A reimagined operating model will drive successful health system consolidation

For the past 50 years, US health systems and hospitals have adapted to deliver increasingly sophisticated clinical care while optimizing resource utilization (facilities, beds, clinicians). Continuously evolving therapies, increasing evidence-based guidelines, and shrinking reimbursements have forced health systems to reimagine operations and restructure their market footprint. During this period, the US population increased by 57% while hospital beds declined by 37% (see Exhibit 1), underscoring this extraordinary optimization and the ability to safely deliver an increasing proportion of care in an ambulatory setting.

Despite these changes, health systems are struggling with the confluence of our aging population (by 2034, the US will have more older people than younger people), the increased prevalence of chronic diseases (6 in 10 Americans have a chronic condition), the impacts of climate change, and an unsustainable upward trajectory of the cost of care.

HFS Research, in partnership with Cognizant, has studied the future state of the US healthcare delivery landscape, the ramp-up of health system consolidations, and how prepared health systems and hospitals are to embrace them. The study incorporates insights from more than 150 health systems’ CXOs who are on the front lines of redefining America’s healthcare delivery.

Exhibit 1: Healthcare delivery has seen extraordinary optimization. One bed that was occupied by three patients in a month in 1975 is more recently being occupied by five patients in a month as hospital use their resources more efficiently

Source: American Medical Association, US Census Bureau, Centers for Disease Control and Prevention, HFS Research, 2025

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