PwC recently released a report, “From breaking point to breakthrough: the $1 trillion opportunity to reinvent healthcare,” that forecasts a major shift in how the U.S. healthcare system will operate by 2035. The report highlights how new digital and AI based technologies are expected to drive a transformation toward more personalized, consumer focused, and cost effective care.
For Lilac Software, the study underscores the importance of the problems we are working on. The themes PwC identifies match closely with the capabilities we believe health plans will need in the years ahead.
Rising Costs and Systemic Pressures
PwC points to a few culprits for the huge spending increases:
- Huge medical cost utilization and trends running in excess of 8% the past several years
- 90% of costs are for chronic disease states and mental health
- Siloed care delivery
- Aging population
The result is a healthcare industry marked by even more severe provider burnout, consumer frustration, worsening outcomes, and affordability concerns. These speak to the reason Lilac exists. We see a clear path to solving root pain points through more prevalent data unification, analytics, and, increasingly, agentic AI to automate rote, repetitive work that makes the industry so inefficient and draining.
What 2035 Could Look Like
PwC predicts that by 2035, healthcare will look very different:
- Tech enabled parents and caregivers
- Data rich care at home with analysis that anticipates events and disease states
- Precision virtual infrastructure
- Physicians focus on data to triage risk and care interventions; moving from managing disease to anticipating it
- Hospitals and other sites become short term precise interventions tied closely to virtual first primary systems
- Proactive and predictive personalized care and precision medicine with insights into everyone’s unique physiology
- AI driven drug discovery that will reduce timeframes and costs
Lilac’s approach is closely tied to these shifts. Our data intelligence layer and orchestration tools are designed to anticipate risks and improve decision making. Agentic AI modules provider a means for cost effective proactive outreach, efficiency in administrative processes, and better integration of member and provider engagement.
The Future Role of Payers
PwC places particular emphasis on the role of payers. With medical cost trends rising quickly, plans will be expected to deliver more value with fewer resources. PwC suggests that payers must move away from legacy infrastructure and take on the role of data clearinghouses that can actively manage risk and support affordability across the ecosystem.
This reality is one of the driving forces behind Lilac’s direction. Our cloud hosted platform is built to consolidate data from across disparate systems and to reduce reliance on outdated, fragmented tools. By providing a unified view of member and provider interactions, the platform helps payers pursue the kind of value-based, data-driven strategies PwC describes.
Structural Reinvention
PwC’s report makes clear that change will not be easy. The shift will require executives to move resources away from infrastructure heavy, fragmented models toward more integrated and intelligent platforms. PwC stresses the need for traditional organizations to commit to structural reinvention, embrace outcome based strategies, and leverage automation.
Lilac is working in this direction by enabling health plans to retire legacy systems, modernize their data environments, and introduce agentic AI for highly targeted use cases where there is a clear path to better outcomes and reduced costs.
Conclusion
PwC paints a picture of a trillion dollar transformation in healthcare driven by AI and digital tools. The pressures and opportunities it describes echo the challenges Lilac is addressing with our focus on unified data, analytics, and agentic AI. While the road to 2035 will require significant change, the alignment between PwC’s predictions and Lilac’s work highlights how payers can begin preparing today.
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Interested in learning how your plan’s end of year initiatives can benefit from Lilac’s powerful analytics and agentic AI solutions? Reach out here to start a conversation with the Lilac team.
