mckinsey -美国医疗保健的未来：“风暴再临 2.0”还是黄金时代 Future of US healthcare Gathering storm 2.0 or a golden age

Mcsey

&company

HealthcarePractice

FutureofUShealthcare:Gatheringstorm2.0oragoldenage?

ShouldhealthcareleadershunkerdowntoweatherthenextgatheringstormorreimaginetheirbusinessesthroughAI,automation,andinnovative-care

models?Thebestleaderswilldoboth.

byShubhamSinghal,DrewUngerman,andJasonAzzoparde

withTuhinaKapoor

November2025

Healthcareindustryeconomicscontinuetoberoiledinthepostpandemicera,andtheoutlookforfundingsuggestscontinuingrelentlesspressure.HealthcareindustryEBITDAasaproportionofnationalhealthexpenditure(NHE)was200basispointslowerin2024comparedwith2019.

From2024through2027,itisexpectedtofallanother100basispoints,withmarginalrecoveryexpectedby2028throughtargetedinterventions,

accordingtoMcKinseyresearch

.

Nonetheless,thepotentialopportunityfromadvancesinAI,automation,efficientsitesof

care,medicalscience,andcaremodelinnovationisstaggering.Weestimatethattheavailableimprovementopportunityis9to15percentofNHEonarun-ratebasis.1

Asalways,theopportunitytoimprovehealthcareoutweighstheheadwindsifhealthcareleaderscanunlockthetransformationrequiredtoseizetheopportunity.

Gatheringstorm2.0?

Healthcareisstillreelingfromthe

stormunleashedbythepandemic

.Nowitfacesanothergatheringstorm—oneemergingfromfundamentalshiftsinthemacroeconomiclandscape.

Thetrade,economic,andsecuritystructuresthatemergedfromthepost–ColdWarunipolar

orderare

givingwaytoamultipolarworld

.Intensifyinggeostrategiccompetitionisleadingto

higherdefensespending2andapushtoreversethedeclineoftheUnitedStates’shareofglobalmanufacturingvalueadded,whichfellfromabout25percentin2000toroughly15percentin

2024.3Inaddition,tradeuncertaintyishigh,4withapushtocontainthetradedeficit,whichhas

greatlyexpandedoverthepasthalfcentury.Concurrently,theUSmiddleclasshassteadily

eroded,andreversingthistrendisacriticalpriority.Between2000and2018,themiddle-wage

employmentsharedeclined6percent,andmedianwagesgrewjust1percentannually,comparedwith7percentforlow-wageearnersand5percentforhigh-wageearners.5Simultaneously,the

USfederaldeficitispoisedtosurpass$1.9trillioninfiscalyear2025—apeacetimehigh—withinterestcostsonthatdebtedgingcloserto$1trillionannually.6

Thesechallengesportendaperiodoftectonicshiftsinthetrade,economic,andsecurityorder.

Healthcare,despitebeingadomesticindustry,sitssquarelyonthefaultlineoftheseshifts.

In2024,thefederalbudgettotaled$6.8trillion,andthefederaldeficitwas6.4percentof

GDP(Exhibit1).Mosteconomistsagree,however,thatasustainablelevelisbelow3percent.7

However,recentNATOpolicieshaveintroducedanewchallenge:Membercountriesrecently

agreedtoraisedefensespendingto5percentofGDP,8whichfortheUnitedStateswouldmeanatwo-percentage-pointincrease.Ifthispolicyhadbeenineffectin2024,theUSdeficitwouldhavebeen8.4percent,furtherstrainingfiscalsustainability.WithMedicareandMedicaid

accountingforapproximately22percentofthe2024federalbudget,healthcareislikelytofacecontinuedpressureasfiscalconstraintstighten.

1McKinseyValuePoolsanalysis(surveyof1,069cliniciansin2021);CMSLimitedDataSetClaimsData(2022),CentersforMedicare&MedicaidServices,accessed2025;MerativeMarketScanCommercialClaimsDatabase(2022),Merative,

accessed2025;SeanP.Keehanetal.,“Nationalhealthexpenditureprojections,2024–33:Despiteinsurancecoveragedeclines,healthtogrowasshareofGDP,”HealthAffairs,2025,Volume44,Number7.

