The Future Ain’t What It Used to Be

By Clive Riddle, February 5, 2008

A couple of weeks ago, MCOL in conjunction with the Seventh Future Care Web Summit, conducted its annual e-poll on health care trends for the coming year and beyond. As the same three basic questions are asked each year, results have been tracked since 2003. So, given the massive change in the economy during the past twelve months, how do health care executives and other professionals feel about the future?

Answers were not that surprising to the questions: (1) which trends will have the greatest overall impact in 2009; and (2) which predicted trend is least likely to have an impact in 2009. But I was taken aback somewhat with answers to the question which stakeholders will be better off, worse off, or the same in 2009.

Comparing current answers with previous years is difficult, for the first question: "Which of the following health care business trends do you think will have the greatest overall impact in 2008?" That’s because “Effects of the Recession” was contemplated as a trend in previous years, and over half (57.3%) of respondents list that as the trend that will have the greatest impact, and I would agree with them.

Here’s a table listing responses to this question since 2003:

Trend	2009	2008	2007	2006	2005	2004	2003
Advances in health care technology	3.4%	11.8%	7.5%	16.6%	13.6%	11.9%	10.8%
Consumer Driven health plans	3.4%	13.4%	18.5.%	21.0%	22.7%	14.4%	15.1%
Compliance issues	1.1%	0.8%	3.4%	0.8%	0.9%	5.9%	18.0%
Effects of the Recession	57.3%	NA	NA	NA	NA	NA	NA
Health Care Reform Initiatives	21.3%	23.6%	11.0%	28.1%	13.6%	4.3%	N/A
Increased consumer cost sharing	9.0%	33.9%	40.4%	25.8%	38.2%	35.6%	38.8%
Disease Management initiatives	3.4%	12.6%	7.5%	3.0%	5.5%	23.7%	N/A
Other	1.1%	3.9%	11.6%	4.5%	5.5%	4.2%	17.3%
Grand Total	100.0%	100.0%	100.0%	100.0%	100.0%	100.0%	100.0%

One way to compare any of the other trends(which have been listed each year) with previous years, you need to multiply this year’s response by two, or divide pervious year’s in half, to factor in this year’s new Recession trend that was missing before. When you do that, it makes the runner-up choice (health care reform initiatives, with 21.3% in 2009) all that more prominent. While all other trends dropped to around a third of their previous levels (except compliance, which still only weighed in at 1.1%) reform stayed basically the same as last year.

So the conclusion for 2009 not surprisingly, is forget everything else, two “R’s - recession and reform, will dominate this year in health care.

When asked “which of the following predicted trends do you feel is least likely to occur or have an impact in the next two years,” respondents had little consensus regarding any particular trend. What is interesting, however, is to compare these answers to previous years.

Here’s a table listing responses to this question since 2003:

Trend	2009	2008	2007	2006	2005	2004	2003
Health Plan cost sharing will level off/slow down	11.2%	15.0%	11.0%	13.1%	19.3%	18.6%	9.5%
Major growth of Consumerism initiatives including consumer driven plans	22.5%	15.0%	17.8%	15.4%	14.7%	12.7%	18.2%
Major advances in patient/provider/plan electronic data transfer	15.7%	22.0%	14.4%	14.2%	16.5%	20.3%	20.4%
Significant National Health Care Reform Legislation will be Enacted*	21.3%	14.2%	16.4%	13.5%	22.9%	11.9%	22.6%
Premium Increases will continue to slow down	22.5%	23.6%	23.3%	30.7%	14.7%	22.9%	N/A
Further growth/adoption of disease management and wellness	6.7%	12.6%	16.4%	12.7%	11.0%	13.6%	N/A
Medicare HMO reforms	N/A	N/A	N/A	N/A	N/A	N/A	15.3%
Medicare prescription drug coverage	N/A	N/A	N/A	N/A	N/A	N/A	13.1%
Hospital Medicare Outlier Payment Reform	N/A	N/A	N/A	N/A	N/A	18.6%	9.5%
Other	0.0%	3.9%	0.7%	0.1%	0.9%	0.0%	0.7%
Grand Total	100.0%	100.0%	100.0%	100.0%	100.0%	100.0%	100.0%

As you can see, despite the significant segment that views reform as a trend with the greatest overall impact for 2009, the “doubters” have increased in the past year as well. Last year, as the election season was heating up, 14.2% felt reform would be the trend least likely to happen. This year, that number rose to 21.3%.

Also, interestingly, doubts regarding the last most significant innovation have increased. In 2008, 15.0% listed growth in consumerism as the trend least likely to occur or have an impact; that number increased to 22.5% in 2009. But optimism must be increasing for electronic data transfer. In 2008, 22.0% listed this as the least likely trend; that number decreased to 15.7% in 2009.

The conclusions to this aren’t that surprising either: 1) there are plenty of cynics mixed in with those sure that reform will take place; 2) perhaps because consumerism was politically as a Republican agenda, and now we are facing a Democratic agenda, a growing number think Consumerism initiatives will wane; and 3) given the priority the Obama team is giving electronic health records and data transfer, there is less cynicism that this will eventually happen.

I mentioned that I was surprised by answers to the third question: “Which of the following stakeholders do you view as being better off, the same or worse off in the coming year?” Of course, respondents think things are going to be bad all the way around. I just thought they’d be even more negative.

While as expected, few answered “better off” for any category of stakeholder, the level that answered “same” (as opposed to “worse off”) was surprising. I would have expected a resounding “worse off” response for all categories. Even more perplexing was to when these responses were compared to previous years. The change simply wasn’t as large as I would have thought, and consumers were strangely rated in better position for 2009 versus 2008. Perhaps this is due to the specter of reform?

Here’s tables listing responses to this question, compared to the past two years:

2009 Winners and Losers:

By Next Year:	Better Off	Same	Worse Off	Grand Total
Consumers	16.9%	14.6%	68.5%	100.0%
Employers	8.0%	25.0%	67.0%	100.0%
Physician	5.7%	40.2%	54.0%	100.0%
Hospital	3.4%	35.2%	61.4%	100.0%
Health Plans	11.5%	43.7%	44.8%	100.0%
Pharmaceutical	20.5%	44.3%	35.2%	100.0%

2008 Winners and Losers:

By Next Year:	Better Off	Same	Worse Off	Grand Total
Consumers	6.5%	18.2%	75.3%	100.0%
Employers	20.5%	32.1%	47.4%	100.0%
Physician	46.2%	41.0%	12.8%	100.0%
Hospital	21.8%	37.2%	41.0%	100.0%
Health Plans	14.1%	35.9%	50.0%	100.0%
Pharmaceutical	49.4%	32.5%	16.9%	100.0%

2007 Winners and Losers:

By Next Year:	Better Off	Same	Worse Off	Grand Total
Consumers	7.6%	20.7%	71.7%	100.0%
Employers	19.9%	45.2%	34.9%	100.0%
Physician	46.6%	42.5%	11.0%	100.0%
Hospital	17.8%	37.0%	45.2%	100.0%
Health Plans	11.7%	41.4%	46.9%	100.0%
Pharmaceutical	38.9%	31.9%	29.2%	100.0%

Now, that the books are closed on the first month of the last year of the decade, we don’t have to speculate much more on what 2009 will bring. We can just make sure our seat restraints are locked in position, and hang on for the ride.