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1、McKinsey&CompanyHealthcarePracticeMcKinseyonhealthcare:InnovatetothriveAselectionofarticlesfrom2023McKinseyonhealthcare:InnovatetothriveispublishedbyMcKinsey,sHealthcarePractice.McKinsey&CompanyHealthcarePractice500WoodwardAvenue,Suite2850Detroit,Ml48226ThemissionofMcKinseyzSworkinthesocial,healthca
2、re,andpublicsectorsistohelpmeasurablyimprovelives,livelihoods,andhealthandcreateresilientcommunitiesaroundtheworld.Transforminghealthsystemsisanessentialpartofthismission.Wearecommittedtosupportingprivateandpublichealthcareleaderstoimprovetheaffordability,accessibility,quality,andexperienceofhealthc
3、are.Globalleader,Social,Healthcare,andPublicSectorEntitiesPractice:ShubhamSinghalGloballeader,HealthcarePracticeandMcKinseyHealthInstitute:DrewUngermanEditor:GwynHerbeinAssistanteditor:JuliaAndersonBauerArtdirector:LEFFExternalrelations:SharmeenAlamandAnnaDirksen1.eadreachandrelevancepartners:ScottB
4、lackburnandNikhilSahniCoverimage:-strizhGettyImages“Investingintheneweraofvalue-basedcarezbyZahyAbou-Atme,RobAlterman,GunjanKhanna,andEdwardLevine,copyright2022byMcKinsey&Company.Thegatheringstorm:TheuncertainfutureofUShealthcare/byAddieFleronandShubhamSinghal,copyright2022byMcKinsey&Company.Imageon
5、pages12-13:RapidEye/GettyImages,imageonpages38-39:JoseA.BernatBacete/GettyImages,imageonpages66-67:ko_orn/GettyImages,imageonpages80-81:oxygen/GettyImagesThispublicationisnotintendedtobeusedasthebasisfortradinginthesharesofanycompanyorforundertakinganyothercomplexorsignificantfinancialtransactionwit
6、houtconsultingappropriateprofessionaladvisers.NopartofthispublicationmaybecopiedorredistributedinanyformwithoutthepriorwrittenconsentofMcKinsey&Company.Copyright2023McKinsey&Company.Allrightsreserved.What,saheadforUShealthcarein2024Uncertaintyhasbeenthenorminhealthcarein2023,andthat,snotlikelytochan
7、gein2024.Apresidentialelectionyearloomsinthecontextofpressureonfederalgovernmentfinancesfromlargebudgetdeficitsandtheimpactofhigherinterestratesonfederaldebtservicingcosts.Inaddition,thehealthcareindustryfacesuncertaintyaboutthefinancingofMedicareandMedicaid;regulation,includingviewsabouthorizontala
8、ndverticalintegration;andoverallindustryeconomics.Inthefaceofthisuncertaintysomemightcallitopacitydiscerningseniormanagementteamscanactonafewtrendsthatareclearer.Someofthetrendsandpossibleresponsesgermanetostrategyandperformanceofyourorganizationsarehighlightedbelow.Whafsaheadforhealthcareplayers:An
9、overviewWeoutlinedin2022howthegatheringstormfueledbyinflationandworkforceshortageswouldputpressureonhealthcareoverthenextfewyears.Indeed,thepressureonhealthcareleaderscontinuesunabated.Inresponse,industryplayerswillhavetoconsiderrepositioningtheirbusinessesaswellasgearinguptoensuresuperiorbusinesspe
10、rformance:-Hospitalsystemsfacea200-basispointgapbetweenreimbursementratesandcostinflation,accordingtoMcKinseyanalysis.Thegapcouldrequireperformancetransformationsonthepartofhealthsystems,includingmoreoutsourcing,rampingupdigitalandautomationefforts,andbusinessrationalization.In2024,employersarefacin
11、grisinghealthinsurancepremiumswellabovetheircomfortzoneofannualincreasesoflessthan4percent.1Aspayersseecontinuedincreasesinmedicalcostsandacceleratingprescriptiondrugcosts,thispressurewillrequirehealthplanstorenewfocusonmedicalandadministrativecostcontrol.Thesecostpressuresoffermanyopportunitiesfort
12、ech-enabledservicescompaniesthatcanshowcustomersnear-termreturnoninvestmentfromtheirproducts.Atthesametime,manyhealthcareservicesandtechnologycompanieswithoutdemonstrablereturnwillfaceseveredownsidetotheirbusinesses.Higherinterestratesandlessliquidityinthefinancialmarketshaveraisedthehurdlerateforpr
