On October 1, 2,334 hospitals, 80 percent of those Medicare evaluated, began a full year of reduced Medicare payments under the Hospital Readmissions Reduction Program. The penalty was set by patients discharged between July 2023 and June 2025. Next year’s penalty is already determined by discharges that ended this past June, even though CMS has not published it. The patients leaving hospitals this month will shape a penalty that begins in October 2028.

That lag matters to anyone selling to hospitals. Executives know the penalty is a delayed bill for past performance, so a company that promises to cut next year’s penalty signals to the CFO, within minutes, that it has not studied how the program works. The companies that earn executive attention understand the mechanics, the money behind them, and who inside the hospital carries each piece of it.

In more than 30 years on both sides of the hospital table, I have seen few problems that sellers describe so consistently at the level of their product while executives experience them as a financial condition spread across several budgets. Readmissions are one of them, and closing that distance is what earns a company a place in the executive conversation.

What Changed in 2027

More hospitals are paying. Only 578 hospitals avoided a penalty this year, down from 641, and it is the second straight year the results have worsened, according to Healthcare Dive. Ten hospitals received the maximum 3 percent penalty, and the average is 0.44 percent.

• Medicare Advantage patients now count. For the first time, CMS calculated readmission performance using Medicare Advantage and traditional Medicare patients together. The penalty is still taken only from traditional Medicare payments. More than half of Medicare beneficiaries are now in Medicare Advantage, so hospitals are being measured on a much larger population, including patients whose care after discharge is governed by a health plan’s authorization rules.

• The measurement window is shorter. CMS cut the performance period from three years to two, so results now reflect a hospital’s recent performance more quickly, in both directions.

• Some states took much larger hits. West Virginia’s average penalty rose from 0.40 to 0.71 percent. Pennsylvania, New York, and South Carolina also rose sharply, Texas now has 24 hospitals facing cuts of 1 percent or more (up from 16), and 95 percent of evaluated hospitals in Florida were penalized, according to Becker’s.

Why a Small Percentage Carries So Much Weight

The program measures 30-day readmissions for six conditions and procedures (heart attack, heart failure, pneumonia, COPD, coronary artery bypass surgery, and elective hip and knee replacement). CMS compares each hospital’s result on each measure with the median of a peer group, made up of hospitals serving a similar share of patients eligible for both Medicare and Medicaid, and combines the results into one reduction. Three features of that design shape how executives think about it.

• The penalty applies to everything. The reduction is taken from all traditional Medicare base inpatient payments, regardless of condition. Excess heart failure readmissions reduce what the hospital is paid for every traditional Medicare joint replacement, stroke, and sepsis admission for the year. For a hospital with $150 million in Medicare base inpatient payments, a 1 percent penalty is $1.5 million.

• It is relative. Hospitals are measured against their peers, so a hospital can improve and still be penalized if its peer group improves faster. Executives experience it as a competition they have to keep winning every year.

• It is specific. Because the penalty is calculated measure by measure, each hospital’s data shows which conditions pushed it above its peers. A hospital penalized for heart failure and pneumonia has a different problem from one penalized for hip and knee replacement, and different executives own each one.

The Full Cost of a Readmission Sits on Several Ledgers

The penalty is the most visible cost of a readmission, and for some hospitals it may not be the largest. The same readmission can reach a hospital’s finances in at least five ways.

• The Medicare penalty. Quality leaders usually manage it, the board sees it, and the CFO absorbs it.

• Medicare Advantage contracts. Many Medicare Advantage plans apply readmission review policies that can deny or combine payment for a related readmission. The same plans control authorization for post-acute care. A 2024 Senate investigation found that UnitedHealthcare’s denial rate for post-acute care requests rose from 8.7 percent in 2019 to 22.7 percent in 2022. When a skilled nursing placement is denied or delayed, a patient who needed that support may go home without it. If that patient is readmitted, the readmission now counts toward the hospital’s Medicare penalty as well. This ledger usually sits with managed care contracting.

• TEAM episodes. About 740 hospitals in CMS’s mandatory TEAM model are accountable for the total cost of five surgical episodes through 30 days after discharge, and a readmission inside that window counts against the episode target. Beginning January 1, 2027, most TEAM hospitals take on downside financial risk. Coronary bypass and joint replacement appear in both TEAM and the readmission program, so a single readmission can count against the hospital twice. This ledger sits with the CFO and surgical service line leaders.

• Value-based contracts. In accountable care organizations and other shared-savings arrangements, readmissions reduce the savings the hospital and its physicians would otherwise earn. Population health leaders usually track this one.

• Capacity. The average readmission cost $16,300 in 2020, about 12 percent more than the average original admission, according to federal hospital data. In a hospital running near capacity, a readmitted patient also occupies a bed that could have held a scheduled surgical patient or relieved a crowded emergency department. That cost lands with the COO.

Each ledger belongs to a different executive and is reported on a different schedule, and in most hospitals no one adds them together. A company that helps an executive see the combined figure has changed what the executive believes the conversation is about.

Very Few Companies Truly Sell Readmission Reduction

Very few companies can sell readmission reduction effectively, with their solution truly mapped to the measures and dollars behind it. Many more contribute to it, including companies in patient education, remote monitoring, pharmacy and medication reconciliation, care navigation, transportation, nurse staffing, post-acute coordination, analytics, and food and housing support. If what you sell touches what happens to a patient after discharge, you have a reason to be in this conversation. The work is connecting your product to the financial condition the executive is accountable for.

I teach this as a progression. Start with what you sell, move to the larger problem it addresses, then to the financial condition that problem creates, then to its economic consequence, and finally to the executive priority it affects. Here is how that progression looks for a few common solutions.

• Medication reconciliation → adverse drug events in the first weeks at home → heart failure and COPD readmissions → a penalty taken from every traditional Medicare payment → CFO margin and CMO quality standing

• Post-acute coordination → delayed or denied skilled nursing authorization → patients discharged without the support they need → Medicare Advantage readmission exposure and TEAM episode cost → CFO and managed care leadership

• Transportation → missed follow-up appointments → avoidable readmissions → occupied beds and displaced surgical cases → COO capacity and surgical growth

• Nurse staffing → compressed discharge teaching on short-staffed units → readmissions on the measured conditions → penalty and publicly reported quality → CNO and CFO

The executive conversation begins at the end of each chain. The product enters later, as the answer to a problem the executive has already agreed is worth solving.

Questions That Move the Conversation Up

Discovery questions show an executive very quickly which level you are working at. An operational question such as “How do you handle discharge planning?” invites a description of a process, and the executive will usually hand you to the person who runs it. A financial question invites the executive to name a problem and put a number on it. Questions like these keep the conversation at the executive level.

• “Which of the measured conditions is driving your penalty, and is your current readmission work focused on those conditions?”

• “How are Medicare Advantage authorization delays affecting where your patients go after discharge?”

• “When a TEAM patient is readmitted, who sees that cost, and how soon?”

• “If you combined the penalty, denied readmission payments, TEAM episode costs, and the beds those patients occupy, what would the figure be?”

• “Who owns that figure today?”

The last question is often the most valuable. It tells you who really owns the problem, and the answer is frequently someone other than the person you have been calling on. It also speaks directly to the first question in what I call the Three-Question Screen, the moment an executive decides whether a subject is theirs.

What a Hospital’s Objections Tell You

An objection usually reveals what the executive believes they are being offered. When a hospital pushes back, ask what the objection says about how the opportunity was framed earlier.

• “Our penalty is under 1 percent.” The executive believes the conversation is about the penalty alone. The other four ledgers have not entered the discussion.

• “Quality handles readmissions.” The opportunity was framed as a quality initiative, so it was routed to the quality department. The financial condition behind it belongs to the CFO, the COO, and managed care.

• “We already have a transitional care program.” The executive thinks you are selling a program. The more useful discussion is which conditions, payers, or patient groups the current program does not reach, and what that costs.

• “There is no budget this year.” The problem has often not been sized. A figure that spans several ledgers can change which budget the solution comes from and who approves it.

Start With the Hospitals You Already Serve

The strongest opportunities are usually inside hospitals that already buy from you. You have trust built through an established relationship. You know how the organization works and where friction sits. You have relationships with clinical, operational, and financial leaders who can sponsor you, and you have credibility from what you have already delivered. Look at the readmission results for each of those hospitals and ask what larger financial problem you can now help it solve. That question often leads to an executive your original sale never reached.

Readmissions Arrive Alongside Everything Else

The penalty landed on executives who are managing more financial pressure at once than at any point I can remember. Understanding that full picture is what allows a company to explain why its conversation deserves time now, and where it fits among everything else competing for the same capital.

• Margins are diverging. Kaufman Hall data shows national hospital operating margins fell 5 percent year over year from January through May 2026, as reported by Becker’s. Hospitals with 500 or more beds were the only size group to improve.

• Fewer patients are insured. The enhanced ACA premium subsidies expired at the end of 2025, and marketplace enrollment fell from 22.1 million to 19.2 million by February 2026, according to KFF. Hospitals are preparing for more uncompensated care and more emergency department visits.

• Medicaid changes begin December 31, 2026. Under the 2025 federal budget law, Medicaid work requirements and eligibility checks every six months begin for expansion adults, although states can seek more time on work requirements. Reductions in provider taxes and state-directed payments follow beginning in 2028.

• TEAM downside risk begins January 1, 2027, for most participating hospitals.

• The next readmission penalty is already set. Under the two-year window, discharges through June 2026 determine the penalty that begins in October 2027.

Every one of these lands on the same small group of executives and draws on the same capital budget. Executives rank problems by size, timing, and ownership. A company that understands where its solution sits among them, and can describe the financial condition it addresses, is the one an executive makes time for.

Building This Into Your Sales Team

Most sales teams are trained to present their product well. Far fewer are trained to find the larger financial problem, identify who owns it, size the consequence, and lead a conversation at that level with a CFO, COO, or CNO.

My C-Suite Selling Workshop is built around your company, your products, your hospital buyers, and the opportunities already in your pipeline.

For more on how executive meetings are earned, read Selling to C-Level Executives Starts With Access on my website.

Is There a Better Business Inside Your Current Business?

Many established companies have more opportunity inside their current business than they realize.

The opportunity is not always a new product, more sales activity, or a better version of the same offer. Sometimes it comes from taking a fresh look at what the business is truly capable of solving, who will value that solution most, and how it should be positioned commercially.

For companies selling into healthcare, this can be especially important. A training program, consulting engagement, technology solution, clinical service, or operational capability may have greater strategic value than the current offer and price point reflect.

It may be possible to create a business with:

Bigger clients.
Larger deals.
Better economics.
Less competition.

That does not happen simply by selling harder.

It happens when something more fundamental changes in what the business is asking the market to buy.

A $5,000 training program may become a $100,000-plus strategic proposition. A $10,000 to $20,000 consulting engagement may open a conversation at the $1 million level. A $150,000 contract may become a $500,000-plus opportunity when it addresses a larger executive priority, reaches the right buyer, or becomes part of a broader solution.

On September 4, I am joining Dr. Chetan Walia for a live 60-minute Zoom session to explore this question:

Is there a better business inside your current business?

We will discuss how we look for these opportunities, where they tend to exist, and how one strategic shift can change several parts of a business at once, including the buyer, deal size, economics, competitive position, and growth potential.

This will be a practical strategic exploration for established business owners, consultants, and leaders who are ready to look beyond incremental growth.

September 4
11:30 a.m. ET
Live on Zoom

Free to attend. No sales presentation.

Reserve your place

Lisa T. Miller and Dr. Chetan Walia

For years, companies have competed to appear on the first page of Google.

They invested in keywords, search engine optimization, paid advertising, backlinks, and a steady stream of content designed to attract visitors to their websites.

That model is changing.

People are still searching. In fact, they may be searching more than ever. But instead of entering a few keywords and reviewing a list of websites, they are asking complete questions and expecting a complete answer.

They are asking ChatGPT, Perplexity, Google AI, Claude, and other platforms questions such as:

“What companies help hospitals reduce surgical cancellations?”

“What technology can improve charge capture in the operating room?”

“Which vendors specialize in hospital workforce optimization?”

“What should a health system consider before adopting an AI documentation platform?”

The search engine is no longer simply directing the buyer to information. It is reviewing the information, interpreting it, and assembling an answer.

Search is becoming a conversation.

For companies selling into healthcare, this shift has significant implications. Your potential buyers may begin evaluating your company long before they visit your website, respond to an email, attend a conference, or agree to a meeting.

The question is no longer only whether your website ranks.

The more important question is whether your company can become part of the answer.

Healthcare Buyers Are Asking More Sophisticated Questions

Healthcare buying has always been complex.

A hospital rarely buys a product because one person likes it. Decisions are influenced by clinical outcomes, financial impact, operational feasibility, technology requirements, compliance, reimbursement, workforce implications, patient experience, and organizational priorities.

AI search allows healthcare buyers to investigate all of these issues in a much more conversational way.

A hospital executive can begin with a broad question, review the response, and immediately ask:

“What would the return on investment look like for a 400 bed hospital?”

“What departments would need to participate?”

“What implementation barriers should we anticipate?”

“What evidence should we request from the vendor?”

“How does this compare with another approach?”

The buyer is not merely searching for a company. The buyer is building an understanding of the problem, the possible solutions, the risks, and the criteria that should guide a decision.

This means your content cannot focus entirely on your product.

You need to help the buyer understand the decision.

Your Website Must Answer the Questions Behind the Purchase

Many healthcare company websites explain what the company does but fail to answer the questions buyers actually have.

They include general statements about innovation, transformation, efficiency, and better outcomes. Those claims may sound appealing, but they do not give an executive enough information to understand the business case.

AI systems also have difficulty recommending a company when its language is broad and interchangeable with dozens of competitors.

If you sell into hospitals, your content should clearly answer questions such as:

1. What specific healthcare problem do you solve?

2. Who inside the hospital experiences that problem?

3. What is the operational and financial impact of leaving it unresolved?

4. Which executive is most likely to care about the outcome?

5. What evidence supports your approach?

6. What is required to implement it?

7. How long does it take to see results?

8. What risks or barriers should a hospital evaluate?

9. How is your approach different from available alternatives?

10. What measurable result should the hospital expect?

These answers should not be buried inside a sales presentation that a buyer receives after agreeing to a meeting. They should be clearly represented across your website, articles, case studies, podcast appearances, videos, research, and executive commentary.

The companies that explain the buying decision most clearly will have a greater opportunity to influence how the market understands the category.

Being Found Is Not the Same as Being Trusted

AI visibility is not simply a new form of keyword placement.

An AI platform must have enough confidence in your company and your content to include you in an answer. That confidence comes from clarity, consistency, authority, and evidence.

If your website describes your company one way, your LinkedIn page describes it another way, and your sales team uses completely different language, it becomes difficult for both the buyer and the AI system to understand your position.

Healthcare companies should create a clear and consistent description of:

1. The market they serve

2. The problems they solve

3. The buyers they support

4. The outcomes they produce

5. The expertise they bring

6. The category they occupy

Specificity matters.

“Improving healthcare through innovation” says very little.

“Helping health systems reduce avoidable surgical cancellations by identifying patient readiness issues before the day of surgery” gives the buyer and the search platform something concrete to understand.

Credibility also matters. Original research, named experts, detailed case studies, measurable outcomes, published frameworks, client examples, clinical evidence, and thoughtful answers to difficult questions all strengthen your authority.

You cannot simply claim to be a trusted authority. You must create the body of work that demonstrates it.

