The Future of Health: What PwC’s $1T Shift Means for Health Systems

Healthcare is standing at a crossroads. According to PwC’s new report, The Future of Health – From Breaking Point to Breakthrough, as much as $1 trillion in healthcare spending will shift to AI-driven, digital-first models by 2035.
The report is blunt:

“Healthcare organizations need to be primed for disruption. If you aren’t anticipating new entrants, you’ll be outflanked.”

The systems that fail to adapt will struggle, while those that embrace new operating models will unlock entirely new pathways to growth, efficiency, and improved patient outcomes.

PwC’s Vision of Healthcare in 2035

PwC describes a healthcare landscape transformed by technology and consumer expectations. Instead of being hospital-centered, care will be digital-first and home-centered. Patients will increasingly interact with their providers through virtual platforms, guided by AI that manages everything from initial triage to follow-up care.

This future relies on AI as the backbone of operations. Today’s staff-intensive administrative processes — intake, documentation, billing, scheduling — will be largely automated or augmented by machine learning systems. Clinicians will still play the most critical roles, but their focus will shift from routine execution to higher-order judgment and coordination of AI-driven workflows.

Just as important, the financial foundation of healthcare will look different. Payment models will move away from fee-for-service structures, rewarding providers for affordability, efficiency, and improved health outcomes. This creates a direct incentive for health systems to adopt technologies that reduce administrative waste and deliver more accurate, real-time insights.

PwC sums it up best: “By 2035, the health system will no longer be defined by hospitals. Care will be digital-first, home-centered, and AI-powered.”

Why This Matters for Health Systems Today

It may be tempting to think of 2035 as far off, but the reality is that the forces driving these changes are already reshaping healthcare today.

Margins are under pressure across the industry. Hospitals face rising labor costs and reimbursement challenges, with many operating at or below break-even.

At the same time, payer scrutiny has intensified. Insurers are deploying their own AI tools to flag and deny claims, creating an arms race in documentation accuracy and coding precision.

Layered on top of this are workforce challenges. Coders, CDI specialists, and clinicians are in short supply, and burnout is at an all-time high. Many organizations simply cannot hire their way out of these problems. Administrative overhead is no longer just expensive — it’s unsustainable.

As AKASA SVP and co-founder Ben Beadle-Ryby wrote in his recent report on how Medicaid reductions are impacting health systems:

“Generative AI isn’t just innovation — it’s future infrastructure. It’s how we protect margins, reduce burnout, and improve care in the face of daunting pressure.”

The PwC report serves as both a warning and a call to action: if leaders wait until 2035 to reinvent their operations, it will be too late. The time to build an AI-enabled foundation is now.

The Untapped Opportunity in the Mid-Cycle

One of the most overlooked — and most impactful — areas for transformation is the mid-cycle. This includes coding and clinical documentation improvement (CDI), functions that sit between patient care and billing.

Mid-cycle operations are highly complex, often involving hundreds of data points per encounter, yet they remain surprisingly manual. Coders and CDI specialists sift through documentation to assign codes, resolve ambiguities, and capture clinical detail.

Even with existing tools, these workflows are fragmented and error-prone.

The stakes are high. Industry data shows that 5–8% of claims contain quality and DRG inaccuracies, and that more than 414 million medical records are created each year with poor documentation. That means health systems often provide excellent care but fail to receive credit for it in outcomes, rankings, or reimbursement.

This is exactly what PwC means by “outdated cost pools.” The mid-cycle consumes enormous time and resources, while offering one of the clearest opportunities for AI to add immediate value.

How AKASA Brings PwC’s Future Into the Present

The vision PwC describes for 2035 is one AKASA is already making a reality.

Our generative AI (GenAI)-powered Mid-Cycle Optimization Suite transforms coding and CDI into a smarter, more efficient, and more accurate process.

Unlike rules-based tools, AKASA GenAI reviews 100% of inpatient encounters prebill, re-coding them from the ground up and surfacing documentation and coding opportunities tied to DRG accuracy, compliance, and quality.

The impact is measurable:

• +1,540 quality indicators captured per 10k discharges
• 79–93% of flagged encounters capture at least one missing quality indicator
• Material improvements in SOI, ROM, POA, Elixhauser, and HCC capture

These results aren’t just theoretical. Cleveland Clinic, one of the world’s most respected health systems, has been pioneering the use of generative AI in the mid-cycle and partnering with AKASA.

“Accuracy was our north star when it comes to documentation and coding. The chips fall where they may in terms of our outcomes and proper reimbursement. But the precision with which the solution really delivered results was an extremely compelling argument for us to lean in.”

~ Nick Judd, MBA, RHIA, Senior Director of RCM – HIM at Cleveland Clinic

Unlike rules-based tools that miss context, AKASA’s GenAI reviews 100% of relevant inpatient charts, surfacing missed documentation and coding opportunities that directly impact DRG accuracy, compliance, and quality. Every recommendation comes with clinical evidence and context, giving coders and CDI teams the confidence to act.

The results speak for themselves. Health systems working with AKASA have unlocked tens of millions in already-earned revenue, improved quality capture, and seen operating margins improve by as much as 27%.

Just as importantly, staff are no longer buried in manual reviews — they can focus on the cases that matter most, supported by AI rather than overwhelmed by it.

By putting health systems on the glide path to autonomous mid-cycle operations, AKASA ensures they’re not just keeping pace with PwC’s vision of the future, but they’re ahead of it.

The Future Isn’t 2035 — It’s Now

PwC’s Future of Health report makes one thing crystal clear: the next era of healthcare will be AI-powered, digital-first, and outcomes-driven. Health systems that cling to outdated manual processes and cost structures will fall behind. Those who adopt AI today will be positioned to lead in 2035 and beyond.

At AKASA, we see this as validation of the work we’re already doing. By transforming the mid-cycle with GenAI, we’re helping health systems strengthen margins, improve accuracy, capture quality, and prepare for the digital-first future of healthcare.

The future isn’t 10 years away — it’s here. And with AKASA, health systems can start realizing it today.