The consensus heading into 2027 is clear: The ambulatory care boom is not over.
Outpatient services accounted for 57% of hospital revenue as of 2024, up from 52% in 2020, according to American Hospital Association data, and the AHA’s Sg2 forecasting models projected 17% growth in outpatient volume over the next decade.
Rising costs, value-based payment models and shifting patient expectations have already pushed ambulatory growth from a strategic priority into the center of the C-suite playbook. By late 2025, some health system leaders were declaring the timing could not be better to accelerate that investment, and other organizations began elevating ambulatory strategy to its own C-suite post.
In responses to Becker’s, nine health system leaders from across the country said they expect ambulatory care to remain a significant growth driver in the coming year.
Chad Grant, executive vice president and COO of Grand Blanc, Mich.-based McLaren Health Care, pushed back on a common explanation for ambulatory growth.
“We are continuing to see outpatient volumes growing at a much faster pace than inpatient volumes, and it’s not just patient preference driving the growth,” Mr. Grant said. “In our experience, it is due to coverage gaps, payer pressures, an aging population in our service areas, and increasing chronic disease acuity pushing care to an ambulatory setting.”
For McLaren, that understanding shapes how the system builds. Mr. Grant said every project is fashioned around what a specific community needs rather than applied by formula, with primary care, imaging and specialty services connected back to the hospital network.
For some systems, the shift is already visible in the physical footprint they are designing. Dorval R. Carter Jr., president and CEO of Saint Anthony Hospital in Chicago, said his organization is currently in the design phase for a new replacement hospital with a smaller inpatient bed count, paired with an expanded medical office building and a new ambulatory surgery center.
“Lower cost of care, patient preferences, as well as a push from the health insurance companies are the major drivers of this trend,” Mr. Carter said. “What has also made this flux possible are the advances in care that don’t require patients to be hospitalized for many of the medical interventions.”
The same logic, applied over a decade, has produced scale in rural settings. Mickey Foster, CEO of Pinehurst, N.C.-based FirstHealth of the Carolinas, said his system has expanded from roughly 10 to 12 ambulatory practices a decade ago to more than 100 today, adding about five to 10 new practices each year. Much of that growth has come from independent practices choosing to affiliate with FirstHealth, a pattern Mr. Foster attributed both to the difficulty of operating independently in today’s environment and to the value of connecting to a larger system.
“Expanding our ambulatory network has allowed us to preserve and strengthen local access to care, bring additional services closer to patients and create stronger connections across the continuum of care,” he said.
Terry Murphy, president and CEO of Dover, Del.-based Bayhealth, framed 2027 planning around a named internal initiative — “The Next Wave” — that emphasizes purposeful growth over broad expansion. Bayhealth serves rapidly growing and aging communities in Kent and Sussex counties, and Mr. Murphy said the system is focused on connecting ambulatory, hospital-based and virtual care into a more seamless patient experience.
“As we plan for 2027, we’re focused on smart, sustainable growth,” Mr. Murphy said. “We’re looking closely at community needs, patient demand and how we can connect ambulatory, hospital-based and virtual care to create a more seamless experience for our patients.”
For safety-net systems, the calculus looks different. Erik Mikaitis, MD, CEO of Chicago-based Cook County Health — the region’s largest safety-net provider — said the challenge heading into 2027 is not whether to grow but whether that growth can be sustained as the number of uninsured patients rises due to federal funding cuts.
“Too often, safety-net systems and the patients they serve have been left behind as payment models have evolved,” Dr. Mikaitis said. “We see an opportunity to change that by focusing on keeping people healthier, preventing avoidable medical crises, and ensuring patients receive the right care in the right setting, regardless of their ability to pay.”
Ed Jimenez, CEO of Radnor, Pa.-based Main Line Health, addressed a concern that surfaces whenever ambulatory investment accelerates: whether it comes at the expense of hospital care. He rejected that framing directly.
“This isn’t about replacing the hospital,” Mr. Jimenez said. “It’s about creating a more connected continuum of care. Patients who come to us through an ambulatory setting should know they also have the strength of a comprehensive health system behind them, including hospital-based care when they need it.”
Main Line Health’s new Downingtown campus will bring primary and specialty care, imaging, lab services, urgent care and outpatient surgery under one roof — ambulatory not as a substitute for the health system, but as a wider door into it.
Colin McHugh, president and CEO of Nashua, N.H.-based Southern New Hampshire Health, said ambulatory investment only works if the care experience is connected end to end — from primary care through specialty services and beyond.
“Access to primary care that is seamlessly connected to specialty care and other services across the system is foundational,” Mr. McHugh said.
James Leonard, MD, CEO of Urbana, Ill.-based Carle Health, echoed that priority, adding that the work extends into how systems schedule care, manage referrals and deploy technology to create real coordination across sites.
“Healthcare will continue to evolve, and because we know our patients and communities deeply, we can anticipate their needs and stay ahead of how they want to access care,” Dr. Leonard said.
Louis G. Smith Jr., senior executive vice president and COO of Bellaire, Texas-based Harris Health, added another dimension: the role of community investment and political will. In 2023, voters approved funding for new Harris Health clinics and expansive renovations to existing locations, and the system is now expanding its ambulatory footprint in high-need areas alongside a push into home-based care, virtual services and population health programming.
“Our goal is to make ambulatory care more convenient, connected and equitable to keep our community healthy and thriving,” Mr. Smith said.
Dr. Mikaitis framed the broader challenge for the field heading into 2027.
“We believe the next phase of growth will be less about volume for volume’s sake and more about building a sustainable model that improves outcomes while meeting the needs of all patients, no matter their insurance status,” Dr. Mikaitis said.
