Table 1. Transition from Current Care to the Future State
Current State
Health care systems
Revolving around academic medical centers (AMCs) and large hospitals
Siloed large academic medical centers in a spoke-and-hub model
Most surgery performed at AMCs
Most care within hospital walls
Payment systems
Focus on cure (and maybe rehabilitation)
Pay per specific transaction (fee-for-service)
Sustainability of health services
Managed care; early attempts at value-based payments
Care providers
Physician-driven care
Partnerships in health care
Provider organizations, health insurance, pharma, and med tech industry
Future State
Academic health systems that focus on the community and the continuum of care
Integrated delivery networks
Care pushed out to home - both acute (hospital at home) as well as chronic care management
Surgery performed at community surgical centers
Hospitals will provide most care remotely rather than on site
Focus on prediction and prevention
Pay by quality / outcomes
Bundle services around an episode (bundled payment)
Payment per population (such as accountable care organizations)
Emphasis on prevention of disease
Precision medicine
Increasing role of artificial intelligence in decision-making
Increasing role specialization
Focus on multidisciplinary clinical teams
Diminishing focus on physicians
Nonmedical tech giants (e.g., Google, Apple, Amazon, Microsoft)
Education and social care providers
Retail corporations and pharmacy chains (e.g.., Walmart, CVS, Walgreens)
Service provider industry (e.g., Uber, healthy food chains)