Top 10 Healthcare Industry Predictions For 2022

The solar is setting early, the wind is blowing and the fireside is warmly lit. All of which implies it’s time to collect with household, reconnect with outdated mates, and predict what lies forward for the healthcare business.

If you happen to’ve learn my annual predictions earlier than, that I not often get all the pieces proper. However wanting again ultimately yr’s listing, I believe I did fairly properly. (“Biopharma will get pleasure from a short-lived repute rebound?”) Did I get different issues mistaken? Something that impressed you? I invite you to let me know on Twitter @sacjai.

Earlier than we transfer on to this yr’s listing, let me say upfront that it deliberately omits any predictions about COVID-19. That’s as a result of if I’ve discovered something from my previous predictions, it’s that COVID-19 is unpredictable.

And now, I invite you to place your toes up, ignore the soreness in your arm out of your booster shot, and luxuriate in my High 10 Healthcare Predictions For 2022.

1. FTC and DOJ, The place Artwork Thou?

Throughout the economic system, costs are rising. Contained in the healthcare sector, consolidation has largely proceeded unchecked, thank to a long time of neglect on the a part of anti-trust enforcement businesses. For years, pharma was the poster youngster for monopolistic pricing. The managed care business has continued to consolidate, with solely an occasional Federal Commerce Fee (FTC) or Division of Justice (DOJ) problem. Today, it’s hospital mergers that needs to be trigger for concern.

However we could also be turning a nook. Earlier this yr, President Biden issued an govt order calling on the federal authorities to look into hospital mergers and overview insurance policies that result in greater costs. Little doubt, the fed’s curiosity in the price of care is one cause they’ve held up the planned merger of Hackensack Meridian Well being and Englewood Well being in my outdated New Jersey stomping grounds.

With fuel costs up and a worldwide provide chain crunch boosting the price of items throughout the economic system, I believe 2022 would be the yr the FTC and DOJ regain their footing and understand that limitless consolidation is dangerous for anybody who has to pay a medical invoice.

2. Unicorns Will Look Extra Like Drained Previous Horses

The valuations of all the brand new healthcare corporations which have proliferated these days are based mostly on the scale of the “complete addressable market” and the assumption that these corporations will seize the lion’s share of that market.

However in the end traders are going to take a better take a look at the precise variety of sufferers in these markets and understand the outcomes these startups are touting are based mostly on negligible pattern sizes that may’t be scaled up. With no use for his or her merchandise, startups with duplicative providers will probably be winnowed away in a survival of the fittest competitors—assume Squid Video games with a bunch of enterprise capitalists carrying these creepy masks.

3. The Nice Medicare Benefit Debate Will Rage On

Credit score Don Berwick and Richard Gilfillan for a revived dialog in regards to the worth of MA plans. (I depend each as mentors and mates and so they’ve by no means shied away from asking robust questions.) From a pure {dollars} and sense viewpoint, their arguments have some benefit. 

Alternatively, MA has broadened our conception of healthcare and innovation in methods fee-for-service Medicare by no means has. Lawmakers nonetheless can’t agree on whether or not fee-for-service Medicare ought to provide dental advantages. In the meantime, MA plans have supplied dental protection for twenty years. Plus imaginative and prescient care, listening to aids and the types of issues that handle the determinants of well being, like meals, health and transportation advantages.

If MA plans replete with these advantages value extra (and there’s appreciable proof that they don’t), it would simply be as a result of they do extra and do it higher too. That’s to not say MA doesn’t have loads of room for enchancment. There have been dangerous actors out their ginning up danger scores and too many plans have an excessive amount of high quality print that restricts entry to care. However Don’s and Rick’s prescription, to scrap the entire thing, isn’t the reply (disclosure: I lead SCAN Well being Plan, a significant non-profit Medicare Benefit plan). I’m wanting ahead to a wholesome debate clear by to 2023.

4. Medicaid Will Develop into the New Medicare

For many years, Medicare has been a hot-bed of innovation as good individuals have confronted the problem of offering reasonably priced care to the age group that wants it essentially the most. In the meantime, a rising variety of innovators are starting to take a look at an excellent more durable inhabitants to serve—individuals on Medicaid. 

Not like older adults, lots of whom spend hours every year selecting well being plans and who vigorously have interaction with their physicians, Medicaid enrollees are sometimes passively enrolled. Generally they don’t even know they’ve been enrolled. And so they usually lead sophisticated lives that don’t go away them a lot time to spend half-hour sitting round a ready room whereas the physician finishes seeing different sufferers.

What’s extra, there isn’t as a lot income related to Medicaid. All of which implies it’s a must to work more durable to deal with a way more tough cohort of sufferers for lots much less cash.

