I’ve decided to split my predictions into work comp stuff (where I do most of my work) and health care stuff not directly related to work comp. Here’s my health care predictions…
1. Health care cost inflation will remain low. After five years of growth at or below 4 percent, health care costs remain relatively stable at 17.4 percent of GDP. It is possible that health care costs for 2014 will come in below that benchmark due to increasing productivity and stable health care costs. In the interest of setting a metric, I’ll predict costs remain at 17.4% of GDP…
2. ACA will be less of a story. The healthcare.gov website appears to be working well – at least on the front (enrollment/consumer) end. Work on the back end (communications with internal governmental programs and agencies, financial links, and ties to health plans) continues but seems to be proceeding apace. We’ll base evaluation on the volume of news stories this year vs 2014.
3. Employer take-up of health insurance will remain stable; if it drops it won’t do so by more than a percentage point. Despite the hysteria from ACA opponents claiming employers would drop insurance en masse, it hasn’t happened. And it won’t.
4. Expect 11 million plus enrolled via the Exchanges this year (federal and state). Initial enrollment in late 2013 was strong in key states, and the outreach efforts are paying off.
5. More ACOs will close down or suspend operations, while others will grow and expand. Net is we will see more lives covered via ACO-type models. For those of us old enough to remember the halcyon days of HMOs this is hardly surprising. The number of HMOs reached 640+ in the late eighties before market forces led to consolidation via merger/acquisition, failure of some, and expansion of the successful ones into new markets. This is how it works – a decreasing number of ACOs is not an indication that the model doesn’t work.
6. More hospitals will close as the reduction in Medicare and private pay reimbursement hits those unable to adapt. While there will be pain in affected local communities, this is inevitable as a sixth of our economy goes thru restructuring. It happened in the oil industry in Pennsylvania in the 1940s, shipbuilding in the 1960s, textiles, clothing, clothing, furniture, automobiles…
7. More doctors will work for very large multi-specialty groups and health systems. Currently about three-fifths of physicians are employed; expect that to bump up by a couple percent.
8. Care extenders will get more care authority. This is going to be contentious, at times nasty, politically charged. It is also inevitable. PTs can do a lot of things orthopods currently do; nurse practitioners are already delivering a lot of primary care, and nurse midwives are increasing their scope of practice in many areas.
9. Specialty drugs will continue their meteoric rise in cost and prevalence. I know, an easy one, but absolutely worthy of note as they will become an even larger portion of medical spend, forcing payers and policymakers to make some very hard decisions about coverage.
10. Ebola will disappear from American mass media. If it’s not here, we don’t care, and it won’t be here. Yet another example of the American public and American media’s obsession with really bad things only when they directly affect us.
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