Tuesday, January 8, 2008

Medical Trends, Future, Predictions, Costs - No Tree Grows to the Sky

The health care cost tree has grown to the sky. U.S. health costs are unsustainable. I believe the U.S. health system will adjust. It will innovate and make changes to provide affordable care for its people. It has to. That’s what successful societies economies do.

Here are a dozen adjustments you are likely to see in the next five years.

1) The most significant change for reducing costs will deductibility of health premiums and other health expenses for individuals – in short, , across the board health deductions for all.

2) Portability of health plans across state lines for all health plans will become a reality. It may be accompanied by a reduced and more uniform state mandates.

3) Health plans will move to cover most pre-existing illnesses and high risk individuals. This is in the works at AHIP (American Health Insurance Plans). It will progress to avoid adverse political events.

4) Private health plans will start to cover more of the uninsured once they realize the uninsured population offers marketing opportunities: 85% are employed, ½ are aged 18 to 34. ¾ say they are in “excellent” or “very good health,” and 2/3 have college educations.

5) Health plans, patients, and physicians will switch to generic drugs. Indeed, most major payers will no longer pay for brand drugs if effective generics are available.

6) Retail and worksite clinics, and other care outlets, will proliferate. More entrepreneurial physicians and hospitals will join .to create more outpatient-based and convenient entry points into the system.

7) The “system” will close in on excessive and abusive compensation for health plan executives. The successful suit against Dr. William McGuire for stock backdating is the tip of the iceberg, It consisted of a civil fine of $7 million, $12.7 million for “ill-gotten gains,” and a forfeiture of options already issued.

8) Prescribing by pharmacists and office dispensing by doctors will increase. It will be done in the names of “convenience” and “cost reduction.” The strategies may be counterproductive and cost more than they save..

9) New information technologies – e- patient education sites, e-visits, and e-web videos – will change who patients and doctors interact. They may lower costs. These new approaches require broad band access but not necessarily EMRs, or EHRs.

10) The shift to outpatient care, spurred by consumer demand, changes in technology, and less invasive procedures, will accelerate. People will realize much hospital care, by its very nature, is unaffordable, partly because of high “facility fees.”

11) Prevention will take off for these reasons - public campaigns to promote awareness, new pharmaceutical products to prevent smoking and obesity, employers not hiring smokers or obese people, lower premiums for “clean” living, doctor rewards for performing preventive tests, Medicare’s decision not to pay for preventable “never events,” employer-based wellness programs.

12) The consumer-directed movement, defined as high deductibles linked to HSAs, will gain traction as employers, employees government, and consumers weigh cost-saving benefits of more selective, elective, value-based quality care.

I forecast costs, not the sky, will level off or fall. The sky’s not the limit. People want change, from the roots to the top of the tree. Changes are underway.


PemiRobin said...

I would like to add that care may become more standardized as these "bundles" of services that reduce adverse events become the standard of care.

Robin Fisk

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