Your Best Sales Content May Not Look Like Sales Content

The strongest content for AI search is often the same content that helps a healthcare executive make a better decision.

Consider the questions that arise during an actual hospital sale.

What does the CFO ask?

What concerns the chief medical officer?

What does information technology need to evaluate?

What objections come from operations?

Why does value analysis delay the decision?

What prevents a pilot from becoming an enterprise agreement?

Each of these questions can become a useful article, guide, video, podcast episode, or frequently asked question.

A medical technology company might publish an article explaining how hospitals evaluate the total financial impact of a new device.

A workforce company might explain the hidden costs of persistent hospitalist vacancies.

A healthcare AI company might provide a practical framework for evaluating workflow readiness, governance, staff adoption, and measurable return.

This content does more than attract attention. It demonstrates that your company understands how hospitals operate and how healthcare decisions are made.

That understanding can become an important competitive advantage.

From Human Search to Agent Conversations

The next stage may extend beyond a person asking an AI platform for information.

We are moving toward a world in which the AI agent conducting the search may communicate directly with an AI agent representing your company.

A hospital’s agent could ask:

“Does this solution integrate with our current systems?”

“What evidence is available for organizations of our size?”

“What are the implementation requirements?”

“Can you provide relevant case studies, estimated economics, security documentation, and available meeting times?”

Your company’s agent could respond instantly with approved information drawn from your website, knowledge base, evidence, and internal resources.

Eventually, these agents may compare solutions, qualify opportunities, answer preliminary questions, and help both parties prepare for a more productive human conversation.

This does not remove people from healthcare selling.

It makes the quality and structure of your information even more important.

Your company must be prepared to communicate with the buyer whether the first interaction occurs through a salesperson, a website, a search engine, or an AI agent.

What Companies Selling Into Healthcare Should Do Now

Begin with five practical actions.

First, identify the real questions buyers ask throughout the hospital buying process. Interview your sales team, customers, implementation leaders, and subject matter experts.

Second, review your website for clarity. A buyer should quickly understand what you do, who you serve, what business or clinical problem you solve, and what measurable outcome you produce.

Third, turn internal expertise into public authority. Publish detailed answers, original perspectives, decision frameworks, case studies, and practical guidance.

Fourth, make your evidence easy to find and understand. Do not hide your strongest proof inside a PDF, proposal, or presentation that search platforms cannot easily interpret.

Fifth, test your visibility. Ask several AI platforms the questions your ideal hospital buyer might ask. Look at which companies are mentioned, how the category is described, and whether your company appears accurately.

The goal is not to produce more generic content.

The goal is to become a credible source that helps healthcare buyers understand an important problem and make a better decision.

Search is not disappearing.

It is becoming more conversational, more interpretive, and more influential throughout the buying process.

The companies that prepare for this shift will not simply compete for a position on a results page. They will help shape the answer a healthcare buyer receives before the first sales conversation ever begins.

Is Your Company Part of the Answer?

Healthcare buyers are researching your company, your category, and the problems you solve before they ever speak with your sales team.

I help healthcare companies strengthen how they are positioned, found, and understood by hospital decision makers.

Explore Selling Into Healthcare Strategy

By Lisa T. Miller

An executive says, “This is interesting. Let’s keep talking.”

The sales team leaves encouraged. The executive understood the problem, asked thoughtful questions, and discussed next steps.

Then the deal slows down.

Operations needs more detail. Finance wants different numbers. IT raises integration concerns. A clinical leader is not convinced the workflow will work. Procurement enters late. The executive who liked the idea is still supportive, but support never becomes a decision.

This is a central reality of selling to hospitals: executive interest is not organizational approval.

A hospital is not a single buyer. It is a decision system. That system must determine whether your solution matters now, whether the value can be measured, and whether the organization can implement it without creating unacceptable risk.

These are not late stage objections. They are the three decisions underneath the entire deal.

Decision One: Is This Important Enough to Address Now?

Most hospital sales conversations begin too close to the solution.

The seller explains the technology, service, or clinical advantage. The presentation may be impressive, but it still leaves the executive with a fundamental question: Why does this deserve attention now?

Hospitals face constrained capital, labor pressure, regulatory demands, and competing strategic projects. A real problem can remain unfunded because it is not yet an executive priority.

That means the first job of the seller is not to prove that the solution works. It is to connect the problem to an issue the organization has already decided matters.

This requires more than researching a title. Title research tells you what a leader generally cares about. Priority research tells you what this particular leader is accountable for right now.

Look for expansion plans, margin pressure, public quality goals, new value based contracts, capacity constraints, and service line investments. Then develop a point of view about where your solution fits.

For example, a patient engagement platform should not lead with automated messages and digital pathways. If the hospital is participating in a bundled payment model, the more urgent conversation may involve avoidable emergency department visits, readmissions, adherence during the recovery window, and the ability to identify risk earlier. The product has not changed. The business context has.

Before requesting an executive meeting, write a short priority hypothesis:

What is the hospital trying to improve? Which metric reveals the problem? What has made the issue more urgent? What happens if performance does not change?

You will not have every answer. The purpose is to arrive with an informed observation worth discussing.

Relevance earns attention because it demonstrates that you have entered their world before asking them to enter yours.

Decision Two: Is the Value Real and Measurable Here?

Once a hospital agrees that the problem matters, the next question is not simply, “What is the ROI?”

The real question is, “What would have to be true for this result to occur in our organization?”

Generic ROI claims weaken credibility because they skip the hospital’s current state. A projected 20 percent improvement means very little without a baseline, a source for the data, a time frame, and a clear explanation of the assumptions.

A credible business case has five elements: current performance, expected improvement, time to value, payback period, and confidence in the estimate.

Start with what the hospital can observe. That may be staff hours, denial rates, supply expense, operating room delays, canceled procedures, call volume, referral leakage, readmissions, or days in accounts receivable. If the desired outcome cannot be measured directly, break it into smaller indicators that can.

Suppose a workflow creates 200 avoidable calls each week and each call consumes three minutes of staff time. That represents 520 hours a year. This is not yet a final ROI calculation. It is a testable model. The hospital can validate the volume, labor cost, and portion of calls the solution can realistically prevent.

Instead of debating a large unsupported claim, the seller and buyer can examine a few visible assumptions.

The strongest business cases also present a range rather than one perfect number. Show a conservative case, an expected case, and a stronger performance case. State what would cause each scenario to occur. A CFO is more likely to trust a modest estimate with transparent assumptions than an aggressive estimate built to impress.

The value story must also change by audience. Finance may focus on margin and payback. Operations may care about throughput and workflow reliability. Clinical leaders may prioritize safety, outcomes, and staff burden. The numbers should connect, but their meaning will differ.

ROI is not a slide. It is a shared model of how the hospital expects value to be created.

Decision Three: Can We Say Yes Without Creating More Risk?

The greatest competitor in many hospital deals is not another vendor. It is the current way of working.

The status quo may be inefficient, expensive, and frustrating, but it is known. A new solution introduces questions about implementation, integration, adoption, training, cybersecurity, clinical disruption, ownership, and accountability. If those questions remain unresolved, doing nothing can feel safer than moving forward.

This is why benefits alone rarely close a complex hospital deal. The seller must reduce the perceived risk of change.

Map the people required to make the decision safe. The economic sponsor may support the investment. An operational owner must believe the workflow can be implemented. A clinical validator may need to protect patient care. IT and security must assess the technical environment. Finance may validate the baseline. Procurement needs a path to contracting.

These people are not obstacles surrounding the buyer. Together, they are the buyer.

A well designed pilot can help the organization resolve uncertainty, but only if it is built as a decision instrument rather than a discounted demonstration. A serious pilot has a defined baseline, a specific population or department, an accountable owner, a time frame, agreed success measures, and a decision that will follow the results.

Without those elements, a pilot can produce activity without producing evidence. The project ends, everyone agrees it was promising, and no one knows what must happen next.

After the contract is signed, speed to a measurable result lowers doubt, strengthens the executive sponsor, and creates a path to expansion. In hospital sales, delivery determines whether one contract becomes a larger relationship.

The Real Source of Deal Velocity

Sales teams often try to shorten hospital sales cycles by increasing follow up or pushing harder for the next meeting. That may create motion, but motion is not progress.

Complex deals move when uncertainty is removed in the right order.

First, the hospital must see the issue as strategically relevant. Second, leaders must believe the value is measurable in their environment. Third, the broader organization must believe it can act without creating more risk than it solves.

Before your next hospital meeting, ask yourself three questions.

Can I explain why this issue matters to this organization now?

Can I show how value will be measured using the hospital’s own operating reality?

Can I identify the people, evidence, and implementation steps required to make a yes feel responsible?

If any answer is unclear, the deal is not ready for more persuasion. It is ready for better preparation.

Put These Three Decisions to Work on Your Hospital Deals

Inside the Hospital C-Suite Buying Decision

This is a working session built around your team’s actual hospital opportunities, not a training video or hypothetical case study.

Before the session, I research your product category, your buyers’ regulatory calendar, your target accounts, and relevant public CMS data. Your team then applies the findings directly to the deals you are working to advance.

Your team leaves with four working assets: a Six Forces action plan for your product, a seven data sources intelligence checklist, an executive business case structure, and a custom ROI framework built from your buyers’ own numbers.

Available formats: a 90 minute virtual working session, a half day intensive, or a conference keynote.

Learn more about the workshop and C-Suite Selling Strategy Advisory:

https://www.lisatmiller.com/healthcare-sales/

Today Begins Our Weekly Office Hours

Along with the new community, I’m launching live Office Hours every Friday from 12:00 PM to 1:00 PM Eastern.

Starting today, July 31, 2026.

These sessions are designed to be interactive.

Bring your questions.

Bring your current opportunities.

Bring the executive conversations you’re preparing for.

We’ll discuss real situations, review strategies, and work through challenges together.

For the first four weeks, Office Hours will be offered at no cost.

My hope is that these sessions become a place where people can learn from one another, gain practical ideas, and leave each week with strategies they can immediately apply.

Join Us

If selling to executives is an important part of your business, I invite you to become part of the community.

Register for Friday Office Hours:

https://us06web.zoom.us/meeting/register/rc5VokuxSU2ubvuufn-enA

I’ve spent my career studying how executives make decisions, why they say yes, and why they don’t.

I’m looking forward to sharing what I’ve learned and learning from this community as well.

I hope you’ll join us.

Join the Facebook Group:

https://www.facebook.com/groups/sellingtothecsuite

After more than 30 years of selling to executives, advising CEOs and founders, and helping companies win some of their most important enterprise customers, I’ve come to a simple conclusion.

Most sales advice isn’t designed for executive buyers.

There is no shortage of content on prospecting, objection handling, closing techniques, or CRM best practices. Yet very little addresses the one challenge that changes everything:

How do you earn the Executive Yes?

Selling to executives is fundamentally different from selling to managers or end users.

Executives don’t buy products.

They buy outcomes.

They buy confidence.

They buy people they believe understand the business challenges they are responsible for solving.

That realization is why I’ve launched a new community.

Welcome to Selling to the C Suite

This Facebook group is a place for founders, CEOs, entrepreneurs, sales leaders, consultants, and enterprise sales professionals who want to become more effective at engaging executive decision makers.

Whether you sell into healthcare, technology, manufacturing, financial services, or any other industry, the principles of executive selling remain remarkably consistent.

Inside the community we’ll explore topics such as:

• How executives actually evaluate opportunities.

• Why great products still lose executive support.

• Building credibility before the first meeting.

• Leading executive conversations instead of giving product presentations.

• Understanding the different executive buying styles.

• Selling business outcomes instead of features.

• Creating executive level messaging that gets attention.

• Winning consensus across complex buying committees.

• Avoiding the common mistakes that cause executive opportunities to stall.

My goal is simple.

To create the most practical community anywhere for professionals who sell to senior executives.

No hype.

No generic sales advice.

Just practical strategies that help you win more executive conversations and more executive decisions.

Introducing Weekly Office Hours

Along with the new community, I’m also launching live Office Hours every Friday from 12:00 PM to 1:00 PM Eastern.

These sessions are designed to be interactive.

Bring your questions.

Bring your current opportunities.

Bring the executive conversations you’re preparing for.

We’ll discuss real situations, review strategies, and work through challenges together.

For the first four weeks, Office Hours will be offered at no cost.

My hope is that these sessions become a place where people can learn from one another, gain practical ideas, and leave each week with strategies they can immediately apply.

Join Us

If selling to executives is an important part of your business, I invite you to become part of the community.

Join the Facebook Group:
https://www.facebook.com/groups/sellingtothecsuite

Register for Friday Office Hours:
https://us06web.zoom.us/meeting/register/rc5VokuxSU2ubvuufn-enA

I’ve spent my career studying how executives make decisions, why they say yes, and why they don’t.

I’m looking forward to sharing what I’ve learned and learning from this community as well.

I hope you’ll join us.

I think this approach is stronger than a simple announcement because it explains why the group exists, establishes your authority without overselling it, and gives readers a clear reason to join rather than simply telling them that the group is live.

Join the Facebook Group:

Register for Friday Office Hours:

Best, Lisa

Most sellers chase a single path into a hospital and stall the moment it closes. In this week’s episode, Gavin and I mapped every route in — and the one move to make this quarter.

In this issue:

• National GPOs are a timing game and the deadline mistake that costs sellers years

• When regional GPOs beat the nationals

• The paths everyone forgets: the VA and government fast-tracks

• Going direct, and the $200K deal an order number almost killed

• Why the CFO does care about your commodity product

• Certification and buy-local: leverage you already have

• Hospital innovation funds as an entry point

• Arming your clinical champion (issue, impact, urgency, outcome)

• Value analysis, and the one move to make this quarter

Most companies selling into hospitals pick one door — usually a national GPO — knock on it for eighteen months, and then tell themselves the market is closed. It isn’t. Hospitals buy through at least seven distinct channels, and the sellers who win understand all of them and choose deliberately. Gavin and I walked through every one on this week’s episode. Here is the full map.

National GPOs are a calendar, not a gate

Vizient, Premier, and HealthTrust control roughly 60 to 70 percent of the hospital supplies market, so everyone wants on contract. What most sellers miss is that a national GPO is fundamentally a timing game. These organizations contract in cycles — they go out to the market with RFPs every few years, category by category. If you sell beds and the bed refresh is two years out, your job right now is preparation, not persuasion.

The single biggest mistake I see — and I watched it happen recently — is missing the cycle entirely. A company discovered the RFP for their category had already termed: suppliers had submitted their data, the deadline had passed, and nothing could be done except wait years for the next round.

So track the cycles. Reach out to the contract holders who buy in your category and introduce yourself before the RFP drops. Go to the GPO conferences. Ask about innovation programs and custom contract vehicles that bypass the normal cycle when a member hospital wants something specific. And when the RFP does come, be thorough: distinct value, great pricing, easy to work with. The GPO will not reach out to you. You have to know when your category comes due.

Regional GPOs reward high touch

Before you chase a national contract, look hard at regional GPOs and purchasing coalitions. They are more accessible, they move faster, and they contract in categories the nationals often don’t touch. Their entire value proposition to member hospitals is “we do more for you” — save money, make money, drive efficiency — and they bring on suppliers with that lens.

That means the expectation is high touch. If you can offer something unique — hands-on service, a free assessment alongside your product — a regional coalition gives you access to a large pool of hospitals in a genuinely collaborative way. Landing a few regional contracts first and using that traction to go national is a legitimate strategy, not a consolation prize.

