When Washington Stalls, Care Can’t: How ACOs Can Build Resilience Beyond Federal Funding

Government shutdowns are no longer rare anomalies; they’ve become recurring interruptions in federal operations. For healthcare organizations, particularly ACOs and value-based care (VBC) providers, the stakes are high. Care delivery does not pause because of political gridlock. Attribution lists remain active, quality benchmarks continue to track performance, and high-risk populations still require monitoring, outreach, and intervention. Even when Medicare and Medicaid payments continue during a shutdown, operational friction emerges in quieter but significant ways.

How funding disruption manifests in healthcare operations

Previous shutdowns and the ongoing 2025 federal funding halt have highlighted recurring challenges for healthcare organizations:

• Cash flow and reimbursements: While Medicare payments may technically continue, leadership often delays approvals and financial reconciliations, creating uncertainty in cash flow. Shared savings payouts, appeals, and audits may slow down.
• Care coordination staffing: Grant-dependent roles, particularly in community health centers or population health teams, may face hiring freezes, reducing workforce capacity for patient outreach and follow-up.
• Technology and program delays: CMS has reduced operations to critical functions only, pausing policy rollouts, educational initiatives, and new program implementations that support VBC models.
• Data bottlenecks: CMS portals, verification systems, and help desks may be slowed or temporarily unavailable, affecting reporting and compliance activities.
• Decision-making focus: Executive attention often shifts toward risk containment rather than strategic innovation during shutdown periods.

While these disruptions rarely stop care completely, they slow momentum and make consistent execution more challenging under risk-bearing contracts. As Anthony Wright, Executive Director of Families USA, observed, “We shouldn’t need a shutdown to prevent a massive spike in health insurance premiums,” highlighting how political uncertainty can ripple into patient access and affordability.

What history shows

Looking back at previous shutdowns, budget freezes, and policy swings across MSSP and state-based VBC programs, a consistent pattern emerges: organizations that maintain operational consistency even at a smaller scale tend to recover faster and sustain performance. Those that pause initiatives until clarity returns often experience slower rebound and gaps in care continuity.

Bob Riney, President and CEO of Henry Ford Health, and Tina Freese Decker, President and CEO of Corewell Health, have both emphasized the stakes: the shutdown threatens the ability of hospitals and health systems to plan and deliver critical care, especially in vulnerable communities. Their comments underscore a simple truth – while politics may stall, patient care cannot.

Impacts on community health centers and safety-net providers

Community health centers (CHCs) and safety-net hospitals face heightened challenges during shutdowns:

• Service reductions: Some centers may cut services or staff due to revenue uncertainty, placing additional pressure on emergency departments and local health systems.
• Funding gaps: Ongoing revenue cuts, combined with shutdown-related delays, limit operational planning and affect care delivery for vulnerable populations.
• Rural and underserved hospitals: Expiration of rural hospital support programs and proposed Medicaid add-on reductions create financial strain, potentially affecting staffing and infrastructure investments.

These realities reflect what many leaders have voiced publicly: the shutdown’s impact extends beyond administrative inconvenience. It directly affects the continuity and reach of healthcare delivery.

Operational patterns that support continuity

Across shutdown cycles, healthcare organizations that sustain operations under uncertainty tend to rely on four foundational practices:

1. Protect revenue integrity

• Automate claims processing, eligibility checks, and coding validation to reduce financial friction.
• Minimize avoidable revenue leakage before delays occur by establishing early reconciliation routines, proactively identifying high-risk claims, and ensuring encounter data is complete and accurate across all risk contracts.
• Leverage dashboards or control towers to monitor potential payment gaps in real time, so corrective action happens before delays impact cash flow.

2. Standardize care coordination

• Create repeatable outreach cadences, escalation steps, and documentation pathways that function independently of staff availability.
• Leverage workflow automation to maintain patient follow-up and monitoring.

3. Maintain real-time visibility

• Monitor patient cohorts, contract exposure, and provider performance consistently.
• Access to timely data allows leadership to respond with precision rather than reactively guessing at risk.

4. Consolidate infrastructure

• Integrate care coordination, documentation, analytics, and reporting into a unified system.
• Reduce dependencies on multiple disparate tools that can misalign during operational stress.

As Anthony Wright notes, uncertainty shouldn’t translate into stalled operations: “We shouldn’t need a shutdown to prevent a massive spike in health insurance premiums,” emphasizing the real-world consequences of delayed action.

Resilience beyond federal funding

Shutdowns and political volatility are inevitable. The organizations that thrive are those whose operational continuity does not depend on policy stability. Care delivery should remain consistent, cash flow monitored, and patient engagement uninterrupted regardless of federal disruption.

To build this resilience, healthcare leaders can focus on actionable measures: audit and automate revenue cycle processes, standardize care coordination workflows, centralize real-time visibility across patient populations and contracts, and consolidate fragmented systems into unified operational infrastructure. By taking these steps proactively, healthcare organizations can sustain care quality, protect financial performance, and minimize disruption to patients, even in the face of federal uncertainty.

As Bob Riney and Tina Freese Decker highlighted, the ongoing funding uncertainty demonstrates that patient care, not politics, must drive organizational priorities. Infrastructure, not crisis reaction, defines resilience. By observing patterns from past shutdowns and implementing workflows that sustain activity during uncertainty, healthcare organizations can continue delivering value to patients while navigating federal funding volatility.

How prepared is your organization to maintain continuity when external factors disrupt funding? Consider evaluating the resilience of your workflows, systems, and care coordination processes today.