can mitigate organizational turbulence, with leadership development serving as an investment in long-term organizational stability.
Ultimately, one message became clear by the end of the Exchange: Hospital leaders are looking well past incremental improvements.
“The hospital models are dead,” a rural hospital executive said. “Everybody’s trying to do CPR on the old model versus thinking about what’s the new model.”
Whether it’s ambulatory expansion, virtual care, partnerships, leadership structures, or organizational design, CEOs are strategizing through the lens of what comes next.
Yes, I’m still talking about it: Last week at our CEO Exchange in Avon, Colorado, even more became very clear: if you’re still thinking of a hospital as a destination, you’re already behind.
I’ve been watching health system strategy evolve, but the conversations I heard in the Rockies felt like a definitive pivot. The “four walls” of the hospital are officially a thing of the past. CEOs are now designing systems around an ambulatory-first, “no wrong door” philosophy.
We heard about integrated care sites that mash together primary care, behavioral health, dental, and even optometry under one roof. One of my favorite moments was hearing two CEOs who, historically, were supposed to spend their careers hating each other, decided instead to build a shared walk-in clinic.
It turns out that when leaders stop protecting their turf and start looking at what the community actually needs, everyone—including the bottom line—wins.
But how do you scale that without losing your soul? That’s the part that always gives the C-suite a headache. The consensus in the room was pretty straightforward: centralize the “boring” stuff like revenue cycle and marketing (hey, I didn’t say it!!), but keep decision-making local. As one executive put it, “Implementation is local.“ If the people on the front lines feel like they’re just taking orders from a corporate office three states away, your strategy is dead on arrival.
Also today, a reality check on the relationship between nursing and HR.
Jennifer Spinelli, director of system talent acquisition at Beebe Healthcare, joins us on HL Shorts to discuss a disconnect I’ve seen play out in a hundred different ways. You have nurse leaders who are feeling the immediate, visceral burn of a staffing gap on the floor, and TA leaders who are trying to balance that urgency with the cold reality of the labor market.
How do you bridge that gap without someone ending up frustrated? It comes back to transparency and shared data. When everyone is looking at the same map, it’s a lot easier to agree on the destination.
Both stories point to a new era of healthcare leadership that values partnership over competition and operational alignment over corporate mandates. Whether you’re building a new clinic or a new workforce pipeline, the most successful leaders are the ones willing to tear down the silos they spent years building.
To avoid losing funding, many states are pursuing proven cost-saving strategies like downsizing inpatient care rather than untested approaches, some experts say.
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The Rural Health Transformation Program is beginning to reshape how hospitals in rural America deliver care. But with nearly a trillion dollars in Medicaid cuts looming and pressure to show results or risk losing funding, many states are pursuing the safest path available: paying hospitals to downsize.
Congress established the $50 billion, five-year fund under the One Big Beautiful Bill Act to improve healthcare access, quality and outcomes in rural areas — and to win over a handful of Republicans who threatened not to vote for the bill over concerns it would gut Medicaid funding and take out rural hospitals in the process.
The funds are meant to improve rural healthcare access, which has been declining in the U.S. for years. More than 100 rural hospitals have closed in the past decade, and more than one-third are at risk of closing, according to the nonprofit Center for Healthcare Quality and Payment Reform.
The OBBBA will reduce Medicaid spending by an estimated $911 billion over the next decade and increase the number of uninsured people by 10 million, according to the Congressional Budget Office. The RHT program, meanwhile, could offset 37% of the estimated cuts to federal Medicaid spending in rural areas, or about 5% of the total estimated cuts to federal Medicaid spending, according to a KFF analysis of the CBO’s estimates.
In light of the massive funding cuts, the RHT program may not live up to its promises, experts say.
“If we weren’t facing a trillion-dollar cut in the Medicaid program over the next 10 years, this could be a once-in-a-generation policy,” said Bradley Cunningham, a regulatory and policy analyst at the Association of American Medical Colleges.
In December, all 50 states received their first-year awards, totaling $10 billion and averaging roughly $200 million per state. The program caps direct care spending at 15% of funds, steering the bulk of the remaining money toward infrastructure, technology, workforce and new care models.
However, states only had about seven weeks to prepare their applications. So, their plans largely focus on proven cost-cutting strategies rather than innovation, and now they’re locked into whatever they proposed.