The paths everyone forgets: government and the VA

The VA is one of the largest health systems in the country, and most sellers never consider it. Yes, getting on a federal contract can be slow. But there are vehicles: you can partner with a company that already holds contracts — particularly veteran-owned and disabled-veteran-owned businesses, which receive preferential set-asides the VA must carve out. Joining forces with one of those firms can get you on contract with elevated status.

The government also runs fast-track programs. I recently came across a hospital-at-home initiative actively soliciting innovative solutions for expedited review. Nobody sends you an alert for these. You have to stay curious and keep looking.

You can always sell direct

There is no rule that says a hospital can only buy through its GPO. If you can beat the GPO price on a comparable product — “I can save you 20 percent on the same thing” — hospitals can and do make that decision. State-run hospitals often run their own RFPs and can buy from anyone. While you work on getting on contract, sell direct.

But understand what actually kills direct deals. Gavin asked me about this, and it’s one of the most painful things I’ve seen in 25 years: the order number. A hospital was looking at six figures in savings on something as generic as janitorial liners, and the deal stalled because switching vendors meant pulling an item number out of the system and loading a new one. An hour of somebody’s attention, weighed against hundreds of thousands of dollars — and the hour won.

The lesson: never just say “we’ll save you money.” Write out the switching process step by step. Show them it’s three moves and you’ll be there for all three. Make it frictionless, because the person on the other side isn’t spending their own money — they’re spending their own time. What’s in it for them is a win without a headache.

Yes, the CFO cares about your commodity product

I hear this constantly from companies selling into the middle layer of the hospital: “The CFO will never care about our product.” I disagree, because I have sat across from CFOs and talked about janitorial bags. Will a commodity product get you a meeting on its own? Probably not. But a low-risk, easy-to-execute savings opportunity worth $100,000 or more absolutely gets attention — if you package the opportunity and the execution path together. CFOs want easy wins; I’ve had CFOs ask for more of them. So go deliver an easy win.

Certification and buy-local are real leverage

If you qualify as a minority- or women-owned business, get certified. Start with your state certification — often done in 30 days — then pursue the national one. I ran my company for 23 years and only got my women-owned certification during COVID. It was rarely the reason I won, but it strengthened everything else I brought, and it made me harder to displace: replacing a strong provider who is also a certified diverse supplier is a difficult internal conversation. Some systems actively court diverse vendors — Northwell holds supplier days for exactly this.

Buy-local is the cheat code almost nobody uses. I once won a services RFP in New Jersey and found out afterward that the health system’s CEO had made local purchasing a strategic goal — supply chain was tracking local spend and reporting progress upward, and my company counted toward it. There is an entire national movement behind this: the Healthcare Anchor Network, where health systems have committed on the order of a billion dollars over five years to local sourcing. Check the websites of the hospitals around you. If they have a buy-local commitment, you have an advantage you did nothing to earn except exist nearby.

Innovation funds: the non-obvious entry point

Fifty or sixty health systems now run venture funds and innovation programs. If you’re a newer company or have something genuinely innovative, these are commercial partners, not just investors. Hospitals are hunting for non-patient-care revenue, so they will invest, co-develop, deploy your product across their facilities, and take it to market with you. When UPMC faced a massive Epic implementation, it didn’t hire consultants — it bought the largest third-party Epic consulting firm, used it internally, then commercialized it. That is how these systems think. Find the innovation officers and start conversations.

Arm your clinical champion — don’t abandon them

A physician who loves your product is a door-opener, not a deal-closer. Finance, supply chain, IT, legal, and value analysis still stand between enthusiasm and a PO. I’ve seen a department chair — maximum leverage, all the paperwork done — struggle to push a product through. That’s not dysfunction; if hospitals said yes to every champion, there would be a hundred versions of the same product on the shelf.

Your job is to arm your champion. Not with 16 pages — with two or three: a defined ROI tied to how the hospital actually gets paid, and talking points built on four elements — issue, impact, urgency, outcome. Name the problem. Quantify the value (”on these DRGs, we save $500 per case”). Give it urgency — new cases, a safety event, a quality penalty they need to show progress against. Physicians are smart, but you’re asking them to do your selling. Hand them the language and they will thank you for it.

Value analysis: make yes easy

Even on a GPO contract, you still face value analysis — and good products die there. The committee exists for the right reasons: safety, clinical alignment, nursing buy-in, and financial discipline. Vendors fail when they show up linear and thin. Build a complete value packet — clinical, operational, and financial — that gives the committee a 3D view of the decision. Be patient with the bottleneck, and be creative on the friction: buyback programs, drawing down existing stock before yours comes in. The question underneath it all: how easy are you to buy from?

The one move to make this quarter

After the contract is signed, the work is adoption — stay close to your champion in the first 90 to 180 days, then deliberately expand to other physicians, departments, and facilities in the system. Most companies never optimize the contract they already won.

And if you have no contract, no certification, and no connections? Go local and go direct. Pick the five or ten hospitals closest to you, learn their initiatives — buy-local commitments, innovation programs, coalition memberships — and pursue each with a specific strategy. It takes one or two hospital contracts to change a company’s trajectory. Serve well, and the referrals do the rest.

The full conversation is on YouTube.

If you want to go deeper on any of these paths, reach out at lisatmiller.com.

One more thing

Everything above comes down to one question. Does your business match how healthcare organizations actually buy? That is exactly what my Healthcare Buying Decision System™ is built to answer. It is a personalized executive strategy review where I look at your solution, your message, your business case, and your sales assets, then show you how to gain access to the right buyers and build a strategy that wins. You get a clear view of what healthcare buyers need to see and the next strategic move I would make if this were my business.

Start here at the Healthcare Buying Decision System.

Over the last few months, I’ve been working on something that has fundamentally changed the way I think about enterprise growth.

For more than 30 years, my work has focused on helping companies understand how enterprise organisations actually evaluate, justify and approve major buying decisions.

At the same time, Dr. Chetan Walia has spent years helping businesses become the obvious choice through his Category of One™ methodology.

As we began working together, we realised something interesting.

Most enterprise businesses focus almost entirely on improving how they sell.

Very few spend enough time understanding how enterprise buyers actually buy.

And even fewer ask the question:

Why do buyers ultimately choose one business over another when several appear equally capable?

Those are two completely different strategic problems.

One is about understanding the enterprise buying decision.

The other is about becoming the preferred choice once you’re in the room.

When we combined both perspectives, we discovered opportunities, positioning shifts and commercial strategies that neither methodology would have uncovered independently.

The result is something we’ve called Category of One Enterprise Strategy™.

It’s a private 90-minute strategic intensive where we apply two complementary strategic systems directly to your business.

Not to review your sales process.

Not to critique your marketing.

But to redesign how enterprise buyers evaluate—and ultimately choose—you.

We’re currently running a limited number of these sessions as part of a private pre-launch.

There is no cost during this phase.

We’re simply looking to work with a small number of businesses, apply the methodology, gather feedback and continue refining the experience before making it publicly available.

If your business depends on winning larger clients, navigating complex buying decisions, or becoming the obvious choice in competitive enterprise markets, I’d love to invite you to learn more.

https://www.waliamiller.com

This is the written companion to the latest Selling to Hospitals episode. If you sell into health systems, this one is worth the full listen:

9 Stealth Strategies to Get the Meeting, Win Trust, and Close Big Hospital Deals Podcast Episode

Selling to hospitals is not like selling into other industries.

The stakes are higher. The decision process is more complex. The buying committee is more layered. The executives are busier, more skeptical, and under more financial pressure than ever.

That is why so many companies with strong products, strong services, and strong outcomes still struggle to get traction.

They are not failing because their solution lacks value.

They are failing because they are trying to sell into hospitals with the wrong level of strategy.

For years, sales teams have been told to send more emails, post more on LinkedIn, automate more outreach, ask more discovery questions, and keep following up.

Those tactics may have a place, but they are not enough when you are trying to get in front of hospital CEOs, CFOs, COOs, CMOs, CNOs, service line leaders, and other senior decision makers.

Hospital executives do not need more vendor noise.

They need sharper thinking.

They need insight.

They need context.

They need to know that you understand their world before you ever ask for their time.

The first challenge is getting the meeting.

Most outreach gets ignored because it looks and sounds like everything else. A cold email that says you can reduce costs, increase revenue, improve efficiency, or reduce risk is not enough. Hospital executives hear those claims all day long.

One underused strategy is direct mail.

Not a postcard. Not a generic brochure. Not a glossy sales piece.

A thoughtful executive package.

A FedEx envelope still gets attention because it physically lands on someone’s desk. It bypasses the crowded inbox. It feels more intentional. But the package only works if what is inside is worth reading.

That is where thought leadership matters.

If you are trying to sell into the hospital C suite, you cannot show up with thin marketing materials. You need something substantial enough to demonstrate your thinking before the meeting happens.

That brings us to one of the most important assets any hospital seller can create.

The Core Authority Asset.

A Core Authority Asset is not a standard white paper. It is not a sales deck. It is not a generic industry report.

It is a deliberate piece of executive level thinking built around one big idea. It should reframe how a hospital executive sees a problem they already care about. It should make the reader think, “That is exactly the problem we have been trying to name.”

When done well, it gives a champion something to forward internally. It gives an executive something to act on. It makes the next step obvious, which is a conversation with you.

This kind of asset should be substantial. It may be ten to fifteen pages or more. It should include insight, market context, original thinking, examples, data, visuals, and a clear point of view. It should not be boring. It should not feel like a stretched out brochure.

The strongest Core Authority Assets come from deep expertise.

They come from what you have seen on the front lines.

They come from the problems you know are costing hospitals money, time, trust, capacity, or outcomes.

The second major challenge is winning trust once you are in the room.

Many sellers waste the first ten minutes of a forty five minute executive meeting on casual chatter, company history, team introductions, and slides about themselves.

That is a mistake.

A hospital executive gave you time for a reason. Use it well.

You can be warm and professional without drifting. You can create rapport without losing the room. One of the simplest ways to show respect is to say something like, “I value your time, so I am going to get right into the reason we are here.”

Executives appreciate that.

The meeting should be organized, intentional, and valuable from the first few minutes. It should be built around the hospital’s priorities, not your company’s biography.

This is where many sales presentations fail.

They are too linear. Too company centered. Too feature heavy. Too slow to get to the real issue.

The better approach is to lead with the problem beneath the problem.

Do not simply say you can increase revenue. Show where revenue is being lost.

Do not simply say you can reduce costs. Show the hidden process gaps that are creating unnecessary cost.

Do not simply say you improve efficiency. Show the operational friction that is creating delays, rework, staff burden, or patient experience issues.

Hospital executives need specificity.

The third challenge is understanding who is in front of you.

Two CFOs may have the same title and completely different decision styles.

One may be innovation oriented. They may ask how your solution could be applied in new ways. They may want to explore new models, pilots, or use cases.

Another may be protective. They may say, “We already do this,” or “Our team has this covered.” That does not mean the opportunity is dead. It means you need to listen differently.

A protective executive needs to feel understood before they will consider a new approach. You may need to use examples from similar organizations where leaders believed they had the issue handled, only to discover hidden opportunities once the right analysis was done.

The best sellers are not robotic.

They are listeners.

They hear what is said, but they also hear the intent behind what is said.

That matters even more when you are presenting to a room with multiple executives.

A CEO, CFO, COO, CMO, CNO, CIO, and service line leader may all be looking at the same decision through different lenses.

The CFO cares about financial impact.

The CMO cares about physician relationships.

The COO cares about operational execution.

The CIO cares about integration.

The CNO cares about staff burden and clinical workflow.

You have to understand that every answer you give to one executive may influence how another executive evaluates you. You also have to know that even if one person is not the final decision maker, they may still have the power to derail the decision if they lose confidence in your answer.

That is why context matters more than consensus.

There is a popular belief that every large healthcare deal requires consensus from twelve, fifteen, or seventeen stakeholders. There is some truth to the idea that more people are involved in hospital buying decisions. But when selling to the C suite, the goal is not always to get everyone to agree equally.

The goal is to give the true decision maker the right context to make a confident decision.

Senior executives will seek input. They will ask their teams for perspective. They will want to understand risk, workflow, financial impact, and implementation. But they do not always need unanimous agreement to move forward.

They need confidence.

That confidence comes from your ability to establish executive context, expose the real problem, earn trust, win the business, and commit to outcomes.

This is the discipline of executive selling.

It starts before the meeting.

You study the hospital’s environment. You understand reimbursement pressure, CMS changes, value based care, margins, staffing issues, patient flow, post discharge management, chronic condition burden, and operational priorities.

You do not walk into the room asking basic questions you should have already researched.

You walk in with insight.

That does not mean you never ask questions. It means your questions should be thoughtful, selective, and tied to the conversation. Asking a hospital CFO, “What are your pain points?” is not the same as bringing a clear point of view and asking which of three strategic issues they want to spend the most time on.

Preparation earns credibility.

Value keeps the conversation moving.

Another way to prevent deals from stalling is to create meaningful engagement after the meeting. One useful strategy is to ask for a lightweight piece of data that allows you to provide a directional analysis.

For example, if the hospital gives you twelve months of relevant spend or utilization data, you can return with specific insight. That gives you a reason to continue the conversation that is not just, “I am checking in.”

It also gives the executive something concrete to remember.

You are no longer just another vendor.

You are the person who showed them where money, time, or opportunity may be hidden.

The final piece is delivery.

Too many companies work incredibly hard to win the deal and then lose momentum after the contract is signed.

That cannot happen in hospital sales.

Once a hospital chooses you, the clock starts immediately. Trust is not secured when the agreement is signed. Trust is deepened through onboarding, responsiveness, early value, and a clear commitment to outcomes.

If your sales process was high touch, strategic, and executive level, your delivery process must be the same.

Hospital leaders are making difficult decisions in a difficult environment. They are under pressure to protect margins, improve outcomes, manage labor constraints, support clinicians, adopt new models of care, and operate beyond the four walls of the hospital.

The sellers who win over the next five years will not be the ones with the loudest outreach.

They will be the ones with the deepest understanding.

They will know the hospital business model. They will understand how reimbursement is changing. They will be able to connect their solution to executive priorities. They will bring insight before asking for trust.

Selling to hospitals is hard.

But it is not random.

The companies that win will be deliberate. They will build authority before they ask for access. They will use meetings wisely. They will understand the different executives in the room. They will move beyond generic claims. They will commit to outcomes quickly.

Most importantly, they will stop selling like vendors.

They will start showing up like strategic partners.

I am excited to share a new opportunity:

Category of One Enterprise Strategy™

A private 90-minute strategic working session with myself and Chetan Walia.

We analyze your business through two strategic lenses:

→ How enterprise buyers actually make decisions.

→ Why they should choose you over every alternative.

⸻

You leave with:

✓ Your Enterprise Positioning Strategy

✓ Executive Buying Strategy

✓ Category of One Direction

✓ Executive Message

✓ Buying Friction

✓ Next Strategic Move

Email me at lisa@lisatmiller.com to learn more.

Learn about Chetan's How To Be a Category of One Business

In episode twenty two of Selling to Healthcare, I get practical about Context Selling, moving past the idea that executives need more information and showing how what they actually need is context, something true about their own business that they could not see for themselves. I lay out exactly what a C Suite executive needs from a seller to feel confident enough to make the call.