Who’s up for the innovation problem? CareMore, my outdated firm, for one. And Cityblock Well being, for one more. However I predict they’ll quickly discover themselves with loads of firm as a brand new crop of leaders sees the chance in entrance of them. Bear in mind when docs shied away from accepting Medicare sufferers? Identical to that, good innovators will see the urgent want (and obligation) to offer care to the Medicaid inhabitants. They’ll bounce proper into the motion, and, as they uncover new methods to offer high quality care at a decrease value, we’ll all be higher off for it.

5. Extra Discuss Than Motion On Well being Fairness

Forgive me if I sound like a damaged file. Sure, it is a repeat prediction, however the level can’t be burdened sufficient. Well being fairness would be the nice embarrassment of our time, and to make issues proper, we want extra revolution than evolution.

Sadly, what we’ve seen to date, and what I’m afraid we’ll proceed to see in 2022, are small, incremental steps towards progress. Positive, there will probably be just a few organizations that can do issues which are a bit extra forward-leaning—and even just a few organizations that will probably be based with an categorical give attention to lowering disparities amongst particular populations. However these teams will largely be the exception.

As an alternative of press releases and buzzwords, we want sturdy information assortment, public transparency, and actual incentives to make massive adjustments. 

Make no mistake about it: the dominant gamers within the healthcare discipline can resolve this persistent drawback in the event that they wish to. However to date they’ve proven little curiosity in specializing in options. Maybe it’s time to tie govt bonuses to disparity reductions? That’ll wake them up.

6. Major Care is the New Black

With an eye fixed towards “capturing danger,” everybody will proceed to hurry into the first care sport. Walgreens, CVS, Walmart, Amazon, Greenback Normal and Finest Purchase are all searching for a bit of the motion. 

Sure, enhancing and increasing primary care is crucial to lowering costs and improving outcomes. But profitable major care fashions are constructed on the competent and keen backs of assured generalists who use consults, somewhat than limitless referrals, to offer the very best care for his or her sufferers. Too lots of the new major care entrants don’t get this; they purchase into the concept that Go=MD. Quickly they’ll be taught that that is only a method for burnout, disenchantment and substandard care. (Someway it all the time finally ends up being costlier too.)

7. Sounding the Alarm on Job-Shifting

Job-shifting continues to speed up in a healthcare atmosphere fueled by the infusion of personal capital and pushed by value pressures on legacy healthcare organizations. For years, we’ve seen loads of misplaced rhetoric round “high of license” observe, which is usually a euphemism for having the bottom value employee within the healthcare provide chain carry out the work. The work of a specialists goes to generalists. The work of generalists goes to nurse practitioners. The work of nurse practitioners goes to LVNs, that of LVNs to group well being employees, and so forth.

These practices can work, however solely after they’re embedded in high quality administration and collaboration. However inflammatory rhetoric round “impartial observe” is undermining the collaborative observe mannequin, and lots of organizations are forgetting what many people have identified for a very long time: groups > people.

Subsequent, yr, anticipate a lot of organizations to check out the place and the way work is allotted. The easiest will create collaboration platforms that allow every member of every group to contribute their absolute best to each affected person encounter.

8. Anticipate a Guerrilla Marketing campaign In opposition to Misinformation

The issue of misinformation in healthcare appears so massive and so unwieldy that not one of the dominant healthcare organizations have taken it on. COVID-19 introduced the issue into focus, but it surely predates COVID and lots of public well being officers privately lament that that is the largest problem they face. 

Search for that to alter within the coming yr. Anticipate unlikely alliances between healthcare organizations and tech organizations, as these two teams collaborate to push again towards the tide of deceit. It’s an uphill battle, however one which should be waged within the identify of public security and group well being.

9. AI/ML Will Develop into the Massive New Diagnostic Weapon of Alternative

There’s been loads of discuss not too long ago about AI/ML (that’s Synthetic Intelligence and Machine Studying for many who don’t get emails on a regular basis touting their potential). Regardless of the hype, these applied sciences are lastly beginning to present up in clinics. I was skeptical of their potential, however corporations like Perspectum are utilizing these applied sciences to obviate the necessity for invasive liver biopsies. Ultimately, we’re on the cusp of a tech revolution in diagnostics.

10. Ted Lasso Meets Healthcare: Much less Burnout, Much less Cynicism, Extra Appreciation

Like most of America, I fell in love with Ted Lasso. The present alerted me to how cynical I’d turn into about sure topics and made me wish to dwell a “post-cynical life.”

So I did a thought experiment. What if Ted Lasso have been the pinnacle coach of America’s main healthcare organizations? Nicely, the individuals who work for them would have extra enjoyable at work. They’d be much less inclined to burn out and extra inclined to sincere self-reflection.

On this one, chances are you’ll say I’m a dreamer. However as John Lennon stated, “I’m not the one one.” Anticipate this to be the yr that healthcare bounces again from the doldrums of pessimism. It’s possible you’ll not see clinicians dancing down the hallways of the hospital, however I do assume you’ll see them ever extra appreciative of one another—and happy with the work they do. And that’s price toasting as we rejoice 2022.

Joyful new yr.