How Did the DMCB Do With It's Healthcare Predictions for 2015?

While the Disease Management Care Blog is pretty good at spotting current health policy silliness, its track record at predicting the future has been rather spotty.  Regular readers have undoubtedly forgotten this brazen attempt at 2015 health care augury, but the transparent DMCB refuses to bury its mistakes.

So how did it do with its Ten 2015 Predictions?

1. Mitt Romney will win the Republican nomination and avoid discussing health care.  The DMCB got some of this right, but who would have predicted that the President would cleverly upend his opponents by embracing the term "Obamacare?"

2. A close election will hinge on an improving economy, not on Obamacare. In the end it wasn't really that close, but the DMCB was correct in foreseeing that Mr. Romney's candidacy would be undermined by dropping unemployment levels and the bottoming out of the comatose housing market.

3. The Supreme Court will rule Obamacare unconstitutional: Boy, the DMCB got that wrong.  But in its defense, few foresaw that SCOTUS would ignore the Affordable Care Act's statutory language and rule that a penalty was really a tax all along.

4. There will be no generalizable and published peer-review studies on the electronic record of the medical home that conclusively show that either saves reduces health care costs.  "Bingo!" says the DMCB.  It hopes 2015 is different and that a p value is < 0.05.

5. ACOs will not criticize CMS about the tardy delivery of claims data necessary to manage its assigned populations. The DMCB says the silence over this issue is deafening, which means either a) CMS has overcome its dismal track record on providing timely information or b) the ACOs are reluctant to go public with any concerns.  The DMCB has heard rumors that the latter is true.

6. Speaking of ACOs, their physicians will trump patient preferences over savings.  The DMCB says the jury is still out on this, but time will tell if its call about this ACO Achilles heel is as important as it thinks it is.

7.  Health exchange deadlines will be pushed back. To the DMCB's knowledge, CMS is holding firm on the fall 2015 implementation date.  The DMCB takes some credit, however, for being among the first to spot this issue and bring it to its readers' attention.

8. CMS will kick the Sustainable Growth Rate (SGR) down the road. "Bingo again!" says the DMCB.  It got his one right and looks forward to how Congress will deal with this in 2015.

9. Medical academics will increasingly turn to social media instead of print to make their mark on the scientific world. The DMCB believes this trend is continuing but has yet to reach a tipping point.

10. CMS Interim Administrator Tavenner's status will remain in recess limbo.  OK, it wasn't all that hard to bank on continued partisan bickering, but the DMCB got this one right too.

Will the DMCB offer up predictions for 2015?  Stay tuned!

Twelve Health Care Predictions for 2015

While the Disease Management Care Blog eschewed forecasting for 2015, it has decided to reverse course and inaugurate the 2015 blogging season with a contrarian duodecimal exercise in futurism.

Will this antidecimal augury align with the mysterious cosmic order and governing perfection?  Let the thousands of DMCB readers (more on that in a future post) be the judge in January 2015......

1. Obamacare will neither succeed nor fail.  This hugely complex law will have too many outcomes, statistics and analyses that will be subject to too much spin by both supporters and detractors. Like puppies clamoring for the mother's attention, the loudest wins, but only in 15 minute media increments.

2. Inflation returns, with a vengeance: While we won't know it until well into 2015 or 2016, 2015 will be the year that the sleeping giant of healthcare costs awakens. Millions of new insureds in an improving economy will finally get their pent-up pricey preference-sensitive health care needs fulfilled.

3. All boats benefit.....While the PHM industry will continue to extol its cost-savings value proposition, its investors will profitably ride the rising tide of overall increased health spending.

4. Duh, it's the delays stupid: While low income Americans will appreciate having access to subsidized health insurance and Medicaid, the middle class' unsubsidized sticker shock will threaten the fall 2015 elections. Caught between conflicting advice of insurance actuaries and political hacks, the White House's regulatory choices will be obvious.

5. Unfavorable prognosis for physician income means an emerging bull market for concierge medicine: Past attempts to replace the SGR never fail to disappoint and 2015 will be no exception. That, however, will only be on the icing on the bitter cake of foregone co-pays and coinsurance by patients who chose all those stinky bronze plans.  As a result, more docs will bail on their insurance contracts and open "concierge" practices.

6. Navigators Ver. 2.0: Knowing that 2015 could be a high water mark for top-line income from newly insured patients, hospitals will step up and hire their own "navigators." Unsurprisingly, they will not seek out the healthy millennials. And insurers, thanks to the "3Rs" that are largely backed by Uncle Sam, won't care about the resulting adverse selection.  

7. Snowden blow-back: as the promise of big-data grows, fearful health care consumers will be even less inclined toward allowing access to their health information.  Too bad they won't be given a say.

8. Innovator's Dilemma for health tech: solutions that are simple, transparent and modular will continue to make 'from the bottom' inroads into a tech industry that - like early data storage - is too complex, opaque and entangled.

9. Speaking of health tech, patient-monitoring solutions that offer more insight and less data will grab market share.  Instead of a series of blood glucose results dumped into an electronic inbox, think algorithms that suggest insulin dose adjustments.

10. Thanks to the battered healthcare.gov brand, conservatives will be better positioned to thwart other "big government" proposals in 2015 outside of health care (for example, education, carbon markets or immigration reform). Progressives will focus on simpler stuff, like increasing the minimum wage and keeping The New York Times afloat, but miss a decades-long setback of Obama-inspired liberalism.

11. ACOs stumble: Far more ACOs will fail than succeed in hitting their risk-share thresholds because docs can't say no, one patient at a time. As a result, we'll see these organizations begin to cut costs by parting company with some of their recently hired physicians, further fueling the concierge medicine movement.

12 Commercial scientific misconduct: Unable to resist the allure of bonus payments (like this) or the branding that is dependent on the public release of quality outcomes, at least one large health entity will be caught committing "reporting fraud."