Outpatient volumes are projected to grow 20% over the next decade while inpatient discharges rise just 7%, according to Vizient’s 2026 Impact of Change forecast, a 10-year outlook that pushes ambulatory care to the center of health system strategy.
The forecast, built on Vizient’s disease-based and MS-DRG–based modeling of patient-level claims and local market data, projects demand across the full continuum of care. Its throughline: demographics no longer tell the whole story. An aging, higher-acuity population is colliding with contracting insurance coverage, care redesign, new therapies and competition from disruptors — and the net effect is care leaving the hospital faster than raw population math alone would suggest.
“These forecasts reflect a fragmented healthcare system adapting to a new normal,” said Brianna Motley, vice president of Vizient Strategy Intelligence.
Where the volume is moving
The forecast’s site-of-care projections over the next 10 years show the shift in stark terms:
- Home health grows fastest, up 27% by 2036 (13% within five years), as recovery, rehabilitation and chronic-disease management move into the home.
- Office and clinic visits rise 16% and hospital outpatient and ASC volumes grow 15% — the ambulatory workhorses absorbing the bulk of new demand.
- Inpatient discharges grow just 7%, and skilled nursing stays rise only 3%.
- Emergency department visits climb 6%, but almost all of that growth is high-acuity.
- Urgent and retail care grows 5%, while virtual care settles in as a permanent fixture rather than a pandemic commodity.
Demand shaped by more than demographics
One of the forecast’s sharpest points: population growth alone would lift both inpatient and outpatient demand about 14% over the decade. What happens next diverges by setting.
On the inpatient side, that population tailwind is largely canceled out — care redesign and systems-of-care efforts subtract about 8 percentage points, and innovation and technology, including expanded GLP-1 use that keeps patients out of the hospital, subtract another 4 to leave net growth of just 7%.
Outpatient runs the other way. Epidemiologic and sociocultural change, plus favorable policy and site-of-care shifts, push the same population growth to 20%.
Vizient attributes the underlying pressure to six forces: strong growth in the 65-plus population; payer pressure pushing care to lower-cost settings; rising chronic disease (obesity, diabetes, heart disease and behavioral health conditions); increased patient price sensitivity and competition from disruptors; clinical innovation that changes when and where care is delivered; and ongoing care redesign across the system.
Where service lines split
The forecast splits growth by service line, and outpatient projections run well ahead of what population change alone would predict:
- Cardiovascular leads outpatient growth at 29%, followed by neurosciences at 27% and behavioral health at 22%.
- Cancer outpatient volumes grow 20%, while surgery and medicine each rise roughly 19% as procedures and management shift to ambulatory sites.
- Orthopedics outpatient grows 17%, and women’s health outpatient rises 9%.
Inpatient tells the opposite story, with growth concentrated in the highest-acuity lines. Cardiovascular (13%), medicine and neurosciences (11% each) and behavioral health (7%) see the most inpatient growth, while orthopedics inpatient volume declines 4% and women’s health inpatient falls 6% — clear evidence of the outpatient migration in those specialties.
A few service-line dynamics stand out in Vizient’s commentary:
- Cancer: Inpatient care concentrates on the most complex, high-acuity patients while diagnostics, treatment and follow-up keep moving to outpatient settings as the population ages and incidence rises.
- Orthopedics: Policy pressure, workforce constraints and lower-resource pathways favor ambulatory, office-based, rehab and nonsurgical access points, with inpatient surgery anchored to joint, fracture and revision cases.
- Behavioral health: Demand is expected to outpace population growth across the continuum, with community-based, intermediate and virtual services shifting care toward ambulatory settings.
- Women’s health: Falling birth rates and immigration restriction constrain volume as a growing 65-plus population drives demand for pelvic health and menopause care.
ED becomes a wider front door
The projected 6% rise in ED visits masks a widening split. High-acuity visits are forecast to grow 9% over the decade, while low-acuity visits stay flat, migrating to alternative sites. Vizient ties the trend directly to coverage loss: as insurance contracts, more patients delay preventive and upstream care and turn to the ED, driving up cost and congestion and stretching inpatient resources with potentially avoidable, higher-acuity admissions.
Post-acute and pediatrics move in opposite directions
Post-acute care is one of the decade’s biggest growth stories, up 31% overall as the population ages and recovery shifts out of the hospital. Home and domiciliary hospice visits (41%), home and domiciliary E&M visits (34%) and home visits (30%) lead the category, while SNF stays grow only 3% and hospice stays 9%.
Pediatrics runs the other way. Continued birth-rate decline, compounded by bed closures, holds pediatric inpatient volume flat to slightly negative — roughly -2% over 10 years — while pediatric outpatient grows a modest 6%, with pediatric behavioral health the clear outlier on the outpatient side.
The strain the forecast flags
Vizient frames the decade as one where the margin for error narrows, and identifies five system pain points leaders will have to manage: rising medication noncompliance as payer disruption and patient costs increase; reduced upstream access that pushes patients into higher-cost, higher-acuity care; ED overuse among the under- and uninsured; inpatient resources strained by acuity-driven admissions, longer stays and readmission risk; and post-acute bottlenecks that delay discharges and raise costs and complications.
The forecast’s bottom line for hospital and health system strategists: growth is real, but it is landing in ambulatory, home and virtual settings. Capturing it will depend less on adding hospital capacity than on care coordination, workforce strategy and site-of-care planning built for a broadening continuum rather than a building.
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.