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Happy Friday, fam!

Today, in honor of the Thanksgiving season, I'll be sharing what I'm thankful for in healthcare. But before we get started, a few housekeeping items:

If you haven't filled out this industry events survey yet, would you do me a huge favor and take 2 minutes to respond? We're planning our Hospitalogy events calendar for 2026 and I want to meet up with as many of you as possible!
Speaking of which… We're hosting 4 IRL Hospitalogy meetups across the country NEXT WEEK on Dec 5th!! If you're in Dallas, Nashville, NYC, or Chicago, click here to reserve a spot.
I hope you enjoyed Tuesday's "What If Healthcare Had Black Friday Deals?" article. While those healthcare deals weren't real, this mug is! It's the perfect gift for yourself, your "white elephant" gift exchange, or the knee-curious person in your life. Pre-order yours so you get it in time for the holidays.

Let's get into it.

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BLAKE'S BREAKDOWN

What I'm Thankful for in Healthcare

Being grateful in healthcare can feel a little unhinged.

When I look back over the past few years of writing Hospitalogy and talking with many of you, I am genuinely thankful. Not in the "corporate values slide" kind of way, in the "this strange, broken system is full of people who keep showing up anyway" kind of way.

So here is what I am thankful for in healthcare right now.

I am thankful for the people who keep the lights on in an absurd system

Across hundreds of conversations, DMs, and survey responses, one theme keeps coming back: nobody is phoning it in.

Health system CEOs walking me through 1% operating margin improvements that took two years of hand-to-hand combat. Rev cycle leaders trying to do RCM without turning into cartoon villains. Population health execs who spend their days stitching together five data sources just to find the right patient list.

One nonprofit CEO said something to me this year that has stuck in my head:

"We are not chasing EBITDA, we are chasing enough oxygen to keep the mission alive."

That sentence sums up so much of the tension you all feel.

You guys sit in board rooms where the slide says "Mission" on the left and "MLR" on the right and your job is to reconcile that contradiction in the middle. The fact that many of you still default to "what is right for the patient" first is something I will never take for granted.

I am thankful that even with all the nonsense, the default setting for a huge chunk of this industry is still "try to do the right thing."

I am thankful for the builders who are quietly changing the game

If you zoom out over the last few years of Hospitalogy deep dives, there is a pattern.

Behind the loud press releases and cheesy booths, there are operators and founders doing very unsexy work:

Turning diabetic eye exams into a workflow that actually happens
Cleaning up documentation so doctors can practice at the top of their license instead of the bottom of their inbox
Building real VBC infrastructure inside health systems that were designed for DRGs, not downside risk

At HLTH this year, the line I kept hearing was some version of:

"AI is only interesting if it actually changes the P&L and gives people their time back."

That is the energy I am thankful for.

Not "AI for vibes", but AI as a way to pull revenue cycle out of the gray zone, to surface diagnoses that were buried in the note, to give nurses ten minutes back so they can talk to a patient instead of a screen.

I am thankful for the operators who insist that tech must earn its place in the workflow and on the income statement.

I am thankful for people who tell the truth, even when it annoys their own side

Healthcare is full of sacred cows and carefully worded talking points. You all know this dynamic.

I have lost count of the number of times a senior leader has said to me on or off the record:

"If we actually priced our contracts the way the press release sounds, we would be bankrupt in 6 months."

Or the health plan exec who said:

"Our biggest risk is not regulation; it is the day hospital CFOs realize they should stop signing our 80-page specials with a blindfold on."

Those are the people I am thankful for.

The folks inside big incumbents who quietly send me their read of a deal. The actuary who DMs me to say "that study everyone is citing is garbage." The clinician who replies to a newsletter and writes three paragraphs explaining how a policy actually lands in the clinic on a Tuesday afternoon.

I am thankful for the internal dissidents and polite troublemakers who keep us honest about what is working and what is theater.

I am thankful for this weird little corner of the internet we built together

When I joined Workweek in early 2022 and sent the first Hospitalogy email to around 2,000 people, I had no idea whether anyone would care.

By the end of 2022, there were 13,000 of you.

By the end of 2023, there were 23,935 of you.

This year we crossed 50,000+ subscribers.

Open rates have bounced around from 55%–65% in earlier days to closer to 47%–50% now as deliverability games evolve and Apple keeps doing Apple things. But the gray line on the chart, the total unique opens, keeps drifting up.

That line represents the one thing I care about most: actual humans opening the email, reading, thinking, arguing, sending it to their teams, or using it in a board deck.

