Predict-O-Meter
Joe Public 2030 makes five bold predictions about the future, which range from exciting and promising to ominous and discouraging. Through the Predict-O-Meter, we’ll continuously assess the state of the healthcare industry to track the accuracy of the five predictions.
Five Potent Predictions Reshaping How Consumers Engage Healthcare
The Copernican Consumer
What influenced our latest rating?
At the end of 2023, we had this prediction at “Nailed It.” For now, we’re moving that back a notch. We’re still optimistic about the coming Copernican Consumer, especially given the potential disruption of AI on healthcare. And science and technology keep advancing, whether it’s sleep apnea monitoring with the new Apple Watch or advances in digital twins. But as with all things healthcare, the question is more of a “when” than an “if,” with some key aspects of the consumer-center health world, like the hospital-at-home strategy, slowing a bit. The Copernican Consumer continues to progress, but it’s unclear whether she will arrive fully by 2030.
Consumers will become the center of their own health universe more than ever before, enabled by sensors, AI, and other technology, as well as services geared toward empowering them, leading to profound implications for both consumers and healthcare organizations. Potential results could include a dramatic reduction in the need for primary care clinicians, an entirely new sector devoted to personal health management, true precision medicine combined with health management, and more.
Constricted Consumerism
What influenced our latest rating?
A year ago, the Constricted Consumerism prediction was 100% on track, and that doesn’t change a year later. Whether it’s continued restrictions from insurers, like more prior authorizations (and the failure of congress to act on them), or the continued pressure on rural healthcare, consumers face an increasingly difficult healthcare landscape. And the future in that regard looks awfully dim. The impact of the new Trump administration on healthcare could be monumental, and there’s little reason to suspect that the next few years will be beneficial for healthcare consumers. Consider the millions who would face higher costs should the ACA insurance subsidies be allowed to expire. There was even talk during the election of shifting the ACA marketplace to create insurance pools based on healthcare need, or eliminating the rule requiring insurers to ignore pre-existing conditions. Both of these will be sold as more “choice” for consumers, but as with many promises in healthcare, the opposite will be true. We also see the continued slow but sure shift from employer-sponsored health insurance to companies providing cash allowances and sending employees out into that very same ACA market place.
While consumers will become increasingly responsible for their own health and use of healthcare services, they will actually become less and less empowered in the choices they have for care, especially in higher-acuity, higher-cost situations. While many in the industry will continue to sing the praises of choice, the reality is most consumers will have far fewer choices moving forward, often in ways they might never ever consider or see.
Funnel Wars
What influenced our latest rating?
Well, you can’t win them all. A year ago, the disruptors were moving full-steam into healthcare, and this prediction was a “Nailed It.” A year later, the ground is littered with fallen entrants, and we’ve moved this prediction all the way back to orange. Wal-Mart shuttered clinics and its health unit; Walgreens looks to sell VillageMD, likely at a huge loss, and move back out of care delivery; CVS Health is closing stores and MinuteClinics; Optum shut down its virtual care offering; Teledoc Health stock and leadership are in shambles; Dollar General closed its mobile health initiative. At the same time, many traditional health systems are finally finding their financial footing. So why not move this all the way to “Utterly Wrong”? Well, for one, there’s just too much money in healthcare for outsiders to not keep trying (to wit, Amazon is still in the game, as is Apple). The industry still needs disruption in so many ways, so we can’t dismiss it outright.
Today we tend to consider hospitals and health systems as birds of the same feather in terms of business model, with variances based on size, scope of services, for-profit/non-profit, and other factors. Moving forward, we could see the splitting of the health system model, with some systems moving even further to the larger, more comprehensive “health” organizations, others retracting into solely acute-care destinations – the “giant ICU on a hill” – and others somewhere in the middle. These models may emerge based on core geographic/market differences such as presence of competitors, plan consolidation/power, regulation, and dozens of other market forces. Yet the primary area where this transformation would play out is with health, wellness and the lower-acuity care points – what we’re calling The Funnel Wars.
Rise of Health Sects
What influenced our latest rating?
If we could invent a higher ranking than “Nailed It,” we’d apply it to this prediction. A year ago, with the emergence of the “medical freedom” movement with clinical offerings opening in Florida, it was fair to mark “The Rise of the Health Sects” as a done deal. Little did we know what was coming on November 5, when the national election ushered in the Trump administration, with a full Republican congress. What follows is likely to be a widespread application of political health beliefs to our national health policy. And that’s with or without the confirmation of Robert Kennedy Jr., an avowed vaccine opponent and overall healthcare outlier. Consider Idaho, where a local health board made it illegal to provide Covid-19 vaccines, a first in the country. The influence of political views on healthcare has already rocked the U.S. in the first part of this decade, from the Covid-19 pandemic to the Dobbs decision on abortion. It’s hard to believe that politization of healthcare could grow in the second half of the decade, but from women’s reproductive rights to LGBTQ and transgender healthcare to the ACA, HIPAA and other healthcare laws, it’s likely going to be a very bumpy few years.
Challenges to and skepticism of the mainstream medical field and science itself have exploded in the past two years because of the pandemic and political tribalism in the U.S. Anti-vaxxers, non-maskers and Covid deniers are just the start of an expansion of this distrust of experts, which taken to its potential end could result in multiple “health sects” – primary “schools” of medical thought that coalesce around political/world-views. Imagine “Mainstreamers,” who follow the establishment healthcare point of view, “Progressives” who follow minimal medical intervention combined with complementary and alternative medical solutions, and “Contrarians” who deny mainstream medical thought and create their own set of “alternative facts” on everything from vaccines to childbirth to end of life care, and everything in between. These sects will not only follow the medical thinking that best fits their world-view, they may in fact create their own reality through alternative research, diagnosis and treatment approaches, and models for the delivery of care itself.
Disparity Dystopia
What influenced our latest rating?
Unfortunately, one year later, we are forced to keep the prediction of “Disparity Dystopia” as fully on track. If the problem is health inequities and disparities, than the backlash against DEI and anything related to it will certainly slow or block solutions altogether. As noted above in Constricted Consumerism, threats to the ACA, Medicaid or other public healthcare programs will impact millions, while bankruptcies from medical debt continue to grow. As explained in our book, climate change disproportionately affects those who face health disparities, and the fallout from global warming will only get worse. All of this for a healthcare system that is already the most expensive among advanced countries and which is well behind those peer countries in most health metrics.
The Covid-19 pandemic shone an ugly light on the disparities that have plagued the U.S. healthcare system for decades. Unfortunately, that health gap is more likely than not to expand, as the “haves” gain access to increasingly more expensive medical treatments, health services, and personalized care, while the “have nots” will face growing shortages of basic health resources, from clean water and air to physicians and clinicians, rural healthcare, and more. This shift will be compounded by the mental health crisis, which disproportionately affects systemically disadvantaged populations and groups outside traditional healthcare access channels (teens, for example). All while those entities that might address these disparities increasingly struggle financially – health systems, health plans, state and federal governments – and others lack the incentives to focus on the growing issue.
