medical trends - Twelve Health Care Predictions for 2007

Thoughts from the Edge

Here are my top ten health care predictions for 2007. These are thoughts from the edge. From Megatrends, I learned trends start out there at the edge, away from Washington, D.C. From Edge Cities, I learned cities at the edge of major metropolitan areas are where the action and population growth are. From Edgeware: Insights from Complexity Science for Health Care Leaders, a VHA, Inc publication, I learned to heed these maxims.

•“When life is far from certain, lead from the edge.”

•“Tune your place to the edge.”

•“Go for multiple actions at the fringes.”

•“Listen to the shadow system, realizing that informal relationships, gossip, rumor, and hallway conversations contribute significantly to mental models and subsequent actions.”

So to the edge I go.

1.Home care will boom. A friend of mine started an edge business focusing on maintaining “dignity and independence” for the elderly in their homes by offering cleaning, transportation, and home care services. She can’t keep up with business. Home care, long thought to be at the edge of health care, is booming. It’s growing faster than any other health care sector. Home care is decentralization or, as the feds like to say “the declining concentration of health care,” at work. When people are old, sick, or dying, they want to be home. That is why home health agencies, visiting nurse associations, home hospice care, durable home good companies, and home monitoring technology firms, are growing fast – at the edge of the system.

2.The Universal Health Care movement will take shallow roots in states at the edge of the continent – California, Massachusetts, Maine, and Vermont. These edge states are where progressives hang out, and in the case of California, where legal and illegal immigrants flock and where big health care problems-- the uninsured, hospital bad debt, and untreated chronic disease—are huge. The California proposal may be in for heavy sledding. It drew this response from the San Francisco-based Pacific Research Institute.

"The idea that taxing physicians' revenue will cause them to provide more care of higher quality defies understanding," said John R. Graham, director of Health Care Studies at the Pacific Research Institute. "Instead they'll spend more time with accountants figuring out how to hide their incomes, or prospecting for new practices next door in Nevada or Arizona."

3.Consumer-driven high deductible health plans (CDHPs), powered by HSAs, have reached the tipping point and will explode in growth. This will occur because more employers will completely replace HMOs and PPOs with these new plans. Critics of CDHPs, such as the Commonwealth Fund and similar think tanks, say these consumer-based plans are an edge phenomenon, a cosmetic but not a real solution. But they may be wrong. Congress has just passed legislation to make HSAs easier to offer and to acquire, and more plans have low cost or free preventive services as incentives to join these plans. These three things – complete replacement by employers, Congressional easing of HSA entry and acquisition, and low cost of free preventive services – will tip CDHPs over the edge.

4.Workplace wellness and preventive programs will escalate as employers seek to prevent “presenteeism” (the feeling that one must show up for work even if one is too sick , stressed or distracted or disturbed to be productive), and to reduce absenteeism from work. In employers’ eyes, a healthy employee is more likely to be a working and productive employee, adding not subtracting from the bottom line. So far evidence indicates this may be true. Returns on investment in employee wellness and prevention programs have been in the 2:1 to 3:1 range. The development of sophisticated software to document this return and its bottom line impact is persuading employers to adopt these programs. With continually rising costs, many employers feel they have no other choice.

5.Taking care of health problems of employees, both on an acute and chronic basis, at the worksite will become a growth industry. American HealthWays has made a science of reaching chronically ill clients both at home and work with protocol-bearing nurse extenders. Their evidence-based programs provide specific and personalized interventions for each individual in a population, irrespective of age or health status, and are delivered to consumers by phone, mail, Internet and face-to-face interactions. American HealthWays is contracting with a number of Blues plans and large employer grous. Niche companies, led by physicians and often using Internet technologies, are springing up at the edge to supply workplace health services... These include onsitedoctor.com and teladoc.com. These various efforts could be characterized as disease management at work.

6.Web-based companies offering the right information at the right time, real time, at the point of care will create their own demand. These include companies like Emmi Solutions, offering relevant, timely, easy-to-comprehend patient education at every health care interaction; Medical Dialogue, offering automated and standardized informed consent forms; Meddirect offering credit lines at the point of care; and Active Health Management, which puts together all sorts of data from many sources, to help doctors and patients make clinical and financial decisions. The idea behind all of these smart, small, and swift-acting companies is to bring the creative potential of the computer to bear in a timely, time-saving, and time-enhancing as human support systems- real time at the right time.

