Consumers, not patients, are going to have a far greater impact on the future of health care delivery in the coming years.

A new report (PDF) from consulting company Oliver Wyman, whose experts have examined the health care disruption issue in previous speeches, interviews and reports, takes a close look at just how influential consumers — and outside innovators — may be.  

"Empowering the consumer is what's toppled many markets," says Tom Main, partner at Oliver Wyman and co-author of the report, "The Patient to Consumer Revolution." For examples of that, see what's happened with the established players in such markets as books or newspapers, the report points out.

In a similar, but not identical, way companies that know consumers, technology or both, such as Walgreens or Google, have already begun to crack into health care with lower-priced, more accessible offerings that are going to pressure traditional providers to make startling changes.

As Main asks, would you rather have your kid's earache checked out via a $25 smartphone app, for a few more bucks at a retail clinic that day, or, for $90 at a provider-based clinic where you had to wait a day and a half to get an appointment?

It's possible that the insurer could share some of the savings with the patient in that scenario, he adds.

Perhaps most chilling are the broader numbers that indicate inpatient utilization will decline 25 percent in a first wave of growth in population health management, resulting in a movement to ambulatory care and the elimination of most preventable events by smart care teams. That decline will accelerate again as part of a second wave of declining utilization, falling another 40 percent, driven by the reshaping of care based on such things as big data, sensor technology and genomics.

Main says those estimates are based on offerings already in the market. "We feel really good about the projections."

But it is not a certainty that hospitals and health systems are going to be driven out of the picture, Main notes. Hospital executives' willingness to take more of an offensive approach and Medicare's pace of change will play a role in how well the field adapts. Hospitals and other established providers need to flip their strategy to focusing 70 percent of their efforts on offensive moves from the current 30 percent, the authors note.

That's a big shift, but it is doable.