By Richard E. Anderson, MD, FACP, Chairman and Chief Executive Officer, The Doctors Company and TDC Group
Now that so many aspects of the U.S. healthcare system have been tested by near-battlefield conditions, we can see the emerging risks and opportunities that have developed over nearly two years of disruption.
Under extraordinarily trying circumstances, our clinical frontlines have found innovative ways to care for millions of patients despite distancing restrictions and life-threatening conditions. Decades of development in digital medicine have accelerated the adoption of remote, personalized care, which encouraged massive investment in medicine by new corporate entrants. Concurrently, medical science has countered a global pandemic by creating remarkably effective vaccines and delivering billions of doses all in a year’s time.
However, the pandemic has also unearthed serious fault lines in American healthcare. Access to care, health equity, health literacy, and an epidemic of health misinformation have all been highlighted as life-and-death issues unresolved in this country.
What Will Healthcare Look Like in a Decade?
As we at TDC Group look forward, we are exploring the trends, challenges, key lessons, and emerging risks in the next decade of healthcare.
The following six predictions suggest how the business of U.S. healthcare will change over the next 10 years.
- The cost of healthcare will continue to rise—and continue to be a critical issue—despite the increasing prevalence of value-based care models.
- Healthcare providers will become more consumer oriented in response to large non-legacy corporate entities playing a greater role in delivering care.
- Advanced practice clinicians (APCs) will become the primary care providers for many Americans, reserving MDs and DOs for complex cases.
- Digital advances, including wearable technologies, will account for more than half of global healthcare investment.
- Most systems for electronic healthcare records (EHRs) will be interoperable, enabling data to move as a patient moves—without the Herculean lifts often currently required to make systems work together.
- Healthcare providers will find it easier to treat patients across state lines via telehealth, which will become part of healthcare in every setting.
Prediction One: The cost of healthcare will continue to rise—and continue to be a critical issue—despite the increasing prevalence of value-based care models.
In 2019, the most recent year with 12-month statistics, healthcare costs comprised nearly 18 percent of U.S. gross domestic product (GDP). The Centers for Medicare and Medicaid Services (CMS) project that healthcare spending will outpace annual GDP, reaching $6.2 trillion—almost 20 percent of GDP—by 2028. According to research sponsored by the Peter G. Peterson Foundation, Americans will not be rewarded with better health outcomes in exchange for the higher spend.
Furthermore, these figures do not account for the impact of the pandemic.
The increases come from already high administrative costs, the ever-growing cost of prescription drugs and long-term care, an increasingly elderly population, as well as high provider salaries and defensive medicine. Tests and screenings are also much costlier in the U.S. than in other countries.
Additionally, the consolidation of healthcare is currently driven principally by economics, with two conflicting perspectives: providers wishing to protect revenue streams, and payers seeking to decrease costs and simplify access. Consequently, value-based care models, in which providers are generally paid a global fee for each patient, supplemented by incentive payments based on the quality of care—not the quantity—are supplanting traditional fee-for-service models.
Yet, new financing and delivery models will need to account for growing demand for extraordinarily expensive specialty drugs that are unaffordable without excellent health insurance, intensifying the fight for affordable healthcare as a social justice issue. The overall percentage of healthcare funded by government is likely to continue to increase, but most care will still take place in the private sector.
Another driver of healthcare costs is fragmented care. Patients today often must navigate through disconnected appointments with multiple specialists, labs, and imaging facilities—each like its own island, with no bridge between them. This lack of coordination puts patients into a complex obstacle course of time requirements, transportation needs, and administrative hassles. Clinicians, meanwhile, face additional liability risks if fragmented care leads to delayed or incorrect diagnoses. All parties can benefit from the improved patient safety and provider job satisfaction, leading to reductions in professional liability, that will come from a path out of the maze.
Fragmented care is akin to buying 30,000 individual car parts, assembling them yourself, and expecting a better, cheaper car than you can readily obtain from your dealer. That’s pretty much how we’ve tried to purchase medical care in the U.S. for a long time. It has never made much sense, and makes even less today.
Prediction Two: Healthcare providers will become more consumer-oriented in response to large non-legacy corporate entities playing a greater role in delivering care.
The trend of patient-centered care morphing into consumer-driven care will accelerate, but there will remain a distinction between medicine’s definition of “patient-centered care” and retail’s perspective on “customer service.”
The corporate giants, from big tech to consumer retail, have moved aggressively into medicine with a focus on consumer convenience. Retail medicine is now an important part of primary care delivery in the U.S. and is poised to become even more so. Powerful partnerships between traditional integrated delivery systems and some of the large pharmacy chains make data from millions more people available to expand the database for retail medicine:
- Walgreens: With its VillageMD partnership, Walgreens is the first national pharmacy chain to offer full-service provider offices co-located at its stores on a large scale. Its goal is to open 500 to 700 physician-led primary care clinics in the next five years. These will include primary care telehealth and at-home visits around the clock, 365 days a year.
- CVS: Following its merger with Aetna, CVS planned to have 1,500 HealthHUBs associated with its pharmacies by the end of 2021. These will play an important role in managing patients’ chronic diseases between primary care visits.
- Amazon: The online retail giant recently opened its online pharmacy and is preparing to acquire and manage provider networks. Customers can now have prescriptions for most medicines delivered to their front door by Amazon.
- Apple Health: All 1.4 billion Apple mobile devices include the Apple Health app, which cannot be deleted. This technology is an incredibly efficient mobile system for clinical use and is being widely adopted in healthcare facilities nationwide.
