As the year draws to a close, I’ve been thinking about what’s in store for healthcare in 2019. I offer ten predictions below: sincere ones, hopeful ones and a few final thoughts submitted with my tongue planted firmly in my cheek.
Real Predictions
1. Humanism and humanity will make a real comeback.
When you walk the halls of most hospitals and clinics these days, two subjects you hear a lot about are patient dissatisfaction and physician burnout. The two are closely linked. In the past, digital health has been seen as the fix for these challenges. But I think in the year ahead we’ll finally start to have honest conversations about addressing both problems by advancing business models that increase the amount of time physicians spend with patients while improving the quality of those interactions. We will begin the year with renewed appreciation for the invaluable men and women who deliver care to patients in the United States.
2. The epidemic of loneliness will take center stage.
There are few issues as gripping or as human as loneliness. As far back as the year 2000 the Harvard political scientist Robert Putnam told us we were experiencing a decline in social capital. Thankfully, thought leaders including Senator Ben Sasse and former Surgeon General Vivek Murthy are finally drawing attention to this issue. In the coming year, I believe we will expand on this discussion. We’ll have an honest conversation about loneliness as a social determinant of health, which will lead doctors, nurses, and other healthcare professionals to reassess their power to address this epidemic. Solutions for addressing loneliness will not lie in the healthcare system alone—but it is a great place to start.
3. Medicare Advantage will be seen as a template for the healthcare system of the future.
Anyone looking for a progressive model of care that leverages the power of the public and private sectors to improve outcomes need not look further than Medicare Advantage plans. Increasingly, startups (Iora Health, Devoted Health, Bright Health, Clover Health) and incumbents (Anthem, Humana, United Healthcare, among others) are discovering that Medicare Advantage plans offer powerful tools to improve and measure outcomes — especially when they take into consideration the social determinants of health. Medicare Advantage plans operate under “full risk” for all medical expenses and so there is margin to fund solutions to problems like hunger and housing insecurity that have a real impact on health, but for which there is otherwise little investment. What was once a stigmatized program will continue its assent to the mainstream and, in many cases, become the preferred choice of patients and clinicians alike.
Hopeful Predictions (A man can hope, can’t he?)
4. Quality measurement will focus on what happens in the exam room.
“That which is essential is invisible to the eyes,” Antoine de Saint-Exupéry famously wrote in The Little Prince. The same could be said about clinical care. It seems that we have a measurement and documentation requirement for just about everything these days, but these practices appear to do little to improve quality or patient satisfaction. So let’s all recommit ourselves to measuring quality where we all know it matters most and where our patients can feel it firsthand: in the exam room. We must reaffirm the importance of the quality of interactions between doctors and patients.
5. The health care industry will make progress on new models for drug pricing.
President Trump is talking about drug pricing. Secretary of Health and Human Services Alex Azar is talking about drug pricing. And the administration just appointed my former CMS colleague John M. O’Brien as the new drug pricing czar. Even pharmaceutical CEOs are making provocative, meaningful statements about drug pricing. With all this focus, I’d wager something interesting is about to happen.
6. We will finally learn what Amazon, Berkshire Hathaway and JP Morgan are up to.
The joint partnership between these three firms will be bold, surprising, and unexpected. Atul Gawande is building a dream-team to run the venture that includes industry heavyweights like Jack Stoddard and Dana Safran. So far they haven’t disclosed what they’re doing. Whatever it is, I suspect it will resemble all of Gawande’s work to date: elegant and highly compelling.
7. Tech companies will get into the health care delivery business.
And it will be exciting. Many people didn’t notice that, along with new outposts in New York and Virginia, Amazon announced that it’s building a tech hub in Nashville. Most insiders suspect that has something to do with Nashville’s concentration of hospitals and health IT firms. But Amazon’s not the only high-tech player jumping into the health care waters. Apple, Google and Microsoft have all indicated an interest in the sector, and have even begun recruiting top physician talent such as Stanford internist Sumbul Desai (Apple), Geisinger CEO and psychiatrist David Feinberg (Google), and Harvard cardiologist Maulik Mazumdar (Amazon). In the past, these companies have built alliances that didn’t yield results and brought products to market that were more sizzle than substance. This year, I suspect, could be a turning point.
Three For the Road
8. More buzzwords.
In the past decade, we got “meaningful use,” “block-chain,” “value-based,” and “patient-centered”—not to mention an incredible diversity of mind-numbing acronyms. I’m not sure what language mashups we can expect next year, but rest assured they’ll generate plenty of conferences and spam emails.
9. Another unlikely, head-scratching mega-merger will occur.
Aetna-CVS just closed. Cigna-Express Scripts is not far behind. Investment bankers will grow ever more creative and bold in the coming year. Will Taco Bell acquire Pepto-Bismol from P&G? Will Weight Watchers buy Frito-Lay from Pepsi? (How many points in a Dorito?) I fully expect to wake up to learn that General Motors has acquired Massachusetts General Hospital.
10. We will all keep our new year’s resolutions.
Each of us will lose fifteen pounds. We will all read a book a week. We’ll learn Mandarin, remember to call our grandparents, wash the dog more often and write that mystery novel about the doctor who uncovers a crime syndicate operating out of the hospital cafeteria.
Happy New Year to all! Wishing you great health and success in 2019.