I challenge the consensus selling myth that has hardened into strategy across the industry, the belief that winning means getting better at selling to the middle of the organization. Instead, I argue that CEOs and CFOs are more involved in major buying decisions than ever, and the executives who seem impossible to reach are simply being approached at the wrong level, with the wrong preparation.

I walk through the five steps of Context Selling: noticing when executives lean in, sharing specific and relevant details through narrative, considering every lens in the room, building a compelling narrative before the meeting, and circulating a Core Authority Asset that carries the narrative when I am not in the room. Along the way, I share stories from Temple University Health System and VIE Healthcare that show what the right context looks like in practice.

This episode is a practical playbook for healthcare sales professionals ready to stop chasing consensus and start building the context that lets the executives who already hold the authority actually use it.

Highlights of this Episode Include:

Information Isn’t Context: A thirty page deck is information. Context is showing an executive something true about their own business they could not see for themselves, and that is what actually moves decisions.

Notice When Executives Lean In: The C Suite engages when you know their market, understand their pressures, and bring a point of view they have not heard, external context and frontline experience their own teams cannot access.

Share the Right Details, Not Fewer: The myth that executives only want the summary is backward. They are voracious readers who want the narrative, how you did it, not just that you did it.

Consider Every Lens in the Room: CEO strategy, CFO margin, CMO patient care, COO workflow. Carry one clear point of view, fluent enough across all four lenses to make every person in the room feel seen.

Build the Narrative Before the Meeting: The meeting is not where you gather context. It is where the executive evaluates whether you already understand their world. Do the deep preparation ahead of time.

Circulate a Core Authority Asset: Most deals die after the meeting, when the narrative cannot survive the retelling. Leave behind a concise, specific document that sells in every room you cannot be in.

Stop Chasing Consensus: The deals that feel stalled are not lost. They are waiting for someone to show up at the right level. Give the executive who already holds the authority the clarity to use it.

You can listen to the podcast here: Context Selling: The 5 Steps | E.22

Ways for us to work together

The Gap Is Not Where Most Sales Leaders Think It Is

In the latest episode of the Selling to Healthcare podcast, I address a recurring pattern I hear from sellers and sales leaders across the industry. When I walk through the practical mechanics of earning true C-suite access—pulling a hospital’s Medicare Cost Report, calculating the cost-to-charge ratio, identifying meaningful variances against IPPS benchmarks, and building a concise one-page margin-leak brief—the reaction is almost always the same: “I’m not sure my team could actually do that.”

That honest admission reveals everything. The gap isn’t a talent problem. It’s a structural one—and it’s the single biggest reason most companies selling into hospitals never break through to executive conversations.

Why Traditional Sales Methodologies Fall Short

Standard sales frameworks like Challenger Sale or Blue Sheets deliver real value. They help reps qualify opportunities, map stakeholders, run discovery calls, and handle objections. But none of them teach the language that actually matters to a hospital CFO: hospital finance grounded in public data sources that drive board-level decisions.

Reps arrive fluent in their product and average—or worse—in the buyer’s world. They lead with features, clinical outcomes, or ROI slides that feel generic. Meanwhile, the executive across the table is wrestling with service line profitability, length-of-stay variances, purchased services as a percentage of net revenue, and labor expense per adjusted discharge.

The math of access is sobering but illuminating. Of roughly 1,000 reps calling on the same large health system in any given quarter, about 950 lead with product. Maybe 40 run a disciplined sales process. Perhaps 5 bring something approaching a real financial point of view.

And only one has done the homework: opening the actual Medicare Cost Report (Worksheet A and C), triangulating it with MedPAR data and the latest IPPS Final Rule. That’s the rep who gets the meeting. Behind them stands a company that chose to invest in insight.

The Proof Is in the CFO’s Reaction

Time and again, when I’ve presented this type of analysis to CFOs, the response is: “I’ve never seen this before.” Not because the data is proprietary or exotic—it’s all publicly available. The gap exists simply because no vendor had ever done the work to translate it into something relevant for their hospital.

That single moment shifts the entire dynamic. The conversation stops being a vendor pitch and becomes a peer-level discussion between two professionals examining the same problem from different seats. You move from competing on price or product to competing on insight—a category most competitors never enter.

Building the Moat: Individual and Organizational Levels

For individual sellers: Start small but deliberate. Pick one hospital in your active pipeline. Download their most recent HCRIS Medicare Cost Report. Spend time with Worksheet A and C until you can explain the cost-to-charge ratio in plain English. Layer in IPPS relative weights for your relevant DRGs and compare actual vs. geometric mean length of stay. Then write a one-page brief. Rewrite it three times. The act of building it is what creates fluency. Do this consistently, and you’ll know more about that hospital’s financial realities than reps who’ve been calling on it for years.

For sales organizations: Turn this into a repeatable system. Update hiring filters to test basic financial curiosity. Make hospital financial fluency a graded part of onboarding. Protect weekly calendar time for brief-building and treat it with the same discipline as forecast calls. Implement peer review of account briefs before they go out. Align recognition and compensation to reward depth of insight, not just activity volume.

Most companies won’t do this work. They’ll talk about value selling in kickoffs and default to activity metrics by Q2. The few that commit create a moat their competitors can’t close simply by hiring more reps or refining decks.

The Opportunity Ahead

This gap is the most valuable territory in healthcare sales precisely because it’s learnable and buildable. It’s uncomfortable at first—being a beginner at financial analysis always is—but that discomfort is the price of admission to the C-suite.

If your team is ready to close this structural gap and turn insight into your strongest differentiator, I’d love to talk. The companies that build this competency don’t chase access. Access starts coming to them.

Listen to the full episode here: The Gap Is Not Where Most Sales Leaders Think It Is | E.20

Learn more about Lisa at https://lisatmiller.com/about

Book an appointment - https://calendly.com/lisa_t_miller/30min

LinkedIn - https://www.linkedin.com/in/lisamiller/

Learn about Lisa’s Services & Workshops:

• https://www.lisatmiller.com/lisa-t-miller-services/

• https://fluentinhealthcare.com/

• https://healthcaresalesmasterclass.com/

That has changed. AI is now wonderful at navigating these public datasets, and the opportunity in front of you is real. Here are the seven sources we covered, with the way I would love for you to use each one.

1. CMS Hospital Care Compare

Think of it as Yelp for hospitals. Star ratings across categories like HCAHPS, readmissions, and patient safety. Drill into the sub-scores and you can see where a hospital has room to grow, whether that is nurse communication, surgical site infections, or ED throughput. I recently pulled left-without-being-seen rates and median ED wait times for a client’s prospect list. His outreach completely transformed, and he started getting responses from people who used to ignore him.

2. Medicare Cost Reports (CMS HCRIS)

This one is my favorite. Every hospital CFO files it, and it is wonderfully detailed. Net patient revenue, payer mix, department-level costs, supply cost ratios, even transplant program detail for facilities that have one. Spend a little time inside your top accounts’ cost reports and you will walk into meetings with the kind of context that earns respect right away. Better yet, build your own metric on top of it. Revenue per operating room. Supply spend per discharge. Something that helps the CFO see her own hospital from a fresh angle.

3. Leapfrog Hospital Safety Grade

A third-party A through F grade across 28 national measures, including hospital-acquired conditions, surgical site infections, medication safety, and nursing ratios. A hospital sitting at a C wants to be a B. If your solution helps move the needle on any of those measures, this is where your opening lives. Handle it gently in the conversation and you will be welcomed as a partner.

4. IRS Form 990 (ProPublica Nonprofit Explorer)

For nonprofit hospitals, the 990 shows you top vendors, executive compensation, research spending, unrestricted net assets, and strategic priorities. I do not always pull it into the deck. I use it to walk into the room prepared, so that when a topic comes up I already know the number. Preparation builds trust faster than any case study, and your prospect will feel it.

5. CMS Open Payments

The Sunshine Act database. It shows which manufacturers are paying which physicians, and for what. Use it as intelligence, not ammunition. If a surgeon is a key opinion leader in ankle reconstruction for one vendor, that does not block you. It tells you what conversation to have and what conversation to skip. It is also a quiet way to spot joint-venture and referral opportunities in non-competing categories.

6. Annual Reports and Strategic Plans

For-profit systems publish investor decks loaded with growth strategy, service line investments, and AI initiatives. Nonprofit hospitals are required to publish strategic plans, often called community reports, every three years. These include community health needs assessments. If a hospital’s community has a high diabetic population and the plan calls for mobile outreach, you already have your opening line and a beautiful way to position yourself as a partner.

7. State Certificate of Need Filings

Thirty-five states still require hospitals to file public applications to add beds, expand facilities, or acquire major equipment. This is the rarest source on the list, and it is forward looking, so you can see what a hospital plans to do twelve to twenty-four months out. New surgical centers. Bed expansions. Hospice growth. This is opportunity you can prepare for before your competitors even know it exists.

A note before you go

The data is half the work. The other half is your thinking, and how you put unique insights together to bring real value to hospital executives. That is how you earn the meeting. Not by knowing what they already know, but by offering a point of view they have not seen before.

What I want most for you is the orchestration. Walk in with three or four specific points that connect their numbers to a fresh point of view and to your solution. Bring the rest in conversation.

If you would like help building this

If you would like to build this strategy into the way you and your team sell, this is the work I do with clients every day.

Email me at lisa@lisatmiller.com.

Or schedule a meeting with me: https://calendly.com/lisa_t_miller/30min

I would love to help you win.

Lisa

Yesterday I published a piece on how C-suite access is earned, never expected. The response was significant, and the conversations that followed, with individual sellers and with the sales leaders who run their teams, surfaced a pattern I want to address directly today.

When I describe the mechanics of Strategy One, pulling a hospital’s Medicare Cost Report, calculating a Cost-to-Charge Ratio, identifying a length-of-stay variance against the IPPS benchmark, building a one-page margin leak brief, what I hear back from sales professionals and sales leaders alike is some version of this: I am not sure my team could actually do that. We have been selling into hospitals for years, and we do not know how to read a Cost Report worksheet, or what a credible margin variance estimate looks like.

If you felt any of that reading yesterday’s piece, I want you to stay with me. The honest answer to where that feeling comes from, and what it actually means for your company and your sales success, is the entire reason I am writing this follow-up.

Most companies selling into hospitals will not earn C-suite access.

Not because their reps are not talented. Not because they are not hungry.

Because they have not built the systems, skills, and support their reps would need to do the work.

Why the gap exists

Most healthcare sales training, including the well-known and well-respected methodologies, gives a rep a framework for qualifying a deal, structuring a discovery call, mapping a buying committee, and handling objections. Those are real skills. They matter. I love the Challanger Sale. A Blue Sheet has tremendous value.

However none of those programs will teach a healthcare sales executive how to read a Medicare Cost Report. None will walk them through what a hospital CFO is actually looking at when reviewing surgical service line profitability. None will show them how the annual IPPS Final Rule reshapes the economics of the very account they are trying to sell into. None will explain why the relationship between charges and costs is the single most important number on the financial page for the executive they want to reach.

That is not a flaw in those programs. They are sales methodologies. What reps need layered on top of them is fluency in hospital finance that matters to the CFO.

Most companies do not hire for it. Most onboarding does not include it in depth and the typical rep arrives at a hospital account fluent in the language of their product and average in the language of the buyer.

That is the gap. It is structural, not personal. And it is the reason most outreach from a vendor sales team into the C-suite gets ignored.

Why the gap is good news

Here is the part I want you to hear clearly.

The gap most companies do not invest in closing is the most valuable territory in healthcare sales.

Let me show you the math the way I see it.

If a thousand reps are calling on the same large health system this quarter, roughly 950 of them are leading with their product. Maybe 40 of them are well-trained on a sales methodology and running a clean process. Maybe 5 of them have built something approaching a real financial point of view on the account. Maybe 1 has actually opened the Medicare Cost Report and triangulated the data against MedPAR and the IPPS tables before reaching out.

That one rep is the rep who gets the meeting. And behind that one rep, almost always, is a company that made a decision the other companies did not.

When the CFO’s inbox surfaces an email that references their actual DRG 470 cost variance, their actual implant Cost-to-Charge Ratio, their actual length of stay against the geometric mean, that email does not get sorted as a vendor pitch. It gets sorted as something worth a reply. In a single exchange, the rep has demonstrated what the other 999 cannot: they understood what it is like to sit in the CFO’s seat. And the company behind them has demonstrated something even rarer, which is that they decided the work was worth doing.

That is the moat. And the most important thing I can tell you about it is this: the moat is learnable, and it is buildable across a team - especially if the team is coachable.

What building the competency actually requires

It takes time. It takes intention. It takes reading source documents most reps will never open. It is a competency. It can be built deliberately, in months, by any seller willing to do the work, and by any company willing to sponsor it.

The proof that the gap is real is in the reaction it produces on the other side of the desk.

When I presented my findings to CFOs, the common response was, “I have never seen this type of analysis before.”

Sit with that sentence for a moment. CFOs of major hospitals, people who field vendor presentations every week and review board-level financial reports every month, telling me they had never seen this kind of analysis. Not because the analysis was exotic. Not because the data was proprietary. Everything I built came from publicly available sources: the Medicare Cost Report, the IPPS Final Rule, MedPAR. The data was sitting there, free, for any vendor who wanted to use it.

The reason the CFO had never seen this analysis was simpler. No vendor had ever built it for them.

That is the moment the room changes. The conversation stops being a sales call and becomes a conversation between two people looking at the same problem from two different seats. From that point forward, the vendor is no longer competing on price or product. They are competing on insight, which is a category most of their competitors are not even entering.

And what insight requires is strategic thinking grounded in deep healthcare expertise.

That is what is on the other side of this work. And that is why it is worth doing.

At the individual level

You start with the Medicare Cost Report. You pick one hospital you care about, ideally one in your active pipeline. You download their most recent HCRIS submission. You open Worksheet A and Worksheet C, Part I. You spend an evening, then another, then another, until you can explain in plain language what a Cost-to-Charge Ratio is and why it matters more than the gross charge. You learn to read Worksheet D-1 the same way.

Then you move to the IPPS Final Rule for the current fiscal year. You learn what the relative weight is for the highest-volume DRGs in your space and what the base payment rate produces for that hospital. You learn what the geometric mean length of stay looks like next to that hospital’s actual length of stay. You start to see the gaps the CFO is being asked about by the board.

Then you layer in MedPAR. You learn how to read aggregated claim-level performance by DRG, and how to compare the hospital’s actual reimbursement against what the IPPS tables predict it should be.

Then you write a one-page brief on that hospital. Just one. You do not send it yet. You write it because the act of building it is what teaches you. By the time you finish the third version, you will know more about that hospital’s financial reality than the rep who has been calling on it for two years.

That is the work. It is not glamorous. It is uncomfortable for a while, because being a beginner in financial analysis is uncomfortable for anyone. But that discomfort is the price of admission to the C-suite conversation.

What I have described is one entry point. Every company selling into hospitals can build a financial analysis that connects what they sell to what the CFO is being measured on. A capital equipment company can anchor on case-level margin. A supply chain partner can anchor on purchased services as a percentage of net patient revenue. A workforce technology vendor can anchor on labor expense per adjusted discharge. The data is sitting in public sources for any company willing to pull it.

The point is not the specific analysis. It is the discipline of building one.

At the company level

The same work, sponsored at the company level, looks very different. It is not an individual rep’s evening study. It is a structured commitment from sales leadership.

Its a strategy.