“They had to prioritize speed over thoroughness,” said Aaron Bujnowski, a managing director with the healthcare industry group at consultancy Alvarez & Marsal.
As a result, rural health systems in at least 25 states will need to rightsize to receive funding, NPR reported in April. That can mean cutting services, such as dialysis or labor and delivery, or subsidizing conversions to the Rural Emergency Hospital designation, which requires eliminating inpatient care.
That could affect academic medical centers and other large providers, as they often absorb patients when rural facilities cut services or close. The wave of rural hospital closures over the past decade has already pushed patients to urban academic health systems, increasing volumes and straining capacity.
The point was driven home by an AAMC member who ran the only academic medical center in his state, said Leonard Marquez, senior director of government relations and legislative advocacy at the AAMC.
“He looked at me and said, ‘If my rural hospitals are not healthy, I cannot be healthy,’” Marquez said.
Five buckets, 50 plans
States are taking sharply different approaches to the RHT program. Bujnowski identified five broad categories: Downsizing and REH conversion, as in Kansas and Montana; workforce development, including Maine’s expanded scope of practice for physician assistants; technology and alternative payment models, with 42 of 50 states including some form of value-based care expansion; social determinants of health, including food-as-medicine programs in Arkansas and Pennsylvania; and states that are still refining their plans.
The applications for funding were “so divergent” that it’s difficult to discuss the program in holistic terms, Cunningham said.
Moreover, the program’s clawback authority, which allows the CMS to reduce a state’s funding in subsequent years if it fails to demonstrate outcomes, is weighing heavily on states’ decision-making.
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Because of this, states have strong incentives to pursue proven models rather than untested approaches, as they must demonstrate measurable progress in the first year or risk losing funding in the second.
That dynamic likely limits innovation and spurs cuts because reducing services will quickly lead to direct and measurable progress. So, states are more inclined to expand capitated primary care payments or subsidize REH conversions — interventions with existing track records — than attempt something novel without a demonstrated history of results.
Still, not everyone sees the service cuts as a loss.
Framing the program as incentivizing hospitals to shrink is misleading, said Robert Parris, a managing director who leads government-focused healthcare advisory work at consulting firm Huron. What’s actually happening, he said, is that communities are getting more of what they need and less of what they don’t.
“It’s more about reallocation as opposed to taking away,” Parris said.
The program is also shifting how leaders think — from what services a facility can provide within its own walls to what care the surrounding population actually has access to, said Paul Johnson, a managing director who works directly with rural hospital clients at Huron.
Many hospitals had these changes on their wish lists for years, but they couldn’t justify the investment because they were focused on surviving the next budget cycle.
“It’s almost like a license for them to pivot into things that they know they’ve had to do,” Johnson said.
Programs over people
But with nearly half of rural hospitals operating in the red, the 15% direct-care cap doesn’t replace what they lost from Medicaid cuts, forcing difficult decisions about which services to keep.
Hospital boards are weighing four options, Bujnowski said: Close services, convert to a Rural Emergency Hospital, develop truly innovative payment models or improve access to technology like digital health tools.
In many instances, the first two offer the clearest path to continued funding under the RHT program.
The need to demonstrate outcomes, as well as the looming threat of funding clawbacks, could also cause hospital leaders to become overly focused on program management at the expense of the communities they serve.
“The most common mistake could be to put programs over people,” Bujnowski said.
The best leaders will ensure their initiatives stay aligned with what patients in their communities actually need. Boards should ask what sustained, community-appropriate care looks like beyond 2030, when the program’s funding runs out.
“That should be your North Star,” Bujnowski said.
But whether the program’s limitations allow for genuine transformation — or simply a managed, federally-funded downsizing — is a question that won’t be answered for years.
Hospitals are urging the government to intercede after Eli Lilly followed through with a controversial plan to halt drug discounts to providers that didn’t comply with the drugmakers’ paperwork requirements.
Lilly cut off select hospitals’ 340B savings on Thursday, according to multiple hospital lobbies. The drugmaker argues it’s a necessary step to ensure hospitals aren’t double dipping on discounts in federal programs.
But hospitals slammed the move as illegal, and a thinly veiled attempt to boost Lilly’s profits that will undermine access to care for U.S. patients. The American Hospital Association and the lobby 340B Health called on federal regulators to overturn the policy.
