By Tim van Biesen, Josh Weisbrod, Roger Sawhney and Julie Coffman
For those working on the front line of US healthcare, the pace of change must seem unrelenting. Powerful forces are affecting physician practice and healthcare institutions, and this has major implications for how we pay for care, how physicians make decisions and deliver care, and how organizations purchase and use drugs and devices. Although we have been talking about change for decades, this time, the trends may be irreversible.
To better explain the magnitude of these changes, in 2015, Bain & Company fielded a national survey of 632 physicians across specialties and 100 hospital procurement administrators in the US. (For a complete description of the methodology and the questions asked in the survey, download the PDF.) This survey updates our 2011 Physician Attitudes Survey, which is discussed in the Bain publication “The new cost-conscious doctor: Changing America’s healthcare landscape.” 
Our latest survey confirmed what we have long assumed to be true: The dynamics of change vary substantially across different regions of the country. To highlight these differences, we oversampled two regions that have distinct market characteristics—Massachusetts and Mississippi/Alabama. As we expected, in states like Massachusetts, the pace of change is faster because of several factors: more competition among payers and provider organizations, and an activist policy and regulatory environment that promotes change.
Other than the strong regional differences, the most provocative findings were the speed of change since our last survey; the growing dissatisfaction of physicians working in management-led organizations; the accelerated loss of autonomy over clinical decision making; the increasing number of surgeons who report that procurement departments exert more influence now than ever over purchasing decisions; and, for some segments of the market, the corresponding relative decline in the role of the sales representative as an information source on new products.
In this chart digest, we present the results of our survey and outline the implications for three sectors: care financing and delivery, medtech and pharma. We begin each chapter with our key findings, then illustrate the most significant survey responses with charts.
The financing and delivery of healthcare is becoming more systemized
While healthcare costs have slowed, in part due to macroeconomic forces, per capita costs have not decreased. Nonetheless, the effort to drive down costs and increase quality has led to a trend toward consolidation and more professionally managed organizations in many regions of the country. These organizational shifts have produced changes along a number of dimensions: increasing use of standardized clinical protocols and electronic medical records, more objective metrics for measuring clinical performance, payment models that put providers at risk for outcomes and a shift in physicians’ perceptions of their own responsibility for cost. In order to better demonstrate the totality of these changes, we combined these dimensions into what we call a “systemization index” (see Figure 1).
Larger-scale, more systematic changes are occurring, partially because previous efforts to wring out excessive cost from the system through incremental measures have been ineffective. Although the environment was already forcing change, the Affordable Care Act has certainly served as a significant catalyst to transform a delivery system that has been largely unaccountable and fragmented.
Survey respondents report that systemization has produced compelling challenges for them individually and for their organizations. These organizations are struggling to identify optimal operating models by testing new strategies and managing massive organizational transformation, all while trying to keep their clinicians engaged and aligned with their mission.
When we asked physicians how their use of analytic and clinical tools has changed over time, they responded that over the last two years, use of electronic medical records (EMRs) has nearly tripled and use of treatment protocols has more than doubled, although there are differences by region and organization type, which we highlight later on. And the percentage of physicians reporting a personal responsibility to control costs has more than doubled from a decade ago.