It looks like a hiring filter that asks candidates to read a sample Cost Report excerpt and discuss what they see. It looks like onboarding that includes financial fluency as a graded module, not an optional reading list. It looks like protected time on the rep’s calendar each week to build account-level briefs, with that time treated as carefully as a forecast call. It looks like internal analyst capacity, or an external partnership, that helps reps pull and validate the data without losing a day to it.

It looks like account reviews where the rep’s brief on a target hospital is critiqued by peers before it ever leaves the building. It looks like a recognition and comp system that rewards the depth of an account brief, not just the velocity of activity.

Most companies will not build this. They will say the right things in a kickoff and then default to activity metrics and pipeline coverage by the second quarter. The companies that do build it stop running the same uphill battle on every account, and the gap between their results and the rest of the market becomes the kind of margin a competitor cannot close by hiring more reps.

Why I am telling you this

I have worked across the desk from hospital CFOs for 25 years. I have served in interim leadership roles inside health systems. I have built the financial analysis that goes into board packets. The reps I have respected most over those decades, the ones who consistently won the meetings I would not have given to others, were not the ones with the polished decks or the longest case study libraries. They were the ones who could open a Cost Report and tell me something I did not already know about my own hospital. And behind almost every one of them was a company that had chosen to make that fluency a non-negotiable part of how they sold.

That is the profile. It is not common. It is not supposed to be. And that is precisely why it works.

So if you read yesterday’s article and felt the mechanics were out of reach, here is what I want to leave you with. The gap you felt is the gap. It is real. It is also the most valuable thing in healthcare sales to close. The companies that close it stop chasing access. Access starts coming to them.

If you lead a sales organization selling into hospitals and you want to build this competency across your team deliberately, on a structured path, that is the work I do with company sales organizations and with the individual sellers who want to invest in their own ceiling.

The C-suite selling discipline I described yesterday sits on top of this competency.

You can reach me at lisa@lisatmiller.com.

The companies that will not do this work are not your competition. The companies that will, are.

The good news is there are not many of them. Yet.

———

For a conversation about building C-suite financial fluency inside your sales organization, reach me directly at lisa@lisatmiller.com.

Why outreach alone will not get you in the room, and the three strategies that will.

If I had to name the single most common frustration I hear from sales leaders and individual contributors, it would be this one: I cannot get a meeting with the C-suite. I have called, I have emailed, I have followed up, and nothing is working.

I hear it every week. It comes from reps selling clinical products, capital equipment, services, software, consulting. It comes from founders trying to close enterprise health systems. It comes from seasoned account executives who have been hitting quota for years and suddenly cannot crack a specific account.

So let me put a stake in the ground, because this is the foundation of everything I teach about selling to hospitals.

Access is earned. It is never expected.

That one sentence will change the way you build your pipeline if you let it. The frustration most sellers carry is built on a quiet assumption: that outreach should be enough. That because you sent a thoughtful email, or left a polite voicemail, or made a LinkedIn connection, a meeting should follow. It will not. And it should not.

Hospital executives are not withholding meetings because they are difficult. They are withholding meetings because there are not enough hours in their day to take one that does not move their priorities forward. The CFO has a multi-billion-dollar budget, payer negotiations, capital decisions in motion, and a board to answer to. The COO is solving for throughput and labor. The CMO is balancing quality, safety, and physician relationships. None of them owe you their time. They will give it to you if, and only if, you have earned it.

So the question becomes simple, and it is the one I want you to sit with: what does value actually look like, defined from their seat, not yours?

Why “value” has quietly stopped meaning value

Most sales training in our industry teaches you to lead with the same three buckets: reduce cost, increase revenue, reduce risk. Those are true. They are also, at this point, generic.

The most common move I see reps make in the name of value is sending a case study. I love a good case study. They have their place. But pause and think about it from the executive’s side of the table.

Right now, this week, that executive’s inbox is full of case studies. Every rep is sending one. When everyone leads with the same proof point, the proof point stops working. Worse, a generic case study sent cold signals something the sender probably does not intend to communicate. It signals that the conversation is about the vendor, not the executive. It is transactional. The executive can feel it.

So if generic case studies, broad ROI claims, and templated outreach are not the path, what is?

There are 3 out of the 8 strategies I coach my clients on. Let me take them one at a time.

Strategy one: lead with a unique insight about their hospital, not your solution

This is the strategy that separates the rep who gets the meeting from the rep who keeps following up.

A unique insight is not a stat you pulled from Google or a generative AI summary of the industry. It is your own thinking, applied specifically to the hospital you are trying to reach, drawing on data and experience the executive themselves may not have stitched together.

Here is a concrete example. Say your service is operational improvement in the OR. The generic version of your pitch is, “We help hospitals improve OR throughput, and our clients have seen meaningful gains.” That gets a polite no.

Now compare that to this. You pull the executive’s Medicare Cost Report. You go into surgical line profitability by DRG. You look at DRG 470 or DRG 475, cross-reference against two other publicly available data sets, and you build a one-page executive brief that says: based on three publicly reported data points, here is what we are seeing inside your DRG 475 profile, here are the three areas with the most room to improve, and here is what that improvement is plausibly worth.

Let me show in detail what I mean:

Leveraging Medicare Cost Reports and Public Data for DRG-Level Profitability Outreach

By triangulating data from the Medicare Cost Report (HCRIS), the CMS Inpatient Prospective Payment System (IPPS) Final Rule Impact File, and the MedPAR dataset, you can construct a highly credible, data-driven narrative. This approach moves the conversation from a vendor pitch to a peer-level financial review.

The Three Pillars of Public Data

To build a compelling executive brief, you must synthesize three distinct but complementary datasets:

1. The Medicare Cost Report (HCRIS)

The Healthcare Provider Cost Reporting Information System (HCRIS) contains the annual Medicare Cost Reports submitted by all Medicare-certified hospitals. This is the foundational document for understanding a hospital’s true cost structure, beyond what they charge.

Key Worksheets for Surgical Profitability:

• Worksheet A: This worksheet maps the hospital’s trial balance expenses to specific Medicare cost centers. It shows the raw, unallocated costs for departments like the Operating Room (Line 50), Medical Supplies Charged to Patients (Line 71), and Implantable Devices Charged to Patients (Line 72).

• Worksheet C, Part I: This is arguably the most critical worksheet for profitability analysis. It calculates the Cost-to-Charge Ratio (CCR) for each ancillary department. By dividing total costs by total charges, the CCR allows you to convert a hospital’s gross charges on a patient claim into an estimated actual cost. For surgical lines, you will look specifically at the CCRs for the Operating Room and Implantable Devices.

• Worksheet D-1: This worksheet computes the inpatient operating cost. It provides the average cost per diem for routine care (e.g., Med/Surg beds, ICU). When combined with the length of stay for a specific DRG, this allows you to estimate the routine room and board costs for those patients.

2. The CMS IPPS Final Rule Impact File and Tables

Published annually, the IPPS Final Rule dictates how Medicare pays for inpatient stays. The associated data tables provide the payment parameters for every DRG.

Key Data Elements:

• Relative Weight: Each DRG is assigned a relative weight that reflects the average resources required to treat patients in that group compared to the average Medicare case. For example, DRG 470 has a specific relative weight that, when multiplied by the hospital’s base payment rate, determines the base reimbursement.

• Geometric Mean Length of Stay (GMLOS): The IPPS tables publish the national geometric mean length of stay for each DRG. This serves as a critical benchmark. If a target hospital’s average LOS for DRG 470 is 3.5 days, but the national GMLOS is 2.2 days, that variance represents a quantifiable margin leak.

3. The MedPAR Dataset

The Medicare Provider Analysis and Review (MedPAR) file contains claim-level data for all Medicare Part A inpatient discharges. While the raw file is massive, aggregated MedPAR data (often available through secondary analytics platforms or CMS public use files) provides hospital-specific performance metrics by DRG.

Key Data Elements:

• Average Total Charges by DRG: The average amount the hospital billed for DRG 470 or 475.

• Average Medicare Payment by DRG: The actual average reimbursement received.

• Average Length of Stay by DRG: The hospital’s actual average LOS for that specific procedure.

The Analytical Methodology: Connecting the Dots

To build the executive brief, you must connect the data from these three sources to estimate the hospital’s true margin on a specific DRG.

1. Determine the Revenue: Use MedPAR data to find the hospital’s average Medicare payment for DRG 470.

2. Estimate the Costs:

◦ Take the hospital’s average total charges for DRG 470 (from MedPAR).

◦ Apply the hospital’s overall or department-specific Cost-to-Charge Ratios (from HCRIS Worksheet C) to those charges to estimate the true cost of the case.

◦ Pro-Tip: For orthopedic and spinal procedures, isolate the implant charges and apply the specific CCR for “Implantable Devices Charged to Patients” (Worksheet C, Line 72). This often reveals that high implant costs are destroying the margin.

3. Calculate the Margin: Subtract the estimated true cost from the average Medicare payment.

4. Identify the Variance: Compare the hospital’s estimated cost and actual Length of Stay against the national averages (from the IPPS Final Rule tables).

The One-Page Executive Brief Template

This template is designed to be sent directly to a hospital CFO or VP of Finance. It uses their own data to highlight a specific financial vulnerability and proposes a targeted discussion.

CONFIDENTIAL EXECUTIVE BRIEFING Prepared For:

[Executive Name], [Title], [Hospital Name] Subject: Margin Variance Analysis: Surgical Service Line (MS-DRG 470 & 475) Date: [Date]

Executive Summary Based on an analysis of [Hospital Name]’s most recent Medicare Cost Report (FY [Year]) and CMS MedPAR claims data, we have identified a significant margin compression within your high-volume orthopedic and spinal surgical lines, specifically MS-DRG 470 (Major Joint Replacement) and MS-DRG 475.

While these procedures represent a critical revenue stream, your facility is currently underperforming national benchmarks in cost-to-serve and length of stay, resulting in an estimated margin leak of $[X.XX]M annually on Medicare volume alone.

Data-Driven Observations (Based on Publicly Reported Data)

1. Implant Cost Variance (HCRIS Worksheet C, Line 72) Your Cost-to-Charge Ratio (CCR) for Implantable Devices is currently [X.XX]. When applied to your average implant charges for DRG 470, your estimated implant cost per case is $[X,XXX]. This is [X]% higher than the regional average of $[X,XXX]. This suggests an immediate opportunity for vendor contract renegotiation or physician preference item (PPI) standardization.

2. Length of Stay (LOS) Drag (MedPAR vs. IPPS Final Rule) According to recent MedPAR data, your average Length of Stay for DRG 470 is [X.X] days. The CMS Geometric Mean Length of Stay (GMLOS) for this DRG is [X.X] days. This [X.X] day variance, when multiplied by your routine per diem cost of $[X,XXX] (derived from HCRIS Worksheet D-1), represents an excess cost of $[X,XXX] per discharge.

3. Operating Room Efficiency (HCRIS Worksheet A & C, Line 50) Your Operating Room cost center shows a fully allocated cost per minute that exceeds peer facilities of similar size and acuity. This indicates potential bottlenecks in OR turnover times or over-allocation of overhead, compressing the margin on fixed-reimbursement DRGs.

The Financial Impact By closing the gap to the 50th percentile benchmark in just two areas—Implant Costs and Length of Stay—[Hospital Name] could realize an estimated margin improvement of $[X,XXX] per Medicare discharge for DRG 470. Across your annual Medicare volume of [X] cases, this represents a $[X.XX]M bottom-line opportunity.

Proposed Next Steps: This analysis is based on publicly available CMS data. We have developed a proprietary methodology to help facilities like [Hospital Name] capture these specific margin opportunities without disrupting clinical workflows.

If you are open to a further discussion on our strategies, lets schedule a call to review the underlying data model and discuss how we may be able to provide our O.R. financial improvement strategies to your hospital.

That is not a pitch. That is consulting.

And it gives the executive something none of your competitors are giving them: thinking that is specific to their hospital.

I hear the objection all the time: “if I give it away, they will take the brief and ignore me.”

First, they are already ignoring you, so the downside is zero.

Second, they will not.

Their reaction is going to be the opposite. They are going to think, if this is what they put in a one-page brief I did not even ask for, what would they bring to a working conversation? What would they bring as my advisor? What would they bring if I were actually using their product or service? That is the line of thought that opens the calendar.

Strategy two: publish original content only you could have written

The second way to earn access is to be visible in the market with original thinking that no one else can replicate.

I am not talking about a fluffy blog post that any AI tool could generate in ninety seconds. I am talking about real intellectual work. A quarterly industry review on a topic you own. A point of view on a CMS policy shift, with the implications spelled out. An original research piece pulled from your customer interviews and your team’s collective field intelligence.

The test is simple. Could a generalist sit down and produce the same piece in an afternoon? If yes, you have not built a moat. The piece you want to produce is one where the answer is no. It is the piece authorities and associations start citing because it is the cleanest articulation of a problem they have all been trying to name. It is the piece an executive forwards to a colleague and says, I want us to think about this.

That kind of content earns access on autopilot, because executives reach out to the author. You become a known voice on a specific topic, and the meeting requests start coming the other direction.

Strategy three: show up differently in how you reach out

The third move is more tactical, and it amplifies the first two. Most outreach looks identical: same templated email, same LinkedIn message, same cadence. So when something different lands in the executive’s inbox, they notice.

A short asynchronous video is one way to do this. Thirty seconds, looking into the camera: I put together a one-page brief specific to your hospital and your surgical service line. I would like to send it over. Would that be useful? That is a very different ask than “do you have 15 minutes next week.” You are not asking for time. You are offering value, and asking permission to deliver it.

Another version is a no-charge executive brief delivered to the team. Thirty minutes, on a specific topic that matters to them, no pitch attached. Hospitals appreciate this when the content is genuinely useful, and it gives you a chance to meet the team in a low-pressure setting where you are the one giving, not asking.

One more variation that works well: send the executive a piece of original content you have written and ask for their feedback. Not a pitch. A genuine ask: I put this together, and I would value your perspective. Is there anything you would add, change, or push back on? Executives respect people who are willing to be edited, and it positions you as a peer, not a vendor.

In all three tactics, the through line is the same. You are not asking for access. You are demonstrating, in advance and in concrete form, the kind of value you would bring once the relationship existed.

The bigger picture

Marc Benioff has said for years that every meaningful enterprise deal Salesforce closed in its early growth years involved the CEO. Not procurement. Not the line manager. The CEO. That is not a vanity statistic. It is a discipline. Salesforce built a motion that earned that level of access on every important deal.

You can build the same motion. It does not replace what you already use. If your team runs Challenger, MEDDIC, or Miller Heiman, keep them. They are good. Layer on top of them a C-suite selling discipline that treats access as something earned through unique insight, original content, and differentiated outreach.

That is the missing layer. When my clients install it, the results are not incremental. They are material.

So the next time you feel the frustration of a quiet inbox, do not ask why they are not responding. Ask the harder question: what have I given them that would make a response inevitable?

That is where the work is. And that is where the meetings are.

———

For a conversation about building a stronger C-Suite strategy inside your company, reach me directly at lisa@lisatmiller.com

The market has quietly changed the rules

The research is no longer ambiguous. In the most recent Edelman–LinkedIn B2B Thought Leadership Impact Report, 54% of C-suite executives say they spend an hour or more every week reading thought leadership, and 75% report that a single piece of it has led them to research a product or service they were not previously considering (LinkedIn Marketing Solutions). Nine in ten say consistent, high-quality thinking makes them measurably more receptive to outreach. And 70% admit a piece of someone else’s thought leadership has, at least occasionally, made them question whether they should keep working with an existing supplier.