On top of that, the Hospitalogy brand is on track for around $800k–$1M in revenue this year between ads, membership, and products. That is a wild sentence to write for a kid who just wanted to nerd out about health system strategy.

The only reason this newsletter and this membership platform exist is because you all keep showing up. You open the email when your inbox is a war zone. You whitelist the domain when IT decides that Hospitalogy is apparently a national security threat. You forward issues to your CFO or CMO. You take calls with sponsors when the offering is relevant instead of rolling your eyes.

I am deeply thankful that thousands of very busy, very serious healthcare people have chosen to make room for this newsletter in their week.

And yes, that includes the folks who only read "Miscellaneous Maddenings." You are my people, too.

I am thankful for the Hospitalogy Membership and the folks pushing it to be better

The community survey we ran this fall was a humbling read.

You told me clearly what matters:

Practical, operator-grade takeaways
Honest, unfiltered conversations
Real stories from the trenches
IRL and live sessions that feel like they could not have happened anywhere else

You also told me what is not working yet. The feed sometimes feels quiet. The "how do I jump in" moment is not always obvious. Many of you did not even realize you could host events or share your own content.

That feedback stings a little, in a good way. It means the foundation is there, but the potential energy has not fully converted into kinetic energy yet.

I am thankful that you care enough to critique this community instead of silently drifting away.

I am thankful for the 9% of members who have raised their hand and become paid members while 91% hang out in the broader ecosystem. That split tells me there is both trust and responsibility here. I owe you real value, not just vibes.

I am very thankful for the first ever Hospitalogy in-person event in September

This year, something shifted from theory to practice.

On September 18, we put 50 value-based care leaders in a room at Hotel Magdalena in Austin for the first ever Hospitalogy Retreat. No giant expo floor. No army of badge scanners. Just a group of operators, innovators, payor leaders, and health system execs talking candidly about risk, MA headwinds, specialty bundles, and what it actually takes to make VBC financially sane.

You guys flew in, carved a day out of your calendars, and trusted that this strange little experiment would be worth it.

We sat in roundtables where people admitted, out loud, things like:

"We are not sure this model pencils out yet, but we are trying anyway."

and

"Our biggest constraint is not the model, it is whether our clinicians believe us when we say this time is different."

Then we went outside, hit golf balls at Butler Pitch 'n Putt, and kept the conversation going in a way you just cannot replicate on Zoom or in a convention center hallway.

To everyone who attended that first Retreat in Austin, thank you.

You helped prove that this community is not just a list of email addresses. This community is a set of relationships that can be built and deepened in the real world. That changes how I think about every future event and every future product.

I am thankful for the fact that healthcare is still full of possibility

Healthcare in 2025 is bizarre.

On one hand, we have insurers playing games with denials that would make a casino blush. We have opaque contracts, PE roll-ups that treat clinicians like interchangeable widgets, and policy whiplash that can erase a business model with one memo.

On the other hand, we have:

Teams building new VBC constructs that try to align economics with actual outcomes
Health systems finally admitting they cannot be all things to all people and recalibrating strategy
Startups focused on real problems, like Medicaid redetermination, behavioral health access, and making sure a patient actually understands their bill
AI tools that, when implemented well, give clinicians time back instead of stealing more of it

I am thankful that the signal is getting louder relative to the noise, and that so many of you are committed to making sure the next decade is better than the last one.

Most of all, I am thankful for you, the Hospitalogists

Whether you have been here since the "2,000 subscribers and a dream" days or you joined last week because someone forwarded you a spicy M&A breakdown, thank you.

Thank you for reading.

Thank you for forwarding.

Thank you for sending me corrections when I get something wrong.

Thank you for disagreeing thoughtfully.

Thank you for trusting me with your time and attention.

You guys know I joke around a lot in these sends, but I do not take any of this lightly. This newsletter and this community exist because a group of serious, overworked healthcare people decided there should be a place where we can talk honestly about strategy, capital flows, incentives, and the weirdness of this industry without falling asleep or losing the plot.

So as we head into the end of the year, here are the questions I am sitting with, and I would love to hear your thoughts:

What are you personally thankful for in healthcare right now, in your corner of the ecosystem?

Where are you seeing real progress on the ground, not just on slides?

What parts of the system are quietly getting better that we do not talk about enough?

Where do you want Hospitalogy and this community to push harder in 2026: more IRL, more operator case studies, more VBC deep dives, something else entirely?

Anyone have intel on under-the-radar organizations or teams who deserve a spotlight because they are actually moving the needle, not just talking about it?

Reply back, send a DM, or bring it into the community. The more we share, the better this whole thing gets.

Happy Thanksgiving season, Hospitalogists!

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