I must have read 10 posts in the last week on social media about what one expert or another thinks will happen in 2024.
It’s very hard to get that right.
Instead, I offer a few (high-level) predictions by the end of the decade.
Cop out? Maybe. More realistic? Yep! Here are four predictions by 2030 (or so).
Timelines and pervasiveness of these predictions coming to fruition depends on a variety of factors—policy and regulations, politics, technology, trends, demographics, data analytics, workforce, and more.
As we all know here, much of how healthcare is delivered and paid for is head-scratching, so I can only base this on what makes sense and what I have some expertise in.
Here goes!
Primary Care will look more like “Direct Primary Care” Models, but with accountability for outcomes.
If you’re unfamiliar, providers who opt for the “Direct Primary Care” model of care only accept patients who elect an annual “fee for access,” and often other perks like extensive, more comprehensive physicals. They often give patients their cell phone number, email, and accept calls and texts up to 24 hours per day. They may or may not bill an individual’s medical insurance.
These providers have limited patient panel numbers, commonly 500, which is very approximately 4-10 times less than your typical primary care provider. Those who can afford and are willing to pay for this service are not your average person. They have financial resources, healthcare engagement, some level of health literacy, and other traits in common. They are also sometimes less likely to have life-limiting comorbidities that may have a genesis in lifestyle decisions.
We can reasonably deduce that those who opt into in-person DPC Models are not your “average” member of the population. So is this scalable to manage a population with health profiles across the spectrum?
This isn’t a solution to manage or improve the heath of the population.
Payers are increasingly looking for primary care providers to have the time and resources to DO MORE, SPEND MORE, OWN MORE. How is this possible?
Prospective advanced alternative primary care models.
Patients are “attributed” to primary care providers based on historical claims and/or by patients voluntarily electing into their practice.
The primary care team does extensive evaluations of their patients, and the results and risk-levels of those patients are sent to the payer.
These are aggregated to determined an average annual payment that should be reasonably adequate to manage the health and healthcare of their patients, and the providers are given that amount up-front. Depending on the program, that amount may be even higher because the providers are taking on the responsibility of care and payment and must invest in a new their structure to do this well.
First, think of the DPC Models. Enhanced communication, proactive outreach, comprehensive evaluations, more time with patients, less paperwork, and all the benefits to work-life balance that go with that.
Providers can also create teams to provide the right care at the right time to each person and ease the typical burdens on providers themselves…technology, clinical decision support tools, streamlined or assisted documentation, etc.
Embedding other provider types besides physicians and non-physician practitioners (NPs, PAs, CNSs), like behavioral health providers and physical therapists, within the practice.
Common reasons patients need to see their primary care (medical) provider are also conditions that physicians and NPPs are often not ideal for treating the patient alone or as the primary clinician, like:
depression
anxiety
substance abuse
behavior modification
falls, safety, balance issues
low back pain
arthritis pain
overuse injuries
gait and mobility impairments
wheelchair modifications, training, equipment
postural impairments
obesity management
Putting these three provider types on teams to manage prevention and disease management, medical, behavioral, physical/functional, whole-person care, collaborate on providing primary care to a population.
reduces the risk of non-compliance with outside referrals
eliminates latency between identification of need and patient engagement and treatment
facilitates teams addressing SDOH barriers to health like waiving co-pays (when permitted by regulations/contract), eliminating access issues/wait times, addressing safety/falls risk, food insecurity, transportation issues
eliminates the stigma of seeking behavioral healthcare
reduces unnecessary physician specialist referrals in favor of conservative treatment, when appropriate (evidence-based)
maximizes collaboration potential and communication between providers in the practice
frees up the physician and NPPs to manage the medical care outside the scope of behavioral health and physical therapy, like medication management
improves provider satisfaction
reduces patient anxiety in having symptoms/condition managed promptly
As more providers and payers collaborate to optimize primary care through full risk arrangements, we will also see:
Downward trends in hospital and ER utilization per capita
The population continues to grow, and hospitals will always be a crucial part of the continuum of care, obviously.
We will theoretically always need hospitals to provide lifesaving care, intensive care, surgeries and step-down care, childbirth and maternal/fetal medicine, and more.
