2015 Through the Windshield

Why I feel impelled to make guesses about important health developments in 2015 when I did such a bad job in regard to 2014 is an unsolved mystery of the universe.  Nonetheless, here goes.

1.  Unlike last year, this year I am going to say that health spending growth will stay muted, although perhaps a little faster than in 2014.  Patient cost-sharing and goverment-dictated provider reimbursements are having an impact.  But the rate of increase will be more than personal income rises, meaning more health care pain for the consumer.

2.  Exchange enrollments will continue to be well below original projections and large numbers of people will keep ignoring the individual mandate.  Going to be interesting to see how many the IRS tries to penalize.

3.  Providers are exhausted from HIT and other “quality” initiatives.  Many have given up on “meaningful use” and many are frustrated at being penalized for readmissions, HAIs, etc. despite real efforts to improve.  Will CMS and the other barons of “quality” finally listen to provider concerns and substantially modify these programs which have done so little to actually improve health status or outcomes?  I say no, because being an ideologue is the hardest thing to change.

4.  Drug companies will continue to introduce more and more “specialty” drugs with very high prices.  Will there be a regulatory or consumer response?  Again, I say not really, people will just keep paying the price and hope for a little competition.  Express Scripts Hep C drug move may be replicated, but don’t kid yourself that it creates any real savings.

5.  Provider risk-taking, which hasn’t really taken off despite what you read, will continue to be slow and adverse financial experiences will lead many to drop the initiatives, as has already occurred in Medicare’s ACO and shared-savings programs.

6.  Too much capital will be available for health care startups and growth companies and valuations will continue to be too high based on a realistic assessment of likely returns.  Exit markets will be strong in the first half of the year, which fuels the availability of even more capital.  Can you say bubble, bubble, toil and trouble.

7.  A possible surprise at the macro level–a significant economic slowdown.  Now that everyone things the economy has real momentum, it probably doesn’t.  How will that affect health care?  Not much probably.

8.  And last but not least, don’t expect Republican control of the Senate  or the likely Supreme Court invalidation of subsidies on the federally-operated exchanges to dramatically affect the reform law.  Its many tentacles are largely in place and the damage is done and will be very hard to reverse.  And Republicans don’t seem to have a better idea.

Now I made the predictions, and now I will try to ignore them when we get to the end of 2015 and they look totally inane.