The place where two rivers meet is called a confluence—a good word for the year ahead in health care. While fee-for-service still rules reimbursement in the U.S., a flood of innovations continues to drive us toward value-based care. We’re in the rapids of health care transformation.
The pressure to lower costs, improve outcomes, broaden access, and create a better consumer experience in a $3 trillion industry—even one known for its resistance to change—is inescapable. The good news is that in every space, from pharma and payers to self-insured employers, at-risk providers and consumers, innovators and industry leaders are stepping up to embrace clinical and financial risk, and to fix healthcare.
And, as always, those who lead will be rewarded.
Opportunities abound even if traditional capital sources decrease. Areas of marked investment and innovation include payment reform, drug pricing, and harnessing vast stores of patient data for evidence-based decision making from drug approval to clinical care.
In this moment of confluence, here are my predictions for 2019:
- Laggards who cling to fee-for-service models will ultimately put their organizations in harm’s way.
- New care models are emerging for vulnerable populations, with a focus on predicting and preventing the onset of high-cost chronic conditions before acute care is needed and increasing access to behavioral care.
- The blurring of lines between payers, at-risk providers, and self-insured employers will drive innovative new business opportunities.
- The modernization of the clinical trial system has begun—via real-world data—and will ultimately lower the cost of drugs, a critical area of focus.
- The consumerization and retailization of healthcare are in full swing, driven by a shift in mindset from what we can do to patients to what we can do for people.
- The continuing rise of the consumer as payer and our increasing health care cost burden.
- Clinical decision support for individual providers is coming of age and eventually stands to fulfill the promise of AI.
- The best management teams in this new era will be an artful blend of health care and non-health care expertise.
- Industry strategic investors and customer partners will play an ever-increasing and all-important role in jumpstarting the upstarts.
- Transparency 2.0 efforts, cybersecurity solutions, and cloud migration will join center stage.
- And finally, more big game-changing M&A transactions are coming in 2019.