Dive Insight:
In January, Lilly said it would begin requiring providers to submit claims data for all of its drugs dispensed in 340B, but the drugmaker didn’t start enforcing the policy until earlier this month.
It was a “crucial step” to root out 340B fraud and abuse that Lilly took “reluctantly,” after a small group of well-resourced hospitals refused to voluntarily comply, the company said in a letter to the Health Resources and Services Administration, the HHS agency that oversees 340B.
Lilly declined to name hospitals that refused to share the data. But on Thursday, the drugmaker followed through on its ultimatum, cutting off 340B pricing for noncompliant facilities, according to the AHA and 340B Health.
It’s a major loss for affected hospitals, which now have to purchase eligible Lilly drugs at wholesale prices instead of getting them at a 20% to 50% discount.That goes directly against the intent of 340B, which was established in the early 1990s to help cash-strapped providers afford pricey prescription drugs, according to the hospital lobbies.
And it’s a policy that Lilly doesn’t have the authority to enact, given that the 340B statute doesn’t allow drugmakers to make discounts conditional on hospitals sharing the data that Lilly wants, they said.
But “we believe Lilly’s actions violate the law and are an unprecedented attempt to rewrite the 340B rules without congressional approval,” said Maureen Testoni, the president and CEO of 340B Health, which represents more than 1,600 hospitals participating in the drug discount program.
A big concern for hospitals is that other drugmakers will enact similar policies if regulators fail to oppose Lilly’s policy. Novo Nordisk is already implementing its own data sharing requirements.
“HRSA and HHS cannot continue to stand by while Eli Lilly and others rewrite the rules for their own benefit and skirt their obligations,” said Rick Pollack, the president and CEO of the AHA.
Hospitals and drugmakers have found themselves arguing the fine points of 340B statute before, after a number of major drugmakers tried to overhaul how 340B discounts were paid.
Historically, pharmaceutical companies have issued 340B savings as upfront discounts. But in 2024, a cadre of developers — including Lilly — said they would instead require hospitals to pay full price for 340B drugs and then divvy out savings in the form of rebates later on, after they verified the medications were eligibile for 340B.
Drug companies argued the move was necessary to ensure that hospitals weren’t gaming 340B in order to inflate their discounts. But no such programs went into effect, after federal judges agreed with HRSA and the hospital industry that Congress didn’t give drugmakers the authority to tweak 340B’s payment structure on their own.
HRSA declined to comment on the record about Lilly’s new policy and whether regulators planned to intercede.
But under the Trump administration, the agency has proved more open to reinterpreting the status quo in 340B. HRSA planned to pilot a rebate program in 340B, but scrapped the idea in February after hospitals sued to block it.
Spats over 340B between hospitals and drugmakers are nothing new. But the disagreements have increased in scope and intensity in recent years as 340B has grown exponentially, lending more heft to arguments from pharmaceutical companies, lawmakers and health policy experts critical of the program that it’s spiraling out of control.
Roughly 3,000 hospitals benefit from discounted drugs under the program, which accounted for a record $66.3 billion in purchases in 2023, according to government data. That’s up more than 50% from $43.9 billion just two years prior.
Much of that snowballing growth is fueled by hospitals acquiring clinics, contracting with more pharmacies and prescribing higher cost drugs in order to inflate their discounts in the program, according to the Congressional Budget Office. Lawmakers have highlighted issues with 340B in congressional hearings, including how 340B statute doesn’t put any parameters around what providers have to do with the savings or require them to report that information.
For more than half a century, physicians ranked among the most trusted professionals in America. Even before modern medicine, when treatments usually failed, patients admired their doctors’ knowledge, dedication and compassion. Today, that trust has eroded, with profound implications for the future of U.S. healthcare.
Gallup polling shows just 44% of Americans rate the quality of care they receive as “good” or “excellent,” the weakest showing since Gallup began asking the question in 2001. Meanwhile, trust in doctors’ honesty and ethics has dropped 14 points since 2021, falling to its lowest point this century.
At first glance, you might assume that this decline resulted from recent developments: COVID-19, political polarization and rising vaccine skepticism. Instead, today’s drop in confidence is the predictable result of decisions set in motion some 20 years ago.
