The healthcare environment will be different by 2035. Challenges facing the industry today will get bigger and major demographic shifts will force stakeholders to rethink their roles and approaches. Business models that operate effectively today are likely to be inadequate in the future as new technologies and therapeutics, as well as ever-tightening financials, spur stakeholders to pick up the pace of transformation.

Demographics

The silver tsunami: The population is aging and the birth rate in the US is falling. The ratio of working age to senior population will hit 2 to 1, down from 4 to 1 in 2015. This shift will increase pressure on healthcare utilization, workforce dynamics, provider economics, federal spending; and tax collection.

Workforce dynamics: A clinician retirement boom looms large. Retirements will contribute to an expected shortage of between37,800 and 124,000 doctors by 2034. At the same time, the rise of the gig economy — set to impact over half of workers as soon as 2027 — and an increasingly fluid and competitive labor market will up the ante for healthcare employers across all sectors.

Consumer expectations: Barring a strong reversal of current socioeconomic and environmental conditions, we will see an increasingly polarized world. Companies will be held to a higher standard and consumers will continue to seek advice in channels they trust — not always from the traditional healthcare players of today. Environmental, social, and governance issues will become critical in the boardroom and C-suite. For healthcare leaders, the imperative to combat health inequity traps will need to become more than talking points.  

Innovation

Tech-enabled care: Technology will improve efficiency and experience. Consumer-facing technologies will continue to grow, with a focus on seamless integration across the care continuum. Tech-enabled health and well-being offerings will allow consumers to engage in their care in more meaningful ways. Increased data interoperability and rapid advancements in artificial intelligence will allow healthcare organizations to improve their insights, automate processes, and drive down costs. Advances in diagnostic technology, medical devices, and medical procedures will make treating complex and acute conditions more efficient and with improved outcomes.

Advancing biopharma science: Pharmaceutical innovation will expand cures for hard to treat diseases such as sickle cell and rare cancers and improve treatment and care plans for conditions such as diabetes, obesity, and Alzheimer’s disease. Pharmaceutical spending is projected to hit $1.4 trillion in 2035, accounting for 16.2% of total healthcare expenditures.

Financial and Economic

Funding crisis: The demographic shift will add to the burden of healthcare financiers. US employers will struggle to accommodate continued increases year over year. But the biggest impact will be felt in government-funded programs. Medicare and Medicaid will serve larger and larger populations, while slow growing coffers will force federal and state governments to look for ways to cover care at lower costs.

Economic pressures: Challenging economics will accelerate a shift away from traditional healthcare economics. Continued adoption of capitated models will necessitate operational and structural changes. Many aspects of our healthcare system need to go through a fundamental transformation in their business models to accommodate and survive the economic pressure cooker that will be the healthcare industry over the next decade. 

Value-based care: We’ll see widespread adoption of capitated and downside risk financial models. Value-based care will become more heavily implemented and integrated with other care models. Payers will also continue to push into care delivery — such as through primary care and home care — in an attempt to control costs.

Healthcare has been characterized by continuous change. Waves of innovation — though perhaps slower than expected and desired — have challenged traditional business models. New insights and methods are constantly being adopted across medical domains, and real healthcare problems are being solved in new ways by incumbents and net new innovators alike. Looking toward 2035, we’ve identified four key vectors where the necessity and opportunity to do things differently will converge and likely accelerate change.

1. A smarter, more efficient industry: Technology and innovation vectors will create step changes in healthcare processes and outcomes.  

Necessity: Growing demand for healthcare that’s convenient and simple to manage. Socio-economic pressures that squeeze profit pools and accelerate the need to pursue business model evolution to achieve necessary increases in productivity, efficiency, and costs. 

Opportunity: Technology can drive gains in efficiency and productivity and allow staff to focus on top of license activities. Adoption of advanced analytics and AI will introduce process automation and more actionable and timely insights, which in turn presents an opportunity to reimagine experiences for consumers and clinicians alike across the value chain. More data and better connectivity will lead to richer understanding of personalised next-best-actions, available when consumers and clinicians not only need them, but in the mode that they want to receive them.

2. Better interventions: New therapeutics and medical advancements in diagnostics and treatment regimens will drastically change optimal care pathways.

Necessity: A growing older population with more complex health needs. Fast-paced research and development pipelines that will offer new breakthroughs. A need for aligned funding mechanisms across pharmaceutical companies, payers, and providers to ensure new curative therapies can reach as much of the population as possible at affordable costs.  

Opportunity: The launch and rapid adoption of advancing scientific approaches will deliver novel cures, enhance the continuum of care, and improve chronic disease management. Oncology, immunology, endocrinology, and neurology are key areas where we will see the greatest changes in outcomes and spending. New clinical protocols and new structures and roles to deliver and to finance these therapies will emerge.

3. Realigning delivery: Utilization patterns will shift with care moving to more optimal settings.

Necessity: Technological improvements are redefining what constitutes a site of care. Traditional profit pools are being squeezed by low funding and increased competition; slumping business models are putting independent physicians, rural hospitals, and various service lines at risk. 

