Entries in Trends & Strategies (116)


Taking the Healthcare Time Machine to 2040 – Two Separate Peeks into the Future

by Clive Riddle, October 4, 2019

Several days ago, I – like numerous others – received a mysterious email from Robert Pearl, MD informing us that “It’s 2040 and the U.S. health system is the best in the world.” He asks, “How did it happen?” and informs us “that question is more difficult to answer than what happened.”

The mystery quickly solved itself, as his new article in Forbes was released that same day: “It’s 2040: How Did American Healthcare Become The Best In The World?” Doctor Pearl quickly explains his thought experiment posed in his email and in the opening of his article: “As far-fetched as this outcome may seem, the purpose of the question is to consider what, specifically, could spark major change in U.S. healthcare. Below are 12 possibilities, each based on the comments and credentials of recent Fixing Healthcare [his podcast] guests.”

So remember – his list derived from his podcast guests isn’t the specific fixes, but rather what movements caused the fixes to happen:


  1. Global Disruption
  2.  Twenty-first Century Tech
  3. The Power Of Moments
  4. Bright Spots
  5. Transparency: "was it because doctors and hospitals were required to disclose their pricing and quality outcome data"?
  6. Healthcare Voting: after "Americans exercised their rights at the polls and demanded change from elected officials?"
  7. Consumerized Care: after "doctors, hospitals and health plans put patients first, resulting in a more consumer-centric and affordable form of healthcare"?
  8. Battling Burnout
  9. Modern Heroes: "was American healthcare saved by a new batch of medical visionaries?"

10.  Social Determinants: "did public health advances in U.S. society lead to better outcomes and greater life expectancy"?

11.  Patient Power: "did patients band together online and use their collective voice to inspire major healthcare changes?"

12.  Internet Reliability: "did sweeping internet regulations help people avail themselves of reliable information and the best medical care possible?"


Now that we’ve considered what might drive healthcare change into 2040, let’s peek into another examination of 2040 done earlier this year by the Deloitte – entitled: Forces of change – The future of health, and opens like this: “The future of health will likely be driven by digital transformation enabled by radically interoperable data and open, secure platforms. Health is likely to revolve around sustaining well-being rather than responding to illness. Twenty years from now, cancer and diabetes could join polio as defeated diseases. We expect prevention and early diagnoses will be central to the future of health.”

We are told that “By 2040 (and perhaps beginning significantly before), streams of health data—together with data from a variety of other relevant sources—will merge to create a multifaceted and highly personalized picture of every consumer’s well-being;” and that “consumers—armed with this highly detailed personal information about their own health—will likely demand that their health information be portable.”


Deloitte says they “anticipate that by 2040 successful companies will identify and compete in one or more of the[se] new business archetypes:


Data and Platforms:

  • ·         Data conveners (data collectors, data connectors, and data securers)
  • ·         Science and insights engines (developers, analytics gurus, insight discoverers)
  • ·         Data and platform infrastructure builders (core platform developers, platform managers and operators)

Well-being and care delivery

  • ·         Health products developer (application developers, inventors/innovators, manufacturers)
  • ·         Consumer-centric health/virtual home and community (virtual health providers and enablers, and wellness coaches)
  • ·         Specialty care operators (world-class health centers, event-specific facilities)
  • ·         Localized health hubs

Care enablement

  • ·         Connectors and intermediaries (enterprise tool developers, supply chain designers and coordinators, delivery service providers)
  • ·         Individualized financiers (N of 1 insurers, catastrophic care insurers, government safety net payers)
  • ·         Regulators (market leaders and innovators, government regulators and policy makers)


So what should we do armed with this glimpse into 2040? Deloitte advises "as stakeholders prepare for the future of health, they should consider the following actions:"

  • ·         Build new businesses
  • ·         Forge partnerships; and
  • ·         Appeal to the newly empowered health consumer


As for me, my primary objective will be to still be alive to see what happens.



Costs & Transparency Number One for 2020 on HCEG’s Top 10 List

By Clive Riddle, September 12, 2019

Once  September is upon us and Pumpkin Spice lattes invade your nearest Starbucks, Christmas decorations should be arriving any day at your nearest Costco, and its not too early to think about what  are the top issues we will be facing in the business of healthcare in new year ahead.

 The Healthcare Executive Group has been doing exactly that for the past decade, presenting their top 10 list of issues at this time for the next year, have announced that for 2020 “Costs & Transparency was voted as the #1 issue/challenge facing healthcare by over 100 C-Suite and director level executives in the industry.”