13、ivateequity(PE)andventurecapitalfirms.Inthesecircumstances,privateinvestorsmustensuretheirportfoliocompaniesdeliverbottomlineperformance,produceorganicgrowthbackedbyprovenbusinessmodels,andhavetheabilitytomakeanyinorganicgrowthaccretivebasedonrobustcapabilities.Large,well-capitalizedhealthcarecompan
14、ieswillfindafavorablevaluationenvironmentforacquiringPEportfoliocompaniesaswellasforformingstrategicpartnershipswithprivateinvestors.WhafsaheadforpayersPayervaluecreationcontinuestoshiftfromadministeringhealthbenefitsandprovidinginsurancetomanagingcareandcapturingdeliveryandpharmacyeconomics.Partner
15、ingwithandenablingphysicians,likelyinrisk-basedarrangements,willcontinuetogaininimportancerelativetoothermodelsofutilizationmanagement.Aspressurefromrisingmedicalandprescriptioncostsmount,scalingprovenphysicianpartnershipmodels(forexample,primarycarecenteredvalue-basedcare)aswellasinnovatingnewones(
16、specialtybenefitmanagementandspecialtyvalue-basedcare)willgrowinimportance.Enhancinghealthoutcomesandmembers*careexperience,promptedbyboththeincentivesingovernmentprogramsbutalsorisingdemandfromemployers,willbeimportantpriorities.Finally,arenewedfocusonreducingadministrativecostswillbehighontheagend
17、aforpayerstoensuresustainablemargins,offerabetterexperienceformembersandclinicians,andtofreeupresourcestoinvestinstrategiccapabilities.WhafsaheadforhealthsystemsHealthcaredeliverywillcontinueitsrestructuring.Thedefinitionofat-scalesystemshaschangedinthepastfewyears;today,ittakesmorethan$13billiontob
18、eatop-20systembyrevenue,andmanyhavereachedtheircurrentpositionthroughinorganicgrowth,accordingtoMcKinseyanaIysis.TherecentwaveofM&A,however,isdistinctfromitspredecessors.Itischaracterizedbycrossgeographydealsdesignedtocreatevaluebyscalinginvestmentsinplatformcapabilitiesacrossdigital,analytics,share
19、dservices,andworkforcemanagement.Beyondscale,sitesofcarehaveshiftedincreasinglyfromthehospitaltoambulatory,home,andvirtualcare.ThistrendwasplayingoutbeforetheCOVID-19pandemicandwascertainlyacceleratedbyit.Butthepivottowardambulatorysiteshasbeenslowerthanexpected,giventheimpactsuchatransitionhasonhea
20、lthsystemrevenue,amongotherstructuralissues.Disruptorsarevyingtomeetconsumers,demandforconvenientaccess,butpatientscanbestucknavigatingacomplexsystemofhealthcareorganizationswhentheirneedsbecomemoreacute.Inparallel,healthsystemshavestruggledtofilltheirclinicalworkforceneeds.Thenursingshortagehasbeco
21、memoreacute:morethan100,000nurseslefttheprofessionfrom2019to2022,andhealthsystemscouldfaceashortageof200,000to450,000nursesby2025.2Anticipatedphysicianshortagesarealsoanissue,thoughhealthsystememploymentofphysicianshasslowed.Regulation(forexample,pricetransparencyandthe340Bdrugpricingprogram)andrisi
22、ngcostsofcapital(duetomacroeconomicfactorsaswellasratingstrajectories)Willcontinuetocreateuncertainty.Whilehealthsystemperformancehasgenerallyimprovedoverthepastyearastheindustryemergesfromthepandemic,asubsetofplayersisreallyshining.Thosethatappeartobebreakingawayarehyperfocusedonresilience,takingam
23、ultileverapproachtogrowthwhileContinuingtoidentifyandtakeactionstoensuresustainablemargins.WhafsaheadforartificialintelligenceinhealthcareGenerativeartificialintelligence(genAl)hascreatedconsiderableexcitementintheindustry.GenAlcouldbecatalyticinacceleratingtheapplicationofdigitalandautomationinheal
24、thcare,therebyofferingsomeanswerstothetwinchallengesofaffordabilityandworkforceavailability.Forexample,adoptingcurrentlyavailabletechnology(includingbutnotlimitedtoautomation,Al,andgenAl)couldallowpayerstoreduceadministrativecostsby13to25percent,reducemedicalcostsby5to11percent,andincreaserevenueby3
