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.
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.