While your humble columnist eschewed forecasting for 2013, he has decided to reverse course and inaugurate the 2014 blogging season with a contrarian duodecimal exercise in futurism. Will this antidecimal augury align with the mysterious cosmic order and governing perfection? Let the readers be the judge in January 2015……
1. Obamacare will neither succeed or fail. This hugely complex law will have too many outcomes, statistics and analyses that will be subject to too much spin by both supporters and detractors. Like puppies clamoring for the mother’s attention, the loudest wins, but only in 15 minute media increments.
2. Inflation returns, with a vengeance: While we won’t know it until well into 2015 or 2016, 2014 will be the year that the sleeping giant of healthcare costs awakens. Millions of new insureds in an improving economy will finally get their pent-up pricey preference-sensitive health care needs fulfilled.
3. Duh, it’s the delays stupid: While low income Americans will appreciate having access to subsidized health insurance and Medicaid, the middle class’ unsubsidized sticker shock will threaten the fall 2014 elections. Caught between conflicting advice of insurance actuaries and political hacks, the White House’s regulatory choices will be obvious.
4. Commercial scientific misconduct: Unable to resist the allure of bonus payments (like this) or the branding that is dependent on the public release of quality outcomes, at least one large health entity will be caught committing “reporting fraud.”
5. Snowden blow-back: as the promise of big-data grows, fearful health care consumers will be even less inclined toward allowing access to their health information. Too bad they won’t be given a say.
6. Innovator’s Dilemma for health tech: solutions that are simple, transparent and modular will continue to make ‘from the bottom’ inroads into a tech industry that – like early data storage – is too complex, opaque and entangled.
7. Speaking of health tech, patient-monitoring solutions that offer more insight and less data will grab market share. Instead of a series of blood glucose results dumped into an electronic inbox, think algorithms that suggest insulin dose adjustments.
8. ACOs stumble: Far more ACOs will fail than succeed in hitting their risk-share thresholds because docs can’t say no, one patient at a time. As a result, we’ll see these organizations begin to cut costs by parting company with some of their recently hired physicians, further fueling the concierge medicine movement.
9. Unfavorable prognosis for physician income means an emerging bull market for concierge medicine: Past attempts to replace the SGR never fail to disappoint and 2014 will be no exception. That, however, will only be on the icing on the bitter cake of foregone co-pays and coinsurance by patients who chose all those stinky bronze plans. As a result, more docs will bail on their insurance contracts and open “concierge” practices.
10. Navigators Ver. 2.0: Knowing that 2014 could be a high water mark for top-line income from newly insured patients, hospitals will step up and hire their own “navigators.” Unsurprisingly, they will not seek out the healthy millennials. And insurers, thanks to the “3Rs” that are largely backed by Uncle Sam, won’t care about the resulting adverse selection.
11. All boats benefit…..While the PHM industry will continue to extol its cost-savings value proposition, its investors will profitably ride the rising tide of overall increased health spending.
12. Thanks to the battered healthcare.gov brand, conservatives will be better positioned to thwart other “big government” proposals in 2014 outside of health care (for example, education, carbon markets or immigration reform). Progressives will focus on simpler stuff, like increasing the minimum wage and keeping The New York Times afloat, but miss a decades-long setback of Obama-inspired liberalism.
Jaan Sidorov, MD, is a primary care internist and former Medical Director at Geisinger Health Plan with over 20 years experience in primary care, disease management and population-based care coordination. He shares his knowledge and insights at Disease Management Care Blog, where an earlier version of this post originally appeared.
Love #6, it’s slow going and well documented EHR APIs would make this process go much much faster but it is happening. Physicians are fatigued with crap software that takes months to implement and learn.
Archon raises a good point: if the ACA’s outcomes turn out to be a miasma of conflicting claims, both sides will be even unhappier with the law. Not only could that further undermine it, but resurrect the single payer option.
ACOs continue to attract the ire of readers, and why not? In order for an ACO to succeed, patients somewhere somehow will need to forego healthcare services. From a policy perspective, what difference does it make if the providers or the insurers preside over that?
Al Lewis would have disappointed me if he didn’t use this post as another chance to remind everyone of his doubts over the saving money claims of the PHM industry. He neglects the irony, however: whether the “bottom line” savings claims are true or not, the unleashing of health care spending in general will result in far more significant “top line” revenue growth. As Yogi also pointed out, in theory there is no difference between theory and practice, but in practice there sure is.
And grammatician Zack is correct. While I continuously struggle to be caught off guard by use of the singular vs. plural, I’ve stumbled on the neither-nr link. I’ve alerted the THCB editors and I’ll fix that on the original DMCB post. Thanks Zack!
For the love of god, “neither” is accompanied by “nor” in the context used in this post.
In the immortal words of the great philosopher Yogi Berra, it’s tough to make predictions, especially about the future. Nonetheless I wouldn’t be betting against most of these. Especially #1. People are going to be arguing this one for years, just like they still argue about whether Reagan was responsible for the fall of Communism.
However, PHM–“population health management, I assume– saving money? “All boats benefit?” Maybe on your planet, but in real life, while disease management and patient-preference conditions may have modest cost-savings, the wellness boat makes the Titanic’s Captain Smith look like Larry Ellison. That industry is on the verge of collapse, and a ton of investors are going to lose a lot of money. There is a 0% chance of this not happening. Take that one to the bank.
The fear of liberals that conservatives will attempt to club to death the beast of “redistribution” with the ACA will prove fully justified. Liberals will attempt to occupy the high moral ground with a stream of anecdotal accounts about those who are joyed to be the recipients of subsidized insurance. Conservatives will attempt to rally moderates to their cause by pointing out the inequities in the exchange rating system, and making sure small businesses and their employees are aware of what is in store for them. Both sides are looking past these skirmishes to the day it becomes evident that the exchanges are actuarially unsound. The liberals, despite the constraints now placed on insurer profitability, will blame the fiasco on insurer “greed,” and beat the drums for “universal single payer.” The conservatives will raise a hue and cry about “bailouts,” leaving the insurers with no rational alternative to withdrawal from the exchanges. The fire in the kitchen will get so hot that both the individual and employer mandates will be suspended indefinitely. The 2014 elections will quash any hopes for “single payer.” And the fate of the uninsured? Conservatives, like the walrus, will say “The time has come to talk of many things.”
I think what the author is missing that many miss about ACA is the weakened state of our economy. Note what the author says in point 2….
“Millions of new insureds in an improving economy will finally get their pent-up pricey preference-sensitive health care needs fulfilled.”
The economy is not improving and in fact will get worse something ACA is not helping. The stock market is a house of cards, real unemployment is well into the teens and the debt keeps piling up.
The Fed will not be able to continue to defy gravity and when everything resets back to reality the comment will not be where’s my HC rather “brother can you spare a dime.”
ACOs will indeed fail. They are just nothing more than a ‘re-branding of things tried and failed in the past. Without wholesale education of the public, the accepting of that education, the requirement of that education and the assumption of their responsibilities, there is no way ACOs can succeed much less survive.
HMOs with nice lipstick?
ACO stumbling will have a strong impact on newly formed hospital alliances. The risk sharing model is contingent upon controlling some of the cost variables, but the risk analysis is constantly changing. One of the most basic pieces of evidence to this is the great uncertainty as to what the demographic makeup will be of the insure population in the risk pool. For this reason, “risk corridors” have been created, to protect insurance companies, potentially shifting the cost burden to the public. http://www.RateHospitals.com agrees that as these organized forms of medicine fail, the concierge medical practice may again redefine the patient physician relationship!
Medical marijuana malpractice.
Don’t Bogart the roach clip.