The ambulatory tipping point has arrived

One of the most consequential decisions a health system can make over the next decade is deciding where it believes care will happen.

Increasingly, the wrong answer is “the hospital.”

The industry’s center of gravity is moving beyond the four walls of the acute care campus and into ambulatory surgery centers (ASCs), physician offices, virtual platforms, retail clinics, and the home. Patients are driving it, technology is enabling it, and policy and reimbursement changes are accelerating it.

Still, many organizations insist on treating ambulatory care as a supporting strategy rather than the operating model emerging around them.

The data suggests that’s a risky bet.

Our 2026 Vizient Impact of Change forecast projects overall outpatient volume to grow 20% over the next decade, reaching approximately 6.2 billion encounters, while inpatient utilization growth softens. The trend is already reshaping how care is delivered, where investments are made, and which organizations are best positioned for growth.

*Numbers in parentheses indicate 2026 volumes. Note: Analysis excludes 0-17 age group. ED forecast defined as urgent and emergent visits. Evaluation and management (E&M) visits defined as visits—evaluation and management, established patient visits—in person, established patient visits—virtual, new patient visits—in person, and new patient visits—virtual. Home health defined as procedures—home nurse visits and home visits—other. ASC = ambulatory surgery center; SNF = skilled nursing facility. Sources: Impact of Change®, 2026; HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) 2022. Agency for Healthcare Research and Quality, Rockville, MD; Proprietary Strategy Intelligence All-Payer Claims Data Set, 2023; The following 2024 CMS Limited Data Sets (LDS): Carrier, Denominator, Home Health Agency, Hospice, Outpatient, Skilled Nursing Facility; Claritas Pop-Facts®, 2026; Strategy Intelligence analysis, 2026.

You must act now

We want to be direct here, because the stakes don't allow for hedging: The time to act was yesterday. The health systems that have made a concerted and consistent investment in consumer-centric care, in meeting patients where they are, and in serving patients in the setting that’s most suited to and safest for them are the ones doing the best. And those who may be lagging on that front will continue to lag. That disparity is only going to widen.

Every quarter your organization delays building ambulatory capacity, investing in distributed-care workforce models, or standing up the operational intelligence to manage a dispersed network is a quarter of lost ground.

So, what does keeping pace actually look like? Here are the concrete strategies we believe health system leaders need to execute on now.

Strategy 1: Let safety lead, but don't let it become an excuse

Safety has to be the No. 1 consideration in every site-of-care decision. Where is the patient going to receive the highest quality and highest level of care that’s needed? The clinical rationale needs to be sound, and the evidence for clinical quality needs to be comparable (if not better) than what the inpatient setting offers.

But here's the nuance we see leaders miss: Safety is the starting point of the conversation, not the end of it. Too often, the argument for keeping a service in the inpatient space defaults to safety without any real interrogation of what would be required to move it. The right question is what would it take to make this safe to move, and are we willing to invest in that?

There will be market-to-market variation in what can shift and how. Workforce availability is a real constraint—even as the center of gravity shifts for demand, there may not be the staffing in the market to appropriately deliver that care safely. Quality and safety have to rule the day. But treat those constraints as problems to solve, not reasons to stand pat.

Strategy 2: Rethink workforce deployment across the entire care continuum

If you think you can’t provide outpatient services, you’re not looking hard enough at how you’re deploying resources. That's where the real opportunity lies.

Here's the truth that many health systems haven't fully internalized: Much of the ambulatory care that's offered doesn’t need to be provided by a physician. Leverage your APPs, your techs, and your aides. Think about ways to deploy technology to carve out additional capacity for ancillary services.

Get creative. Consider sitter services: How can you use technology to free up the human sitter currently stationed in a recovery room and redeploy them where they’re needed more? How can you use virtual tools to let a single provider scale their patient panel or tend to more rooms at a given time?

The workforce strategy for the outpatient shift should center on deploying the people you have differently—across a distributed network, supported by technology, and operating at the top of their license.

Strategy 3: Build ambulatory operational intelligence

Health systems are far more likely to have advanced analytic capabilities and operational dashboarding for their inpatient sites of care. But ask the same question about their ambulatory sites, and the answer is often silence.

If you’re not tracking capacity, supply, and demand across your ambulatory network in real time, you’re flying blind. Proactive operational dashboarding across the entire care continuum is key. You need to know where capacity exists, where demand is building, and how to move people and resources in response.

The inpatient world has had this for years. The ambulatory world needs it now. And the health systems that build it first will have an operational advantage that compounds over time.

Sources: Impact of Change®, 2026; Proprietary Strategy Intelligence All-Payer Claims Data Set, 2023; The following 2024 CMS Limited Data Sets (LDS): Carrier, Denominator, Home Health Agency, Hospice, Outpatient, Skilled Nursing Facility; Claritas Pop-Facts®, 2026; Strategy Intelligence analysis, 2026.

Strategy 4: Don’t assume any service line is immune

Here's a risk we see health systems taking that they shouldn’t: assuming that any service line or care modality is immune from shifting or being disrupted. That assumption is a liability.

Consider cardiovascular services. We’ve seen a lot of reticence and hesitance around shifting cardiovascular patients outside the four walls of the hospital—it’s a very sick population, and the instinct to protect it is understandable. But the Impact of Change forecast shows cardiovascular medicine projected to grow 29% in the outpatient setting over the next decade. The procedures that were unthinkable in an ASC five years ago are on the migration path now.

The lesson: If you think your service line is the exception, you're probably the one being disrupted. Every service line needs a site-of-care strategy.

Strategy 5: Read the for-profit signal and move

One of the most reliable indicators of where healthcare is headed is where sophisticated investors are putting their money.

That’s why we pay close attention when large for-profit healthcare organizations accelerate investment in ASCs, diagnostic centers, and other outpatient care settings. These organizations are making a calculated judgment about the future economics of healthcare delivery. They're betting that growth, margin, and patient demand will increasingly concentrate outside the hospital campus.

Health systems should take notice when organizations known for financial discipline and operational rigor are making the same bet at scale.

The for-profits are responding to the same forces outlined throughout our forecast: favorable reimbursement dynamics, a growing list of procedures eligible for outpatient delivery, advances in clinical technology, and consumers who increasingly value convenience and access.

The point isn’t that health systems should mimic every move made by the for-profit sector. But these investments provide a signal. The market is showing us where value is being created and where future growth is expected to occur.

The gap will widen. Which side will you be on?

Here’s what we'd ask of health system leaders reading this: pull up your ambulatory strategy. Pressure-test your assumptions about which service lines are immune. Audit your operational dashboards—are they built for the inpatient world you're leaving behind, or the ambulatory world you're entering? Look hard at your workforce deployment: Are you leveraging every team member at the top of their license, supported by technology?

The time to act was yesterday. But today is still better than tomorrow.

The Vizient Impact of Change forecast provides health system leaders with the analytics, scenario modeling tools, and expert guidance needed to navigate utilization shifts across service lines, sites of care, and planning horizons. Learn more about Impact of Change and the rest of our comprehensive data and insights portfolio.