That is not a content marketing finding. That is a competitive intelligence finding.

At the same time, Corporate Visions’ analysis of more than 150,000 deals found that 79% of buyers say sellers look the same — and that a seller’s ability to differentiate is one of the strongest predictors of winning the deal. In high-stakes purchases, the buying experience and the framing of the problem now explain 59% of the decision, while the offering itself explains only 41%.

Translation for anyone selling into the C-suite: the asset that frames the problem wins more often than the product that solves it. Executives are not short on vendors. They are short on language for what is actually broken on their P&L.

That is the gap a Core Authority Asset is built to close.

Thought leadership versus a Core Authority Asset

Most “thought leadership” today is a stream — posts, newsletters, podcasts, decks, lead magnets, and one-off articles, each restarting the conversation from zero. It produces awareness. It rarely produces authority. And it almost never survives the journey from a champion’s inbox to an executive committee.

A Core Authority Asset is different in kind, not degree.

It is the single, deliberate, market-facing artifact upon which your entire commercial strategy is allowed to depend. It is a concentrated, high-signal expression of your hard-won point of view — architected with executive-grade positioning, original frameworks, a narrative arc, proof points, and crystal-clear takeaways — so that a C-suite executive can read it in one sitting, instantly recognize their own strategic reality in it, and confidently champion it (or forward it to their board, peers, and other key stakeholders) with their own reputation attached.

It is not a brochure. Not a deck. Not a lead magnet. Not a one-off article.

It stops being “content” the moment it becomes the reason deals move forward when you are not in the room.

Why a unique point of view is now the differentiator

The Edelman–LinkedIn data is blunt about what earns executive attention: thought leadership that references strong research and data, that helps buyers understand their challenges and opportunities in a new way, and that offers concrete guidance — not recycled advice (LinkedIn). The C-suite, in other words, is allergic to anything that sounds like everyone else.

Corporate Visions calls this the Value Wedge — the intersection of what is unique to you, important to the buyer right now, and defensible with evidence. Without it, conversations collapse into parity, and the buyer either picks the incumbent or picks on price.

A Core Authority Asset is your Value Wedge made portable. It is the place where your point of view stops living in your head and starts living in executive inboxes, board pre-reads, and Monday morning exec syncs. It is the document a COO underlines on a Saturday and brings into a leadership meeting on Tuesday — because something on the P&L is not moving and your framing names it more precisely than anyone else’s.

What a Core Authority Asset actually does

When it is built correctly, a Core Authority Asset performs four jobs at once — jobs that scattered content cannot.

1. It translates expertise into the language of the executive committee. Champions trust you. Executives need a frame. A Core Authority Asset gives the champion something forwardable that survives the journey upward without you in the room.

2. It converts attention into a decision-room conversation. Edelman’s research shows that hidden buyers — the unseen influencers who stall or accelerate 40% of B2B deals — actively seek out perspective-shifting content and will advocate for less familiar vendors when the thinking is strong enough (Edelman). A Core Authority Asset is built to be the artifact those hidden buyers reach for.

3. It compounds authority instead of resetting it. Every talk, post, proposal, podcast, and sales conversation now points back to the same defensible asset. Visibility stops being a treadmill and starts being a flywheel.

4. It justifies premium pricing. Edelman finds that effective thought leadership makes buyers “willing to seek you out — and even pay extra for your expertise” (Edelman 2024 Report). Authority, once recognized, is the most defensible margin in B2B.

The strategic test

If you want to know whether you have a Core Authority Asset or merely a portfolio of content, ask three questions.

· Could a prospect’s COO read it on a Saturday and bring it into Monday’s executive sync — with their own reputation attached?

· Does every talk, post, proposal, and podcast you produce point back to the same defensible argument, or does each one start the conversation over?

· Is there a single piece of intellectual capital in your business that makes the case for you in your absence — inside rooms your calendar will never reach?

If the answer to any of these is no, you do not have an authority problem. You have an asset problem.

The bottom line

The market is paying a premium right now for one thing in particular: a clear, original, evidence-backed point of view delivered in a form executives actually consume. Sellers who look the same lose. Sellers who frame the problem better than the incumbent — in a single, forwardable artifact — win the deal, the price, and the next one after it.

A Core Authority Asset is not more content. It is the one piece of intellectual capital that turns your expertise into the kind of recognized authority that executives act on, champion, and pay for — without you having to sell one conversation at a time.

It is the asset your commercial strategy is finally allowed to depend on.

The Strategic Influence™Workshop

I wrote The Executive Yes Book and developed The SEAD System because I’ve lived the exact challenge you’re facing, which is doing exceptional work that should open C-suite doors… yet still watching high-value deals stall because your expertise hasn’t been translated into the kind of commercial authority executives can immediately act on and forward upward.

That’s exactly what Chapter 2 in The Executive Yes book is about.

I’m opening the founding cohort of the Strategic Influence™Workshop exclusively to my community. You can learn more about the live two-day workshop here.

What it is:

A live, two-afternoon intensive (90 minutes each) built 100% around Chapter 2. In just two sessions you will walk away with your Core Authority Piece — the single market-facing asset that turns your expertise into authority executives recognize, trust, and forward with their own reputation attached.

What you’ll leave with:

A finished architecture for your Core Authority Piece (positioning, POV, section-by-section outline, frameworks, narrative arc, and proof points)

Your sharp one-sentence C-suite positioning

A complete 12-month thought-leadership and distribution strategy (pre-call sequence, mid-deal references, partner/content plan, launch plan, and first decisive action already on your calendar)

The exact way to stop selling one conversation at a time and start letting the asset do the heavy lifting

Dates & Times (both sessions are live with me):

• Day One – Wednesday, June 10 · 2:00 – 3:30 PM ET

• Day Two – Thursday, June 11 · 2:00 – 3:30 PM ET

Everything is recorded and you’ll have 12-month access to the full library.

Founding-Cohort Extras (only for this first group):

Chapter 2 Strategic Influence™ workbook (diagnostic + templates)

Private founding-cohort community (get real-time feedback)

Live group office hours with me 30 days after Day Two

Regular price after the founding cohort will be $1,000. As a verified book owner, your founding-cohort price is just $600 (or two payments of $350).

→ Reserve Your Founding Seat Here:

Spots are deliberately limited so I can work directly with every participant. Once the founding cohort closes, this exact live format and pricing will not be repeated.

This intensive is where Chapter 2 becomes the asset that starts moving your biggest deals forward.

I’d love to see you there.

-Lisa

PS - A Core Authority Asset is the single, deliberate, market-facing artifact upon which your entire commercial strategy is allowed to depend. It is a concentrated, high-signal expression of your hard-won point of view — architected with executive-grade positioning, original frameworks, narrative arc, proof points, and crystal-clear takeaways.

In short: it is the one piece of intellectual capital that turns your expertise into the kind of recognized authority that executives act on, champion, and pay for — without you having to sell one conversation at a time.

PPS - You will leave the two day workshop with your own Core Authority Asset that opens doors to the Executive Suite.

https://strategic-authority-lab.lovable.app

In episode sixteen of “Selling to Healthcare,” Lisa T. Miller takes on one of the most persistent myths in modern B2B sales — the idea that executives can no longer make meaningful buying decisions without full committee consensus. Drawing on behavioral economics, neuroscience, and real-world case studies, Lisa explains what actually drives the final yes and why the brands that win in healthcare aren’t the loudest or the most feature-rich, but the most trusted.

She unpacks the psychology behind executive decisions — from the powerful role of emotion and personal value, to Kahneman’s Prospect Theory and the risk-aversion that quietly shapes every C-Suite choice. Lisa makes the case that B2B buying is far more emotional than B2C, and that fear of professional risk is often a stronger motivator than the promise of a better outcome.

Lisa then walks through the five-stage architecture of the modern executive buying journey, sharing the data sellers need to understand: most purchase requirements are defined before vendors are ever contacted, peer networks dominate shortlist creation, buying committees have ballooned to 10+ people, and 86% of B2B purchases stall somewhere along the way. She illustrates how the committee builds awareness while the executive still decides — using the Merck/IBM story, where a single CEO-to-CEO conversation overturned a fully-aligned committee recommendation.

This episode offers healthcare sales professionals a clear-eyed playbook for selling to deciders, not just committees — by winning the emotional argument first, reframing the cost of inaction, investing in thought leadership long before the formal evaluation begins, and giving executives the clarity, evidence, and strategic insight to use their authority well.

Highlights of this Episode Include:

• The Myth of the Rational Executive: B2B brands drive stronger emotional connections than B2C brands — because the professional stakes of a bad business purchase are enormous, executives won’t commit without trust and emotional buy-in.

• Personal Value Beats Business Value: Buyers who see personal value are 71% more likely to buy and 8x more likely to pay a premium — only 14% will pay a premium for business value alone.

• The Kahneman Effect: Executives are more motivated to avoid loss than to acquire gain — the most effective sales narratives lead with the cost of inaction, not the benefits of action.

• The Invisible Buying Journey: 83% of buyers have mostly or fully defined their purchase requirements before they ever speak with sales — by the time you’re invited in, the shortlist is often already formed.

• Peer Networks Build the Shortlist: 73% of B2B executives rank word-of-mouth and peer recommendations as the most influential factor in deciding which vendors to consider — social proof outperforms any vendor demo.

• The Committee Informs, the Executive Decides: The Merck/IBM story shows how a unanimous committee recommendation was overturned by a single CEO-to-CEO conversation — authority still exists, it’s just less visible.

• Consensus Often Masks Risk-Aversion: Buying committees that have grown to 11, 12, or 15 people aren’t larger because decisions got more complex — they’re larger because willingness to own the tradeoff got smaller.

• The Two-Stage Brain: Decisions are made emotionally in the amygdala and justified rationally in the prefrontal cortex — if you haven’t won the emotional argument, no amount of ROI data will close the deal.

• Thought Leadership Shapes Decisions Months in Advance: Effective thought leadership engages the 95% of buyers who aren’t actively in-market, reframing assumptions and shaping decisions long before the formal evaluation begins.

• Sell to Deciders, Not Just Committees: The work isn’t to assemble a coalition large enough to remove all friction — it’s to give the executive who already has authority the clarity and strategic insight to use it well.

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Today I am writing about a topic that I have spent a lot of time thinking about - it’s consensus buying and consensus decision making.

While I agree that committees and alignment are important, I do not believe they are solely responsible for making decisions. In fact, in my experience, leaders are still the ones making the final call.

The traditional view of the C-suite executive as a purely rational, data-driven decision-maker—often characterized as a “Tin Man” devoid of emotion—is fundamentally flawed. Extensive research across behavioral economics, psychology, and B2B sales data reveals that executive buying decisions are deeply emotional, heavily influenced by risk aversion, and increasingly reliant on peer networks and thought leadership.

While B2B purchases are often justified with logic, return on investment (ROI) calculations, and total cost of ownership (TCO) models, the actual decision to buy is driven by personal value, trust, and the desire to mitigate professional risk. Furthermore, the modern B2B buying journey has evolved into a complex, non-linear process involving large buying committees, extensive self-directed research, and the growing influence of AI and digital communities.

This report synthesizes real-world stories, case studies, and industry research to provide a comprehensive understanding of how executives truly make buying decisions.

Part I: The Myth of the Rational Executive

For decades, B2B sales and marketing strategies have been built on the assumption that business purchases are entirely rational. The executive, it was assumed, evaluates features, compares prices, calculates ROI, and selects the objectively best option. Research consistently and emphatically proves otherwise.

Emotion Drives B2B Decisions More Than B2C

A landmark study conducted by Google and CEB’s Marketing Leadership Council (now part of Gartner) surveyed 3,000 purchasers of 36 B2B brands across multiple industries. The findings were striking: B2B brands drive more emotional connections than B2C brands, not fewer. While most B2C brands had emotional connections with 10% to 40% of consumers, seven out of the nine B2B brands studied surpassed the 50% mark .

The reason for this counterintuitive finding lies in the inherent risk of B2B purchases. When a consumer makes a poor purchase, the stakes are relatively low. However, when an executive makes a poor business purchase—particularly a large-scale technology or services acquisition—the stakes are enormous. Responsibility for a multi-million dollar software acquisition that fails can lead to poor business performance, damaged reputation, and even the loss of a job . The business customer will not commit unless there is a substantial emotional connection and a deep sense of trust to help overcome this professional risk.

The Power of Personal Value

The same Google/CEB study revealed that B2B purchasers are almost 50% more likely to buy a product or service when they see personal value in it—such as an opportunity for career advancement, or pride and confidence in their choices . Buyers who perceive high personal value are 71% more likely to buy, and they are eight times more likely to pay a premium for the solution .

In contrast, only 14% of business decision-makers are willing to pay a premium for business value alone—that is, for unique product features or differentiation . Business value is considered table stakes; personal value is the true differentiator. This means that executives are not just asking, “What does this do for my company?” They are simultaneously, and often unconsciously, asking, “What does this do for me?”

Risk Aversion and Loss Avoidance: The Kahneman Effect

Nobel Prize-winning psychologist Daniel Kahneman’s research on behavioral economics, particularly Prospect Theory, is essential to understanding executive decisions. Kahneman demonstrated that human beings are fundamentally risk-averse and will seek risk more often to mitigate a loss than to acquire a gain .

In a B2B context, choosing a new vendor or implementing a new solution is inherently risky. Executives are often hesitant to change the status quo for a potential gain. However, if their current situation is framed as a loss to be avoided—a competitive threat, a growing inefficiency, a regulatory risk—they become far more willing to take the “risky bet” of a new solution . This is why the most effective sales narratives do not lead with features and benefits; they lead with a vivid picture of the cost of inaction.

This dynamic also explains the enduring truth behind the old adage, “Nobody ever got fired for buying IBM.” Executives often default to established, safe brands not because they offer the best features, but because they offer the lowest perceived professional risk . The fear of career damage is a more powerful motivator than the promise of a better outcome.

Part II: The Architecture of the Modern Executive Buying Journey

The way executives and their organizations evaluate and purchase solutions has changed dramatically, driven by digital transformation, economic pressures, and the proliferation of information channels.

Stage 1 — Triggering the Need

Buying journeys rarely begin with a vendor’s outreach. They begin with a problem, a strategic shift, or an external trigger. Research from 6Sense shows that nearly half of buyers (49%) say economic conditions shortened their buying cycles, and 62% say those pressures pushed them to engage sellers earlier . Common triggers include:

• A competitive threat that reveals a capability gap

• A regulatory or compliance change that forces technology upgrades

• A leadership change (new CEO, CFO, or CIO) who brings a new strategic agenda

• A failed internal initiative that creates urgency for an external solution

The executive’s recognition of a problem is the true beginning of the buying journey, and it happens long before any vendor is contacted.

Stage 2 — Self-Directed Research and the Invisible Journey

Once a need is recognized, executives and their teams conduct extensive independent research—often without the knowledge of any vendor. The data on this phase is striking.

The practical implication is profound: by the time an executive engages with a vendor, the shortlist is often already formed. Winning the deal frequently depends on being present and credible during the research phase, not just during the sales process.

Stage 3 — Building the Shortlist Through Peer Networks

Executives do not build their vendor shortlists in isolation. They rely heavily on trusted peer networks, industry communities, and external advisors.

