Demystifying Medicine One Month at a Time

Tag: predictions

Health Care Predictions Re-Visited

Luciano Lozano. 'Be the bonsai.'

Luciano Lozano. ‘Be the bonsai.’

Happy New Year, one and all! I hope that it’s a healthy one for you.

Since we’re here at the beginning of 2016, it’s time again to look at some predictions I made about health care in the U.S way back in 2013 (also revisited a year ago).

  1. Obamacare will move ahead. Despite 2 different hearings before the Supreme Court and dozens of repeal challenges, the Affordable Care Act stands.
  2. Medicine will enter the era of ‘Big Data.’ Anyone seen those TV ads for ‘Optum,’ (to name just one big data player)? We are already here.
  3. Big data will lead to targeted medical marketing. This wasn’t even a prediction. It’s already been happening for years.
  4. Greater price transparency will come to health care. Not really close to cracking this nut, but a lot (a ton!) of attention is now focused this way.
  5. By 2020, all states will have expanded Medicaid. We are already to 30 states plus the District of Columbia. More on the way.
  6. The number of uninsured will be cut in half within four years. Not quite there yet, but the number of uninsured is the lowest since 1972.
  7. The number of NPs and Physician Assistants will continue to grow, as will the field of community health workers. Yes and yes.
  8. We will see the first nationwide health plans. Yes — the key word here is consolidation — insurers, hospitals, etc.
  9. Finally, a continuous doctor-patient relationship will become a luxury that can be purchased. Everything keeps pointing in this direction.

I’m giving myself a solid seven out of nine this year, up one from last year — and the remaining two predictions are also likely to prove true over time.

One area not covered here that will continue to see explosive growth: Telemedicine. It’s the Wild West. Which company will emerge as a market leader? Stay tuned.

HealthCare Prediction CheckUp

doc-office-aca_wide-403577f90f9f2aa9fdfb92060c1f512825900d1f-s6-c30A while back I made a list of predictions about the world of health care as we entered the Obamacare era.

Let’s see where we stand:

1. “Obamacare will move forward” — in spite of staunch opposition. — Check.

2. Big Data #1 — you’ll be nudged by your doctor or medical home with reminders for preventive care items like flu shots or colonoscopies. — Check minus. This was already happening (e.g. letters reminding women of annual mammogram screenings), but not yet to the extent I foresee.

3. Big data #2 — targeted medical marketing along the lines of Netflix or Amazon, using your prior purchases/preferences. — Nope. I still see this coming. We are at the precipice of a slippery slope.

4. “Patients will be a step closer to becoming true consumers.” What I meant here is that we will see increasing efforts launched to provide price transparency and comparability for health care services, so that patients will actually be able to value shop. — Big proto-check. Big because of a few key efforts — see Elisabeth Rosenthal’s amazing series called “Paying Till it Hurts” in the NY Times, which inspired its own Facebook group and grassroots effort to rein in health costs and bring greater transparency to the ‘market,’ and Steve Brill’s TIME magazine wholly devoted to the mysteries of the ‘chargemaster’ — we are moving quickly in this direction. But only a proto-check because we are nowhere near where we need to be.

5. “More people will get insurance. The 47 million uninsured will be cut in half within four years…” — Check. We are well on the way. See #6.

6. “By 2020, all states will have expanded their Medicaid pools, providing more coverage to the poorest of the poor.” — Nope. But 27 states and the District of Columbia potentially have us near a tipping point. I gave myself some leeway here, and I’m confident we’ll get there.

7. “The number of nurse practitioners and physician assistants will grow dramatically. Nurse practitioners will continue to gain more independence in practice. A new category of health worker will flourish: the community health worker, a lay combination of social worker and medical provider. In particular, community health workers will help with the 5 percent of people who account for half the health care spending in the U.S.” — You betcha.

