American health care faces persistent issues with consolidation, workforce shortages, integration of new technologies, and unrelenting economic pressure. In 2023, technologies such as clinical decision support (CDS) and other artificial intelligence (AI) tools continued to emerge rapidly, offering both promise and risk. Meanwhile, even as long-standing care and business models are upended, the ripple effects of COVID-19 continue. Physician shortages are growing, especially in primary care, though advanced practice clinicians (APCs) are filling some of the gaps.
Health care organizations are looking to their vast wealth of data for insights that can improve care for patients, promote professional satisfaction for clinicians, mitigate liability, and streamline medical practice.
Each year, TDC Group looks ahead to health care trends over the next decade, focusing on challenges, key lessons, and emerging risks. To help guide the actions of medical leaders making critical decisions, we lay out some of the most pressing issues medical professionals must address.
Highlights from our predictions for how U.S. health care will change by 2033 include:
AI-powered clinical decision support tools will help reduce administrative burdens, freeing up more time for patient care—but they present new risks in the process.
AI has become a critical technological tool—albeit one that is still in its earliest stages. Many health care practitioners say they welcome AI-powered assistance in lifting administrative burdens, but few health care systems have developed a plan for using AI tools in scheduling and billing—much less for diagnosis or other phases of patient care.
AI-powered tools are being implemented in more medical specialties, and they are being deployed to provide administrative support that allows medical professionals to focus directly on patients. More research studies are examining AI-powered CDS tools in practice, evaluating their ability to provide evidence-based recommendations for diagnosis and treatment, improve care quality, and reduce adverse events. As these efforts show, generative AI has inspired enthusiasm—tempered by healthy doses of caution and safety concerns.
“Even when using valid clinical decision support tools, medical professionals must apply critical thinking, clinical judgment, and additional diagnostic testing as needed to validate CDS recommendations,” says Peter Kolbert, JD, Senior Vice President for Claim and Litigation Services for Healthcare Risk Advisors (HRA), part of TDC Group. For instance, though an algorithm anticipates a patient’s active myocardial infarction, the emergency department physician must still secure additional evidence or confirm test results prior to sending the patient for stenting or angioplasty. Otherwise, the physician risks a subsequent medical malpractice claim of misdiagnosis if the procedures are unnecessary. Even as CDS can streamline clinicians’ workflows, it does present additional patient safety and litigation risks.
“Medical record documentation of human judgment in response to AI guidance will be essential to patient safety and mitigating the risks of allegations of negligence,” Mr. Kolbert says.
APCs and alternative models of care will be two keys to alleviating the primary care and elder care crisis.
The Association of American Medical Colleges predicts that demand for medical services in the U.S. will grow much faster than physician supply, leading to an estimated physician shortage of between 54,100 and 139,000 by 2033. In primary care, specifically, some relief is coming for overburdened physicians, as APCs, including nurse practitioners (NPs) and physician assistants (PAs), are among the fastest-growing professions.
Leaders in primary care emphasize the importance of role definition, so physicians and APCs can collaborate effectively within state-based scope-of-practice limitations. This will broaden access to care while helping each team member practice at the top of their license.
By 2050, the population of Americans 65 and older is projected to increase by more than 50 percent. More of this population is choosing a home in lieu of institutional care, requiring a care model that works with patients to modify their environments to support that choice. “Nurse practitioners are providing much-needed in-home care and community-based options for elder care,” says Paul Romano, President of TDC Specialty Underwriters, part of TDC Group.
In a time of worsening physician shortages, new approaches to primary care, home care, and elder care are essential. Thoughtful structuring of care teams can assist many specialties in maintaining or expanding access to care while containing costs, relieving burdens for physicians, and continuing to provide high-quality and attentive care.
Nuclear malpractice verdicts—driven by social inflation—will continue to push insurance rates and health care costs higher.
A notable difference between the U.S. and similar countries is the rising cost of malpractice litigation. Numerous factors contribute. The consolidation of health care creates large corporate health care systems that make attractive targets for plaintiffs’ attorneys and hold little appeal for juries sympathetic to injured patients. These systems often wish to avoid the uncertainty of extended litigation, which may incline them to settle cases more frequently.
Social media and nuclear verdicts remain powerful influences. Social inflation, which occurs when an insurer’s average claim cost grows faster than the overall inflation rate, has reshaped numerous markets, but its effect on health care has been outsized.
“People are, understandably, sympathetic to injured patients,” says Robert E. White, Jr., President of TDC Group. “Jurors can also form emotional bonds with credible, empathetic medical professionals, but it’s harder to be sympathetic to a hospital—if jurors perceive a health care organization as a faceless but deep-pocketed entity, then an enormous award may be easier for the plaintiff’s attorney to inspire.”
Over the decade ending in 2021, social inflation alone has increased losses incurred by physician-focused insurers by between $2.4 and $3.5 billion—8 to 11 percent. By creating pressure to increase insurance premiums, social inflation increases health care costs and can make care less accessible.
What will health care look like in a decade?
These are our 2023 predictions for how U.S. health care will change over the next ten years:
1. The shadow of the pandemic will still be present over health care, as physicians face continuing pandemic-related lawsuits, unanswered questions around care for long COVID patients, and delayed diagnoses stemming from COVID-19 disruptions.
2. Health care consolidation will continue unabated and continue to be a driver of increasing health care costs.
3. Nuclear malpractice verdicts—driven by social inflation—will continue to push insurance rates and health care costs higher.
4. Patient use of retail health care clinics will increase—forcing a serious re-examination of “patient-centered care.”
5. APCs and alternative models of care will be two keys to alleviating the primary care and elder care crisis.
6. AI-powered clinical decision support tools will help reduce administrative burdens, freeing up more time for patient care—but they present new risks in the process.
7. AI tools will “listen” to patient-clinician interactions to reduce the burden of documentation, which is a top driver of clinician burnout.
8. AI tools will increase HIPAA and cybersecurity risks for health care.
9. The flood of data from patient wearables will continue to overwhelm clinicians.
10. Big data will pay off—but only for those organizations that successfully harness it.
To access detailed insights from our team of health care experts who uncover challenges, key lessons, and emerging risks, visit “What U.S. Healthcare Will Look Like in 2033.”
Richard E. Anderson is chairman and chief executive officer, The Doctors Company and TDC Group.