HCEG explains that “executives from payer, provider and technology partner organizations were presented with a list of over 25 topics. Initially compiled from webinars, roundtables and the 2019 Industry Pulse Survey, the list was augmented by in-depth discussions during the [HCEG Annual] Forum, where industry experts explored and expounded on a broad range of current priorities within their organizations.”

Ferris W. Taylor, HCEG Executive Director in a statement comments that “It shouldn’t be surprising that costs and transparency is at the top of the list along with the consumer experience and delivery system transformation. Data, analytics, technology and interoperability are still ongoing challenges and opportunities. At the same time, executives need to be cautious, as individual health, consumer access, privacy and security are on-going challenges that also need to remain as priorities.”

Here, verbatim is the 2020 HCEG Top 10 Challenges, Issues and Opportunities:

1. Costs & Transparency - Implementing strategies and tactics to address growth of medical and pharmaceutical costs and impacts to access and quality of care.

2. Consumer Experience - Understanding, addressing and assuring that all consumer interactions and outcomes are easy, convenient, timely, streamlined,  and cohesive so that health fits naturally into the “life flow” of every individual’s, family’s and community’s daily activities.

3. Delivery System Transformation - Operationalizing and scaling coordination and delivery system transformation of medical and non-medical services via partnerships and collaborations between healthcare and community-based organizations to overcome barriers including social determinants of health to effect better outcomes.

4. Data & Analytics -  Leveraging advanced analytics and new sources of disparate, non-standard, unstructured, highly variable data (history, labs, Rx, sensors, mHealth, IoT, Socioeconomic, geographic, genomic, demographic, lifestyle behaviors) to improve health outcomes, reduce administrative burdens and support transition from volume to value and facilitate individual/provider/payer effectiveness.

5. Interoperability / Consumer Data Access - Integrating and improving the exchange of member, payer, patient, provider data and workflows to bring value of aggregated data and systems (EHR’s, HIE’s, financial, admin and clinical data, etc) on a near real-time and cost-effective basis to all stakeholders equitably.

6. Holistic Individual Health - Identifying, addressing and improving the member/patient’s overall medical, lifestyle/behavioral, socioeconomic, cultural, financial, educational, geographic and environmental well-being for a frictionless and connected healthcare experience.

7. Next Generation Payment Models - Developing and integrating technical and operational infrastructure and programs for a more collaborative and equitable approach to manage costs, sharing risk and enhanced quality outcomes in the transition from volume to value. (bundled payment, episodes of care, shared savings, risk-sharing, etc).

8. Accessible Points of Care - Telehealth, mHealth, wearables, digital devices, retail clinics, home-based care, micro-hospitals; and acceptance of these and other initiatives moving care closer to home and office.

9. Healthcare Policy - Dealing with repeal/replace/modification of current healthcare policy, regulations, political uncertainty/antagonism and lack of a disciplined regulatory process. Medicare-for-All, single payer, Medicare/Medicaid buy-in, block grants, surprise billing, provider directories, association health plans, and short-term policies, FHIR standards, and other mandates.

10. Privacy / Security - Staying ahead of cybersecurity threats on the privacy of consumer and other healthcare information to enhance consumer trust in sharing data. Staying current with changing landscape of federal and state privacy laws.

Corresponding with Executive Director Ferris Taylor, I asked who the list has changed and evolved during the past five years. Ferris replied that “everything has changed in healthcare in the last 5 or so years and that is reflected in the changes in the HCEG Top 10. The Affordable Care Act was really the 'accessible care act' - upwards of 20 million more people now have insurance but affordability in terms of premiums and escalating deductibles have affected everyone. It shouldn't be surprising then that cost and transparency has gone to the top of the list. For 2020, the HCEG Top 10 relate much more to how central the consumer is for all stakeholders. Healthcare is finally coming into the 21st century with digital technology, holistic individual health and a focus on the consumer journey in everything we do." 


Growing where you are already planted

Kristin Rodriguez, Health Plan Alliance, June 24, 2019


Dan Michelson, CEO of Strata Decision believes integrated delivery systems need to shift their focus from buying and building hospitals to leveraging their existing platforms to generate growth and often more profitable streams of revenue.  This creates the ability for delivery systems to become a hub for health and healthcare in the future.

