Shifting Share: How Leading Disrupters Are Redefining Market Influence

Disrupters have accelerated their presence, filling access gaps across the continuum with lower-cost, consumer-friendly options. What started as niche convenience has become a competing infrastructure. Increasingly, traditional systems are adopting similar strategies, including scaling ambulatory footprints, integrating payer partnerships and digitizing access. The market is less divided between “new” and “old,” but every organization is competing on agility and integration nonetheless.

Sg2’s disrupter data use a continuously updated National Provider Identifier roster of major organizations cross-referenced against our All-Payer Claims Database. The result is a unique, quantifiable view of who is capturing patient volume and where those shifts are most pronounced.

Where the Volume Lives

When we overlay disrupter activity with our outpatient portfolio framework, most activity remains rooted in routine care. Together, recurring and transactional visits make up over three-quarters of all outpatient volume. That is an evolution from three years ago, when preventive care made up a much higher proportion. The increase, particularly in recurring visits, illustrates that high-frequency, lower-acuity interactions are fertile ground for disrupters. They reward scale, technology enablement and convenience—areas in which nontraditional entrants excel.

Note: Analysis excludes 0–17 age group. Data are filtered to exclude the following procedure groups: dental, DME and supplies, lab—chemistry/hematology, lab—microbiology/pathology, lab—other, medications, ungroupable, vaccine administration. Percentages may not add to 100% due to rounding. DME = durable medical equipment. Sources: National Provider Index List, February 2025; Sg2 All-Payer Claims Data Set; IQVIA; Sg2 Analysis, 2025.

For health systems, this concentration creates both risk and opportunity: the highest-volume services are also the most portable. The issue is less related to site ownership and more concerning end-to-end care orchestration. Winning no longer hinges solely on clinical capability; it now depends on seamless access, digital continuity and brand trust that extends beyond the four walls of the hospital.

Evolving Market Presence Among Leading Disrupters (2021–2024)

From 2021 through 2024, Sg2’s data show a rebalancing of service line volume across the five highest-volume disrupters: Optum, Agilon, Teladoc, CVS and Ivy Rehab Network. The past four years reflect an active redistribution of market influence as these organizations recalibrate around scale, integration and consumer access. Together, these shifts point to a marketplace that is continuously reorganizing around the intersection of value and convenience.

Note: Analysis excludes 0–17 age group. Data are filtered to exclude the following procedure groups: dental, DME and supplies, lab—chemistry/hematology, lab—microbiology/pathology, lab—other, medications, ungroupable, vaccine administration. Percentages may not add to 100% due to rounding. Sources: National Provider Index List, February 2025; Sg2 All-Payer Claims Data Set; IQVIA; Sg2 Analysis, 2025.

Key Observations

• Optum continues to expand its reach across nearly every service line, demonstrating how integrated, payer-backed platforms can build scale across both transactional and longitudinal care.
• Agilon’s growth across ambulatory settings reflects the increasing influence of physician-aligned networks focused on managing longitudinal patient relationships.
• Teladoc’s steady presence in medicine reflects the normalization of virtual chronic care as a sustained component of the delivery ecosystem.
• CVS’s relative decline in outpatient share highlights the limits of retail-first access models when not supported by deeper clinical integration.
• Ivy Rehab remains a leading presence in musculoskeletal care, though its relative share has compressed as multispecialty and network-based competitors expand into that space.

Overall, the competition has shifted from gaining entry to maintaining relevance across the care continuum, where scale, data integration and relationship continuity increasingly define staying power.

Implications for a Shifting Competitive Landscape

The changing distribution of disrupter activity highlights an important reality: competition in health care is no longer about who enters the market but who can sustain relevance across the continuum. The leading disrupters are not converging on one model. Instead, they are refining where and how they compete, adjusting portfolios to balance scale, access and recurring engagement. Health systems can apply the same agility by reinforcing their core strengths and extending their reach through integration and consumer alignment.

Redesign access around the consumer, using intelligence to anticipate change. Disrupters have raised the bar on convenience and immediacy. Health systems can meet that challenge by simplifying appointment scheduling, embedding digital navigation tools, and expanding access points in ways that maintain clinical oversight and continuity. Analytics that identify shifting patient behaviors and disrupter penetration by service line can help health systems focus investment where engagement is most at risk. Understanding where consumers are disengaging is the first step in bringing them back into the fold.

Compete through coordination and own the intervals between visits. The future advantage lies in connecting care, not owning it. Systems that align virtual, outpatient and inpatient experiences into a cohesive journey will create a more durable form of loyalty than site-based presence alone. Recurring touchpoints are emerging as key drivers of retention. Building continuity between preventive, chronic and specialty care through data, communication and shared accountability can help systems preserve patient relationships as care options expand.

Partner with precision. Collaboration can expand reach or close service gaps, but partnerships should serve a strategic purpose. The goal is not to participate in every innovation but rather to selectively align with organizations that enhance differentiation and long-term resilience.

The next phase of competition will not reward the largest footprint or the newest technology, but instead those organizations that can convert access into attachment through building trusted, continuous relationships that make patients feel known, not just seen.