MSSNY PULSE

The U.S. primary care market is on the verge of significant transformation, with nontraditional providers projected to represent 30% of the market by 2030, according to Bain & Company’s most recent report. As traditional fee-for-service models face growing challenges, new players, including payer-owned practices, advanced primary care (APC) providers, and value-based care enablers, are rapidly gaining ground. Payer-owned providers, such as UnitedHealth Group’s Optum and Humana’s CenterWell, are set to capture 20% of the market, leveraging advanced care management and navigation capabilities to address complex patient needs effectively. Meanwhile, APC providers, particularly those focused on senior care, continue to scale despite regulatory headwinds, demonstrating the ability to improve clinical outcomes while managing costs.

Retailers like Walmart and Walgreens, once seen as key disruptors, have struggled to deliver comprehensive primary care, with many scaling back operations. Consumer trust in retail clinics remains limited, with less than one-third willing to seek care beyond basic services like vaccinations. These challenges underscore the complexities of blending retail and healthcare delivery models. At the same time, value-based care enablers, such as Aledade and Privia Health, are rising in prominence, helping traditional providers transition to more sustainable payment models. These partnerships are expected to double their market share to 10% by 2030 due to their ability to reduce costs and enhance care quality.

Traditional health systems face increasing pressure to innovate or risk losing ground. Many are exploring new strategies, from becoming preferred specialty providers for risk-taking primary care groups to developing innovative care models tailored to specific populations. As the landscape evolves, success will hinge on adaptability, creativity, and a focus on delivering high-quality, value-based care. Physicians must stay informed and proactive to thrive in this rapidly changing environment.

The Future of Primary Care: Traditional and Nontraditional Models Continue to Evolve (Ney, MD, Brookshire, & Pinto Basto, Bain, 12/24).

The Medical Society of the State of New York, in coordination with the American Medical Association, is asking physicians to answer a survey to help inform our advocacy and legislative efforts. We are focusing today on the pressures some physicians feel from hospitals, insurers, and private equity groups to sell their practice and/or become employed by a large organization.

The survey should take about 8-9 minutes to complete for most of you; owners/partners in their practice will take closer to 10-11 minutes. Please keep in mind that you can restart where you left off if needed.

Results to numerical questions will only be presented in aggregate, and open-ended comments we might highlight will not include any identifying information.

Please click on the link to continue. You can start the survey and return to finish it at a later time if needed. Feel free to contact Molly Reese at the AMA ([email protected]) or Moe Auster at MSSNY ([email protected]) with any questions.

Take Survey Now

As the healthcare industry enters 2025, several critical topics are set to redefine care delivery and organizational strategies, presenting both challenges and opportunities. Experts emphasize that understanding these trends will be pivotal for providers aiming to thrive in a rapidly evolving landscape.

Service line management remains a cornerstone of healthcare delivery, yet health systems struggle to balance standardization and customization. As the focus shifts toward outpatient growth and operational efficiency, strategies targeting sustainability will take precedence. The era of relying solely on high-revenue surgeries or traditional service lines is fading, pushing leaders to embrace innovative approaches to driving growth.

Value-based care (VBC) continues to gain traction, with leading organizations demonstrating its potential for cost savings and improved quality. Successful systems have embedded VBC into governance, financial frameworks, and clinical operations. By integrating data analytics, negotiating risk-based contracts, and engaging care teams, these organizations are setting the standard for what VBC can achieve.

Care variation reduction (CVR) efforts are also evolving. Historically focused on inpatient care, CVR is now expanding into outpatient and ambulatory settings, addressing shifts in care delivery. Advanced technologies, particularly AI, enable healthcare leaders to identify cost and quality variations, creating new opportunities for improvement.

The role of AI in healthcare decision-making is another pressing topic. While AI has shown promise in streamlining administrative tasks, its true potential is transforming clinical care. Collaboration across payers, providers, and researchers will be crucial to breaking data silos and harnessing AI to improve patient outcomes and care processes.

As drug costs continue to rise, specialty pharmacies are becoming increasingly vital. Once overlooked, these pharmacies now represent a strategic asset for health systems and plans. Leaders recognize their ability to drive success in risk-based environments by integrating pharmacy operations into broader organizational goals.

5 key healthcare topics for 2025 (and why you should care) (Plattenburg, Advisory, 1/9).