Health-care futurist expects private sector to drive improvements to system

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Most Americans will breathe a sigh of relief when the new year arrives on January 1. However, the turbulent events of 2020 likely will have a major impact on the health-care industry in 2021 and beyond.

“It has been a tumultuous year, both politically and socially, and also with the pandemic,” said Ian Morrison, Ph.D., a consultant and author who specializes in the future of health care and the changing busines environment. “We all are reeling a bit from multiple pressures and forces that have not only transformed our lives but transformed the health care industry.

Related: COVID continues to put a damper on health, pharma industries

“There is no doubt we have seen a hammering both of the economy and the related impact on the disparities of the country, the differences between rich and poor that are amplified by race. We are in a difficult time right now, but I am hopeful that as we turn into 2021, there will be a new day and a renewed interest in addressing fundamental challenges.”

Morrison was the keynote speaker for the virtual “Top of Mind Online” summit from the Center for Connected Medicine on December 9. Diane Holder, president and CEO of UPMC Health Plan, moderated the presentation.

“Some colleagues and I put together some scenarios back in March with regard to how the pandemic might play out,” Morrison said. “A number of things surprised me. One was the bounce-back in the stock market, which seemed to be ahead of the evidence of recovery. The second surprise would be the speed of the response of the health system. We saw health systems doing 20 years of innovation in 20 days. I think the industry surprised itself at how resilient and responsive it could be.”

The election of a Democratic president and a divided Congress likely will tap the brakes on any major action by the public sector next year.

“I think we are going to see some recommitment to the Affordable Care Act,” Holder said “Certainly at the state levels, there will be more support for it. I think we will look again at what it means to have a lack of coverage, what affordability means and how we think about value.” Morrison agreed. “We may see some capitulation in terms of opposition to the ACA,” he said. “I think we will see a general tone to fix or restore positive elements of the ACA.”

The industry also will be keeping a close eye on transparency regulations.

“I think that what happens with price transparency is outrage when people get to see the vast differences in price,” he said. “When it comes to surprise billing, one man’s surprise is another man’s business model. Transparency appeals to both parties for different reasons. I would be amazed if we don’t see the continuation of this transparency trend. The whole openness-of-data question is the other big key. We need to liberate the engine of innovation in American health care, not stifle it through regulatory inhibition of the ability to create new products using data platforms.”

Morrison expects the private sector to drive innovation for the near future.

“Given where we may be politically, which is no big consensus to shift to the left and that we probably won’t do much more than shore up the ACA, the action in the private marketplace is going to prove to be the most important set of changes over the next 10 years,” he said.

Morrison’s research finds that many employees are ready for change.

“There is a growing dissatisfaction with employer-sponsored coverage, particularly in out-of-pocket costs,” he said. “We may be reaching the limits of our ability to cost-shift. The question is, now what do you do? I think we are going to see employers, partly out of necessity but also to meet the needs of workers, find affordable solutions.”

Morrison said employers too often confuse choice with quality.

“We found that employers thought their employees wanted a wider network, but employees were saying, ‘give me something cheaper, as long as my doctor is in it,’” he said. “We have found that people are quite willing to move if you make the incentives clear to them, but we haven’t done a very good job of that in terms of our benefit design.”

Value-based health has the potential to increase quality and reduce costs.

“I see recognition that there needs to be migration to a value-based model over time,” Morrison said. “The question is getting to the tipping point to get the engine of the entire enterprise to move toward that mode. Employers recognize there is a high-value quadrant, but they haven’t always backed that up in benefit design.

“The Achilles heel is that we really haven’t stepped up and rewarded the good guys on the value side If I ran a big company, I would encourage and put a lot of investment in the message that` this is an improvement over what you have.’”

Morrison believes the pandemic may prove to be a catalyst for change over the long term.

“I have been a critic of the industry for 30-odd years and used to tease health-care leaders that they moved at the speed of glacial erosion,” he said. “But that was not true in response to the pandemic. They really did step up quickly. The pandemic is going to look in our history more like 9/11 than Ebola. I hope we seize the opportunity to transform through things like telehealth and value-based care and this whole issue of social equity and social determinants. It’s not to just go back to what we had but to take the opportunity to make some progress.“