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39 WOMEN'S LEADERSHIP 39 CEO / STRATEGY 8 winning moves amid the new normal in health By Gary Ahlquist, Jeff Gitlin, Igor Belokrinitsky, PwC Strategy& H arry Truman, tired of endlessly equivocating advisers, fa- mously requested a "one-armed economist" who could give unambiguous advice. is article is an attempt to get our arms around the future of health and make definitive recommendations de- spite the uncertainty. Our view of the future is defined by two sources of uncertainty. e first is the volatility of demand for care and coverage. e second is who will absorb this volatility. Demand for care and coverage has been rising steadily but has suffered a major setback. It may recover quick- ly, slowly, or continue to fluctuate, driven by epidemiology, economy, politics and preferences. Likewise, the risk transfer to consumers and providers has been underway for some time. However, few providers or payers are big enough to absorb the new waves of risk — a further consolidation may be needed, or a greater government intervention. e next major structural change in the industry is underway. e best-case scenario is a rapid, sustained recovery. Even this sce- nario will put a strain on the current players, breaking many. A more likely scenario is a slower recovery, punctured by seasonal spikes in infection. At the regional level, all stops would have to be pulled out to meet the challenge. is could give rise to very large integrated re- gional networks, providing care, coverage and select social services. ese networks might be private, state-owned or a combination of the two. In the worst-case scenario characterized by ongoing fluctuation, these networks would expand to the national scale as the only way to absorb the constant shocks. Under any of these scenarios, providers and payers will need to get closer to consumers and employers and closer to each other — while playing closer attention to how they execute. Here are eight factors that define the new normal: 1. Surprisingly, many organizations have found that despite the crisis, their strategies are still fundamentally valid. e yearslong reposi- tioning toward more consumer-centric, risk-bearing, technology-aid- ed care has not been canceled — it has only accelerated. e CEOs we know are sharpening their focus and doubling down on their com- mitments. 2. However, payer and provider strategies do need to become more responsive and predictive. e ability to flex capacity, accurately price risk and keep the customers and the workforce engaged will be key. On the patient/customer side, we are seeing a much greater effort to improve engagement. As infection rates fluctuate, payers and provid- ers will have to make sure that the journey toward greater health and wellness does not grind to a halt as it did this summer. On the strategy side, we are seeing shorter analytics-supported planning cycles, short- er executive agendas, more involvement from the board and greater focus on the market. 3. However, better focus and planning are not enough — health orga- nizations will need to execute faster. Many of our clients are reexamin- ing their operating models and clearing out the "dampeners" between the executive intent and the front-line, customer- and patient-facing teams. ey are also taking a fresh look at their battle-tested C-suite. 4. For most organizations, speed is not enough — they will need resil- ient scale. Resilient scale means more capacity — measured in people, facilities, technology, supplies, capital and management bandwidth. Resilient scale means a higher pain threshold for the shocks to come and higher cost efficiency. Big is beautiful — the Andean condor, one of the largest birds in the world, is able to soar for a hundred miles without flapping its wings even once. 5. Where will this scale come from? We anticipate significant consoli- dation and believe that the size of an average provider system will dou- ble as large systems grow and small systems fold. Critically, we antic- ipate more consolidation between providers and payers. While these combinations have seen their share of setbacks, they have weathered the COVID-19 storm with confidence, benefiting from extra resourc- es and capabilities. We believe the future is with the next-generation integrated health networks. 6. e integrated health networks will be sorely needed by the Amer- ican communities decimated by the pandemic. Payers and providers have cast a critical safety net, expanding their reach into housing, transportation and other nonclinical drivers of health. From now on, every community will have fewer resources and greater needs, requir- ing a coordinated, networked community health effort led by trusted health organizations. is effort will help the most vulnerable while also helping the communities get back to work safely. 7. A safe return to work is a priority for providers and payers them- selves. eir workforces are large, diverse and under tremendous strain. e wave of furloughs, layoffs and benefit reductions is underway, leav- ing the employees further traumatized. Going forward, they will feel ev- ery bump in the road very acutely. However, we need them to perform better than ever — doing more work, sometimes remotely, and rising to new challenges. e talent imperative has to be at the top of every health executive's agenda, with a plan to reenergize, upskill and flex the team. 8. Finally, and perhaps most importantly, the biggest priority for the providers and payers is the customer — the person they are here to serve. Understanding her and winning her trust will make or break the health organizations of the future. Volatile demand and increasing competition between larger rivals is moving the system closer to the customer — into her phone and her home, providing care, advocacy, navigation and service. On this frontier, providers, payers, retailers and technology companies will compete for attention, data and a lifetime re- lationship. One size will not fit all — the risk pools have shied, as have the behaviors of individuals and families. Virtual care in particular has emerged as the most valuable player in keeping the seniors safe, engaged and healthy. Fortunately, the regulators have kept pace, with a push to- ward more virtual, more transparent, more portable care. Providers and payers have been through the wringer, but they have also been given a new opportunity to lead their people and their com- munities. Hopefully these suggestions serve as helpful signposts for the road ahead. Gary Ahlquist, Jeff Gitlin and Igor Belokrinitsky are PwC Strategy& con- sultants who advise provider and payer executives n