CHICAGO – Health care is going to change more in this decade than in the past 45 years, according to health futurist and medical economist Jeffrey Bauer, Ph.D.
"We’re going to go through an incredible period of disequilibrium and readjustment," he said in a plenary session at the American Academy of Dermatology summer meeting. "It’s going to be several years of real ups and downs."
Dr. Jeffrey Bauer
Dr. Bauer’s forecast for 2015 through 2019 is far less bullish than most, giving just a 20% chance that national health spending will increase as a percentage of gross domestic product. The potential for stagnation is 35% and for decline is 45%.
Over the same time period, 35% of health care providers will cease to exist as currently organized, 40% will continue as organized, although precariously, and 25% will thrive by reinventing the way health care is delivered, said the nationally recognized author and management consultant.
Dr. Bauer made the following recommendations for improving the odds of success in the changing health care system:
• Manage the transition in core function from acute care to disease management.
The one-size-fits-all clinical paradigm is fast disappearing as a result of the ongoing revolution in medical science that is making medicine more precise. Cost-effective care will be achieved through personalized, preventive medicine that matches therapies to each patient’s specific disease characteristics.
• Those who build care teams will do better.
The site of care will continue to shift from hospital to clinic, pharmacy, worksite, and home, and care teams that extend physicians’ reach with nonphysician practitioners will become the best-practices delivery model. "The real key, if you want to be the 40% that survives or the 25% that thrives, is to recognize the value of care teams," Dr. Bauer said.
• Physicians need to position themselves to transition from fee-for-service reimbursement to bundled and value-based payment.
Patients simply don’t have the disposable income to pay more for care, forcing providers to rationalize pricing. Embrace the concept that future successes will be based on multi-stakeholder partnerships comprised of purchasers, payers, practitioners, and providers.
• Work to reform how health care is delivered.
"It’s important that we reform health care delivery so that people can get to you when they need to, but I am just as fervently of the belief that the Affordable Care Act doesn’t do that," he said. "We’ve got to find another way there."
Many of the tools needed to fix the way health care is delivered are already in physicians’ hands. They include advocacy through professional societies, utilization of advanced data analytics to demonstrate value and eliminate unexplained variation from objective performance standards, and adoption of performance improvement tools such as Six Sigma or Lean to ensure that care is delivered correctly all the time and as inexpensively as possible.
Dr. Bauer disclosed no conflicts of interest. He is the author of the just-released book: "Paradox and Imperatives in Health Care: Redirecting Reform for Efficiency and Effectiveness" (CRC Press, 2014).