As we near the end of the year, it is again
time to go to the crystal ball and issue predictions for what the year 2020
holds in store for health care. This year, I consulted three well-known Venice
Beach astrologers, two reputed Chakra healers, and an old Ouija board to arrive
at 10 predictions that have a 50/50 chance of being correct.
In all seriousness, here is how I see the
dialog around our nation’s health care system evolving in 2020.
1) The push to deliver home-based care will
continue. An
under-appreciated driver of costs in U.S. health care is the price of
hospitalization. The average hospital bed costs more than $2,000 a day, and in many areas of the
country more than $3,000. This big price tag, combined with enabling
technologies and evolving patient preferences, is creating pressure for health
care delivery organizations and health plans to think differently about how and
where care is delivered. Home-based primary care, urgent care, palliative care,
and even hospital-at-home care will continue to grow in popularity for
patients. Meanwhile, it will get a mixed reception from the people who deliver
care; while they may value the intimacy afforded by home-based care, they may
not appreciate the windshield time and the relative inefficiency of traveling
to homes instead of working out of clinics.
2) The balance of power will begin to shift
from hospital systems back to physician groups. All around the country, physician groups who
face acquisition by hospital systems are looking for an alternative. One of the
most promising is being offered by Aledade, the venture-backed company that organizes private
physician groups into accountable care organizations (ACOs). Likewise, within
specific specialties, such as oncology and cardiology, private equity companies
are beginning to roll up provider groups to drive performance, negotiate more
favorable contracts, and leverage purchasing power. Companies like One Oncology—an emerging
oncology roll-up—will grow in number as physicians seek ways to remain independent
of hospital systems. Of course, as markets evolve, it remains a distinct
possibility that even equity-backed physician groups will eventually end up
acquired by large hospital systems.
3) Drug pricing will continue to be a
front-page issue; at the same time, pharmaceutical innovation will also
dominate headlines. We are entering a
phase where drug prices will continue to draw negative attention, but that
attention will be balanced by the breathtaking innovation coming from
biotechnology and pharmaceutical companies. When I was a medical student,
cystic fibrosis would lead to certain death for patients in their 20s or
30s—even with intensive management. Today, a series of drugs from Vertex
Pharmaceuticals—yes, expensive drugs—has transformed cystic fibrosis from a
fatal disease into a chronic disease. As these breakthroughs like these
multiply, expect the national dialog to shift focus from the high cost of drugs
to finding new and different ways to pay for them in order to expand access to
the most innovative products.
4) Medicare-for-All will quickly morph into
“Medicare Advantage-for-All.” Medicare Advantage has grown in popularity during the
last ten years. Many Medicare beneficiaries believe that the quality and value
of the care delivered in Medicare Advantage programs is superior to
fee-for-service alternatives. Likewise, Medicare Advantage continues to get
good reviews from clinicians and health care delivery organizations who feel
appropriately compensated for delivering quality care to their patients. In the
upcoming election year, look for candidates who want to expand access while
promoting competition and remaining friendly to the private sector to discover
“Medicare Advantage for All” as a compelling strategy/alternative to the more
controversial “Medicare for All.” (Full disclosure: my parent company, Anthem,
operates Medicare Advantage products.)
5) Big Tech and Silicon Valley will continue
to play in health care, but they won’t upend the system anytime soon. There’s a lot of talk about tech
companies entering the care delivery space and having a transformative impact
on it. We should expect these companies primarily to enable care models that
make extensive use of artificial intelligence, machine learning and blockchain
technologies — which are currently ill-supported by existing payment and
business models. That said, don’t expect a big payoff right away; it will be
years before these innovations impact care at scale, allowing big tech to
develop material revenues in health care.
6) On a related note, big box retailers and
other atypical organizations will attempt to enter the health care market with
a big splash. Walmart and Best Buy are just two of the national
retailers that have taken steps recently to enter the health care market. There
will be more. Many of them will rush headlong into an industry they know little
about – and they won’t take the time to learn their way around. As a result,
many will roll out ill-conceived products and services, and make a
predictable set of mistakes: overestimating customers’ willingness to pay,
overestimating returns/clinical savings from new programs, and assuming
patients want to be more engaged in their health than they actually do. And
then, just as quickly as they entered the market, expect many of these
companies to turn tail and leave, replaying a movie that we’ve seen over and
over again for the last 20 years.
7) Amid revelations about data privacy,
companies that are transparent and ethical will come out ahead. Recent disclosures about biased algorithms and
data privacy are just the first of many such revelations we can
expect in the coming year. Potentially questionable uses and ownership of data
will raise eyebrows and blood pressures—particularly as Americans who have used
services for DNA testing come to terms with the fact that they may not have
fully understood the privacy implications when they handed their genetic data
over for analysis.
8) When it comes to social determinants of
health, expect more talk than action. Lots of companies are talking about social determinants of
health (or “drivers of health,” as many are beginning to refer to them), but a
close examination reveals that only a few companies are designing substantial
interventions and making innovative breakthroughs in the space. Don’t expect
that to change in the near future. (Bias: I consider my own company and one of
the few focused on action and impact)
9) Mental health conditions and substance
abuse disorders will take the main-stage. New startups that increase access to care for mental health
conditions and substance use disorders have been growing in number. That’s a
good sign. Perhaps even more important, stigma around behavioral health
conditions is slowly diminishing as prominent public figures come forward to
disclose their personal challenges with depression, addiction, anxiety, bipolar
disorder, and other common yet debilitating mental health conditions. In the
future, expect talking about and receiving treatment for behavioral health
conditions to become de-stigmatized — and we will be a better society for it.
10) The public will begin to examine the
behaviors and practices of “non-profit” health systems. Too many non-profit hospitals and health systems
have operated for too long like for-profits—and people and communities are
beginning to take notice. Unsustainable rate increases; surprise billing;
medical collections leading to bankruptcy...Expect regulators to begin a robust
conversation about what requirements need to be met in order to maintain
non-profit status. In some cases, non-profit board members with a clear focus
on the public good will question whether the for-profit management style is the
best way to provide health care to their communities.
And one bonus prediction...
11) Fax Machines will see their bitter end. Angry doctors will take to the streets and
throw their fax machines to the ground in “Office Space” -style tirades. Their
front desk staff will use baseball bats to destroy these machines (while
simultaneously relieving stress). And then some poor soul will be tasked with
reassembling the fax machines because, unfortunately, they will still be the
primary technology used for health information exchange in the year 2020.
What are your predictions (or hopes) for 2020?
I am eager to hear from you. Send me a tweet @sacjai.
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