25、to12percent.However,healthcarehaslaggedbehindotherindustriesintheadoptionofAl.Forseveralreasons,theindustryhashadahardtimeadoptingthetechnology.Forexample,Alrequirestimeconsumingandoftenmanualpreparationofcleanandstructureddata;well-planned,narrowusecases(suchaspredictingaspecificeventoroutcome);mod
26、eminfrastructure;andhard-to-hiretalent(suchasdatascientistsanddataengineers).Giventheneedforempatheticandintelligentinteractionsinaserviceindustrysuchashealthcare,therecognition,comprehension,andcontentcreationcapabilitiesofgenAlrepresentamajoropportunity.Itisparticularlyappealinginitssimplicity:gen
27、Althrivesonunstructureddata,whichisplentifulinhealthcare;itispretrained;anditisbroadlyunderstoodbypeopleacrosstheorganization.ThepotentialusecasesforgenAlcrosseverydomainandfunction.GenAlusecases,inadditiontoexistinganalyticsusecases,couldhelpaddressrealburdens,includingreducingpreparationtimeandimp
28、rovingqualityofclinicaldocumentation,modernizingoutdatedorlegacyapplications,andpersonalizingpatientandmemberoutreachatscale.Unlockingthisvaluewillbealeadershipchallenge.Seniorhealthcareexecutiveswillneedtoeducatetheirboards,leadershipteams,andemployees;attracttalent;driveadoption;andpursuechangeman
29、agementinitiativessuchasworkflowshifts.Scalingpilotstoproduction-scalesolutionswithconcurrentprocesschangeswillbeimportantdifferentiatorsin2024.WhafsaheadinprescriptiondrugsGLP-IdrugsholdthepromiseOftreatingtype2diabetes(in11percentoftheUSpopulation;38percentofthepopulationhasprediabetes3)andobesity
30、(42percentofadults4),potentiallyhelpingtoavoidmanyotherailments,suchasheartandchronickidneydisease.ThepopulationofpatientsmeetingclinicaleligibilitycriteriaforGLP-Isisoneofthelargestofanynewdrugclassinthepast20to30years.Althoughthereismuchtobeexcitedabout,experienceshowsthattakingadvantageofmedicala
31、dvancesisoftenelusiveinhealthcare.GLP-Ismustbetakenconsistentlytomaintainweightloss;however,initialstudiesindicatepersistencyandadherencetotherapyispoor(32percentofmembersremainpersistentatoneyearand27percentduringthesecondyear5).Nonetheless,theshiftincareandfinancingmodelsthataccompanyGLP-Idrugsare
32、likelytobematerial.ThegrowthoftheGLP-Imarkethasamplifiedtheconversationaroundpreventivecareanddemonstratedtheimpactofmediaawarenessandconsumer-drivendemandintreatmentdecisions.Itsexpansionhasalsofueledtheriseoftelehealthproviders,broadeningaccesspointsforconsumers.ThegrowthoftheGLP-Imarketpresentsco
33、stchallengesintheneartermbecausebenefitswillaccrueovertime.Theannualwholesaleacquisitioncostperpatientrangesfrom$12,000to$16,000.Thehighcostofthetherapyraisescomplexcoveragedecisionsforpayersandplansponsors,madeevenharderbythepotentialspendingwastefromtherapydiscontinuation.GLP-Idrugsarenottheonlybr
34、oadpopulationdrugsemergingorintheIate-Stagepipeline;othersincludetreatmentsforAIzheimerfSandnonalcoholicfattyliverdisease.Newdrugshavethepotentialtonotonlyimprovepatients*healthbutalsoheightentheneedforbettertherapyandcostmanagement.Theresultingbusinessmodelchangesacrossthehealthcarevaluechainarelik
35、elytobemeaningful.Inthiscompendium,weofferanoverviewofwhatzstocomein2024forpayers,healthsystems,andhealthservices,aswellasaselectionofarticlesfrom2023onthesesectors.Wehopethattheyshedlightonthechallengesandopportunitiesyourorganizationsface.Shubham Singhal is the global leader of McKinseyrS Social,
36、Healthcare, and Public Entities (SHaPE) practices and Drew Ungerman is the global leader of McKinsey,s Healthcare Practice and the McKinsey Health Institute.,Kathryn Mayer, Aon report: Big increase projected for 2024 employer health care costs, SHRM, August 29, 2023.,Gretchen Berlin, Meredith Lapoin
37、te, Mhoire Murphy, and Joanna Wexler, Assessing the Ii蝴ering impact of COVID-19 on the nursing workforce, McKinseyz May 11,2022.3 National Diabetes Statistics Report, Centers for Disease Control and Prevention, accessed November 20, 2023.Adult obesity facts, Centers for Disease Control and Preventio
