Who will win the future in health care?

Purpose, focus, antifragile DNA ready to disrupt

The future will not belong to health systems with the most beds, clinics, or capital. It will be won by those with the clearest sense of purpose, the sharpest focus on a few critical competencies, and the DNA to become antifragile—not merely resilient in the face of change but strengthened by it because they are willing to disrupt their own strategic playbooks.

The conventional playbooks run by health systems are increasingly obsolete. Generative AI is changing how we work. Almost two percent of the population ages out of commercial and into Medicare products annually. Critically, success requires teams to excel at managing actuarial risk (forecasting costs for populations) and financial risk (operating efficiently against budget targets).

Yet, many health systems remain tethered to their old strategic plans. Too few have prioritized the agility to adapt overbuilt acute care assets to control costs. Actuarial and financial risk management are underdeveloped. Disjointed service experiences are misaligned with evolving consumer purchase preferences.

While leaders may recognize these performance gaps and hope for a different outcome, too many are unwilling or unable to change.

What follows is my thinking on one way to reframe system strategy development. My goal is to present a new strategic framework to inform decisions, actions, and resource allocation. Four keys to the framework are offered, followed by a set of provocative questions for executive teams to shape their response to a fast-moving, uncertain future.

Lead with purpose: strategy begins with identity

In a marketplace that rewards authenticity and adaptability, health systems must first answer: How do we want to show up?

This is not a branding exercise. It is a strategic imperative.

Michael Porter argued that sustainable advantage comes from being deliberately different. The strategic identity of a health system, specifically its stance in the market, its commitments to communities, and its point of view on what it solves for, must guide every structural and investment decision. In a world of endless choices, identity helps systems make the right trade-offs.

Strategic Imperative: Define who you are by the unique value you aim to deliver—especially as other systems in the market pivot toward similar goals using similar tools.

Focus on the few competencies that matter most

The temptation in complex organizations is to be good at everything. But future success depends on being world-class at the right few things—the critical competencies that drive strategic advantage in emerging markets.

In the decade ahead, three are especially vital:

1. As Medicare Advantage and alternative payment models accelerate, health systems must become fluent in actuarial risk, proactive care management, and member engagement. This is not adjacent work—it is the new core business.
2. As labor shortages intensify, particularly in primary care, success in workforce model innovation requires reimagining care teams, workflows, and licensure boundaries. Systems that cling to legacy staffing models will fall behind.
3. As technology-enabled operating agility, generative AI, intelligent automation, and modular IT architectures redefine how work is done, systems that integrate these tools to drive speed, precision, and scalability will have a distinct edge.

Build cultural antifragility

In Antifragile: Things That Gain from Disorder, author Nassim Nicholas Taleb argues that certain systems benefit from disorder. Unlike fragile organizations that break under pressure, or merely resilient ones that return to baseline, antifragile systems improve when stressed.

In healthcare, this means designing organizations that not only withstand disruption but also evolve because of it.

Characteristics of antifragile health systems include:

• A portfolio of controlled, scalable experiments
• Decentralized problem-solving and adaptive learning
• Essential strength in critical areas—data, workforce, supply chain
• Cultural norms that reward learning, speed and iteration over perfection

Strategic imperative: Make adaptability a competitive weapon by structuring for learning, not control.

Avoid the innovator’s dilemma: disrupt yourself

Christensen’s The Innovator’s Dilemma teaches us that organizations often fail because they over-invest in their core business while ignoring early-stage disruptions.

In health care, the risk is real: home-based models, AI-first care platforms, and digital-native risk-bearing entities are attacking the periphery of health systems’ value chains.

To stay ahead, leaders must be willing to cannibalize today’s revenue to build tomorrow’s relevance. The success metric needs to balance current margins with future relevance, but with a healthy bias toward where we are going rather than where the system has historically succeeded.

Strategic imperative: Don’t protect legacy models; build new ones better aligned with how care, risk, and relationships must be structured to deliver on evolving customer purchase behaviors.

Executive discussion framework: 12 questions

Use these questions to challenge your leadership team’s assumptions, surface areas of misalignment, and provoke clarity around what matters most.

On identity and purpose

• What are we uniquely positioned to do better than anyone else in our market?
• What do our patients, physicians, and partners believe we stand for—and is it consistent?
• Are we making decisions that reinforce our purpose, or dilute it?

On competency and focus

• If we could be great at only three things, what should they be?
• Are we allocating disproportionate resources to the few competencies that truly matter?
• What are we still doing that someone else could do better—and why haven’t we stopped?

On antifragility and culture

• How do we react when we’re under stress—as a system, as leaders, as teams?
• Where in our organization are we learning the fastest—and how are we scaling those lessons?
• What small bets are we placing that, if successful, could change our trajectory?

On disruption and reinvention

• What parts of our current business model would we not rebuild if we started from scratch?
• Where are emerging competitors quietly eroding our future relevance?
• Are we protecting cash flow from old models—or investing in models that will generate relevance five years from now?

Closing thought

Strategic frameworks rooted in identity, focused on essential competencies, and built for antifragility can dynamically guide action amid uncertainty. As the market moves faster and traditional moats shrink, the winners will not be the largest; they will be the clearest, the sharpest, and the most unshakably adaptive.