2“Chartpack:Defensespending,”PeterG.PetersonFoundation,July2025.

3“Americaletitsmilitary-industrialmightwither.China’sisbooming,”WallStreetJournal,May29,2025.

4EconomicPolicyUncertaintyIndex,EconomicPolicyUncertainty,accessedSeptember9,2025.

5BasedondatafromtheUSBureauofLaborStatistics,OccupationalEmploymentStatistics,andMcKinseyGlobalInstituteanalysis,courtesyoftheMcKinseyGeopoliticsPractice.

6“Thebudgetandeconomicoutlook:2025to2035,”CongressionalBudgetOffice,January17,2024.

7“Thefederalbudgetinfiscalyear2024:Aninfographic,”CongressionalBudgetOffice,March20,2025.

8“DefenceexpendituresandNATO’s5%commitment,”NATO,August27,2025.

FutureofUShealthcare:Gatheringstorm2.0oragoldenage?2

FutureofUShealthcare:Gatheringstorm2.0oragoldenage?3

Exhibit1

TheUSbudgetdeficitisatanunsustainablelevel.

USbudget,bysector,2024,$billion

SocialSecurity

andincome

securityprograms

1,870

Nondefense

discretionary

960

Interest

881

Defense

850

Medicareand

Medicaid

1,483

Othermandatory

752

BudgetdeficitasshareofGDP,%(quarterly)

5

0

–5

–10

–15

–20

6,796

200020052010201520202024

Source:O代ceofManagementandBudget;“Thefederalbudgetinfiscalyear2024:Aninfographic,”CongressionalBudgetO代ce,March20,2025;USBureauofEconomicAnalysis;USDepartmentoftheTreasury;McKinseyanalysis

McKinsey&Company

Infact,recentlegislationandregulationshavefocusedoncurtailinghealthcarespend.The

recentlyenactedOneBigBeautifulBillAct(OBBBA),signedintolawonJuly4,2025,couldlowerfederalspendingonhealthcareby$1trillionoveraten-yearperiod.9Thelawincludesaseriesofchangestogovernment-subsidizedhealthinsurancethatmayreduceenrollmentinMedicaidandAffordableCareAct(ACA)marketplaces.10Thelawalsochangestaxprovisionsforproviders,withimplicationsvaryingbystate—reducingstateprovidertaxesbyfreezingnewtaxes,disallowing

taxincreases,andphasingdownthe“safeharbor”thresholdforexistingprovidertaxesin

Medicaidexpansionstates.11ThenewlimitsonprovidertaxesinstatesthathaveadoptedtheACAexpansioncouldleadtolowerdirectedpaymentsforproviders.12

Inadditiontotheimpactsfromrecentlegislation,aseriesofemergingpoliciescouldfurther

reshapethefinancialoutlookforhealthcarestakeholders.Forexample,site-neutralpayment

policiesunderconsiderationatthefederallevelcouldtriggerdeclinesinnetpatientservice

revenue(NPSR),especiallyforhospitaloutpatientdepartments,whichhavehistoricallyreceivedhigherreimbursementratesthanindependentphysicianoffices.13Additionally,expandedtariffs

9“EstimatedbudgetaryeffectsofPublicLaw119-21,toprovideforreconciliationpursuanttoTitleIIofH.Con.Res.14,relativetoCBO’sJanuary2025baseline,”CongressionalBudgetOffice,July21,2025.

10“InformationconcerningMedicaid-relatedprovisionsinTitleIVofH.R.1,”CongressionalBudgetOffice,June24,2025.

11“H.R.1-119thCongress(2025-2026):OneBigBeautifulBillAct,”USCongress,July4,2025.

12“WhichstatesmighthavetoreduceprovidertaxesundertheSenatereconciliationbill?,”KaiserFamilyFoundation,June18,2025.

13KlaraK.Louetal.,“Medicaresite-neutralpaymentpolicies:Effectsofproposalsonhospitalsandbeneficiarygroups,”HealthAffairs,2025,Volume44,Number6.