But as advanced primary care practices scale and demonstrate reduced hospitalization and ER rates, better able to address urgent needs and closely manage fragile patients, the hospital will begin to see less of these types of patients.
a patient with CHF who gained 3 pounds overnight and whose BNP was creeping up will get the care they need before a full-blown CHF exacerbation and hospitalization
a patient whose mobility is declining and needs home modifications to remain safety home and prevent falls will have proactive referrals to home health for PT and OT to address the home, and the medical social worker in the practice to coordinate with community resources and payer supplemental benefits to add services to the home
the patient with diabetes who developed a wound on their foot but caught it early because they were taught and re-taught to check their feet every night will call the practice right when the find it and get treatment before it can progress and cause secondary problems
We will also see hospitals being used less for general med-surg and geriatrics in favor of:
Hospital at Home and Urgent Care at Home Care Delivery
Much more healthcare CAN be done efficiently, safely, and effectively at home. It eventually will be commonplace. I don’t just mean telehealth. Here I mean in-person, acute care at home.
There are a bunch of reasons why I’m so bullish on acute level care in the home. Let me tell you just a few!
Once they understand home-based care is safe and effective, people will want to avoid hospital stays
Engagement in advanced primary care will encourage patients to call 24 hour nurse lines early and avoid more intensive acute care that requires an ICU, for example
Technology! I just bought my partner a 6-lead EKG for $89 on Amazon, for goodness sake. This is only the beginning.
Here’s an example of an Home Urgent/ER level of care provider I have had several wonderful experiences with, called Dispatch Health. There are many stories on their YouTube channel. Here’s one that drives home my point that if something can be done, it will eventually be commonplace.
Here’s a personal story about Dispatch treating my daughter 18 months ago, when she was 15.
My daughter was at her father’s house and I was at my own house with COVID and a high fever. She had been diagnosed with mono a week earlier but now had a severe sore throat and ear pain and was panicked about breathing. She sent me a picture and her tonsils looked very swollen.
I called Dispatch from my house and they called me when they arrived by her and kept me on speaker during the visit per her request and her father’s.
She had strep and very swollen tonsils as well as a double ear infection and 103 fever. They gave her both an antibiotic and an injection of Decadron to help reduce the swelling in her tonsils.
She was crying in pain. I couldn’t be there with her. This was literally priceless, high-quality care in her own bedroom at her father’s house.
The nurse practitioner and EMT stayed for over an hour and until she started to relax, and then checked in with us later that day by phone. They sent a full report to her pediatrician that day.
We didn’t have to take this sick kid to the ER or wait for the pediatrician appt the next morning. It was covered by insurance with an urgent-care copay.
It was seamless, well-coordinated, consumer-friendly, and high quality care.
(I have no formal or business relationship with Dispatch Health. I’m just a fan.)
What I’m Listening to Right Now:
I listen to more books that I read, mostly because it makes doing household chores feel less painful and I look forward to every car ride! If I really love one, I’ll buy the book afterwards, too.
I’m about half-way through this one:
It’s not “light reading/listening,” but it’s excellent. If you are a healthcare and/or research nerd, I recommend it. I deep-cleaned half my house this week listening to it!
It’s about a trauma researcher who has done extensive work on the effects of child abuse on long term health and the impacts on the individual society. The author notes in this book and in the paper linked in the following quote:
The ACE study concluded that child maltreatment was the most costly public health issue in the United States, calculating that the overall costs exceeded those of cancer or heart disease, and that eradicating child abuse in America would reduce the overall rate of depression by more than half, alcoholism by two thirds, and suicide, serious drug abuse, and domestic violence by three quarters. It would also have a significantly positive effect on workplace performance, and vastly decrease the need for incarceration.
Bessel Van der Kolk, M.S.
As the United States grapples with the cost and quality of care and overall health outcomes, perhaps a fourth prediction should be:
The U.S. will spend more money and dedicate more resources to preventing child abuse and neglect.
Have a very Happy New Year, friends!
And remember, as Larry David says, the statute of limitations on “Happy New Year” is three days! 🙂
*Denotes Amazon affiliate link. I only share products I have personal experience with and am happy with.