8. “We will see the rise of the first nationwide health plans. Archaic rules that keep health care local will be modified to eventually allow for consolidation. Like hotel chains, you’ll be able to get health care at the same organization in different cities. The sponsors may be hospitals, say the Cleveland Clinic, or big health insurers, like Aetna. As with hotels and airlines, you’ll have frequent visitor programs, and you’ll be able to amass points toward discounts and perks.” — Not yet. Just you wait. Industry consolidation (i.e. mergers and acquisitions) will continue and drive this.

9. “The traditional doctor-patient relationship in which a single doctor gets to know you over years will become a luxury.” — Check. Just take a look here. Or here.

Generously scoring, that’s six out of nine right so far. Sixty-seven percent is no Nate Silver, but there’s plenty of time still on the clock for the long range bets.

The Choice

In two days, we will elect a President who will serve for the next four years.

Despite all the money spent, the rhetoric (or lack thereof), and the continual assault of election-based coverage aimed at all (or microtargetted slices) of us, there are certainties about our future regardless of who is elected:

  • Health care will continue to be an important and divisive issue.
  • Overall health care costs will continue to rise.
  • The health care industry will continue undergoing radical change; so much so, that I predict by the 2020s your basic conception of ‘health care’ and how you interact with the system will be vastly different than it is now.

Don’t get me wrong. The election matters a great deal. In regard to health care, who is elected will impact how these inevitable changes occur and the pace at which they happen.

Of course, in the offing is full enactment of President Obama’s Affordable Care Act (aka ‘Obamacare’) on January 1, 2014. Candidate Romney has promised to block, de-enact, and ulitmately repeal the legislation. The framing of the debate on health care is often over-simplified to fall better into the ‘size of government’ debate–such that if you think government is too big, and that’s a decisive factor for you, the vote as a referendum on Obamacare makes sense. If you believe that the tenets of Obamacare–providing health insurance to nearly all Americans and reforming the way that we finance health care–then your vote likely fits nicely into the narrative of people needing a minimal level of support to avoid catastrophe, bankruptcy, and have some level of opportunity for achievement in this land of ours.

Here is GlassHospital’s list of predictions on where US health care is headed regardless of Tuesday’s choice:

  1. Health care will continue to undergo massive consolidation. Large players (hospitals, health systems, and insurance companies) will get increasingly larger. Doctors will continue losing autonomy as independent agents and will increasingly become employees of these large corporations.
  2. Technology will continue to drive change: On the high-priced end, newer diagnostic and therapeutic technologies will continue to provide cost pressure to the system which will rub raw Americans’ belief that we can be entitled to treatments no matter the cost when we’re the one affected with the disease. We will have to set limits (yes, limits!) on expensive treatments for which there is little to no evidence of benefit to patients (other than claims of ‘latest and greatest.’)
  3. The health care work force, and how you access it will change dramatically. Who you see will be different–it’ll be much less likely to be a doctor. It will be a nurse or a physician’s assistant, or in some cases, a community health worker with specialized training.

In addition, regarding #3 above:

  • You will be more likely to see these newer types of health care professionals in cyberspace, at your workplace, at the pharmacy, or at other points of contact in the economy (Walmart, etc.).
  • You will continue to pay more out of your own pocket, but you will get incentivized for ‘good behavior’ i.e. vaccinations and age-appropriate screenings, as well as better nutrition, weight and avoidance of tobacco.
  • We will move to more a la carte system of health care–where if you want it, you can pay for it. At one extreme, DIY medicine will be the biggest theme of the 2010s and 20s–just as with other hobbies and technologies, medicine will continue to be absorbed by the people and for the people. Fed up with a changing and chaotic system, more DIYers will take matters into their own hands. At the high end of the income and price scale, this means there will be no limits on care for those with the means to afford it.
  • Ethically, there will be calls for physicians to abstain from serving as mere functionaries and technicians, and to continue to exercise professional judgement and not feed the maw of unnecessary and expensive over-treatment, but this horse has already left the barn.

Remember to tell your social networks that you heard it here first. And buy the book(s)!

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