What needs to occur for this transformation to take place? 

In an article published in Becker's Hospital Review recapping the 2019 JP Morgan Healthcare Conference, Michelson outlines six ideas for integrated delivery systems to get started on leveraging their existing platform.  Each represents a formidable challenge, but if we work together and take advantage of resources available to us, we can start moving in the right direction.

  1. Embrace the digital front door: Healthcare providers have long excelled at building relationships and trust once consumers walk into our hospitals and clinics.  We need to harness the ability to create that same meaningful relationship, without limiting ourselves to a physical location.  

    Benjamin Isgur, Health Research Institute Leader at PwC Health Research Institute, echoes this advice.  At the recent Alliance Spring Leadership Forum, he underscored that Private Equity investors are particularly interested in anything that gets closer to the consumer.  And consumers themselves are eager for a new era of care delivery, with new venues and new menu options.  If we don't offer consumers a more convenient alternative, someone else will
  2. Get serious about affordability: This isn’t just about transparency or about reallocating resources more thoughtfully.  It is bigger than combining clinical and financial data.  The healthcare cost problem is huge and policymakers, drug manufacturers, insurers, delivery providers and consumers all play a role.

    It's important we avoid the danger that is “everyone’s problem” becoming “no one’s problem.”  As part of integrated systems, Alliance members are particularly well positioned to get a strong line of sight on this challenge.
  3. Don't just provide, prevent: Michelson points to the “strong strategic rationale associated with taking on a broader role of driving health versus only providing healthcare” in the communities we serve.  Policymakers understand this too; Medicaid and Medicare Advantage plans are encouraged more and more toward payment models and benefit design approaches that take on more than just clinical care.

    Just a few themes in the government-sponsored care space include VBIDtelehealthbenefit flexibility, and behavioral health integration, all of which present unique opportunities to leverage the network, venues of care, community partnerships, and more to reimagine the system’s role in the local healthcare landscape.
  4. Partner to innovate, or miss out: Becoming a hub isn’t just about the digital front door or food farmacies. It also means creating a space for innovators to gather, where research and education can occur so that ongoing evolution becomes a core competency of the system.
  5. Target chronic conditions and specific services: This builds on the center of excellence model in profound ways.  Systems that craft a powerful experience for specific chronic conditions or targeted services stand a better chance of maintaining a relationship with those consumers.  Michelson notes that this is both an opportunity and a threat for integrated systems, as we compete more and more with new platforms gaining competency in serving chronic conditions, like those of CVS Health and Walgreens
  6. Don’t just aggregate data – use it:  An Alliance member and informatics leader said that he envisions the day when his informatics teams can stop being data archeologists and can instead be data analysts.  The truth is that integrated systems are still solidifying their competency as data aggregators.  But it’s not enough.  It’s time to turn our attention to applied analytics: practical data sets that provide decision support so that we can gain better insights and pivot our platforms even faster.

With payers big and small across the country, the Alliance member network is a veritable think tank for executives wrestling these questions and challenges.  Join us and work elbow to elbow with your peers at our upcoming events designed exclusively for Alliance organization leaders. You can also meet and hear from Dan Michelson at the Fall Leadership Forum 2019.


Ten Takeaways From PwC’s Medical Cost Trend Behind The Numbers 2020

By Clive Riddle, June 21, 2019 

PwC's Health Research Institute has just released their 14th annual report on medical cost trends: Medical cost trend: Behind the numbers 2020, which projects the 2020 trend to be a six percent cost increase. As PwC's HRI describes their 47-page report, they project "the growth of private medical costs in the coming year and identifies the leading trend drivers.... based on the best available information through June 2019. HRI conducted 55 interviews from February through June 2019 with health industry executives, health benefits experts and health plan actuaries whose companies cover more than 95 million employer sponsored large group members about their estimates for 2020 and the factors driving those trends. Also included are findings from PwC’s 2019 Health and Well-being Touchstone Survey of more than 550 employers from 37 industries as well as PwC HRI’s national consumer survey of 2,500 US adults."