FutureofUShealthcare:Gatheringstorm2.0oragoldenage?4

onimportedgoods—includingmedicaldevices,pharmaceuticals,andcoresupplies—could

increasecostpressuresacrossthehealthcaresupplychain,compoundingthealready-elevatedinflationarytrends.14Furthermore,proposedmodificationstothe340BDrugPricingProgram

couldsubstantiallyreducereimbursementratesforeligibleproviders.

Thislatestsetofchallengescomesafterthepandemic-inducedstormthathitthehealthcare

industryandgreatlyaffectedproviderand,morerecently,payereconomics(Exhibit2)—as

documentedinMcKinsey’s

ThegatheringstorminUShealthcare

series.Whiletheindustryisinthemidstofrecoveringfromthateconomicdownturn,thecurrentmacroeconomicenvironment,alongwithlegislative,policy,andregulatoryhurdles,portendasecondgatheringstorm.

Exhibit2

TheUShealthcareindustryhasexperiencedunevenperformanceoverthepastsixyears,withlimitedrespiteuntil2027.

EBITDAdistributionacrosshealthcare

segments,2019–27,$billion

Source:McKinseyValuePoolsModel

McKinsey&Company

600

500

Payer

Healthcareservicesandtech

400

Pharmacy

300

200

Provider

100

0

201920242027

14SeanD.Sullivanetal.,“TheconsequencesofpharmaceuticaltariffsintheUnitedStates,”2025,JournalofManagedCare&SpecialtyPharmacy,Volume31,Number6.

FutureofUShealthcare:Gatheringstorm2.0oragoldenage?5

Goldenage?

Theideasforimprovinghealthcarearenotnew,noristhefactthatthetotalopportunityavailablefarexceedstheimpactoftheheadwinds.Whatisnewtodayistheimpetusforchange—the

economichitisbothsevereandmultiyear,withnosignsofrelieffromexternalfunding.Change,however,hasbeenexceedinglydifficultinalargeandcomplexhealthcareindustry.

Yettheconditionsarefavorableforaradicalreimaginationofthehealthcareindustry,particularlywiththeadventofAIandotherautomationtechnologies.Theshortageofclinicallabormeans

thattheapplicationoftechnology,AI,andotherproductivity-enhancingmeasuresdoesnotportendlarge-scalelayoffs.Moreover,thestronggrowthindemandforhealthcareservicesindicatesthatarestructuringdoesnotmeananaggregateshrinkingoftheindustry.

Together,thesefactorscreateanunprecedentedwindowofopportunitytoreimaginehealthcare.Weoutlinethreeofthemostpromisingvectors:enhancingaffordabilityandefficiencywithAIandautomation;makingcarepatientcenteredthroughAI;andreshapingcaremodelswithspecialty-ledinnovationsandmovingsitesofcare.

ImproveaffordabilityandproductivitywithAIandautomation

ThepromiseofAItoimproveefficiencyhaslongbeenanticipated.Now,withtheadventof

generativeAIandadvancedautomation,thatpromiseisexpectedtobecometrulyactionable

andscalable.WhilethevastmajorityofAIsolutionshaveyettogeneratedirectmonetaryvalue,earlyapplicationsaredemonstratingmeasurablegainsinproductivityanddecision-making.

Whatwasoncetheoreticalisnowaugmentingclinicalandadministrativework,enhancinghowcareisdeveloped,delivered,andfinanced.Acrosstheecosystemofproviders,payers,and

biopharma,AIisexpectedtounlockmultibillion-dollarvaluepoolsand,overtime,enableanewagenticworkforceinwhichpeopleandintelligentsystemscollaboratetomanageworkflows,

decisions,andoperations.Takentogether,AIhasthepowertoenhancepatientaffordabilityandproductivityfortheindustry,whichinturncanimprovepatientaccess,outcomes,andexperiencesatscale.

—Providers.Largeandimmediateopportunitiesforprovidersliein

automatinghigh-burden

administrativeworkflows

suchaspriorauthorizations,clinicaldocumentation,andcoding.

