The chronic care reckoning: Redesign or absorb the cost
Article | March 3, 2026
Reading time: 7 mins
When the Vizient Research Institute set out to study access this past year, the goal was not to refine scheduling tactics or expand online booking.
It was to challenge a deeper assumption.
Many organizations still frame access as a throughput issue—more slots, better scheduling, faster booking. But the data suggests something more uncomfortable: the system itself is misaligned with the patients who now consume the majority of care.
Nearly 80% of inpatient admissions currently involve patients with at least one chronic condition. More than half of Medicare beneficiaries aged 65 to 74 already live with at least one chronic condition, and among those 75 and older, nearly two thirds do. Over the next decade, the population age 75 and older is projected to grow 44% while other age cohorts are projected to grow less than 10% or even see a decline.
The center of gravity has shifted. Most systems were built for episodic acute care, but they must now serve an aging population defined by longitudinal multi chronic care needs.
Access challenges continue to persist because the patient profile has fundamentally changed. Current processes and solutions do not match the needs and preferences of the surging demand.
Below are five key takeaways from the study, The access imperative: Reimagining care delivery for a more complex patient population, emphasizing why healthcare leaders can no longer afford to treat care as siloed.
Takeaway 1: Chronic complexity is the core business
Patients with multiple chronic conditions are not a niche cohort—they are the dominant users of healthcare today.
Compared with patients without chronic disease, they generate roughly 10 times more inpatient admissions and emergency department (ED) visits and more than six times as many office visits. On a per capita basis, they account for approximately 17 times more inpatient days.
Future growth will concentrate even further among the most complex patients. Over the next decade, projected ED and office visit growth among patients with multiple chronic conditions will outpace growth among those with a single chronic condition by nearly two to one.
Yet most health systems remain organized around single specialty service lines built for discrete encounters. That structure works when complexity is the exception but falters when complexity becomes the rule.
© Vizient Inc. 2026. All rights reserved.
Takeaway 2: Fragmentation is structural
Fragmentation is often described as a byproduct of workforce shortages or high volumes. Those pressures are real, but they are not the root cause.
The system was designed around providers¬—and patients are forced to navigate their way through a complicated web of systems and structures to seek care.
Approximately 60% of patients with multiple chronic conditions see five or more specialists in a year. Each clinic runs its own scheduling logic, referral pathways and care protocols. A patient with heart failure, diabetes and chronic kidney disease may juggle multiple portals, appointment lines and medication plans—with no single point of orchestration. Individually, each visit makes sense. Collectively, the experience fractures care.
Half of patients with multiple chronic conditions report difficulty securing appointments. Many delay care, while some switch providers. Nearly one third of commercially insured patients in this group report leaving under those circumstances. One in five say they would rather go to the ED than wait for an office visit with their doctor.
This extends beyond dissatisfaction into cost and loyalty erosion.
Medicare beneficiaries with multiple chronic conditions who receive care across more than one health system incur roughly 30% higher annual spend than those treated within a single system. At the same time, more than 80% of chronically ill patients say they prefer to receive all care within one organization. While patients are asking for coherence, the current model delivers fragmentation.
Takeaway 3: The financial ground is shifting
The rise in chronic complexity is primarily a payer mix story.
More than 70% of inpatient admissions among patients with multiple chronic conditions are covered by Medicare. Across this cohort, the mix skews heavily toward Medicare and Medicaid compared with commercially insured populations. As the population ages, margin expansion gives way to margin defense.
Managing chronic disease is central to long-term financial sustainability. If organizations fail to manage this population effectively, they absorb higher utilization and avoidable spend in an unfavorable reimbursement environment.
Capacity constraints compound the issue, especially as inpatient beds and ED space remain finite. When lower acuity chronic demand fills those resources, systems risk crowding out the high-acuity tertiary and quaternary cases that sustain academic distinction and margin. Chronic care strategy is now inseparable from enterprise strategy.
© Vizient Inc. 2026. All rights reserved.
Takeaway 4: Incremental access fixes will not solve structural misalignment
While extended office hours, telehealth and online scheduling are necessary, they are not sufficient.
Most organizations continue to funnel all patients through the same undifferentiated access channels, meaning there are few dedicated pathways for high risk, multi chronic patients who require coordinated specialty access and continuous care management.
Meanwhile, more than 80% of patients with multiple chronic conditions say that care at home options are important. For older adults with mobility limitations, transportation barriers or advanced illness, home-based care is not simply a convenience feature but one that is foundational to continuity of care.
In some markets, specialist wait times stretch nine to 12 months. When access fails, patients default to urgent care or the emergency department. Worse, they leave. But merely adding more appointment slots into an episodic framework will not resolve a structural mismatch. The care model itself must evolve.
Takeaway 5: The future belongs to integrated chronic care models
If the majority of admissions are driven by chronic patients who see five or more specialists, and fragmentation carries a measurable cost premium, system redesign becomes imperative. A more collaborative model for the coming decade looks different:
- Comprehensive care planning: Patients access diverse specialties during the same visit, reducing the need for multiple referrals.
- Enhanced collaboration and communication: Clinicians work together as a team, sharing information and coordinating care plans to address all health issues for each patient.
- Patient-centered approach: Care is tailored to the individual, with a focus on clinical and social needs to improve overall health outcomes.
- Increased efficiency and quality: Deliver higher quality care through faster diagnosing, reduced wait times, less duplication and lower costs.
Caring for older, chronically ill patients must be treated as a strategic priority. That means aligning incentives, infrastructure and governance around longitudinal management rather than episodic throughput.
If we were designing a health system today for an older, clinically complex and predominantly Medicare-funded population, it would not revolve around disconnected specialty clinics and uniform access channels. Yet that remains the dominant architecture that most organizations still operate in.
The chronically ill patient now defines the business. The access imperative is not about improving scheduling: it’s about redesigning the system to support longitudinal care, reducing fragmentation and protecting scarce capacity for the patients who need it most.
Leaders who confront this demand shift directly will protect margin, strengthen patient loyalty and build resilience for the next decade. Those who continue optimizing episodic throughput may discover they have been solving the wrong problem.
Vizient Research Institute—exclusive economic intelligence for Vizient Member Networks—advances rigorous research and strategic insight to help health system leaders navigate transformation and drive long-term sustainability.