Delivery infrastructure has long been designed around hospitals. However, the fragile finances of health systems and increasing number of mergers and acquisitions foster a transition toward care delivery governed at the ecosystem level by national conglomerates. Regional incumbent providers and plans must harness their local advantages to both compete and partner with growing ecosystem players.

Insight #1: Patient health and access are far worse as healthcare emerges from the pandemic.

The ongoing tension between the mission of serving patients and the realities of the healthcare business is intensifying, resulting in deteriorating patient access, quality, and safety. Healthcare leaders must reassess their role and responsibility to their patients, particularly as nontraditional players target profitable customer segments.

Insight #2: Health systems seek long-term durability.

Elevated supply and labor costs, as well as structural revenue pressures, are forcing all health systems to enhance their operational disciplines. Select systems are looking beyond traditional growth avenues like M&A to novel but untested strategies that may unlock protective scale and long-term resilience.

Insight #3: Ecosystem players will configure their assets to guide patient behavior within a market.

Acquisitive national conglomerates seek to oversee local ecosystems of care. The success of their aspirations will not necessarily be determined by scale. Instead, conglomerates’ success will hinge on their ability to bring together assets within a geographic market that both complement — and outcompete — existing care patterns.

Insight #4: Medicare Advantage attracts continued investment despite a tightening business model.

Large plans and retailers continue to make significant investments to keep up with the evolving care delivery and management demands of the program. Organizations heavily investing in Medicare Advantage will aim to better align with specialists to manage costs as local network dynamics change.

Care team roles historically have relied on adding and overextending labor resources. However, the current workforce crisis is intersecting with rapid advancements in technologies such as artificial intelligence (AI) to create an opportunity for true technology-enabled, top-of-license care. Technology will become a part of the care team. The only question is how technology-dependent the care teams will become.

Insight #5: The clinical workforce shortage is a chronic condition for the industry.

Leaders cannot expect an increase in labor supply in the foreseeable future, so they must balance labor cost management with strategic growth enablement. A permanent workforce shortage requires a comprehensive strategy to prepare for growing worker demands and to redesign job responsibilities.

Insight #6: Purposeful technology investments can alleviate workforce pressures.

Unlocking technology’s potential to extend the reach of the care team requires strategic implementation that aligns with broader organization-wide goals and enlists clinician input. As technology inevitably becomes a member of the care team, leaders must redefine roles, training, and compensation accordingly.

Insight #7: Artificial intelligence is a strategy enabler, not a strategy in itself.

Recent advancements in AI capabilities have sparked a frenzy of interest across healthcare — and an onslaught of reactive technology-centric business plans. Effective AI adopters will prioritize integrated governance over isolated initiatives, enabling them to harness fast-changing technologies as tools to support core strategic endeavors and to incorporate data as a key competitive asset.

Treatment economics have traditionally been structured around procedures, relying on management strategies that direct patients to providers based on standardized cost and quality factors. However, the growing array of transformative, high-cost, and personalized therapies and diagnostics offers the possibility of tailoring treatments for each individual patient and ushers in a new era of bespoke care. This shift toward a more customized treatment portfolio with longer time horizons and more complex administration will require new delivery, management, and financing strategies.

Insight #8: High-cost drugs will increase the complexity of care delivery, not just its cost.

Recent pharmaceutical breakthroughs have massively expanded the frontier for drugs in patient care and raised concerns about the portfolio of high-cost therapies as a whole. The daunting complexity of these new drugs hinders many organizations from understanding and rapidly adapting to the unique impacts these treatments will bring to competition, care patterns, and clinical decision-making.

Insight #9: The growing collection and use of real-world patient data will make proactive, personalized patient care possible.

To practically and equitably harness this diverse patient data, organizations must establish more robust systems to integrate and protect data from fragmented, real-world evidence sources. In addition, clinicians must navigate heightened expectations for comprehensive, patient-centric care decisions.

Insight #10: Revolutionary treatments undermine traditional drug cost management tools.

Private payers continue to develop experimental financing models, while the federal government takes landmark cost management action on Medicare. These payment initiatives will motivate shifts across pricing, product, and utilization management strategies that may ripple out to insurance premiums, provider revenues, and manufacturer portfolios.

Insight #11: Employer coverage decisions today will set the pace for the industry’s overall adoption of bespoke care.

Employers’ health benefit spending is becoming more volatile than the steady, incremental rate increases of the past. The aim of employers is to influence care choices so they can balance employee disruption with cost savings. Most employers will make unique, ad hoc coverage decisions for innovative therapies — setting a patchwork of precedents for the entire industry.

The familiar shifts away from hospital-centric care, overextended clinicians, and standardized procedures at scale paint a vision of a radically different future in healthcare. It’s a future where ecosystem leaders oversee most care in a market, technology defines top-of-license care, and treatment delivery and management is bespoke to the individual patient.