The Department of Veterans Affairs (VA) is currently executing its most significant structural transformation in three decades: the Restructure for Impact and Sustainability Effort (RISE). By consolidating 18 Veterans Integrated Service Networks (VISNs) into five strategic regions, the VA is pivoting toward the elimination of the “Geographic Lottery” with a goal of ending the real and perceived variation in care outcomes based on a Veteran’s assigned VA hospital location. The goal is to ensure that cutting-edge, high-standard, evidence-based therapies are available at every site, from a flagship urban medical center to a remote rural clinic.

The core insight for industry leadership is this: the local win strategy that starts at a single facility with incremental, facility-by-facility adoption has been disrupted and will no longer be a viable driver of national growth. To be clear, the 2010’s model of cascading adoption is still possible, but the mechanism of how it is done is fundamentally different. At the heart of this issue is that a strategy built for 2016 assumes a decentralized authority that no longer exists; the 2026 reality is a consolidated, top-down clinical hierarchy that is in rapid implementation. To capitalize on this change, manufacturers must prioritize and pivot to three core pillars: data-centricity, national priority alignment, and regional scalability. Without these, your value story remains locally focused in a health system that has a nationalized vision.

Under the RISE model, decisions will scale with unprecedented speed. Once a solution demonstrates its institutional value, the path to implementation across an entire multi-state region will become hard-wired into the system’s operational fabric.

• For the Innovator: This structural change represents a paradigm shift. While the friction of entry will increase as regional standards tighten, the growth ceiling has been removed. A single regional success now translates into immediate, wide-scale access. A win in one of the five new regions grants immediate, high-velocity access to the entire patient population, bypassing the traditional 170-facility rolling grind.

• For the Incumbent: Reliance on legacy relationships or incumbency status is now a high-risk strategy. To maintain market position, existing players must proactively alter course to support this leaner administrative infrastructure. A defensive strategy must be implemented because a loss at the regional level can now lead to systemic displacement.

  
  

The RISE model will create an environment designed to structurally absorb and utilize breakthrough therapies. The manufacturers who succeed will be those who view the 5-Region Reset as an opportunity to become integrated system partners.