Automationcanalsoenhancediagnosticassessments,acceleratedischargeplanning,and

optimizeoperatingroomutilization,reducingdelaysandincreasingthroughput.Beyond

thesefunctions,AI-enabledworkforcemanagementsolutionscanhelpreducestaffturnover,improveshiftallocation,andboostproductivity.Additionalvaluecanbegainedthrough

automationofcorporateservices(forexample,finance,HR,andIT)andbystrengtheningsupplychainresilienceandcostefficiency,anareawithdirectbottom-lineimpact.We

estimatethatbyusingcurrentlyavailabletechnology,providerscouldseeagrossupliftof

11to17percentofNPSR.15

15McKinseyanalysisbasedonexpertinterviews,casestudies,andauditedfinancialstatements.ExcludesMedicaidNPSRfromconsumerengagementandrevenuecyclemanagementdomainsandMedicareFFS(fee-for-service)revenuefrom

pricingandcontractingduetolackofapplicability.AssumesMedicareFFSNPSRisapproximately50percentofreportedMedicareNPSR.

FutureofUShealthcare:Gatheringstorm2.0oragoldenage?6

—Payers.

AIandautomationpresentanear-termopportunityforpayers

totacklerisingmedicalcostsbytransformingkeycaremanagementfunctions.Inutilizationmanagement,AIcan

acceleratepriorauthorizationbyevaluatingcaseappropriatenessandguidingcaretolower-costsettingswithcomparableoutcomesanddosowithgreatertransparency.Additionally,

predictivemodelscanenhancecaseanddiseasemanagementbyenablingtargeted

outreachandtimelyinterventions.AIcouldalsoimprovenetworkdesignthroughprovider

optimization,unitcostbenchmarking,andsmartercontracting.Theseleverstogethercan

triggeragrossreductioninmedicalcostsof5to11percent.Inparallel,AIcanautomatelabor-intensiveadministrativefunctions,suchasclaimsadjudication,priorauthorization,member

enrollment,andcustomerservices.Takentogether,theseadvancescouldimproveaccuracyandmemberexperiencesandleadto13to25percentinadministrativesavings.Moreover,

theseefficienciescanenablea3to12percentgrossrevenueboostwithqualityimprovement,bettermemberretention,andoptimizedplandesign.16Ascapabilitiesmature,AIcouldhelp

payersbuildmoreagileandintelligentoperatingmodels.

—Biopharma.Accelerationinthepipelineofnewtreatmentshasbeenunderwayforafewyearsnow.

AIisfurtheracceleratingthispipeline

andisalsopromisingtobringdown

developmentcoststoenhanceaffordability.EarlyevidencesuggestsaboostinR&D

productivityinbothresearchandearlydiscovery,aswellasintheclinicaldevelopment

phases,withamorethan30percentincreaseininitialdrugtargetassessment,an

approximatelyfour-toten-percentage-pointincreaseintrialprobabilityofsuccess,andaroughlytwofoldincreaseindevelopmentspeed.17Pharmaceuticalcompaniescouldseea

30to50percentreductioninthecostofclinicaldevelopmentinthelongrun(forexample,datamanagement,regulatorycosts,andenrollmentcosts).18

UseAItomakehealthcaredeliverypatientcentered

Healthcareisnolongerconfinedtotheclinic.Instead,ithappenscontinuouslyinpatients’daily

lives,givenrelativelynewabilitiestoregularlymeasureandcollectindividualizeddatabeyondtheclinic.Withtheabilitytocollectandinterpretreal-timehealthdataandgeneratetailoredcontentthroughAI-poweredassistants,providersandpayerscannowengagepatientsasan“nof1.”

GenerativeAIenablesthecreationofdynamic,personalizedhealthecosystems.Thesesystemscansupporthealthylivingandself-care,connectpatientswithinsocialcommunities,adapt

caredeliverythroughtoolssuchasremotemonitoringandtelehealth,andstreamlinefinancialaccess—forinstance,easierpaymentsystems.

