Blog | Tuesday, January 27, 2015

Health care prediction checkup

A while back I made a list of predictions about the world of health care as we entered the Obamacare era.

Let's see where we stand:
1. “Obamacare will move forward” in spite of staunch opposition. Check.
2. Big Data #1. You'll be nudged by your doctor or medical home with reminders for preventive care items like flu shots or colonoscopies. Check minus. This was already happening (e.g. letters reminding women of annual mammogram screenings), but not yet to the extent I foresaw.
3. Big data #2. Targeted medical marketing along the lines of Netflix or Amazon, using your prior purchases/preferences. Nope. I still see this coming. We are at the precipice of a slippery slope.
4. “Patients will be a step closer to becoming true consumers.” What I meant here is that we will see increasing efforts launched to provide price transparency and comparability for health care services, so that patients will actually be able to value shop. Big proto-check. Big because of a few key efforts—see Elisabeth Rosenthal's amazing series called “Paying Till it Hurts” in the New York Times, which inspired its own Facebook group and grassroots effort to rein in health costs and bring greater transparency to the ‘market,’ and Steve Brill's TIME magazine wholly devoted to the mysteries of the “chargemaster”—we are moving quickly in this direction. But only a proto-check because we are nowhere near where we need to be.
5. “More people will get insurance. The 47 million uninsured will be cut in half within four years …” Check. We are well on the way. See #6.
6. “By 2020, all states will have expanded their Medicaid pools, providing more coverage to the poorest of the poor.” Nope. But 27 states and the District of Columbia potentially have us near a tipping point. I gave myself some leeway here, and I'm confident we'll get there.
7. “The number of nurse practitioners and physician assistants will grow dramatically. Nurse practitioners will continue to gain more independence in practice. A new category of health worker will flourish: the community health worker, a lay combination of social worker and medical provider. In particular, community health workers will help with the 5% of people who account for half the health care spending in the U.S.” You betcha.
8. “We will see the rise of the first nationwide health plans. Archaic rules that keep health care local will be modified to eventually allow for consolidation. Like hotel chains, you'll be able to get health care at the same organization in different cities. The sponsors may be hospitals, say the Cleveland Clinic, or big health insurers, like Aetna. As with hotels and airlines, you'll have frequent visitor programs, and you'll be able to amass points toward discounts and perks.” Not yet. Just you wait. Industry consolidation (i.e. mergers and acquisitions) will continue and drive this.
9. “The traditional doctor-patient relationship in which a single doctor gets to know you over years will become a luxury.” Check. Just take a look here. Or here.

Generously scoring, that's 6 out of 9 right so far. Sixty-seven percent is no Nate Silver, but there's plenty of time still on the clock for the long-range bets..

This post by John H. Schumann, MD, FACP, originally appeared at GlassHospital. Dr. Schumann is a general internist. His blog, GlassHospital, seeks to bring transparency to medical practice and to improve the patient experience.