Here’s Ten Takeaways from their 2020 report: 

  1. Small Uptick: The Medical Cost trend, still rounding to double digits in 2007 (11.9%) and 2008 (9.9%), trended downwards subsequently, to round to six percent since 2016 (6.2%), but have ticked up since the low-water mark of 5.5% in 2017 (and 5.7% in 2018-2019.)
  2. Price, Not Utilization: “Prices have been a larger component of employer benefit costs than utilization since 2004; utilization has hovered around zero percent growth since 2006. Utilization by individuals with employer-based insurance decreased by 0.2 percent from 2013 to 2017 while prices rose 17 percent during that time.”
  3. Impact of High Deductibles: “Average deductibles for employer-sponsored plans tripled between 2008 and 2018. This increase likely has led to a low utilization trend because employees are delaying or forgoing care due to their deductible.”
  4. Stall in HDHP Growth: “The shift to HDHPs by employers seems to have stalled. With 84 percent of employers offering an HDHP option in 2019 and a tight labor market, employers may not be as quick to push HDHPs in 2020.
  5. Acceleration in Retail Rx Spending: “Starting in 2020, retail prescription drug spending growth for private health insurance will begin to increase, hitting between 3 percent and 6 percent annually through 2027.24 The growth in spending can be attributed to the waning impact of generics on the market and the introduction of new drugs.”
  6. Specialty Drug Million Dollar Drugs Pipeline: The portion of total retail drug spending on specialty drugs continues to grow. “We are at an inflection point with drugs in the pipeline. We thought hep C was expensive at nearly $100,000 per treatment. Many drugs in the pipeline are life-altering and come with a price tag of $1 million to $2 million per treatment.”
  7. Growth in Chronic Disease Spending: "Spending by employers on individuals with chronic diseases is nearly quadruple [3.5x] that of healthy individuals while spending on individuals with complex chronic diseases is eight times higher" [8.2x].
  8. Growth in Onsite Clinics: “38 percent of large employers offered an onsite health clinic in 2019, up from the 27 percent that offered a clinic in 2014. An additional 13 percent said they were considering adding one.”
  9. Telehealth Potential: “49 percent of consumers with employer coverage said they are willing to use telehealth in place of an in-person visit.”
  10. Underutilized Wellness and Prevention programs: “For decades, employers have invested in health and wellness and prevention, yet participation remains low.....The small population of employees who participate in their employers’ health and wellness programs generally believe the programs have had a positive impact on their health.”



The Short List of Major Healthcare Implications from A Declining Birth Rate

By Clive Riddle, May 17, 2019

Like most of the industrialized world. the U.S. birth rate is declining, as evidenced in the new  CDC National Center for Health Statistics National Vital Statistics System May 2019 report on "Births: Provisional Data for 2018."  (the final birth report is scheduled to come out this fall.) The big news from the report is the number of births was the lowest in 32 years, and the fertility rate reached another record low.

Here's highlights from the report: 

  • The provisional number of births for the United States in 2018 was
  • 3,788,235, down 2% from 2017 
  • The general fertility rate was 59.0 births per 1,000 women aged 15–44, down 2% from 2017 a
  • The total fertility rate declined 2% to 1,728.0 births per 1,000 women in 2018
  • Birth rates declined for nearly all age groups of women under 35, but rose for women in their late 30s and early 40s
  • The birth rate for teenagers aged 15–19 was down 7% in 2018 to 17.4 births per 1,000 women
  • Rates declined for both younger (aged 15–17) and older (aged 18–19) teenagers
  • The cesarean delivery rate decreased to 31.9% in 2018; the low-risk cesarean delivery rate decreased to 25.9%
  • The preterm birth rate rose for the fourth year in a row to 10.02% in 2018
  • The 2018 rate of low birthweight was unchanged from 2017 (8.28%)

In a Q&A session with report author Brady E. Hamilton, Ph.D. posted in the NCHStats blog, Hamilton is asked if there was a specific finding that surprised him, which he replied "the record lows reached for the general fertility rate, the total fertility rate and birth rates for females aged 15-19, 15-17, 18-19, and 20-24 are noteworthy. In addition, the magnitude of the continued decline in the birth rate for teens aged 15-19, down 7% from 2017 to 2018, is also historic." Hamilton was non-committal about the trend going forward, stating “these data do not answer the question of why the number of births dropped in 2018 or if the decline will continue.”


But assuming the trends do continue, which certainly the opinion of many, there are certainly major implications for healthcare, including this short-list: 

  • Impact of reduced demand for hospital and physician OB services
  • Impact of increased births from higher-age mothers, with greater care complexities involved
  • Longer range reduced demand for hospital and physician pediatric services
  • Longer range reduced available Medicare funding from employed workforce, with growing imbalance of senior retired population compared to working population