The best fortune-tellers, from Nostradamus to Miss Cleo, will tell you that every so often a big, cosmic event comes along that throws off even their most carefully developed predictions. On behalf of all of my fellow healthcare industry prognosticators, I am invoking this clause and begging forgiveness for any disparities that may have arisen between our 2020 predictions and our collectively lived reality.
Nonetheless, with the first doses of the COVID-19 vaccine rolling out across the country, I am hopeful that the world will soon return to some degree of normalcy—and, in turn, my predictions for the future will come true more often than not.
And now, with that disclaimer (and perhaps a grain of salt), I present my top 10 predictions for the healthcare industry in 2021.
1. The COVID-19 vaccine will be widely available ahead of schedule—and vaccine hesitancy will decline. I have no proof to support this, but I believe that vaccine manufacturers have likely provided conservative estimates of their production capabilities. That’s because that’s what I would do if I was in their shoes: under-promise and over-deliver. I therefore expect vaccines to be more widely accessible sooner than promised and expect that the world will return to some degree of what we used to call “normal” by late May or June.
The next challenge will be to overcome the country’s other epidemic: vaccine hesitancy. Less than 60% of people say they’d get the vaccine if it were available to them today. However, I expect that, as more people receive the vaccine and those who don’t become ill on account of COVID-19, vaccine hesitancy will decline. Efforts to reduce hesitancy will also be bolstered by the calm, clear, and trustworthy health communications that we can expect from Surgeon General-designee Dr. Vivek Murthy.
2. Biopharma will enjoy a short-lived reputation rebound…and then mess it up. For years, biopharma (and its cousin, biotech) was bashed for overcharging for incremental innovations and blanketing the airwaves with ill-timed, revolting, direct-to-consumer advertising. (Anyone want their cure with a healthy dose of side-effects?)
The COVID-19 crisis—as well as actual, bona fide innovations, such as Vertex’s recent announcement of a novel treatment for Sickle Cell disease (disclosure: I am a shareholder)—are reversing this public narrative, restoring the belief that biopharma and biotech innovation can solve some of society’s biggest health problems. It’s now up to the industry to maintain this restored esteem with good behavior.
That said, I’m less than optimistic that a year will pass without some rogue industry player committing a trust-destroying move (see JAMA’s new special issue on trust in medicine and healthcare). Still, look for the 2021 Nobel Prize in Medicine (and perhaps Peace) to be awarded, at least in part, to industry scientists—a feat last achieved by former Merck scientist William Campbell, who won for his work on using ivermectin to treat river blindness.
3. Health equity will gain increasing visibility, but little more. The COVID-19 epidemic bolded and underlined what many have been saying for years: we have a crisis of health equity in our nation. Low-income communities and people of color continue to be disproportionately affected by COVID-19 because of structural inequities. The appointment of Yale University superstar Marcella Nunez-Smith to lead President-elect Biden’s health equity task force signals that health equity will take a place of prominence inside the new administration.
Nevertheless—and I so hope I am wrong about this one—I believe that there will be more smoke than fire when it comes to health equity issues. In the weeks following George Floyd’s murder, healthcare organizations (managed care organizations, big pharma, and health systems) issued carefully worded public relations statements indicating support for racial equity—but as public sentiment has died down, so, too, has the impetus to take action.
I hope we can keep up the momentum. In my own organization, SCAN Group and SCAN Health Plan, we’ve taken a harsh look at our own reality. A recent analysis of pharmacy data showed that African-Americans and Latino health plan members fare worse than our Caucasian members on key measures of medication adherence. To address this disparity, we are setting company-wide goals to improve our outcomes with African-American and Latino members. Our overarching objective is for them to achieve parity with their Caucasian counterparts.
I am calling upon others in the industry to drive similar transparency and take action to meaningfully address health equity.
4. Mental health and loneliness will be front and center in healthcare discussions. Declines in mental health over the course of the pandemic are harder to measure than pandemic deaths—but certainly equally significant. And the extent to which people have suffered—and will continue to suffer from the traumas of a traumatic year—will only become clear as the dust settles. When it does, look for mental health to become an even bigger issue as the breadth of individuals experiencing depression is fully realized.
Look also for efforts to address loneliness and social isolation. I have long advocated that—in addition to new programs to support greater social capital development in communities—we need to develop a stronger social compact. There is no better year than 2021 for us to build this compact. We must overcome our natural instincts around denial—and not lose this moment to progress our approach to mental health and community-building.
