Primary care predictions for 2030

In a 2022 report, Bain & Company, a global management consultant firm based in Boston, Massachusetts, released their 2030 market share forecast for the U.S. primary care market. The group predicted the evolution of reimbursement, care and ownership models over the course of the decade, and how their development would impact the primary care market. In their report, they predicted that nontraditional care providers—which include retailers, payers and advanced primary care (APC) providers, among others—would be key players in the transformation of primary care, capturing 30% of the market by 2030.

According to their latest brief, released on December 4, 2024, several of their predictions from two years ago hold true in 2024. Although they’re sticking with their initial predictions, they have made some refinements to their forecast, largely influenced by the strategic repositioning of major retailers and APC providers, the accelerated growth of payer investment through existing primary care delivery capabilities and the rapid growth of enablers.

Their updated forecast expects the share of primary care patients who are served by traditional fee-for-service providers to decrease quicker than they had previously anticipated. Also, while they maintain their expectation that nontraditional providers will serve approximately 30% of primary care patients in 2030, they now project a different mix among those providers. Their latest forecast projects significant growth from payer-owned providers and enabled primary care providers.

Retailer primary care

The report draws attention to specific examples of big-name retailers like Walmart and Walgreens exiting the primary care space within the past few years, indicating that those moves reflect an increased recognition of how difficult it can be to succeed in comprehensive primary care, particularly when balancing different business models. The group expects the retailers that will be successful in primary care are those that focus on three key objectives:

1. Building the right model.
2. Investing to evolve their brand.
3. Ensuring that the right health care expertise exists within their organization.

Health care payers

In 2030, payer-owned primary care is projected to account for 20% of the U.S. primary care market. According to the report, payers find themselves well positioned to navigate the challenges of the primary care industry while scaling effectively, largely due to their past investments in care delivery. Well-established payer-owned health service organizations have developed the capabilities to manage complex primary care delivery, network curation and physician practice management capabilities to support successful care delivery.

Advanced primary care (APC)

APC providers are expected to scale, especially among providers catering to seniors, in 2030. However, they will face additional challenges due to tighter economic conditions and evolving regulations. Medicare Advantage plans continue to encounter obstacles including decelerating growth, updates to risk adjustment models by the Centers for Medicare & Medicaid Services (CMS) and star rating changes. For example, the shift from risk assessment model Version 24 to Version 28 is projected to reduce revenues by 2% to 4%, significantly impacting profitability. Success in this environment will depend on APC providers’ ability to decrease total care costs while delivering high-quality outcomes, solidifying competitive advantage.

Traditional and enabled primary care providers

Bain & Company projects that, moving forward, providers who want to remain independent will look to partner with enablers who can help them successfully transition from fee-for-service payment to value-based payment models, following market demands.

Investment in value-based care (VBC) enablers has seen significant growth, and their influence is expected to continue growing, with enabler-supported providers projected to manage 10% of primary care patients by 2030—up from tan estimated 4% two years ago. However, enablers, like APC providers, will face comparable regulatory challenges. According to the report, the impact that risk adjustment model Version 28 will have on enablers will vary, though it could particularly impact enablers and providers serving higher-risk populations.

Projections indicate that VBC-based enablers that consistently demonstrate cost reductions and high-quality health outcomes will see the most success. According to a Jefferies analysis of CMS data referenced in the report, the top performers in the Medicare Shared Savings Program (MSSP) achieved greater than 7% in cost savings in 2022. The ability to successfully leverage primary care as a means to reduce expensive hospital admissions will remain a key success factor, benefiting both enablers and the physicians they support.

Health systems

Traditional health systems are forced to confront increased competition from population-focused disruptors and nontraditional providers. According to the forecast, the challenges health systems face will depend heavily on the competitive pressures in their local markets, driving significant strategic shifts in the years ahead.

In markets with more competition, health systems will likely adopt one of several approaches to retain relevance. One potential strategy involves becoming the preferred specialty and tertiary care partner for risk-taking primary care providers. By prioritizing specialty care that is both cost-effective and high-quality, these systems can secure referral relationships but must also keep specialty care expenses in check. Other potential strategies include innovating primary care delivery or developing direct-to-employer models to take on greater financial risk.

For health systems choosing to transform, the report highlights critical areas for investment, including improved patient experience, the adoption of advanced digital tools, enhanced care management and a multidisciplinary approach to care delivery. The report also points out that health systems can leverage partnerships with VBC enablers to accelerate their adoption of these innovative practices. With that said, the degree of urgency can vary. In markets where health systems maintain a dominant market share, they’re more insulated from otherwise-disruptive pressures, which could potentially allow them to maintain the status quo for a longer duration without significant overhaul.

As primary care continues to evolve, the report emphasizes the need for health systems to thoroughly assess their existing assets and competitive standing. Those prepared to adapt could position themselves to excel in the increasingly value-focused primary care landscape projected for 2030. Bain & Company anticipates that nontraditional providers will capture a substantial market share, population-focused models will excel at managing payment risk despite facing regulatory and reimbursement challenges, and there will be uncertainty about whether retailers can provide comprehensive primary care. Ultimately, primary care will remain a hub of innovation, with its ownership structure continuing to shift.