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Joe Public 2030

Predict-O-Meter

Joe Public 2030 makes five bold predictions about that future, which range from exciting and promising to ominous and discouraging. Through the Predict-O-Meter, we’ll continuously assess the state of the healthcare industry to track the accuracy of the five predictions.

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The Copernican Consumer

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Constricted Consumerism

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The Funnel Wars

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Rise of Health Sects

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Disparity Dystopia

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Five potent predictions reshaping how consumers engage healthcare

The Copernican Consumer

STATUS:
Spring 2023 Update

What influenced our latest rating?

You know how a healthcare trend like “hospital in home” is really showing promise? When mainstream media outlets like The New York Times and NPR start covering it in depth. But since our last update in December 2022, it seems all anyone can talk about is Artificial Intelligence. In healthcare, there’s significant promise for AI, and rightful concern (though the comment “I see no potential for it in medicine” from a professor at the University of Washington might be a bit extreme). While AI rockets up the charts, other components of the Copernican Consumer are up and down, with blockchain sinking in the “Crypto Winter,” but Apple getting closer to blood glucose monitoring for the Apple Watch.

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Original Prediction

Consumers will become the center of their own health universe more than ever before, enabled by sensors, AI, and other technology, as well as services geared toward empowering them, leading to profound implications for both consumers and healthcare organizations. Potential results could include a dramatic reduction in the need for primary care clinicians, an entirely new sector devoted to personal health management, true precision medicine combined with health management, and more.

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Constricted Consumerism

STATUS:
Spring 2023 Update

What influenced our latest rating?

We’re keeping this prediction at a hard “Nailed It.” But wait, you might be saying, what about all this focus by federal and state legislators to curb prior authorization abuse by health plans, or advance PBM reform? Given the state of lobbying and money driving politics in the U.S., we’re definitely taking a “we’ll believe it when we see it” mindset to any meaningful reform that will help patients while hurting the most powerful forces in healthcare. After all, “consumer-driven healthcare” in the U.S. continues to lead to worse clinical outcomes for many, and medical debt grows unabated. This spring also saw two major shifts that could adversely impact millions of healthcare consumers: the unwinding of the “Medicaid continuous enrollment provision” enacted for the pandemic, and the ending of the official Covid-19 national public health emergency.

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Original Prediction

While consumers will become increasingly responsible for their own health and use of healthcare services, they will actually become less and less empowered in the choices they have for care, especially in higher-acuity, higher-cost situations. While many in the industry will continue to sing the praises of choice, the reality is most consumers will have far fewer choices moving forward, often in ways they might never ever consider or see.

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The Funnel Wars

STATUS:
Spring 2023 Update

What influenced our latest rating?

In the keynote presentation we give for Joe Public 2030, we paint a picture of the future by citing the potential for massive health system entities, such as “Providence HCA” and “Kaiser Intermountain.” Well, we were half-right! The acquisition of Geisinger by Kaiser Permanente shows the potential for the scale of disruption from The Funnel Wars. After the worst financial year in the history of hospitals in 2022, the picture so far is not much better, with ongoing layoffs and continued credit downgrades, with some organizations actually tripping their bond covenants. On the other side, 2023 has brought news from Amazon, Best Buy, Dollar General, Kroger, CVS Health, Walgreens, and Walmart, as well as the continued push into Medicare and Medicaid-focused primary care.

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Original Prediction

Today we tend to consider hospitals and health systems as birds of the same feather in terms of business model, with variances based on size, scope of services, for-profit/non-profit, and other factors. Moving forward, we could see the splitting of the health system model, with some systems moving even further to the larger, more comprehensive “health” organizations, others retracting into solely acute-care destinations – the “giant ICU on a hill” – and others somewhere in the middle. These models may emerge based on core geographic/market differences such as presence of competitors, plan consolidation/power, regulation, and dozens of other market forces. Yet the primary area where this transformation would play out is with health, wellness and the lower-acuity care points – what we’re calling The Funnel Wars.

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Rise of Health Sects

STATUS:
Spring 2023 Update

What influenced our latest rating?

The off-the-charts politicization of healthcare is coming home to roost for providers. Strict abortion bans are causing clinicians to consider moving to other states, or forcing hospitals trying to navigate the new laws to face federal investigation for violating the Emergency Medical Treatment and Labor Act. Walgreens found out the hard way what it means to be between a rock and the hard place in healthcare politics. A hospital in Sarasota, Florida is experiencing chaos thanks to three new board members who ran on the platform of “health freedom.” (In our Joe Public 2030 presentation, we tout the fictional “Liberty Land Health” – again, way too eerily on point.) And in Texas, all physicians at Dell Children’s adolescent medicine clinic are “leaving” following an investigation by the Texas Attorney General regarding gender-affirming care in minors.

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Original Prediction

Challenges to and skepticism of the mainstream medical field and science itself have exploded in the past two years because of the pandemic and political tribalism in the U.S. Anti-vaxxers, non-maskers and Covid deniers are just the start of an expansion of this distrust of experts, which taken to its potential end could result in multiple “health sects” – primary “schools” of medical thought that coalesce around political/world-views. Imagine “Mainstreamers,” who follow the establishment healthcare point of view, “Progressives” who follow minimal medical intervention combined with complementary and alternative medical solutions, and “Contrarians” who deny mainstream medical thought and create their own set of “alternative facts” on everything from vaccines to childbirth to end of life care, and everything in between. These sects will not only follow the medical thinking that best fits their world-view, they may in fact create their own reality through alternative research, diagnosis and treatment approaches, and models for the delivery of care itself.

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Disparity Dystopia

STATUS:
Spring 2023 Update

What influenced our latest rating?

Unfortunately, we have to move this prediction back up to “Nailed It,” given continued negative news related to health disparities and inequities. As we noted above, medical debt continues to grow, and low-income and people of color are hit hardest. Care for trans people, which has always been fraught with bias and hostility, only grows worse for those in states attacking gender-affirming care. In the category of “no (bleep),” women continue to face discrimination in healthcare, with studies showing doctors routinely dismiss pain symptoms from female patients. The impact of climate change is leading to drastic health issues, such as a growth in infectious disease, especially among the world’s poorest. Finally, the U.S. continues to spend more on healthcare for far less benefit than other wealthy nations, with life expectancy statistics actually masking deep health disparities.

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Original Prediction

The Covid-19 pandemic shone an ugly light on the disparities that have plagued the U.S. healthcare system for decades. Unfortunately, that health gap is more likely than not to expand, as the “haves” gain access to increasingly more expensive medical treatments, health services, and personalized care, while the “have nots” will face growing shortages of basic health resources, from clean water and air to physicians and clinicians, rural healthcare, and more. This shift will be compounded by the mental health crisis, which disproportionately affects systemically disadvantaged populations and groups outside traditional healthcare access channels (teens, for example). All while those entities that might address these disparities increasingly struggle financially – health systems, health plans, state and federal governments – and others lack the incentives to focus on the growing issue.

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