In this pretty impressive article, The Consequential Divide: Which Direction Healthcare?, Preston Gee points out that too many people face the future in health care by "wishing  would make it so".  This was something that we had to contend with at IFTF all the time–people saying "you want X, therefore you’re predicting X" about our forecasts. That’s certainly what most people like to do, and then are unprepared when Y arrives instead.

One way around this–which we used extensively at IFTF–is to create scenarios which give alternate views of the future, and provide clues so that the client could recognize which scenario it ended up in. Then you develop a plan for each scenario, and enact it according to the future you find yourself in.

My only problem with Gee’s argument is that he suggests we’re either going to a consumerist-HSA future or to a single payer one. If I was forced to guess I’d say that we’re going through a consumerist-HSA future to a single payer one–and a damn violent upheaval it’ll be too. So that will make the timing of many initiatives very tricky.

But there are plenty of other potential scenarios: consumerism might remain a small deal for most health care providers, or a modest upturn in the employment world might release some of the cost pressure off employees, or a rash of hospital bankruptcies lead us to the "Blade runner" or "Brazil" scenario, or a sensible coming together of providers, plans and employers plus an individual mandate gets us to a quasi-universal insurance with modest price controls. (If you want the full list you’ll have to hire me!)

Bill Walsh probably figured out the best way to use scenarios. In his day the 49ers had a play ready for virtually every eventuality (e.g. for 3rd and 15 on the opponents 30, losing by 6 with 45 seconds on the clock, Montana would fake to rice and dump off to the fullback, or whatever). Scenario-based strategic planning doesn’t have to be that complex. But health care organizations need to realize that there are a range of possible futures out there, and if they want to be live in all of them, they need to prepare.