“73% of B2B marketing executives rank word-of-mouth and peer recommendations as the most influential factor in deciding which vendors to consider.” — Wynter Research (2024) [4]

This peer-driven dynamic is reinforced by the fact that 56% of buyers consult with existing product users before purchasing, a figure that rises to 71% for enterprise-level purchases . For executives, the question is not just “Does this product work?” but “Do people I respect and trust use this product?” The social proof of a respected peer’s endorsement can be more persuasive than any analyst report or vendor demonstration.

Stage 4 — The Buying Committee and the Politics of Consensus

Even when an executive has a strong personal preference, the final decision is rarely theirs alone. The modern B2B purchase involves a large, cross-functional buying group.

These large, diverse groups often have conflicting priorities and success metrics. The IT team cares about integration and security; the finance team cares about cost and ROI; the end-users care about usability. Navigating these competing interests is one of the primary reasons 86% of B2B purchases stall during the buying process .

Stage 5 — The Final Decision and the Override

The final decision is the most revealing moment in any buying journey. It is where the consensus myth most reliably collapses.

Consider the Merck and IBM story, documented by Noel Capon and Christoph Senn in Harvard Business Review. “At about the same time, the pharmaceutical giant Merck decided to outsource its data-processing system. After evaluating proposals from several potential suppliers, the managers tasked with making the selection were in agreement: The contract should go to Accenture. But shortly before it was to be signed, Merck’s CEO received a visit from Sam Palmisano, the CEO of IBM. Palmisano had risen through the ranks of IBM’s sales force and had implemented the firm’s Integrated Accounts Program, which focused on core strategic customers. He fully understood the benefits of nurturing and leveraging executive-level relationships. Merck awarded IBM the contract” (HBR, March–April 2021).

Read that carefully. The evaluation team was in agreement. The contract was about to be signed. Then a different conversation happened, at a different level, and the decision changed.

This is not an anomaly, and it is not a rogue CEO ignoring his organization. It is a CEO using new strategic information, brought to him by a peer, to reach a different conclusion than the group. The committee did real work. The committee did not make the final call. Merck’s CEO did, because with executive-level input and a clearer line of sight to the strategic stakes, he made the buying decision he believed was right for Merck.

The committee built awareness.

The CEO decided.

Part III: The Role of Thought Leadership in Shaping Executive Decisions

Because executives are conducting the majority of their research independently and before engaging vendors, the ability to influence their thinking during the research phase is critical. This is where thought leadership plays an outsized role.

The 2024 Edelman-LinkedIn B2B Thought Leadership Impact Report, based on a survey of nearly 3,500 management-level professionals across seven countries, found that thought leadership is a powerful driver of revenue—not merely brand awareness . The report’s key findings include:

• Effective thought leadership makes buyers reexamine their assumptions about their own challenges, creating demand where none previously existed.

• It can “inoculate” companies against competitors trying to poach their customers by reinforcing the customer’s confidence in their existing vendor’s strategic vision.

• It is particularly effective at engaging the 95% of business clients who are not actively seeking goods or services at any given moment—the “out-of-market” majority

The implication is that the executive buying decision is often shaped months or years before the formal evaluation process begins, through the steady accumulation of credibility and insight delivered via thought leadership content.

Part IV: The Neuroscience of the Executive Decision

Understanding how executive brains process buying decisions provides a deeper layer of insight. The decision-making process is not a single event but a two-stage process:

Stage 1 — The Emotional Decision (Amygdala): The part of the brain responsible for the actual decision is the amygdala, which is emotional and intuitive. This is where the gut feeling, the sense of trust or distrust, and the emotional response to a vendor’s narrative originate. The decision to change—to take the risk of a new vendor—is made here .

Stage 2 — The Rational Justification (Prefrontal Cortex): The rational, logical part of the brain—where language and analysis reside—is used primarily to explain and justify the decision that has already been made emotionally . This is why executives ask for ROI calculations, TCO models, and reference checks. They are not using these tools to make the decision; they are using them to validate a decision they have already made, and to provide cover if the decision is later questioned.

This two-stage model has a critical practical implication: if you have not won the emotional argument, no amount of ROI data will close the deal. Conversely, if you have won the emotional argument, the ROI data simply needs to be “good enough” to provide justification.

Key Takeaways

The following table summarizes the core principles of executive buying behavior and their practical implications.

Executive buying decisions are a complex interplay of logic and emotion, individual psychology and organizational politics, self-directed research and peer influence. The executive who asks for an ROI model is not primarily a rational calculator; they are a risk-averse professional seeking emotional confidence, personal validation, and the assurance that their decision will be respected and defensible.

The organizations that consistently win executive buyers are those that understand this duality. They build emotional connections through thought leadership and authentic relationships. They reframe the cost of inaction rather than simply promoting the benefits of action. They invest in peer networks and customer communities that provide social proof at scale. And they ensure that their own executives engage with buyers not as loose cannons or social visitors, but as genuine growth champions who bring strategic insight and a long-term perspective to every interaction.

In the modern B2B landscape, the brands that win are not the loudest or the most feature-rich. They are the most trusted.

How I can support you executive selling strategies

If your sales team is still trying to win deals by building the biggest possible coalition, you are leaving the most important conversation off the table. I work with revenue leaders to redesign their executive engagement strategy so the right C-suite relationships get built early, the right insights land at the right moment, and the final decision tilts your way. Reach out if you want your team selling to deciders, not just committees.

-Lisa

Drawing on years of working directly with hospital leadership teams — from the early CJR model and bundled payments through BPCI and into today’s conversations about TEAM, ACCESS, and rural health — Lisa explains why the real gap in healthcare sales isn’t effort or intelligence, but depth of understanding. The fluent seller reads CMS updates the way a financial analyst reads an earnings release: not for compliance, but to identify where pressure is building, which organizations are most exposed, and what the commercial opportunity looks like before the rest of the market figures it out.

Lisa walks through six CMS programs every healthcare seller needs to understand — HRRP, VBP, TEAM, ACCESS, Rural Health Transformation, and IOTA — breaking down the mechanics, the financial stakes, and the specific commercial openings each one creates. She also reframes a critical mindset shift: CMS isn’t just handing down rules. They’re identifying systemic problems in healthcare delivery and providing funded, structured solutions. The hospitals that recognize this stop treating mandates as compliance exercises and start treating them as funded pathways to performance.

This episode is a practical map for sellers who want to stop showing up with generic value-based care pitch decks and start walking into executive conversations with the specific regulatory fluency that turns the Federal Register into a prospecting calendar.

Highlights of this Episode Include:

• The Document Most Sales Teams Never Read: The annual CMS rulemaking cycle is free, public, and contains more actionable account intelligence than any paid market research report — yet most reps ignore it.

• HRRP Is Your Easiest Opening: CMS publishes each hospital’s readmission rates and penalty status every year, so you can identify exactly which target accounts are in the penalty tier and which conditions are driving their exposure before you ever make a call.

• VBP Speaks the CFO’s Language: The 2% Medicare withhold-and-redistribute model means every executive owns a piece of the score — and sellers who speak in the specific language of the four domains land a categorically different pitch.

• TEAM Is Reshaping Surgical Sales Right Now: Mandatory bundled payments make hospitals financially accountable for the full 90-day post-discharge picture, and most competitors aren’t yet speaking the language of episode cost variance, gainsharing, or beneficiary incentives.

• ACCESS Is a Board-Level Conversation: A 10-year chronic care model covering two-thirds of the Medicare population isn’t a single sales conversation — it’s a market-shaping event for care management, analytics, and patient engagement companies.

• Rural Health Is a $50 Billion Underbuilt Market: Federal investment is reshaping what rural hospitals can afford, and the competitive landscape is far less crowded than urban markets for sellers who actually speak critical access and Rural Emergency Hospital language.

• IOTA Turns Transplant Conversations Into Revenue Conversations: Up to $15,000 per case in upside payments means every transplant program leader is paying attention — if you can connect your solution to the specific performance metrics.

• Five Questions That Turn CMS Updates Into a Prospecting Calendar: Which hospitals are affected, what’s the exposure, which executive owns it, what does it require them to do differently, and what’s the timeline.

• Programs Compound — and So Does Fluency: Improving readmissions lifts VBP, TEAM, and Star Ratings simultaneously. The gap between hospitals avoiding penalties and those building real strategy has never been wider, and neither has the opportunity.

• This Week’s Fluency Move: Pull the most recent HRRP penalty data, identify the three accounts in the highest tier, and write one sentence that connects your solution to a specific driving condition in the language of the program. If you can’t write it cleanly, you’ve found the next gap to close.

To learn more about Lisa’s work visit –

Lisa’s website

Healthcare Sales Masterclass Training

Fluent In Healthcare Training

About Lisa T. Miller, MHA

Lisa T. Miller is a healthcare strategist, commercialization advisor, and former CEO of VIE Healthcare Consulting, a firm she founded in 1999 and grew into one of the Top 10 healthcare consulting firms in the United States. In 2022, VIE was acquired by Morgan Stanley Capital Partners.

Over a 30+ year career, Lisa has built a reputation for closing complex, high-value deals with hospital executives and helping organizations improve financial performance, operational efficiency, and patient outcomes. She developed a proven C-Suite selling framework that combines deep industry knowledge, education-based selling, and precise value articulation—enabling companies to access senior decision makers and secure multi-million-dollar engagements.

Lisa’s work is grounded in a rare dual perspective. She has spent decades inside hospitals advising CEOs, CFOs, COOs, and service line leaders on critical operational and financial decisions, while also building and scaling a national consulting firm that competed successfully against much larger organizations. This gives her a clear understanding of how healthcare organizations function—how decisions are made, where initiatives stall, and what drives action at the executive level.

Today, Lisa advises healthcare organizations and companies that sell into healthcare on strategy, growth, and commercialization. Her focus is on helping leaders translate complexity into clear decisions, align solutions with what health systems value, and pursue opportunities that drive measurable impact.

Dreamdata reran their B2B buyer journey research this year and quietly reset every benchmark commercial teams have been working against. Eighty-one percent of the buying cycle now happens before a buyer ever talks to a salesperson, up from seventy percent last year. The complexity inside that pre-sale window is accelerating just as fast.

The new numbers:

• 88 touchpoints in the average buying cycle, up from 76

• 4 channels involved, up from 3.7

• 10 stakeholders shaping the decision, up from 6.8

• 272 days from first impression to closed deal — nine months of you not being in the room (The Wise Marketer)

For anyone selling into hospitals, those figures should change how you think about pipeline. The hospital decision cycle was already the most layered environment in B2B. It has now gotten denser, longer, and almost entirely self-directed in the early phases.

By the time your CFO or VP of Supply Chain takes the call, the decision is largely formed. They have read your competitor’s case studies, asked a peer in their CHIME or HFMA network, watched a webinar from someone in your category, scrolled through your LinkedIn posts, and almost certainly run a few prompts through ChatGPT or Claude to stress test their thinking.

The conversation you thought was the start of the deal is closer to the middle. Often the end.

What 88 Touchpoints Actually Look Like Inside a Hospital

The Dreamdata benchmark is conservative for healthcare. A typical health system evaluation now moves through a clinical champion, an executive sponsor, supply chain, finance, IT, compliance, legal, a value analysis committee, an infection prevention review for anything touching the patient, and increasingly a chief AI or transformation officer. Ten stakeholders barely covers it for any meaningful capital purchase or service line decision.

Those stakeholders are not coordinating. They are gathering information independently, mostly through content, and arriving at the table with their own conclusions already formed. Your job between the first signal of interest and the first call is to make sure the version of you that lives in their heads is the version you would actually want representing the deal.

Most sellers have no idea what that version looks like, because they have never audited it.

What Hospital Leaders Are Carrying Right Now

Every C-suite conversation I have had this year keeps returning to the same set of pressures, and they are all converging at once.

Margins. New CMS Regulations. Workforce.

Seventy-two percent of hospital CFOs report operating margins of two percent or less, and Kaufman Hall’s January data shows the new year began with depressed margins, lower volumes, higher labor spend, and rising bad debt.

The CMS TEAM model went live January 1, 2026 — five years, mandatory, bundled payments across five surgical episodes for selected hospitals — and most participants are not operationally ready.

The HCAHPS overhaul is reshaping how patient experience translates into reimbursement under VBP. Workforce shortages persist that no signing bonus is solving. Cybersecurity exposure that the Change Healthcare attack made impossible to ignore. AI adoption pressure with no clear ROI playbook. Site of service economics moving volume out of inpatient and into ambulatory.

Each one of those is a board-level conversation. Most CFOs and COOs are juggling all seven at the same time while running the day-to-day. They have less time to take vendor calls than they did three years ago, and far more sources of information competing for the time they do have.

This is the environment in which “build a content engine” became the dominant marketing prescription across healthcare technology, devices, and services. It is also the environment in which most of those engines are quietly failing.

Why the Content Engine Model Keeps Failing

The current thinking is - buyers self-educate, so produce more for them to consume. Add posts. Add webinars. Add white papers. Add podcasts. Hire an agency. Spin up a content factory.

The factory optimizes for output, not impact. Cadence, quantity, pieces shipped per quarter, touches per account. All of it gets reported on dashboards. None of it consistently shows up in pipeline.

What hospital buyers want is the opposite of volume. They want deep nusanced insights - new innovative ways to help solve their challenges. They want a vendor who understands bundled payment structure better than their internal finance team does. They want frameworks they can take into their next executive meeting. They want a peer-level take on what hospitals three states over are doing about workforce, HCAHPS, or surgical bundles.

The most expensive content mistake healthcare commercial teams are making right now is producing more material that no hospital leader actually needs.

What High-Value Content Looks Like to a Hospital Buyer

Think about content the way a product team thinks about a software release.

Every feature is built for user impact. Every release teaches the team something that gets folded back into the next one. The product gets smarter over time.

Content for hospital buyers should work the same way. Each piece should earn its place in a CFO’s week. It should tell them something they did not already know, give them a structure they can use, or sharpen them for their next executive conversation.

Three qualities separate content that compounds from content that disappears.

It speaks at peer level. Hospital C-suites do not need vendors explaining HRRP or VBP to them. They need vendors who can engage with the second and third-order implications of policy changes most analysts have not yet surfaced. If your content could have been written by a marketing intern with a search engine, it will be read like one.

It carries a point of view. The most shared content among hospital leaders right now is sharp, opinionated work from people willing to take positions on TEAM readiness, HCAHPS strategy, and where capital should and should not be deployed. Generic best-practice content disappears the moment it lands.

It builds infrastructure rather than calendar fill. Each piece should leave something structural behind that makes the next conversation easier. A framework someone references in a board meeting. A model that gets forwarded internally. A point of view that travels through the CHIME, HFMA, ACHE, and AONL networks where your buyers actually live.

The Question No One Is Auditing: What Are Your Buyers Asking AI About You?

There is a layer of the eighty-one percent that almost no commercial team is measuring, and it is the layer where the most consequential conversations are now happening. Your buyers are not just reading content. They are asking ChatGPT, Claude, Perplexity, Gemini, and Google AI Overviews to do the work for them.

The data on this is no longer speculative. Thirty-two percent of B2B buyers now use generative AI tools as much as traditional search when researching vendors.

Forty-seven percent are using AI for market research and discovery, thirty-eight percent for shortlisting vendors, and thirty-three percent to engage with them directly.

Forty-five percent of B2B buyers said they used AI during a recent purchase, and sixty-seven percent now prefer a rep-free buying experience.

Gartner is projecting that by 2028, ninety percent of B2B buying tasks will be AI-handled — not AI-assisted, AI-handled.

