Nontraditional providers to capture 30% of US primary care market by 2030—Bain & Company

NEW YORK - December 4, 2024 - Nontraditional providers, including retailers, payers, and advanced primary care (APC) providers, are expected to capture 30% of the U.S. primary care market by 2030, according to Bain & Company's new study. Building on research initially released in 2022, Bain found that many predictions have held true. Value-based care enablement is attracting greater investment and new players, fueling the shift toward this form of reimbursement. Ownership of primary care practices continues to move toward nontraditional players, population-specific scopes remain a key contributor to success in risk-based payment models, and APC providers with these models continue to scale.

"The primary care landscape is experiencing significant shifts, and traditional and nontraditional models continue to evolve," said Dr. Erin Ney, partner in Bain & Company's Healthcare & Life Sciences practice. "Looking ahead to 2030, we believe the landscape will be defined by the ways in which providers adapt to changing competitive dynamics and succeed in value-based care delivery. Our research still suggests that nontraditional providers are poised to capture a growing portion of market share, but we expect a different mix among them. We anticipate payers will continue to invest behind primary care and population-focused models will continue to be well positioned to take on payment risk even in the face of regulatory headwinds, but significant questions remain about retailers' ability to deliver comprehensive primary care effectively given the challenges they've faced."

Decades of research shows that primary care improves health outcomes, patient satisfaction, and health equity while reducing the total cost of healthcare. However, which organizations will be the main providers of this care in the United States, and which care models will predominate, continue to change.

• Retailers facing challenges: Many retail primary care providers have shifted their approach over the past two years -a trend that likely reflects the growing recognition of how challenging it is to succeed in comprehensive primary care. Bain's new research shows that less than one-third of consumers are currently likely to visit a retail store or pharmacy for primary care needs beyond vaccinations and diagnosing common cold symptoms. To establish themselves as credible primary care providers, retailers will need to ensure their clinical and business models align to their financial and non-financial goals, invest to evolve their brand, and ensure that the right healthcare expertise exists within their organizations.
• Payers continue to gain ground: Bain anticipates that payer-owned primary care will account for approximately 20% of the market by 2030. Payers are well positioned to navigate industry challenges and scale effectively, thanks in part to historical investments in care delivery, and they have developed the differentiated capabilities required to manage complex primary care delivery. In addition to network curation and physician practice management capabilities that support successful care delivery, these payers have extended key capabilities in care management, navigation, and coordination to their primary care practices.
• Advanced primary care providers poised to scale: APC providers are leading the shift toward population-specific care models, demonstrating better clinical outcomes and cost savings by addressing chronic and complex needs. Bain's research indicates that these providers will continue to scale, particularly those focused on seniors, though to maintain their competitive edge, they will have to continue to adapt to tighter economics and regulatory shifts.
• Traditional and enabled primary care providers embrace value-based care: Traditional independent primary care providers cannot escape the growing pressure on fee-for-service payment. While many may hope to maintain their business as usual, payers are unlikely to negotiate higher fee-for-service rates moving forward. More and more, providers who want to remain independent will seek to partner with enablers that can help them successfully transition to value-based payment models.

Venture capital and private equity investment in value-based care enablers has been rising, mirroring steep growth in these organizations over the past few years. As a result, Bain now expects primary care providers that have partnered with value-based care enablers to hold around a 10% share of primary care lives in 2030, compared with the roughly 4% Bain anticipated two years ago.

Editor's Note: For more information or to arrange an interview, please contact: Katie Ware, Bain & Company, tel. +1 646 562 8107, email: [email protected].

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