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.