Prediction Three: Advanced practice clinicians (APCs) will become the primary care providers for many Americans, reserving MDs and DOs for complex cases.
More and more care will be administered in outpatient settings, expanding the role of APCs. Encompassing nurse practitioners (NPs), nurse anesthetists, midwives, and physician assistants (PAs), APCs are becoming the frontline for patient care in both primary and specialty settings, as well as retail clinics.
Through 2030, Conning strategic studies show that physicians, dentists, chiropractors, and podiatrists are each projected to grow at a compound annual growth rate (CAGR) of less than 1 percent, while the CAGR for NPs is forecasted at 6.8 percent, and a CAGR of 4.3 percent is forecasted for PAs. This will place them among the fasting growing of all professions, doubling over this decade.
The integration of APCs into healthcare systems can improve access to care, particularly for underserved populations. Research has shown that patient outcomes are similar to those achieved by physicians treating patients with similar maladies. In fact, one study has shown that utilizing advanced practice nursing in the emergency and critical care settings improves patient outcomes.
Improved care access conveys a business benefit to practices as well as a health benefit to patients. In addition to increasing patient satisfaction and retention, improved access offers better care and less visit lag.
Today, NPs and PAs practice along a continuum ranging from required supervision to complete independence. Over the next decade, we predict that physician shortages, combined with recognition of the competencies of APCs, will drive more widespread independence in practice for APCs.
Prediction Four: Digital advances, including wearable technologies, will account for more than half of global healthcare investment.
The highest-impact trend in healthcare over the next decade will be the further acceleration of the digitization of medicine. Far beyond just using telehealth as an in-person visit replacement, digital transformation will include hospital at home, health apps, remote monitoring devices, new medical-grade sensors, cloud computing, and data analytics. Digital initiatives were a key driver of the increase in global healthcare investment in 2021, with digital health startups comprising 40 percent of the deals and fundraising. This trend will accelerate over the next decade.
Increasingly, health metrics like blood pressure, cardiac rhythm, glucose, weight, and more will be monitored remotely via wearable devices that can be connected to a smartphone. For instance, UCSF Medical Center in San Francisco monitors hospitalized diabetes patients remotely through a virtual glucose management service (vGMS) developed by the medical center.
Increased demand for digital wellness stems from healthcare cost inflation, improved research and development, a rapidly aging global population, and improved integration with the Internet of Things (IoT). These wearables can either transmit information to health providers or allow patients to self-monitor wellness measures through personal electronic devices.
The technology goes far beyond smartwatches and consumer-grade IoT. It involves devices woven into clothing and sensors placed on specific areas of the body to communicate with an overall body area network (BAN) system. We even see implantable devices that can automatically track blood sugar and other levels, so that a patient need not be actively involved in monitoring. Researchers studying teenagers with type 1 diabetes found that interventions combining software and devices for tracking fluctuating glucose levels led to improvements, both in the number of patients in range of target glucose levels and in patients’ quality of life.
Meanwhile, Google has launched its first medical device, Derm Assist, a smartphone app that helps dermatologists diagnose skin conditions without having to see the patient in person. These technologies can save providers valuable time and improve access to care for patients. They can also empower patients to better understand their own health.
Similarly, patients with asthma equipped with certain accessible home health technologies can better advocate for themselves and have more meaningful conversations with their providers about their own health goals. However, for all their benefits, wearables do generate risks for patients and physicians alike. These include poor data quality, as some consumer wearables may not be sufficiently reliable for medical use, security and privacy risks, and the threat of data overload if important data signals are lost in a sea of noise.
Moreover, digital health tools, which have the power to increase access to care, paradoxically have the power to increase disparities. Creators of solutions can mitigate these risks by accounting for health equity requirements during the design phase.
Prediction Five: Most systems for electronic healthcare records (EHRs) will be interoperable, enabling data to move as a patient moves—without the Herculean lifts often currently required to make systems work together.
The maturation and integration of EHRs will accelerate remote care, making it a reality for millions. As interoperability continues to advance, EHRs will help some of the large, nationwide systems move beyond ex post facto data mining and start building real-time analytics into their patient records.
Health plans will continue to consolidate or “associate” with other plans and will expand relationships with frontline care providers, including urgent care centers and health systems, crossing into the direct provision of care. Others will consolidate or merge with technology companies to aggregate and parse massive data to drive utilization decisions, benefitting device design.
Prediction Six: Healthcare providers will find it easier to treat patients across state lines via telehealth, which will become part of healthcare in every setting.
Telehealth was already a vital part of the healthcare landscape, but the pandemic has rapidly accelerated adoption. Digital transformation initiatives share common goals of increasing access to care and improving the patient experience. Currently, three-quarters of healthcare organizations are investing in telehealth.
During the pandemic, virtually every state passed at least temporary legislation to remove licensing obstacles. In addition, 35 states have adopted the Interstate Medical Licensure Compact Commission (IMLCC), which streamlines the process for physicians to practice across state lines.
Opening care across state lines will continue to be accomplished by state action with federal support and, perhaps, the adoption of the Uniform Law Commission’s Model Telehealth Act. This would create a national telehealth provider registry to allow healthcare providers with a clean disciplinary record to offer limited telehealth-only services across state lines.
For more predictions on what healthcare will look like in 2032, visit www.thetdcgroup.com/predictions2032
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