The behavioral shift underneath those numbers is even more striking. The average Google user runs about four searches a day. The average AI user submits in the neighborhood of thirty-four prompts a day. Your buyers are not asking the AI one question about your category. They are asking it twenty, in conversation, with follow-ups, refinements, and cross-checks. By the time they finish a session, they have something close to a private analyst report. Your name is either in it or it is not.

In healthcare, the prompts have already evolved past “best vendors for X.” Hospital CFOs, supply chain leaders, value analysis chairs, and chief AI officers are asking questions that tie directly to the regulatory and financial pressures they are actually managing:

· Which medical device companies help hospitals reduce costs under TEAM bundled payments?

· What vendors have a defensible ROI story for the LEJR episode under TEAM?

· Who actually understands the HCAHPS digital transition and can help us protect VBP revenue?

· Which RPM platforms are being used by TEAM-mandated hospitals for the thirty-day post-discharge window?

· What companies should a system CFO talk to about workforce technology that does not require a five-year payback?

· Which AI vendors do health systems regret buying, and why?

If you do not know whether your name comes up in those answers, you do not know what is happening in the most important sixty seconds of your buying cycle. And almost no one in healthcare commercial is auditing this yet.

Why This Is Structurally Different From SEO

The instinct most marketing teams have is to treat AI search like another SEO channel. It is not. The mechanics are different in ways that change the playbook.

The answer is the result. In Google, you compete for clicks against ten blue links. In ChatGPT, there are no ten blue links. There is one synthesized answer with a small handful of cited sources. Perplexity averages 7.5 cited domains per answer; ChatGPT averages 4.1. If you are not in those four to seven slots, you are not in the consideration set. There is no page two.

Citations behave differently across engines. Perplexity shows numbered, ranked sources inline on every answer. ChatGPT cites sparingly and sometimes not at all. Claude hedges its recommendations and names brands more cautiously. Google AI Overviews collapse their citations behind a link count. Each engine selects sources from a different mix of signals, which means a brand can be visible in one and invisible in another. Cross-engine averages hide what is actually happening.

Recognition and source authority are two different battles. A buyer can hear your name mentioned in a ChatGPT answer without your domain being cited as the source. The reverse is also true. Winning one does not solve the other. Most teams are not even tracking the difference.

The signals that drive citations are not the signals that drive Google rankings. AI engines reward content that is structurally chunkable, FAQ-shaped, comparison-shaped, schema-marked, and that lives on domains the model already trusts as authoritative in your category. A blog post designed to rank for a keyword is often the wrong shape to be cited in an answer.

Personalization quietly distorts what teams see. When a marketing team prompts ChatGPT from their work account to check whether their brand shows up, they are seeing a personalized answer shaped by their own search history. The buyer asking the same question from a hospital network is seeing something else entirely. If you are auditing without a clean room, you are auditing a flattering mirror.

How to Actually Figure Out What Your Buyers Are Asking

This is the part most teams skip. They jump to optimization before they have done the diagnostic work. The right sequence is reverse first, then audit, then build.

Reverse-engineer the prompt set. Sit down with your sales leaders, your sharpest reps, and one or two friendly customers if you have them. Build a list of fifty to one hundred prompts a real hospital buyer would actually type — not the prompts your marketing team wishes they would type. Group them by buyer role (CFO, COO, VP Supply Chain, value analysis chair, chief AI officer, clinical champion), by buying stage (problem-aware, solution-aware, vendor-aware, decision-stage), and by the pressure that triggered the search (TEAM readiness, HCAHPS exposure, workforce, cybersecurity, capital allocation). The prompt set is the audit instrument. Get this right and everything else follows.

Run those prompts across all four engines in clean conditions. ChatGPT in a temporary chat with memory off. Perplexity in a private window. Claude in a fresh conversation. Gemini and Google AI Overviews from a logged-out browser. Run each prompt the same way every time, log the answer, log the sources cited, log whether your brand was named, log which competitors were named, log which categories of source the engine pulled from. This is tedious and it is also the highest-leverage research a healthcare commercial team can do this year.

Score every answer on three layers. First, brand recognition — were you named at all? Second, source authority — was your domain cited as the source the answer leaned on? Third, narrative accuracy — when you were named, was the thing it said about you the thing you actually want hospital buyers to believe? A surprising amount of the time, the AI is naming brands but mischaracterizing them. That is a fixable problem only if you know it is happening.

Map competitive citations. The domains that show up next to yours, and the domains that show up instead of yours, are telling you what the model treats as authoritative in your category. Almost always it is a mix you would not have predicted — a regulatory primary source, an analyst piece you forgot existed, a peer-reviewed study, one specific competitor’s resource page, occasionally a Reddit thread or a niche newsletter. That mix is the actual editorial board for your category right now. Your job is to be on it.

Look at the gaps as a content strategy, not a vanity metric. The most useful output of this audit is not a score. It is a list of prompts where you are invisible, prompts where you are mentioned but mis-described, and prompts where a competitor owns the answer cleanly. Each of those is a content brief. A real one. With a defined buyer, a defined intent, and a measurable target.

Re-run the audit on a cycle. AI engines update their indexes constantly. Citation positions move. Competitors publish. Models change behavior. A one-time audit is a snapshot of a moving target. The teams that win this are running a quarterly cycle at minimum, and the most aggressive ones are running monthly.

What This Means for Healthcare Commercial Teams Right Now

The hospital buyer asking ChatGPT which RPM platforms are TEAM-ready in May 2026 is making a decision that will be largely formed before any vendor knows the question was asked. That is the new front of the buying cycle. It is also where the biggest gap currently exists between the teams who are paying attention and the teams who are not.

Most healthcare commercial teams are still operating as if the funnel begins at the form fill. It does not. It begins at the prompt. The teams that build a disciplined audit cadence on what their buyers are asking AI engines, and a content infrastructure designed to be cited rather than ranked, will own a structural advantage in this market for the next several years. The window on that advantage is open right now and closing fast.

Three Things You Can Do This Week

Here is what to actually do between now and Friday.

1. Run the Stakeholder Mirror Test on your last three closed-lost deals.

Pull the last three deals you lost in the final stages. For each one, list every stakeholder you know was involved. Then list every piece of your content, every LinkedIn post, every email, every webinar that stakeholder plausibly saw before the decision. If the answer for any stakeholder is “nothing,” that is your gap. If the answer is “two LinkedIn posts about our product features,” that is a worse gap. The goal is not attribution. The goal is to see, honestly, what version of you was in the room when you were not.

2. Write one piece this week that no one else in your category could have written.

Not a product post. Not a “five tips” post. One piece — eight hundred words is plenty — that takes a defensible position on something a hospital CFO is wrestling with right now. TEAM target price methodology. The HCAHPS digital transition. The cybersecurity insurance cliff. Site of service economics in your specialty. The test: if a competitor’s marketing team could have written it, do not publish it. If a CFO could forward it to their CEO without embarrassment, you are close.

3. Build one reusable piece of infrastructure, not another deliverable.

Pick one frame, one model, or one diagnostic that your buyers can use without you in the room. A four-question TEAM readiness self-assessment. A one-page worksheet that maps a service line’s HCAHPS exposure under the new methodology. A capital allocation lens for AI investments tied to specific reimbursement levers. Build it once. Put your name on it. Let it travel. The piece of paper that ends up on a CFO’s desk three months from now is worth more than thirty posts that get a polite like.

What I Can Offer That Most People Cannot

Over 25 years inside hospital operations means I read commercial content the way a CFO reads it — looking for whether the writer actually understands how the building works.

Here is what I am opening up to a small group of healthcare commercial teams this quarter:

The Hospital Buyer Content Audit. I will personally review up to ninety days of your outbound content — LinkedIn, email sequences, white papers, webinars, sales decks — and tell you, line by line, what a hospital CFO, COO, VP of Supply Chain, and value analysis chair would actually do with each piece. Read it. Forward it. Roll their eyes. Delete it. You will get a marked-up file, a one-page summary of what is working, what is invisible, and what is actively hurting you, and three specific pieces of infrastructure I would build first if I were running your commercial team.

This is not a content audit from a marketing agency. It is a buyer-side audit from someone who has sat across the table from your buyers for a quarter century.

The Hospital Buyer AI Search Audit. This is the companion offering, and for most teams it is the more urgent one right now. I will build a healthcare-specific prompt set tailored to your category and your buyer roles — CFO, COO, VP Supply Chain, value analysis chair, chief AI officer, clinical champion — and run it across ChatGPT, Claude, Perplexity, Gemini, and Google AI Overviews under clean conditions. You will get a written report covering: where your brand is named and where it is invisible, where your domain is cited as a source and where competitors own the citation slots, where the AI is mis-describing what you do, which prompts are owned cleanly by a single competitor and why, the actual editorial board of your category (the domains the models trust most in your space right now), and a prioritized list of the specific content pieces and structural fixes I would build first to start moving the needle. This is the diagnostic almost no one in healthcare commercial has run yet, and the teams that run it first are the ones who will own the next several years of pre-sale visibility.

Both audits can be run separately or stacked. Stacked is the version I would push you toward, because the AI search audit tells you what your buyers are actually asking, and the content audit tells you whether what you are publishing answers it.

If you are interested in either one, message me directly on LinkedIn at https://www.linkedin.com/in/lisamiller at lisa@lisatmiller.com.

I am taking a limited number this quarter.

The Question Worth Sitting With This Week

If you sell into hospitals, the hardest question to sit with right now is whether the content you are producing would meaningfully sharpen the thinking of the executive you are trying to reach.

Not whether it is on brand. Not whether it shipped on schedule. Whether it would actually move them.

Most of what gets produced fails that test. The commercial teams that pass it are the ones building the next decade of pipeline.

If you want a deeper read on how this specifically plays out for medical device, life sciences, and healthcare technology companies, I wrote a longer companion piece on this earlier this year that is worth reading alongside this one: How Medical Device and Life Sciences Companies Can Use AI Search to Win Hospital Contracts in 2026.

— Lisa

The 5 Forces Behind Almost Every Hospital Decision

One of the things I love about selling to hospitals is that it rewards people who are willing to think deeply.

This is not a market where surface-level messaging wins for long. Hospitals are complex. The people leading them are balancing financial pressure, clinical priorities, operational realities, market dynamics, and constant change. That is exactly why the sales professionals who rise to the top are the ones who learn how to see the bigger picture.

Over the years, I found myself coming back to the same pattern. There were five forces showing up again and again behind hospital decisions. Once I began organizing my thinking around those forces, it changed the quality of my conversations, the kinds of questions I asked, and the way I helped clients position their solutions.

For high-performing salespeople, this framework is incredibly useful because it helps you move from presenting a product to understanding a decision.

Force 1: Alignment to payment models

If you sell to hospitals, one of the best investments you can make is learning how the organization gets paid.

That may sound basic, but in practice it is one of the biggest differentiators. The strongest salespeople do not stop at a high-level understanding of reimbursement. They study payment models closely enough to understand what those models are encouraging hospitals to do differently.

When CMS or Medicare introduces a new model or expands an existing one, it usually shifts priorities. It can change how hospitals think about coordination, outcomes, physician alignment, post-acute strategy, cost, and risk. In other words, it shapes what becomes important.

That is why this force matters so much. When you understand the goal behind the payment model, you can position your offer in a way that feels timely and relevant. You are no longer simply describing a solution. You are showing how your solution supports success in the environment hospital leaders are already navigating.

That is a much more strategic conversation, and hospital executives can feel the difference immediately.

Force 2: Alignment to regulations

The second force is regulation. While this one can feel technical, it is often one of the clearest paths to relevance.

Hospitals operate in a highly regulated environment, and those requirements influence urgency. Whether the issue is price transparency, cybersecurity, supply chain expectations, reporting obligations, or another compliance-related pressure, regulations have a way of moving priorities to the top of the list.

For salespeople, the opportunity is not to lead with fear. The opportunity is to lead with understanding.

When you can show that you understand what a new regulation means operationally, financially, or strategically, you become more credible. If your solution can reduce burden, simplify execution, improve readiness, or help a team respond more effectively, then you are contributing something that is genuinely useful.

That is an important distinction in hospital sales. The best messages do not just describe value in abstract terms. They connect directly to what leaders are being asked to manage right now.

Force 3: Alignment to aspirations

This is the force I believe people overlook most often, and yet it is one of the most human.

Hospitals are institutions, but decisions are still made by individuals. Those individuals have goals. They have milestones they are trying to hit. They have internal expectations, incentive plans, and career ambitions. They want to make progress. They want to be seen as effective. They want to lead important work well.

I saw this clearly years ago after speaking at a hospital association event. A finance leader approached me, and as the conversation developed, it became obvious that the opportunity was not only about helping the organization. He also wanted to grow into a CFO role. If he could bring in the right partner, create meaningful results, and be known internally as someone who drove change, that mattered.

That was such an important reminder. When you understand what success looks like for the person across from you, your conversations become more thoughtful and much more effective.

You begin asking better questions. What are you responsible for this year? What are you trying to improve? What would make this initiative meaningful for you and your team? Those are the kinds of questions that create trust.

And when you help your customer succeed as a person, not just as a title, you create a deeper kind of alignment.

Force 4: Alignment to competition

Hospitals are also far more competitive than many people realize.

They are competing for patients, physicians, service-line growth, reputation, market share, and strategic position. In many markets, leadership teams are constantly thinking about how to protect their strengths, where to grow, and how to become more differentiated.

That creates a very powerful opening for the right salesperson.

If your solution can help a hospital strengthen growth, improve access, protect referrals, enhance its reputation, or become more distinctive in the market, that should be part of your story. Sometimes what looks like an operational improvement on the surface has a much bigger strategic impact underneath.

I think this is especially important for people selling into highly competitive regions. Hospital leaders are not only trying to solve problems. They are also trying to build something stronger. They are trying to lead. They are trying to win in their market.

When you understand that, your message becomes more compelling because it connects not only to operational value, but to strategic ambition.

Force 5: Alignment to unique operational pressures

The fifth force is where strong salespeople really separate themselves.

Every hospital has unique pressures shaped by its community, geography, payer mix, local market conditions, service mix, and strategic activity. One hospital may be dealing with a high Medicaid population. Another may be preparing for hurricane season. Another may be expanding services, managing staffing constraints, or addressing a recent penalty or performance issue.

This is why research matters so much.

The most effective salespeople do not stop with the website or a short company profile. They look at public information, local news, strategic developments, filings, cost reports, community trends, and other signals that help them understand what that specific organization is managing.

When you do that work, you are able to ask questions that feel relevant and informed. You show up differently. You are not talking to a generic hospital profile. You are speaking to a real organization with real priorities at a specific moment in time.

That is often where momentum begins.

Why this framework matters

What makes this framework so effective is that it helps you think more expansively about alignment.

The strongest hospital sales conversations usually touch more than one force. A solution may support a payment model, ease a regulatory burden, and help an executive deliver on a key initiative. It may strengthen market position while also solving a local operational challenge. The more clearly you can connect your offer to what the hospital is already trying to accomplish, the stronger your positioning becomes.

That is why I believe this matters so much for high performers. It gives you a way to prepare better, ask smarter questions, and create more meaningful conversations with hospital leaders.

If you want to elevate how you sell to hospitals, start here. Study the forces shaping the decision before the decision is made. Learn what leaders are navigating. Learn what they are measured on. Learn what the market is asking of them. Learn what they are trying to build.

When you do that, you do more than improve your pitch.

You become the kind of sales professional hospital leaders want in the room.

Healthcare Sales Training That Translates CMS Policy Into Hospital Deals:

Fluent in Healthcare