Opportunity: Care will come through a wider variety of mechanisms, often in more cost-effective and convenient ways. The unit cost of many types of care will begin to drop as mix of care modes and sites of care shifts away from expensive hospital settings.  

4. Innovative products: More affordable health plan options will expand in scope and offer more choices.

Necessity: Pressure from employers and government programs drive changes in benefit structures and markets to procure products. Calls for affordability from all types of funders — government, employer, consumer — conflict with demands for more robust and inclusive coverage.

Opportunity: Integration, coordination, and personalization will be the next frontier for healthcare products. Medicare and Medicaid programs will continue to sharpen the performance curve for payers and providers that deeply understand and align their approaches to serve government program enrolees. Seeking to cap their financial exposure, some employers will turn to fixed contributions supported by an evolved and more affordable direct-to-consumer private solution marketplace or through the Affordable Care Act. Other employers will find ways to provide more personalised benefits for various cohorts within their employees, with more importance on well-being, behavioral health, and focused solutions for conditions or health interest. 

New technologies, business models, and processes must be adopted to ensure the needs of specific populations are being met. But it’s not a one-size-fits-all approach. Here are changes we anticipate happening in five critical markets. Each has different core medical needs, reflecting their unique demographics. Each will require a different combination of stakeholders to create new business models, make new investments, and create new economic arrangements.

Silver surfers: Organizations will reconfigure physical assets and retool workforces to focus on last-mile care delivery for seniors. New tools and incentive models will reward formal and informal caregivers to address the necessary expansion of the clinical workforce to serve the burgeoning senior population. Alternative care sites will spring up, helping seniors avoid costly and unnecessary hospital stays.

Savvy consumers: A low friction, on-demand model will become the norm. The quantified self becomes actionable, moving from tracking health to influencing decisions daily. A robust infrastructure makes data — from consumers and healthcare entities — actionable for providers, allowing them to cut through the noise. Behavioral health providers become central to the care team, increasingly partnering and integrating with primary care. Building and retaining consumer trust becomes a corporate priority.

Healthy families: Employers will develop health plan products to accommodate families, extending coverage to include both children and aging parents, offering greater flexibility and tailored solutions that are integrated into their work and lifestyles. Care models that treat the family as a unit to accommodate shared history, coordinated needs, and modality preferences will evolve. Price and quality transparency tools will empower families to become more discerning shoppers and activated consumers of healthcare services. A robust marketplace of direct-to-consumer solutions will exist, allowing consumers to curate their own set of solutions and services that matter the most to them.

Rural communities: Buoyed by new state payment models, rural hospitals will increasingly focus on preventive and outpatient care. Community-based organizations will play a larger role in care delivery by helping providers meet cultural needs of each rural population and consumers will have greater access to at-home, virtual, and mobile care, minimizing disruption in their daily lives and reducing travel to larger tertiary centers.

Urban workers: Funded by government programs and integrated into the broader care infrastructure, community-based organizations will become central pillars of care delivery for beneficiaries. Benefits integrated across medical, behavioral and socio-economic supports will give members the solutions and access they deserve.

We intentionally limited discussion of who will be involved in delivering and realizing the value described in each of the 2035 markets. The identity, scope, and strategic roles of different types of players will evolve and be varied — likely by geography since healthcare will remain intensely local. Big incumbents could take on the transformative ambition of delivering value in new ways. Or innovators and new entrants could grab the lead and take control. Consolidation could create real economies of scale and scope, or the pendulum could swing to favor the nimbleness and local intimacy of smaller players. Capital markets and industry regulators will shape, limit, or expand the possibilities. But for each major stakeholder, there are a set of no-regrets directions that should be on the table. 

Health Systems

Today: A model centered on inpatient episodes and per-encounter fees   

Tomorrow: Systems assess their inpatient operations, focusing on growing operational efficiency and partnering for scale as appropriate

Payers and employers

Today: Competition for a shrinking talent pool drives retention and recruiting challenges as workers demand benefits that better address their needs 

Tomorrow: Payers help employers expand their role beyond strictly offering health benefits, with increased efforts towards guaranteeing access

Biopharma innovators

Today: A product-centric model with limited connectivity between pharmaceutical companies, providers who select and administer therapies, and payers who cover the treatments 

Tomorrow: Pharmaceutical companies engage in more partnerships with other stakeholders and become involved throughout the care journey, facilitating delivery in novel ways

As we push forward in these directions, industry players will quickly run into norms, structures, and guardrails that have shaped the industry as it exists today. There are at least two primary areas that will significantly influence the pace of change. The first is developing the workforce that’s needed to meet the new demands. That means improved training capacity and focus for new roles, consistent and transferable credentialling, and rebalancing payment rates to create sustainability and stability, among other things. Additionally, we need to foster greater community investment and alignment for critical social programs in underserved and hard to reach cohorts that can both address major social determinants of health and extend the reach of care provision.