Patientsarebeginningtoembracethesepossibilities.TheyseeAInotjustasatoolforefficiencybutalsoasacompanioninnavigatingtheirhealthjourney—whetherthroughanswering

questionsaboutillnesses,guidingself-carefornonurgentneeds,helpingmanagechronic

conditionsviabiometrictracking,orofferingsupportiveexplanationsofimagingandtest

results.19Thisshiftholdsrealpotentialtomeaningfullyimproveaffordability,withadoption

ofthelatesttechnologies,includingAI,estimatedtoresultinnetsavingsof5to10percent

ofhealthcarespending,accordingtoastudycoauthoredbyMcKinseyandpublishedbythe

NationalBureauofEconomicResearch.20Importantly,harnessingAIcanalsobuildtrust,

empowerpatients,andenhanceengagementbetweenpatientsandthehealthcaresystem.Inarecentstudy,licensedcliniciansratedabout78percentofchatbot-generatedmedicalresponses

16ShubhamSinghalandJessicaLamb,“TheAIopportunity:Howpayerscancaptureitnow,”McKinsey,June5,2024.

17“GenerativeAIinthepharmaceuticalindustry:Movingfromhypetoreality,”McKinsey,January9,2024.

18“GenerativeAIinthepharmaceuticalindustry:Movingfromhypetoreality,”McKinsey,January9,2024.

19McKinseyConsumerHealthInsightsSurvey,May2025,n=3,034.

20NikhilSahni,GeorgeStein,RodneyZemmel,andDavidM.Cutler,Thepotentialimpactforartificialintelligenceonhealthcarespending,NationalBureauofEconomicResearchworkingpaper,number30857,October2023.

FutureofUShealthcare:Gatheringstorm2.0oragoldenage?7

toconsumerquestionsas“good”or“verygood.”Comparedwithphysicians’replies,genAI

medicalresponseswererated“empathetic”or“veryempathetic”atarateroughly40percentagepointshigher.21

Eveninoperationalareas,thepatientbenefitisclear.WhenAItoolsareintegratedwith

schedulingplatforms,theynotonlyreduceno-showsbutalsoredirectpatientstowardtherightcaresettings.Forexample,inonestudy,32percentofpatientswhowereoriginallyheaded

fortheemergencydepartmentchoselessemergentcareinstead.22Inanotherstudy,about

44percentshiftedawayfromsame-dayappointments,androughly46percentofassessmentshappenedoutsideclinichours.23Thesechangestranslateintoamoreaccessible,responsive,andpatient-centeredhealthcareexperience.

Transformcarethroughspecialty-ledcaremodelsandshiftsinsitesofcare

BesidesharnessingAI,rethinkinghowandwherecareisdeliveredalsoholdssubstantial

opportunitytoimproveaffordabilityandoutcomes.Emergingmodelssuchasredesigning

specialtycareforcomplexpatientsandshiftingcaretomorecost-effective—whilestillsafe—

settingshaveshownmeaningfulreductionsintotalcostofcare(TCOC)andstrongpotentialforbroaderimpact.24Astheseapproachesmature,thenextfrontierisscalingwhatworksbymovingbeyondpilotstosystemwidetransformationthatbenefitspatients,payers,andproviders.

Specialty-ledcaremodels.Despiteaccountingfornearly40percentoftotalmedicalspend,specialtycarehasbeenonthesidelinesof

value-basedcare

(VBC).WhileVBChasgainedtractioninprimarycare,manyhigh-costspecialties,suchasbehavioralhealth,cardiology,

nephrology,oncology,orthopedics,andwomen’shealth,haveseenlimitedadoption.

Penetrationremainslow,withjust28percentofnephrologypatientsand20percentof

orthopedicspatientscoveredbyVBCmodels,forexample,andevenlessthan5percentinmanyotherhigh-costspecialties.25

Despitelowadoption,thepromiseofspecialty-ledmodelsisreal:Anencouragingexamplecan

befoundinthemanagementofchronickidneydisease,whichisbuiltaroundmultidisciplinary

careteamssupportedbypredictiveanalytics,frequenttouchpoints,proactivecareand

education,andsupportforbehavioralandsocialdeterminantsofhealth.Thesemodelscan

achieve15to40percentlowerhospitalreadmissionrates,20to50percentlowerratesof

hospitalization,anda1.5to2.5timesincreaseinpatientsstartedonend-stagekidneydisease

treatmentwithanoptimal,prescheduledcareplan(forinstance,timelydialysisaccessor

transplantevaluation,ratherthaninemergencysituations).26From2018to2023,patientsinsuchhigh-intensityoutpatientcaremodelprogramshada14percentlowerrisk-adjustedTCOCthanthoseinlessintenseprograms($47,000versus$54,000permemberperyear).27

