While consumers will become increasingly responsible for their own health and use of healthcare services, they will actually become less and less empowered in the choices they have for care, especially in higher-acuity, higher-cost situations. While many in the industry will continue to sing the praises of choice, the reality is most consumers will have far fewer choices moving forward, often in ways they might never ever consider or see.

Today we tend to consider hospitals and health systems as birds of the same feather in terms of business model, with variances based on size, scope of services, for-profit/non-profit, and other factors. Moving forward, we could see the splitting of the health system model, with some systems moving even further to the larger, more comprehensive “health” organizations, others retracting into solely acute-care destinations – the “giant ICU on a hill” – and others somewhere in the middle. These models may emerge based on core geographic/market differences such as presence of competitors, plan consolidation/power, regulation, and dozens of other market forces. Yet the primary area where this transformation would play out is with health, wellness and the lower-acuity care points – what we’re calling The Funnel Wars.

Challenges to and skepticism of the mainstream medical field and science itself have exploded in the past two years because of the pandemic and political tribalism in the U.S. Anti-vaxxers, non-maskers and Covid deniers are just the start of an expansion of this distrust of experts, which taken to its potential end could result in multiple “health sects” – primary “schools” of medical thought that coalesce around political/world-views. Imagine “Mainstreamers,” who follow the establishment healthcare point of view, “Progressives” who follow minimal medical intervention combined with complementary and alternative medical solutions, and “Contrarians” who deny mainstream medical thought and create their own set of “alternative facts” on everything from vaccines to childbirth to end of life care, and everything in between. These sects will not only follow the medical thinking that best fits their world-view, they may in fact create their own reality through alternative research, diagnosis and treatment approaches, and models for the delivery of care itself.

The Covid-19 pandemic shone an ugly light on the disparities that have plagued the U.S. healthcare system for decades. Unfortunately, that health gap is more likely than not to expand, as the “haves” gain access to increasingly more expensive medical treatments, health services, and personalized care, while the “have nots” will face growing shortages of basic health resources, from clean water and air to physicians and clinicians, rural healthcare, and more. This shift will be compounded by the mental health crisis, which disproportionately affects systemically disadvantaged populations and groups outside traditional healthcare access channels (teens, for example). All while those entities that might address these disparities increasingly struggle financially – health systems, health plans, state and federal governments – and others lack the incentives to focus on the growing issue.