How Can Small Acts of Service Create Lasting Healthcare Impact?

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Table of Contents

• The Frame

• Field Notes

• The Pulse

• The Thread

• Field Kit

• Worth Revisiting

• One Question

The Frame

Did the biggest changes in your life start with a grand plan, or with something small that snowballed over time?

Maybe it was a casual conversation that led to your dream job. Or a neighbor's offhand comment that sparked an idea for your side business. Or even meeting your partner because someone's friend couldn't make it to dinner and asked you to fill the empty seat.

The same thing happens in healthcare. The partnerships that transform patient care, the innovations that shift entire health systems, the collaborations that reduce costs and improve outcomes—they almost never begin in boardrooms with strategic initiatives. They can be traced back to something that planted a seed.

As you’ll read in today’s “Field Notes,” they start with one provider asking another: "How can I help you?"

Small moments. Big impact. That's the long game worth playing.

Field Notes

The Power of One Connection: How a Single Referral Sparked a Multi-Year Partnership in High-Value Care

By: Jonathan Smith, PT, DPT

Years ago, when I was a staff physical therapist, I received an unexpected referral from our organization’s emergency department. It was for a patient with low back pain. “Direct from the ER” was not something we would commonly see routed our way at the time.

But it made sense. Rather than sending patients to specialists or prescribing opioids, why not direct them to PT for screening and conservative management? It aligned with value-based care and offered a chance to truly impact outcomes.

So I reached out to the nurse practitioner and physician who made the referral. That conversation turned into a collaborative discussion about a bigger issue: musculoskeletal patients frequently returning to the ED with the same problems. They were being stabilized, treated symptomatically, and sent home, only to cycle back through again. Meanwhile, referrals to orthopedics often led to a path of imaging, injections, prescriptions, and sometimes surgery–while they were confident not all needed that.

Together, we saw another option.

We asked the providers: How can we help you?

Not: How can we get more patients?

How can we ease the pressure you’re feeling and better serve the patients walking through your doors?

We built a professional relationship around shared goals. And over time, that connection grew. 

We began proactively triaging patients headed for the ED from our clinic, fast-tracking care when appropriate, and continuing to reduce unnecessary imaging, medication, and inpatient hospital utilization.

Fast forward several years. I'm now the clinic manager of the same PT clinic where I saw that patient. That same nurse practitioner now runs an urgent care practice with a physician partner. He reached out because he wanted to refer a patient to our clinic. Now we’re building an integrated MSK care pathway between their urgent care center and our clinic. We’re streamlining access, improving patient outcomes, and continuing to shift toward high-value, team-based care.

None of this would’ve happened without that first referral and the willingness to meet a need instead of to make a pitch.

This isn’t about marketing.

It’s not about driving up volume.

It’s about building partnerships rooted in service.

That’s what creates value for patients, providers, and the system as a whole.

Bonus: 30 second clip of Dr. Smith sharing how he delighted his patient and built deep trust through inter-provider collaboration and care planning 👇️ 

The Pulse

Every year, Health Affairs puts out their National Health Expenditure Projections for the next decade. Here are some highlights:

• Health expenditures for 2024 are projected to have grown 8.2% in 2024. While the GDP is also growing (5.3% in 2024), healthcare spend is outpacing it handily.

• From 2024-2033, Medicare spending is projected to grow 7.8% annually.

• The government’s direct share (federal, state, local) of spending in 2024 is expected to be 48% of total spending. State and local Medicaid spending increased by 17.3% in 2024.

• Medicare physician and clinical services are expected to slow to 5.6%. Note this is an increase in growth despite physician fee schedule cuts, partly because volumes of services continue to rise. Between 2026 and 2027, the same Medicare physician and clinical services spending growth is projected to jump to 9.1%.

Congress passed and President Trump signed the One Big Beautiful Bill Act of 2025. There’s a lot to this bill, but this is an interesting visualization from an article in The New York Times. 👇️ 

There’s a lot in this bill about Medicaid cuts achieved through a number of mechanisms. Many believe they will not yield the desired outcomes of preventing access to Medicaid coverage for those who yes-voting policymakers believe shouldn’t be able to receive it to begin with.

I’m not going to weigh in on that. But I will say that the American Hospital Association (AHA) is gravely concerned about how hospitals will both meet the requirements of The Emergency Medical Treatment and Labor Act (EMTALA) and maintain solvency, especially in areas where Medicaid coverage of a population is high. We can and should all be happy that EMTALA exists. But it also means those who no longer have Medicaid coverage also won’t have a payer source and will leave hospitals with no way to cover uncompensated care.

Here’s AHA President and CEO Rick Pollack:

In other recent news, on the regulatory side of the government, CMS’ Home Health Prospective Payment System Proposed Rule included a proposed 6.4% cut to Medicare payments for 2026, which would total a $1.135 billion dollar decrease.

Here’s Dr. Steve Landers, CEO of the National Alliance for Care at Home: 👇️ 

The Medicare Payment Advisory Committee, or MedPAC, a nonpartisan independent legislative branch agency, recommended a 7% cut to home health agencies by a vote of 17-0 in this March 2025 report. The report details the analysis the Commissioners evaluated to make that recommendation.

The below is from the presentation from January 16, 2025, where they shared their preliminary recommendations on payment adequacy in home health: 👇️ 

The Thread:

Policymakers are making top-down cuts to control costs on the legislative and regulatory fronts. Dr. Jonathan Smith’s story shows how bottom-up services can create the value needed to survive as a provider or healthcare organization in this challenging environment. As Dr. Smith notes, asking “How can I help?” is exactly what organizations need to do to survive these financial pressures.

Healthcare professionals—now is a great time to gather insights like Dr. Smith did to share with leaders in your organization. Find areas where you can facilitate outcomes from aligned incentives and then transform care one step at a time.

Because as external funding shrinks, as is expected with the pace of medical cost trend outpacing other spending trends significantly, it’s the internal efficiencies, collaborative care pathways, and creative contracting between providers and payers that will create the resilient systems needed to survive turbulent times. It’s possible to adapt and then thrive, even when it feels like there are only brick walls in front of you.

As Dr. Smith suggests, we can lead with service to create these important relationships that surface value-based opportunities and progress. In his example, this seven-year partnership reduced unnecessary imaging, medications, and hospital utilization. That’s good for patients, but it’s also and example of how we must think and adapt as care evolves. And it must.

Anne Tumlinson, the founder and CEO of ATI Advisory, posted this on Linked In about the One Big Beautiful Bill Act signed on July 4th, and it fits here 👇️ 

Field Kit

Creating and investing in healthcare partnerships between other providers and payers establishes a framework for compounding interest that’s not unlike financial compounding. The small and consistent acts of “service”—as in Dr. Smith’s example, or with a payer, where an agreement to “serve” patients differently yields better financial results for the providers and health outcomes for the patient—generate returns over time.

In Dr. Smith’s example, that referral conversation was a small deposit that compounded into reduced utilization, better outcomes, and eventually an integrated care pathway. An unlike financial compounding that can “crash,” relationship “interest” is much more in your control.

Worth Revisiting

From Timeless Autonomy:

I wrote about medical cost trend here.

I wrote about compounding in health and healthcare here.

One Question

What’s one small service you can provide to either another provider or, if you are non-clinical, for a member of a cross-functional team to invest in compounding interest of relationships?

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