21JohnW.Ayersetal.,“Comparingphysicianandartificialintelligencechatbotresponsestopatientquestionspostedtoapublicsocialmediaforum,”JAMAInternalMedicine,2023,Volume183,Number6.

22AaronN.Winnetal.,“Associationofuseofonlinesymptomcheckerswithpatients’plansforseekingcare,”JAMANetworkOpen,2019,Volume2,Number12.

23KeithE.Morseetal.,“Usecharacteristicsandtriageacuityofadigitalsymptomcheckerinalargeintegratedhealthsystem:

Population-baseddescriptivestudy,”JournalMedicalInternetResearch,2020,Volume22,Number11.

24McKinseyvalue-basedcaredomainanalysisofalargecommerciallyinsureddataset(2018–23)andCentersforMedicare&

MedicaidServicesandMedicareFee-for-ServicePartsAandBclaimsdata.

25AmitKunte,NehaPatel,ZahyAbou-Atme,andAndrewFlynn,“Specialtyrisk:Thenextfrontierofvalue-basedcare,”McKinsey,July22,2025.

26Impactmetricsareself-reportedbythecompanies(MonogramHealth,StriveHealth,CricketHealth,EvergreenHealthwebsites)andsourcedfromtheirpubliclyavailablewebsites,investormaterials,orpressreleases.

27CMSLimitedDataSetClaimsData(2022),CentersforMedicare&MedicaidServices,accessed2025.

FutureofUShealthcare:Gatheringstorm2.0oragoldenage?8

Byleveragingnetworksofspecialistsandmultidisciplinaryteams,specialty-ledcaremodelscanimprovepatientoutcomes,reduceunnecessaryutilization,andalignfinancialincentivesmore

effectively.Forpayersandproviders,thesemodelsrepresentahigh-potentialpathtoimprovingpatientoutcomes,reducingavoidableutilization,andloweringTCOCatscale.

Shiftsinsitesofcare.Wehaveseengreatstridesinrecentyearsintransitioningtomorecost-

effectiveandconvenientsitesofcare.In-homecareexperiencedan8percentannualrevenue

growthoverthepastthreeyears.28Ambulatorycapacityisalsoexpanding,withmoreproceduresmovingtoambulatorysurgerycenters(ASCs)andmorecomplexinfusedtherapiesdelivered

inambulatoryinfusioncentersandsuitesandinthehome,enabledbyminimallyinvasive

techniques,advancesinanesthesia,andbroaderpayercoverage.29Evenbeyondspecialtycare,suchaswithvaccinationsandimaging,wesawpharmaciesadministerabout65percentofadultflushotsinthe2024to2025season.Additionally,basedonasurveyofcliniciansandhealthcareexecutivesassessingexpectedvolumeshiftsbyspecialty,radiologywasprojectedtoseea

25-percentage-pointdeclineinhospital-basedimagingvolumeasproceduresmovetowardambulatorysettingsovertime.30

Webelieveopportunityremainsonthehorizon.Bymovingcareawayfromhigher-costhospitalsettings,thesemodelscangreatlyreduceoverallhealthcareexpendituresandenhancepatientsatisfactionbyprovidingcareinmoreconvenientandcomfortablesettings.Forexample,our

researchfindsthatapproximately50percentofhospitaloutpatientdepartmentsurgicalcasesareeligibletobeperformedinASCs.Thistransitionisprojectedtospur7percentcompound

annualrevenuegrowthfor2024to2029.31Thesuccessofthesemodelsisdrivenbyadvancesinmedicaltechnologyandchangesinpayerpoliciesthatencouragetheuseofmoreaccessiblecaresettings—forexample,theCentersforMedicare&MedicaidServices(CMS)hasproposedphasingouttheinpatient-onlylistandadding547proceduresandcodestotheASC-covered