How the arc bent
To understand why patients now rate their doctors so poorly, we need to trace the full arc of modern medicine: how trust was built, how it peaked and why it declined.
The arc began with the arrival of antibiotics in the 1920s and ‘30s. Before then, doctors more often offered patients hope and compassion rather than cures. But with the availability of sulfa drugs and, later, penicillin, a doctor’s visit was more likely to prolong a life than shorten it.
The second half of the 20th century became medicine’s golden era. In this next section of the arc, breakthroughs in surgery, transplantation, chemotherapy and vaccines were paired with broader access through employer-sponsored insurance and the creation of Medicare and Medicaid. Life expectancy climbed year after year, and public confidence in doctors soared.
But every arc bends. By the 1990s, the daily demands of clinical practice had shifted. Acute problems like pneumonia or broken bones — conditions that often could be treated in a single encounter — gave way to chronic illnesses such as diabetes, heart failure and hypertension. These conditions demand lifelong management: frequent monitoring, medication adjustments and repeated follow-ups.
As chronic disease became more common, and as patients and patients struggled to manage these ever-present conditions, the result was an epidemic of heart attacks, strokes, cancers and kidney failures. Costs soared while clinical outcomes stagnated.
Insurers, caught between surging costs and payer resistance, had only one lever to pull: rationing. They rolled out high-deductible plans, imposed prior authorization requirements and denied more claims. Doctors, meanwhile, reassured by high patient satisfaction scores, resisted transformation. Most kept practicing in small, siloed offices under fee-for-service, a payment model that rewards volume over outcomes. Many who sought stability and greater reimbursement sold their practices to hospitals or private equity firms. Few found the relief they hoped for.
Why patients feel differently now, why doctors denied it
As the gap between patient needs and physician capacity widened, access to care steadily eroded. Appointments that once took days to schedule began stretching into weeks or even months, both in primary and specialty care. And when patients finally got through the door, visits felt hurried. With doctors averaging just 17 minutes per encounter, there was little time to listen fully, explain thoroughly or follow up afterward.
The consequences were predictable. Delayed appointments allowed medical problems to worsen. Rushed exams led to misdiagnoses. And for patients left waiting, worrying or returning with complications, the logical conclusion was that their doctors didn’t care.
Even as patients noticed the increasingly compromised quality, most medical professionals clung to the belief that small fixes could repair the system and restore the doctor-patient bond. They lobbied for a few more dollars from Medicare, a little less billing paperwork and fewer insurer-imposed prior authorizations. But with less than half of Americans now confident in the quality of care they receive — and premiums projected to rise nearly 9% next year — physicians can see that major healthcare reform is required. The era of denial is ending.
Patient confidence has now collapsed. A minority of Americans rate their care as excellent, and the data back them up. Life expectancy remains the same in the United States today as it was in 2010. And healthcare now consumes nearly one-fifth of the nation’s GDP, with half of Americans struggling to afford their medical bills. The question clinicians are asking is what can we do? Other industries provide answers.
Lessons from business turnarounds
Clay Christensen observed that companies and their leaders resist transformation until it is too late, and disaster strikes. Intel’s recent struggles illustrate how even once-great companies can go from the world’s best to an “also ran.” The lesson for the medical profession: that recognize the crisis early enough and embrace bold strategies are the ones that survive.
Their approach and ultimate success fall into two categories:
They maximize operational excellence to close the gap between demand and capacity. In the 1970s, for example, Southwest couldn’t match the major carriers on brand reputation, so it had to become cost effective. It chose to maximize collaboration. Pilots, flight attendants and ground crews operated as a tightly integrated team, following consistent steps at every airport. Planes turned around in 10 minutes, not 30. That efficiency allowed Southwest to schedule six flights a day (one more than the competition) without purchasing more planes or adding staff.
They embrace new technologies that can increase quality and lower cost. Take Netflix as an example. What began as a DVD-by-mail service pivoted early to streaming. Even before broadband was widespread, Netflix bet on the future. The model slashed costs, improved accessibility and delivered higher-quality viewing. Subscriptions stayed affordable, households remained loyal, and the company reshaped an entire industry.
Healthcare can learn from this. In this scenario, doctors would join together to achieve economies of scale, collaborate across specialties to avoid duplication of services and minimize resource waste through clinical care coordination. Moreover, they would apply the principle of specialization to create high-volume centers of excellence capable of providing consistently high quality with far greater efficiency and significantly lower costs.
