From Every Angle: The silver tsunami

The “silver tsunami” is no longer a distant forecast — it’s here, reshaping the future of healthcare in real time. Every day, 10,000 Americans turn 65, and by 2030, one in five U.S. residents will be 65+. This massive demographic wave brings both opportunities and challenges. Older adults are living longer than ever before, but they’re also presenting with multiple chronic conditions, higher medication use and unique social needs that stretch the limits of traditional care models.

For hospitals and health systems, the implications are immense. It’s not just about more patients — it’s about more complex patients who require coordinated, continuous and resource-intensive care. Service lines like cardiovascular and orthopedics are already seeing unprecedented demand, while financial pressures from shrinking commercial payer bases, thin Medicare reimbursements and workforce shortages continue to mount. The traditional inpatient-focused model simply cannot shoulder the weight of what’s coming.

That’s why leaders are rethinking how and where care is delivered. Growth in ambulatory settings, hospital-at-home programs and community-based support networks is no longer optional — it’s critical for sustainability. Financial health will increasingly hinge on the ability to shift to lower-cost sites of care while still investing in preventive programs, chronic disease management and patient experience. Just as important, systems must form strategic partnerships, strengthen transitional care and align their service lines to meet the needs of an older, more medically complex population.

In short, the silver tsunami is not a threat to brace against but a wave to ride. By reimagining care delivery, expanding into ambulatory and community settings, and investing in both people and partnerships, health systems can transform demographic pressure into an engine for growth and resilience. The future belongs to organizations that see aging not as a crisis, but as a call to innovate in ways that improve patient outcomes, sustain providers and strengthen the entire care continuum.

Rethink aging population beyond hospital walls

Tony Guth, Senior Director, Intelligence

Why it matters: The aging population is reshaping healthcare, driving demand across all care settings but especially in ambulatory environments. Hospitals will remain vital for complex cases, yet most growth is happening outside their walls.

The challenge is not just volume — it’s complexity. Older adults present with multiple chronic conditions, high medication use and unique social needs. “At a certain age, you’re going to be a more complex patient consuming a lot more healthcare on average than when you were 20 or 30,” said Tony Guth, Vizient senior intelligence director. “So backup care beyond the hospital walls that can be done in a clinic or ASC setting will be increasingly important.”

While every system and market are different, it’s important for leaders to tailor strategies to meet those needs while adapting to a shrinking commercial payer base and lower Medicare reimbursements. Financial sustainability will depend on how effectively organizations shift into lower-cost ambulatory models.

“Ambulatory care by itself is inherently lower cost,” he said. “For leaders, the opportunity lies in building capacity, forming partnerships and delivering meaningful patient experiences that earn loyalty and trust.”

Strategies to consider:

• Segment the population: Design different approaches for patients — healthier, resource-rich seniors versus vulnerable, high-acuity patients. The spectrum not only impacts their ability to access requisite services but then how it affects utilization as well as patient outcomes. Recognizing that this nuance exists and thoughtfully designing programs accordingly is important.
• Strengthen post-acute and transitional care: Ensure seamless patient handoffs, invest in hospital-at-home and virtual models, and expand community-based support systems. If you pay money up front to send patients to their home and provide the necessary social work needs, they’ll be less likely to show up in the ED later.
• Build operational capacity: Address workforce shortages, extend patient visit times where appropriate, and prioritize navigation support. Consider how you can drive efficiencies across your care continuum and augment your human capital to optimize capacity and meet this growing demand is going to be key.
• Invest in preventive and chronic disease management: Support wellness, disease prevention and medication adherence programs to prevent and slow disease progression. Also remember the importance that social determinants of health play on patient health. “An 80- year-old who has lived a clean life is going be healthier than an 80-year-old who smokes, drinks, has a poor diet and lacks transportation to care,” Guth said.
• Form partnerships: You don’t have to offer the full continuum of care. But to avoid gaps that could cause patients to end up in your hospital, you can use joint ventures and collaborations (e.g., ASCs, specialty providers) to scale ambulatory services. If it’s intimidating, start small and take an incremental stepwise approach. For example, move orthopedics out of surgery, and then consider spine or cardiac. Just make sure that your strategy relates to aging ties to your overarching system mission and your stakeholders across the business are all on board.
• Focus on financial sustainability: As your contracts and how you get paid by CMS changes, you need to look at these lower cost structures and that is by definition ambulatory. Expand into growth areas like ambulatory surgery and specialty pharmacy while adapting to bundled payments. “We expect the majority of many health systems’ margins will be driven by specialty pharmacy in the future,” Guth said.
• Prioritize patient experience: Prioritize patient experience by ensuring high-quality, unrushed interactions supported by technology that enables rather than replaces care. For geriatric patients, this means slowing down operationally — providing clear next steps, personalized support and satisfaction-driven interactions to build loyalty. “With the erosion of the commercial payer mix as people age into Medicare, strategically approaching these patients will support your volume thresholds move forward,” Guth said.

