The healthcare industry simultaneously faces tipping points from the outside and within. Customers and funders have reached a point of exasperation with cost and experience challenges, and social and political support for the industry is crumbling. The industry’s incremental approach to transformation is proving unsuitable to meet the current moment of runaway spending and proliferating technology influences.

In this high-pressure environment, core assumptions about how healthcare businesses operate are unraveling, most acutely around access enablement, spend management, and clinical decision-making. Though the One Big Beautiful Bill Act will bring a sea change to public healthcare funding, a broader look at the industry shows that there is not just one force driving disruption. Instead, today’s shifts represent an evolution in control over care delivery — diffusing from traditional incumbents to many different groups.

This report explores how diffusing responsibility, ownership, and influence create new, uncertain dynamics for healthcare organizations to navigate. Leaders must account for the stakeholders exerting new power and the spillover effects within regional ecosystems. At the same time, leaders must provide clarity for their own organizations, even in the absence of consensus around strategies for the industry.