Medicine could emulate this approach. Physicians would embrace generative AI, take financial risk under a capitated model, find ways to better control chronic disease and empower patients to take on more of their own care. This would decrease demand on doctors, free-up time for their most complex patients and reduce burnout. But this scenario won’t happen if the payment methodology remains “pay-for-volume,” or if new technologies are relegated to administrative tasks rather than applied to improve clinical effectiveness and efficiency.
Of course, there is a third possibility: doctors cling to denial.In this scenario, they keep running faster and faster on the treadmill, cutting more corners each year and hoping small fixes will make a difference.
If this is the path medicine follows, annual costs will outpace inflation, quality will continue to decline, and the gap between healthcare prices and what patients can afford will widen. To fill in the void, entrepreneurs will seize the opportunity and develop generative AI tools that replace (rather than complement) physicians. When that day comes, doctors will regret not acting while they still could.
This week we’re highlighting a trio of stories that shed new light on issues An Arm and a Leg has been tracking closely:
A sharp investigation from our partners KFF Health News on who’s actually filing medical debt lawsuits.
How one state is cracking down on aggressive medical credit card marketing.
Some new, encouraging data suggesting more seniors can afford their medications.
Let’s go!
In at least one state, doctors are now suing patients more than hospitals are
One of the most perplexing realities we’ve come across while reporting on the U.S. health care system (and there are MANY) is this: Hospitals routinely sue their patients over medical debt, yet recoup very little money in the process. So why do they bother?
In fall 2023, we published a two–part investigation with Scripps News and The Baltimore Banner digging into that question.
Since then, we’ve been tracking efforts by advocates, lawmakers, and federal agencies to rein in the most aggressive medical debt collection practices — like destroying a patient’s credit, garnishing their wages, or foreclosing on homes.
And now, in at least one state — Connecticut — KFF Health News and the CT Mirror found that public pressure persuaded many hospitals to stop suing patients over medical debt altogether. Cool!
And recent legislation targeting aggressive medical debt collection practices doesn’t cover non-hospital health care providers. Neither do medical debt protection laws in most other states.
As one Connecticut state senator put it, lawmakers will need to to “go bigger if that’s where the heart of the matter is.”
On a brighter note, Connecticut has passed another law looking out for people facing medical debt…
New rules around CareCredit and other “medical” credit cards
Last week, Governor Ned Lamont signed a bill limiting the aggressive and confusing marketing of medical credit cards inside doctors’ offices and veterinary offices.
Connecticut joins California, Illinois, and New York in passing laws to protect patients from these financial traps.
Health care providers are increasingly pushing medical credit cards as an alternative to in-house payment plans. CareCredit, the biggest player in the field, says these cards are accepted at more than 285,000 locations, including many hospitals.
The appeal for providers is pretty straightforward: Outsourcing billing to a third party reduces administrative burden.
According to Patricia Kelmar, senior director of health campaigns with PIRG, patients frequently don’t understand what they’re agreeing to — whether they’re handed a form at the front desk or an iPad in the exam room.
“It’s just not the place to be looking at terms and conditions,” she says.
As we covered in a previous First Aid Kit, those terms and conditions usually include something scary: deferred interest. In most states, medical debt tied to medical credit cards also isn’t protected by the same consumer laws that cover regular medical debt — New York being the notable exception.
Connecticut’s new law adds meaningful friction that could make it harder for patients to sign up for something they don’t understand:
Health care providers can no longer submit or help fill out applications on a patient’s behalf.
Provider logos are banned from credit card marketing materials, making it clearer the card isn’t affiliated with the doctor or hospital.
Providers can’t charge these cards for services covered by Medicaid.
Kelmar, who’s collecting stories from patients, says it’s a step forward — and a pretty unlikely one, given that Synchrony Financial, which operates CareCredit, is based in Stamford, CT.
Apizza, anyone?
A law from 2022 is making a real difference for seniors
A new study in JAMA finds that legislation capping out-of-pocket prescription costs for seniors has helped many stay on top of their medications.
And, as Undark explains, those good results may be only the beginning. The law was only beginning to phase in during 2024; the full out-of-pocket cap took effect in 2025, and the study’s authors expect even stronger results to follow.
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HENRY KOTULA 