procedureslistforfiscalyear2026.32

Shiftingsites-of-caremodelshaveshownthepotentialtoreduceTCOCby8to10percent

ormore.33Thebenefitsareclearforbothpayersandproviders:betteraccess,lowercosts,

andimprovedpatientsatisfaction.Thistransitionisalreadyunderway,withleadingsystems

makinglarge-scalebetsonoutpatientgrowth.AscensionandTenetHealthcare,forinstance,havebeeninvestinginthistransitionforseveralyears.Tenet,throughitsUnitedSurgical

PartnersInternational(USPI)subsidiary(acquiredin2015),hasdoubleddown,investingmorethan$250millionannually,addingnearly70newASCsin2024,andplanningfor

28McKinseyValuePoolsanalysis(surveyof1,069cliniciansin2021);CMSLimitedDataSetClaimsData(2022),CentersforMedicare&MedicaidServices,accessed2025;MerativeMarketScanCommercialClaimsDatabase(2022),Merative,

accessed2025.

29StevenYoung,BrianOsman,andFredE.Shapiro,“Safetyconsiderationswiththecurrentambulatorytrends:More

complicatedproceduresandmorecomplicatedpatients,”KoreanJournalofAnesthesiology,2023,Volume76,Number5.

30“Influenzavaccinationsadministeredinpharmaciesandphysicianmedicaloffices*,adults,UnitedStates,”Centersfor

DiseaseControlandPrevention,May7,2025;NikhilSahnietal.,“PotentialUShealthcaresavingsbasedonclinicianviewsoffeasiblesite-of-careshifts,”JAMANetworkOpen,2024,Volume7,Number8.

31McKinseyvaluepoolsanalysis(surveyof1,069cliniciansin2021);CMSLimitedDataSetClaimsData(2022),CentersforMedicare&MedicaidServices,accessed2025;MerativeMarketScanCommercialClaimsDatabase(2022),Merative,

accessed2025.

32“CMSproposesboldreformstomodernizehospitalpayments,strengthentransparency,andputpatientsbackincontrol,”

CentersforMedicare&MedicaidServices,July15,2025;“Calendaryear2026HospitalOutpatientProspectivePayment

System(OPPS)andAmbulatorySurgicalCenterProposedRule(CMS-1834-P),”CentersforMedicare&MedicaidServices,July15,2025.

33McKinseyvalue-basedcaredomainanalysisofalargecommerciallyinsureddataset(2018–23)andCentersforMedicare&MedicaidServicesandMedicareFee-for-ServicePartsAandBclaimsdata.

FutureofUShealthcare:Gatheringstorm2.0oragoldenage?9

anothertento12openingsin2025.Ascensionrecentlyannounceditsagreementtoacquire

Amsurgfor$3.9billion,expandingitsASCfootprintfromroughly58sitestomorethan250

nationwide,signalingastepchangeinitscaredeliverymodel.34Thesemovesunderscorehowbothnot-for-profitandfor-profitsystemsareactivelyreshapingtheirportfoliostocapturethecost,access,andpatientsatisfactionbenefitsofshiftingappropriateportionsofcareaway

fromhospitalcampuses.

Theimperativetorestructureandreimagine

Recently,weaskedahealthcareCEO,“Isyouragendagearedtowardthegatheringstorm2.0orthegoldenage?”Sheresponded,“Both!”Theagendaforhealthcareleadersindeedshouldcoverbothrestructuringtobraceforthegatheringstormandreimaginingtoprepareforthegoldenage.

Restructure

Duringeconomicdownturnsorperiodsofdisruption,organizationsthatgetfitthrive.Thispartoftheagendainvolvesthreemajorelements:

—Leanercoststructure.Organizationsneedtoactdecisivelytostreamlineoperations,embedtechnology,andimproveproductivity.Thegoalisnotincrementalgainsbuttransformative

performance—byresettingcoststructuresandexpandingmarginssustainably.

—Strongerbalancesheet.Leadersalsoneedtoshoreupbalancesheetsthroughdebtreduction,refinancing,a