Strengthen the cardiovascular service line through collaboration and innovation

Josh Aaker, Senior Intelligence Director

Why it matters: The cardiovascular service line is at an inflection point. An aging population, coupled with rising rates of chronic conditions like diabetes and hypertension, is driving unprecedented demand. By 2035, nearly 72% of adult CV inpatient discharges will stem from patients over 65. Combine that with a projected 106% increase in valve procedures for the 65+ population and rising rates of multimorbidity, and the strain on capacity is undeniable.

For healthcare organizations already navigating workforce shortages and space limitations, the question is clear: How will we adapt?

“This isn’t a tomorrow problem — it’s a yesterday problem,” said Josh Aaker, senior intelligence director. “We’re already at a capacity crunch, and the demands of an aging cardiovascular population are only going to grow”.

The challenge is significant, but it’s not insurmountable. With the right strategies — spanning capacity planning, multidisciplinary care models and workforce innovation — leaders can not only keep pace with demand but also improve access, throughput and outcomes for patients.

Strategies to consider:

• Reimagine care around the patient. Leaders should “pretend to be an 81-year-old TAVR patient,” Aaker said, and design services through the eyes of older adults, recognizing their mobility, sensory and social-emotional needs. From quieter ICUs to wraparound services like endocrinology, nutrition and palliative support, systems must deliver age-appropriate, holistic care.
• Segment and plan capacity strategically. Demand growth will not be uniform. Scenario planning can identify whether bottlenecks are in cath labs, ICUs, imaging or ED throughput. Some organizations may need dedicated cardiac ICUs, while others may benefit from shifting lower-acuity cases to ambulatory surgery centers or off-campus sites.
• Build multidisciplinary cardio-renal-metabolic programs. With more than 90% of Americans affected by overlapping CV, renal and metabolic conditions, health systems should intentionally design team-based models. Leverage pharmacists, nurse navigators, diabetes educators and digital tools to expand reach while reducing unnecessary physician burden.
• Expand cardiac rehab and prevention efforts. Proactive use of rehab, lifestyle interventions and coordinated primary care partnerships can reduce complications, prevent readmissions and preserve scarce inpatient capacity.
• Optimize site-of-care shifts. Freeing up hospital space for complex geriatric procedures requires moving lower-risk, stable patients to less resource-intensive settings. Advanced imaging can often replace diagnostic caths, while off-campus procedural sites can safely absorb routine cases.
• Invest in imaging and diagnostic capacity. Demand for echocardiography, CT and other modalities is surging. Leaders must expand technology access, rethink compensation for imagers, and partner with radiology to ensure timely reads and intervention.
• Strengthen the cardiovascular workforce pipeline. With a significant portion of the CV workforce nearing retirement, building pipelines through local training programs, expanding advanced practitioner roles, and investing in technologists and imaging staff will be critical. New compensation models that reflect workload and complexity will help sustain retention.
• Elevate pharmacy and supply chain in service line strategy. Pharmacists play a growing role in heart failure therapies and specialty drugs, while supply chain decisions affect everything from device selection to patient experience. Integrating these perspectives ensures affordability, safety and patient-centered product choices.
• Harness technology for efficiency. AI-enabled triage, virtual monitoring platforms and forecasting tools can streamline workflow, reduce bottlenecks and support better resource allocation. While tech won’t replace workforce needs, it can extend their capacity and sharpen operational planning.
• Hardwire coordination and systemness. Cardiovascular care spans the full continuum — from prevention to transplant. Aligning protocols, reducing clinical variation and standardizing transitions across inpatient, outpatient and virtual settings will improve efficiency and ensure patients receive consistent, connected care. “The first clinical team CMS ever suggested was the heart team,” Aaker said. “Getting back to that collaborative model is exactly what we need now.”