7.As drug patents expire at an accelerating rate and costs rise, generics will grow, and pharmaceutical profits will drop, causing drug company lay-offs of sales reps, diversification, and expansion into other health sectors, such as chronic disease management. The public is sensitive to drug prices. Three quarters of consumers are willing to take a generic rather than a brand--name prescription drug. Trends driving the pharmaceutical industry include merger and acquisition activities, licensing barriers, government and payer cost constraints, patent expiration and generic competition, biotechnology-driven drugs, and aging populations

One new source of revenue for drugstores, but not necessarily drug company sales, may be fast-growing retail clinics – MinuteClinics, Rediclinics, and others – strategically located in Walgreens, Walmarts, drugstores, and grocery chains near prescription counters. Retail clinics, in which nurse practitioners and physician assistants can write prescriptions, are prospering at the edge of the health system. Their number will grow to 10,000 by the end of the decade.

8.Obesity will replace smoking as a social ‘no-no” and as the poster child for prevention and symbol of bad behavior. The prevalence of obesity (65 percent with BMIs of over 25, and 31 percent with BMIs of greater thn 31 percent) now far surpasses that of smoking (20 percent).Transfat bans will proliferate across the nation, employers will institute fat-control and fitness programs. Fat-loss drugs will become the Holy Grail, and the diet industry will continue to explode – and fail. Diabetic disease management will become a full-time industry. Technological devices to measure the precise adverse effects on cardiac and pulmonary function and loss of fitness, such as the Mayo-sponsored SHAPE (Superior Health and Pulmonary Evaluation) will become commonplace in health and fitness centers.

9.The “small is big” school of management, which preaches decentralization into smaller more manageable and productive units will spawn a whole new generation of consultants. Here is how John Naisbitt explains what is happening in Mind Set! “It is a shift to a new appropriate scale, right down to the individual, interplay among millions of individuals and companies, economic domains acting in there own interest. Growth and stability is the world is wholly dependent on the degree to which the world decentralizes. The bigger the entity of any kind, the more it must be made up of smaller and smaller, more efficient parts to be successful, The decentralization of companies mirrors the increased success of small, swift-acting entrepreneurial companies.

10.Web-based patient education will explode, for the simple reason that physician-patient partnership and understanding will be necessary to make a consumer-based health system work. Patients must know what is of value and what is not and what to expect and what not to expect at each health are interaction. Giant strides forward will occur as Internet companies seek to cut through the information glut and to reduce it to manageable size. The health care will be watching to see if Revolution Health’s website, revolutionhealth.com, Steve Case’s go at transforming the health care industry as his former company, American Online, transformed the dot.com industry. Case is betting that the growing ubiquity of computers – in homes, offices, kiosks, cafes, and libraries – will transform consumer-driven health care by making health information universally accessible, understandable, and actionable.

11.Baby boomers, 76 million strong and turning 60 every 7 seconds, and accustomed to having things their way, will severely stress the system. Part of the stress will come from “weekend warriors” undergoing knee and hip replacement for those joints, muscles, and tendons worn out or injured from incessant exercise and self-imposed sporting events. Another part will emanate from the perpetual young crowd who feel they need cosmetic procedures to remain looking and functioning in a forever young fashion. And the final part will come from genuine diseases of aging, which now afflict 150 million Americans.

12. There will be much talk but little action about “personalized” and “individualistic” health care as genomic research advances and individualized treatments based on predictive modeling mature. We’re still five years out on making this type of care a reality. Personal health records are much closer and are being subsidized by many companies for their employees. These personal health records may contain individual histories, allergy information, medications, lab data, even images of x-rays, CT scans, and MRIs, cardiograms, HSA and CDHP financial information. The next step will be genetic information and life style cues. Within two years, health consumers will be swiping smart cards at the entry and exit doors at doctors’ offices, ambulatory surgery units, and hospitals.