Aligning the Operating Model With the Business Model To Evolve Our Healthcare System

By Tye Cook, Senior Executive Director, Access Transformation 

As we enter 2025, the healthcare industry is continuing its seismic shift in its business model. Traditionally, healthcare delivery was heavily weighted toward inpatient care, with 80% of care happening within hospital walls and only 20% in outpatient settings. Today, we see a paradigm shift, with many organizations reaching a 50/50 balance—or even leaning further toward outpatient care, with some reporting two-thirds of their patient interactions occurring outside the hospital. This shift is driven by value-based care initiatives, advancements in technology, and patient preferences for more accessible and cost-effective care options. 

However, while business models are evolving, operating models have not kept pace. A lagging indicator of this misalignment is the underutilization of specialists, which exposes inefficiencies in patient flow. The journey from primary care to referrals and specialist consultations often creates bottlenecks, leading to delays and suboptimal use of resources. Organizations that fail to address these inefficiencies risk losing their competitive edge as healthcare delivery becomes increasingly outpatient-focused and consumer-driven. 

Compounding these operational inefficiencies are broader industry challenges, including an aging patient population and a looming shortage of healthcare workers. The extent of workforce shortages varies significantly by geography and role, but one constant remains: Organizations that optimize their operating models will be better positioned to navigate these challenges.  

Strategies such as upskilling the workforce, partnering with local educational institutions to create talent pipelines, and collaborating with governments to streamline licensure requirements—such as allowing Nurse Practitioners in Florida to practice more autonomously—are critical. These efforts not only address workforce shortages but also unlock growth opportunities, which are essential in today’s constrained economic environment. 

Amid these challenges lies an immense opportunity for healthcare organizations to extract more value from their digital investments. Technologies such as advanced analytics, telehealth, and voice-enabled platforms can help streamline operations, improve patient outcomes, and enable new care models. For example, voice as a platform could revolutionize triage processes, allowing for more efficient patient routing and reducing unnecessary referrals. When combined with a more efficient operating model, these technological advancements create the foundation for a more responsive, patient-centric healthcare system. 

The time to act is now. Organizations that align their operating models with the realities of today’s healthcare landscape and fully leverage the capabilities of modern technology will be the ones that thrive in 2025 and beyond. By addressing inefficiencies, managing workforce challenges strategically, and embracing innovation, healthcare leaders can build resilient organizations that not only meet current demands but also anticipate and shape the future of care delivery.