38、n, accessed November 20, 2023.i *,Real-world analysis of glucagon-like peptide-1 antagonist (GLP-Ia) obesity treatment one-year CoSt-effectiveness and therapy adherence/ Prime Therapeutics and MageIIanRx Management, July 11,2023.Disclaimer: These materials reflect general insight based on currently
39、available information. Future results may differ materially from any statements of expectation, forecasts, or projections. These materials are not a guarantee of results and cannot be relied upon as such. These materials do not constitute legal, medical, policy, or other regulated advice and do not
40、necessarily contain all the information needed to determine a future course of action. These materials are provided as is solely for information purposes without any representation or warranty, and all liability is expressly disclaimed. References to specific products or organizations are solely for
41、 illustration and do not constitute any endorsement or recommendation. The recipient remains solely responsible for all decisions, use of these materials, and compliance with applicable Iawsz rules, regulations, and standards.Sincerely,ShubhamSinghalandDrewUngerman2024payersoutlook:Opportunitiesabou
42、ndMonishaMachado-PereiraIn2022,ourarticlesonthegatheringstorminhealthcare1focusedontheuncertaintyfacingthepayersector.Whilemostofthemetaphoricalstormhaspassed,itsaftereffectsshouldnotbeunderestimated.Lookingto2024,Weofferfivemainconsiderationsforpayerexecutives.Highercosts-andthepromiseofgenerativeA
43、lPayershavenotedariseinutilizationspurredbyeffectivebutexpensivetherapiessuchasbroadpopulationdrugs(forexample,GLP-Isfortype2diabetesandobesity,andtreatmentsfornonalcoholicfattyliverdisease)andhigh-costinfusiondrugs(forexample,precisiononcology).Healthsystemlaborshortagesremainunabatedandareunlikely
44、toeasein2024.Weestimatethata$100billionincreaseinhealthsystemcostscouldtranslateintoa9percentemployerinsurancerateincrease.Costpassthroughstoemployeescouldresultinthemostvulnerablememberspayingmorethan75percentofdiscretionaryincomeformedicalservices.Ouranalysisshowsthatevenforpayersthathaveundertake
45、nadministrativetransformations,opportunitiesremaintofurtheroptimizeprocessesusingartificialintelligence,includinggenerativeAl(genAl),adjacentautomation,anddigitaltechnology.Thepotentialreductionsinadministrativeandmedicalcosts,asdescribedbymycolleaguesintheearlierpartofthiscompendium,showhowtherapid
46、paceofadoptionofgenAlcouldhavefavorableimplicationsforallpayers.Thiscouldrangefromhealthsystemandbenefitcontractcollationandqueryingtoamoresophisticatedrequest-for-proposalresponsegeneration.However,challengesarounddataprivacy,governance,andchangemanagementremain.Formanypayers,thebiggestquestioniswh
47、ereandhowtostart.GovernmentbusinessresiliencedespiteconstraintsRecentregulatorychangesinMedicarerates,riskadjustmentmodels,Starscriteria,andMedicaidredeterminationhavestrainedtheVerYbusinesses(Medicare,Medicaid,andIndividual)thathaveprovidedasteadysourceofpayerprofitsandgrowth.IfMedicareAdvantageoff
48、ersananaloguefortheevolutionoftheIndividualsegment,thebasisofcompetitionmayshiftfrompricetowardbenefits,distribution,andretention.Themoreestablishedplayersmaythereforedisplacedisruptors,giventhedepthoftheircapabilitiesinthoseareas.ForMedicareAdvantageandManagedMedicaid,relentlessexecutionofestablish
49、edvalueleversisimperative.Duals(memberswhoqualifyforbothMedicareandMedicaid)acquisitionsandmanagementwillbeacriticalbattlegroundforMedicareAdvantage.ForMedicaid,ouranalysesofrequestforproposalssuggestthatcreatingtighterintegrationwithprovidersthroughrisk-basedarrangementsandjointventurescouldbecompetitivelydifferentiating.
