Impact of Change: The biggest stories shaping healthcare’s future

Editor’s note: This is the first in an ongoing series focused on the biggest stories emerging from the annual Vizient Impact of Change® forecast and the ways healthcare organizations can use forecasting and scenario planning to better prepare for what’s ahead.

The last few years have forced healthcare leaders to get comfortable with uncertainty.

Margins are tighter. Consumer behaviors are changing. Policy and payer pressures keep shifting. At the same time, innovation is moving faster than ever, from AI-enabled clinical insights to new care models and therapies that will rapidly change how healthcare is delivered to patients.

That tension showed up repeatedly as we worked through this year’s Impact of Change forecast.

On one hand, many of the challenges health systems are facing aren’t going away anytime soon. But there also are signs that organizations are adapting in meaningful ways—becoming more operationally coordinated, more ambulatory-focused, and more intentional in their future planning.

That’s really what stood out to us most this year: The organizations that are best positioned moving forward aren’t necessarily the ones trying to predict a single outcome. They’re the ones building strategies flexible enough to respond as conditions change.

Because forecasting today isn’t just about producing a number. It’s about understanding the forces shaping demand—and being able to pressure test decisions before those shifts hit your market.

Forecasting must be dynamic

One of the biggest shifts we continue to think about is how forecasting is used inside healthcare organizations.

Historically, forecasting has often been treated as a static exercise—a set of numbers that’s plugged into long-term planning assumptions and revisited the following year.

But that approach doesn’t hold up very well in today’s environment where health systems are managing shorter planning horizons and navigating a level of volatility that makes five-year assumptions harder to rely on without ongoing adjustments.

That’s why scenario planning is so important.

Rather than looking at a forecast as a single answer, we see it more as a framework for understanding the different forces that could shape demand over time, whether that’s policy changes, technology adoption, shifts in consumer behavior, or changing epidemiology trends.

The goal isn’t necessarily to predict exactly what will happen. It’s to give leaders a clearer way to think through questions like: How will our margin be impacted if outpatient migration accelerates faster than expected? How will payer mix changes affect utilization in our specific market? Do we have enough beds if observation demand rises while inpatient acuity grows? What would happen if our ambulatory strategy successfully captures more procedural growth?

That ability to pressure test assumptions (and then adjust over time as conditions evolve) is increasingly critical.

Especially because so many of the stories we’re watching are interconnected.

Story 1: AI and innovation are beginning to reshape utilization

One of the most interesting themes this year was the growing influence of AI and advanced technologies on care delivery patterns. We’re still early in that transformation, but we’re beginning to see where the effects could become meaningful.

For example, AI-enabled tools may improve diagnostic specificity and help patients move more quickly to appropriate interventions. That may not dramatically change the number of patients entering the system, but it could significantly change how they move through the care continuum and where care ultimately occurs.

At the operational level, many health systems also are becoming more sophisticated in how they use predictive analytics, dashboards, and throughput management tools to improve efficiency.

What’s interesting is that we’re starting to see some of those gains show up in the data.

We expect to see improvements in time to diagnosis, allowing some patients to receive treatment more rapidly and shift demand to specific diagnoses rather than patients with general symptoms being discharged from the ED.

That’s likely less about AI independently “solving” operational challenges and more about organizations becoming much more coordinated around system-wide efficiency goals—aligning incentives, standardizing metrics, and improving visibility into performance across the enterprise.

In many ways, we’re finally starting to see health systems operate more like true systems.

Story 2: The outpatient shift continues to accelerate

Another major story this year is the continued acceleration toward ambulatory and outpatient care.

That shift has been building for years, but it’s becoming increasingly central to long-term growth strategies.

Across the forecast, outpatient demand continues to represent one of the strongest growth opportunities for health systems. At the same time, reimbursement pressures and policy changes continue to push care towards outpatient sites, including ambulatory surgery centers.

A major example is the three-year phase-out of the Medicare inpatient-only (IPO) list, which began in 2026. But interestingly, the biggest long-term impact may not actually come the elimination of the IPO list.

When we looked more closely at the data, what stood out was the broader volume of short-stay activity occurring across the system—particularly non-surgical cases with very short lengths of stay.

That raises larger strategic questions:

• Will payers increasingly pressure low length of stay cases to shift to outpatient or observation settings?
• How will that affect inpatient case mix?
• What happens to observation capacity and ED throughput?
• How should health systems think about future ambulatory investment?

Those are the kinds of downstream effects dynamic forecasting can help organizations model before the market fully shifts.

Story 3: Consumer and payer pressures are changing behavior

This year’s forecast also reflects the continued affordability pressures affecting patients and health systems alike. Coverage headwinds, high deductibles, and changing payer dynamics are influencing how patients interact with the healthcare system.

In many cases, patients are delaying care, deferring services, or waiting until conditions worsen before seeking treatment. That can create ripple effects across the continuum, including increased ED utilization and more severe chronic condition exacerbations.

Those impacts also are highly localized.

The way payer mix changes affect one market may look very different somewhere else. That’s why local market context matters so much when organizations are planning strategy.

National trends are important, but healthcare leaders increasingly need the ability to understand how those trends translate to their own communities, patient populations, and competitive environments.

Considering your market insurance mix, use rates changes by payer and future demand together can inform health systems of the specific tactics that will lead to sustainable, long-term growth.

Story 4: There are reasons for optimism too

It’s easy to focus entirely on the headwinds facing healthcare right now. And those pressures are certainly real.

But one thing that stood out this year is that the story isn’t all negative.

There are meaningful bright spots emerging across the industry.

Innovation continues to open new possibilities across care delivery and utilization management. Expanded GLP-1 indications, for example, are continuing to influence demand patterns across inpatient, clinic, ED, and observation settings as access broadens and utilization grows.

We’re also seeing significant movement in areas like gene therapies and evolving infusion and injectable treatments, which are beginning to reshape how organizations think about specialty care delivery and capacity planning.

Another area our experts spent time modeling this year was pain management innovation.

Advances in how pain is managed—clinically and operationally—could have meaningful downstream effects on utilization over time. As organizations become better equipped to manage pain earlier and more effectively, there’s potential to reduce avoidable ED visits and observation stays tied to chronic conditions or post-surgical complications.

And operationally, many organizations are becoming more disciplined and coordinated in how they approach care delivery overall.

We’re seeing stronger evidence of health systems aligning around enterprise-wide goals, improving throughput, and taking a more intentional approach to ambulatory growth opportunities.

That doesn’t eliminate the challenges ahead.

But it does suggest that organizations are adapting—and that adaptability may become one of the most important strategic advantages moving forward.

The takeaway: Flexibility matters more than certainty

If there’s one thing this year’s forecast reinforced, it’s that healthcare leaders can’t afford to build strategy around static assumptions anymore.

The environment is simply changing too quickly.

Organizations need planning approaches that allow them to model multiple future scenarios, understand what’s driving utilization changes, benchmark assumptions against real-world performance, and adjust strategy as conditions evolve.

Because forecasting isn’t about trying to predict the future perfectly.

It’s about helping organizations prepare for multiple possible futures—and giving them the ability to respond faster when the market changes.