In one scenario, the rise ofdigital comparative shopping tools could drive providers to lowerpricing, while patients begin to seek virtual or retail clinic careforr all but the "highest acuity care episodes." (Photo:Shutterstock)

It's anybody's guess what health care will look like in the year2030, but management consulting company Oliver Wyman narrowed thelist of possibilities down to four scenarios.

The article, published recently online, was written by FritzHeese, a partner in Oliver Wyman's Health & Life Sciences andOrganizational Effectives Practices and David Fries, a seniorknowledge expert in the company Health and Life Sciences division.Per their findings, U.S. health care presently makes up 18% of thetotal gross domestic product, with 38% of that spending going tohospitals, 23% to physician services and 12% to prescriptiondrugs.

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The four possible futures Heese and Fries see:

1. The status quo continues

Under this scenario, health care is still primarily afee-for-service proposition, with Medicare and Social Securityremaining solvent while government deficits continue. Meanwhile,total health care costs would eventually level off in conjunctionwith gross domestic product growth and value-based reimbursementmodels would be only slightly more common than they are now.

According to Heese and Fries, "Next-generation delivery models(like Iora, Amazon, and Omada) with potential for massivedisruption exist, but still at the margins. Innovation happens inpockets. Nobody develops scalable, innovative solutions. Costsincrease, but not faster than the system can withstand. Medicareand Social Security remain solvent. Industry economics are largelyunchanged."

2. 'No profit zone' health care

The next scenario revolves around the possibility of health careas a no-profit zone, the result of political reform the Heese andFries argue could be driven by an increase in deductibles andout-of-pocket spend. In response, the government would launch a"Medicare for All" single payer option, where "payers play only asmall, back office processing role." Incumbents would begin toconsolidate as margins compress, while innovative startups mightnot be able to generate the profit or scalability necessary tobring disruption.

According to the duo, "Incumbents' margins are dramaticallycompressed. Consolidation pushes as far as regulators allow,leaving a few incumbents with razor thin margins, as price andearnings multiples enter mid-single digits. … Despite enoughwell-funded investors to spark competition and drive lower prices,a killer solution doesn't thrive and prosper in the end."

3. Incumbents drive "value" to a tipping point

A third scenario is centralized around an incumbent-led "triumphof value" that unfolds across several key fronts such as shifts inconsumer behavior that prioritize healthy living, the emergence ofa centralized platform that manages all of the public'sinteractions with the health care system and the creation of toolsthat drive "best practitioner choices." Science could also play arole, with advances in genomic therapies placing a greater emphasison personalized prevention and virtual health care becominginterchangeable with brick-and-mortar office visits.

"The health care ecosystem achieves nearly optimal incentivesacross stakeholders and universal access, creating necessary toolsthat drive best practitioner choices," Heese and Fries write."Industrialized Factories compete to deliver the highest quality,lowest cost care possible, leading to more efficient best practicesand standardization."

4. New market entrants take over

The final scenario instead focuses on how new market entrantscould disrupt the health care system. Products or platforms thatproffer quality consumer experiences and integrate various healthcare services would flourish. The rise of digital comparativeshopping tools could also drive providers to lower pricing, whilepatients begin to seek virtual or retail clinic care for all butthe "highest acuity care episodes."

"For incumbents, results mirror the 'Health as a No ProfitZone,' Scenario 2 as they cede wallet share to out-of-industryplayers, now earning only a small profit portion in health care'snew market," Heese and Fries note. "Meanwhile, companies considered'non-health care' in 2019 will accumulate well over a trilliondollars in health care market cap by 2030."

Read more: 

• How important are the indirect benefits of healthcare innovation?
• 9 companies leading health care disruption in2019
• Health care leaders expect more disruptions, surveysays