为未来十年设计医疗保健系统

© Oliver WymanCONTENTSExecutive SummaryThe Looming CrisisReimagining Clinical WorkReducing Administrative Burden And CostsLowering Drug Spend Without Limiting InnovationCarving A Path To An Affordable Healthcare System 11192834 5 © Oliver WymanEXECUTIVESUMMARYThe affordability crisis in healthcare is mounting and consumers are paying the price. Alreadyat nearly $5 trillion, national spending on healthcare is expected to swell to $9 trillion by 2035,driven primarily by the rising unit cost of care. This is unsustainable.Building on our Designingfor 2035 work, theOliver Wymanteam has identified what the industry needs to do to createan affordable, sustainable healthcare system over the next 10 years. In this report, we identifya path to realize over $1 trillion in cost savings — savings industry stakeholders can achieveusing proven tools available today. We also explore additional savings that could be unlockedwith widespread policy and regulatorychanges.We targeted three key buckets of healthcare spending: the labor intensity of care, the highadministrative burden, and the growing cost ofdrugs.Reducing clinical labor intensity:Today, even the most basic of care interactions, such astaking a strep test or getting blood drawn, frequently involve multiple clinicians. We projectclinical labor workforce costs will reach nearly $3 trillion in 2035. Making better use of lesscostly and more accessible sites of care like ambulatory surgery centers, digital platforms, andpatients’ homes can drive spending down. Enabling resources to reach their full potential byintegrating more advanced practice providers to care teams and optimizing workflows withstandardization, automation, and centralization will also reduce the intensity of clinical care.Taken together, these levers can lower labor costs by 25% by2035.Relieving administrative burden:Misaligned incentives, legacy systems, unnecessary processvariation, and fragmentation contribute a significant amount of cost bloat to the industry’sadministrative activities. Continuing at the current pace, we project administrative costs togrow to over $2 trillion by 2035, or $6,400 per capita. Investing in back-office modernizationand digital support tools will relieve burden from general and administrative-related costs.Removing low-value tasks, improving data management, and more effectively collaboratingbetween payers and providers can also cut spending from healthcare-specific administrativetasks. These levers can reduce costs to perform administrative activities by 20% by2035.Curbing impact of growing drug costs:The burgeoning specialty drug market is rapidlydriving up spending. Although drugs can be a more efficient and effective treatment thanhuman intervention, there has been no commensurate decrease in medical spending. Weproject drug spending to more than double to $2.5 trillion by 2035. The industry can take out10% of this cost growth by maximizing the uptake of biosimilars, simplifying the drug valuechain, and expanding direct pricingnegotiation.As cost pressures increase, affordability will become a requirement to compete in 2035. Legacybusiness models that fail to evolve risk losing relevance in the future. This needs to be a topagenda item for all industry stakeholders. We describe actions the industry should take todayto build a better, more affordable, and more sustainablefuture. © Oliver WymanHEALTHCARE’S $1 TRILLION CHALLENGESetting a new trajectory for healthcare spend$9.0trillion*SAVINGS USING TOOLS AVAILABLE TODAYAdditional savings with broader industry disruption and policy changes2035healthcarespendNewtraReduce labor intensity•Right place, right time•Right care team•Reimagine work-$640 billionAccept thestatus quoMaximize efficiencies inthe current modelRelieve administrative burden•Cost of doing business•Simplified processes•Payment/pricing simplification•Standard licencing•Clinical automation-$450 billion*Source: Projected national health expenditures, Centers for Medicare and Medicaid Services-$1.3trillionSAVINGS $7.7trillionjectoryfor2035spendCombat high price of drugs•Biosimilars•Improve value chain•Price negotiation•Value-based drug pricing-$180 billion © Oliver WymanTHE LOOMINGCRISIS1CMS national health expenditure projections;Oliver Wymananalysis.It’s become a familiar trope domestically and even around the world: US healthcare hasbecome exceptionally unaffordable — foreveryone.Over half of adults under the age of 65report having difficulty affording healthcare costs.And by 2035, out-of-pocket expenditures for the average American will rise to $2,500 peryear, up from roughly $1,450 now. Taking a broader view, national health expendituresare expected to double to $9 trillion by 2035 and will represent one-fifth of the entire USeconomy.1The industry has been down this road before. In response to escalating costs in the 1990s,regulators and industry stakeholders were pressed to make deep spending cuts. Althoughthe Balanced Budget Act (BBA) of 1997