5. Federal comprehensive health reform efforts will be put on hold in 2021. While the Biden team signaled strong interest in health policy throughout the campaign and transition, the new president will depart from the Obama administration playbook and take on broader health reforms later in his administration. While Obama passed the HITECH and Affordable Care Acts within his first 15 months in office, the subsequent fights around it consumed his domestic policy agenda for the following 6 years. With the specter of a divided Congress, look for the Biden administration to focus its initial healthcare efforts on COVID-19 and economic recovery—and then address comprehensive health reform down the line.
This is in keeping with the thinking of many who believe that HHS Secretary-nominee Xavier Becerra’s key role in defending the Affordable Care Act in the courts signals a strategy of strengthening the ACA and improving its implementation—not another grand gesture, such as a rumored move to lower the Medicare eligibility age to 60.
6. Look Out for More big bang IPOs and transactions—and more tensions too. Despite the pandemic (or, arguably, because of it), 2020 was a year of significant IPOs and transactions—notably Teladoc-Livongo, Oak Street Health, Clover and AmericanWell. Look for 2021 to be the year that other startup healthcare organizations like Alignment Healthcare and VillageMD enter the public equity markets.
I’ve written before about some of the tensions between public markets and the ethical provision of clinical care. These tensions will only become more acute as a greater percentage of US healthcare is delivered by organizations whose stated primary obligations will be to shareholders, not to the patients and families that they serve.
7. But…valuations will come down to earth over time. The overheated valuations enjoyed by many healthcare and health tech firms will come down as the COVID-19 epidemic abates. Some firms enjoying high valuations have a long path to profitability and capital markets may not be as patient as they presently are as US healthcare slowly normalizes.
Also, many of the firms with high valuations have a high reliance on risk models produced by the federal government; with near-term concerns about the solvency of the Medicare trust fund, look for the Biden administration to take a close look at risk adjustment and other levers to tamp down the rate of Medicare inflation. If there is an overall push to deflate US federal healthcare spending, entities that rely on federal revenues will see declines in their revenues and their valuations.
8. We’re heading for an era of consolidation. Many expected that the pandemic would drive the closure of smaller practices and threaten the sustainability of practice groups that continue to rely heavily on fee-for-service payments. While there was certainly an apparent pick-up in such activity, CARES Act dollars sustained many smaller practice groups whose survival was threatened.
But as the year’s financial realities become apparent and federal support diminishes, the year 2021 may turn into a scary version of “Death of a Salesman,” with Willy Loman reimagined as a sole practitioner struggling to maintain his independent practice. Look for more groups either to sell themselves to health systems or join larger practice aggregators like Optum. Progressive organizations like Aledade may forestall this trend in some markets—but there appear to be a number of unstoppable forces (financial pressures, the rapidly changing regulatory landscape) conspiring to make the already challenging task of maintaining an independent practice even harder.
9. America’s health profession schools will continue to see record enrollment as esteem for the health professions grows. The COVID-19 epidemic is rallying young people around the heroic possibility that exists in the delivery of healthcare. Thank God. While the health professions were previously declining in public esteem and perceived workplace satisfaction, the public’s broad acknowledgement of the heroism of US healthcare workers has made going into the healing professions appealing again.
It will now be up to healthcare organizations to do more to sustain their appreciation for healthcare professionals. That means going beyond doling out branded tchotchkes and statements of praise. Instead, they need to offer real, sustained demonstrations of their value as employees and as people. How about starting with offering healthcare employees more generous health benefits? How about taking a stronger stance against the racism experienced by many healthcare workers in hospitals and clinics?
10. Telemedicine is here to stay. And those who embrace it will be those who once spurned it. The American Telemedicine Association was founded in 1993. Who would imagine it would take 27 years and a global pandemic for telemedicine to go mainstream? Regardless of how it happened, telemedicine is here to stay. The biggest question is, who will deliver it and how? Many telehealth and telemedicine providers arose alongside incumbent healthcare organizations in order to disrupt them. With most healthcare organizations now embracing telemedicine—and more liberal payment policies enabling it—expect traditional hospitals and medical groups to serve as fierce competitors to the disrupters. That’s because patients will ultimately gravitate towards local organizations that offer the full continuum of care—and a combination of in-person and virtual settings—as opposed to receiving care from pure-play virtual provider organizations.
The year 2020 was challenging for us all, personally and professionally. With over 300,000 dead from the coronavirus, this period will be looked back upon as a generational inflection point, full of heroic efforts and incredible tragedy. It will shape the contours of healthcare delivery for decades to come.
So when new year’s eve comes, let’s all drink to a less eventful 2021–but one in which the healthcare industry continues to progress towards care that is better, cheaper, and more equitably distributed.
Wishing everyone the best in the holiday season and beyond!