Healthcare predictions for 2020

As we turn the calendar page that divides the teens of this century from the twenties, I have some predictions to offer on developments in healthcare in the year to come.

AI will evolve from being a mythical disruptor into a tool that incrementally impacts evidence-based medicine but transforms mundane administrative tasks

I believe this is inevitable, but it won’t move at the same pace across healthcare. Privacy concerns, and fear of ceding decision-making to machines, might hamper progress in diagnostics, robotic surgery and medication management. At the same time, I predict rapid and dramatic advances in healthcare administration, where AI will displace old-school processes. Speed and accuracy will rise in registration, scheduling, and health information management, plus charge capture, billing, and collections. Already, inbound and outbound language processing helps patients find specialists, set scheduling, and get reminders and follow-ups. One tool working its way into daily practice: an AI-powered smart device for exam rooms that listens to the conversation between doctor and patient. The device uses natural language processing to pick up on key words and phrases, and automatically enters notes, diagnoses, and orders directly into the EHR. 

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Genome editing will take center stage, forcing an ethical dialog that ranges from the ethics of individual techniques to the very future of the human race

Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) is presently the most widely known genome editing approach, but it’s just one of several techniques currently advancing from experimental toward clinical application. Others include zinc-finger nucleases (ZFNs), and transcription activator-like effector-based nucleases (TALENs). The potential for medical advances (and massively profitable healthcare applications) is enormous. This throws a bright spotlight on ethical considerations that swirl around the notion of editing away unwanted traits that cause disease, deterioration, and perhaps even aging. The World Health Organization’s latest background paper on the ethics of genome editing outlines two sides of a lively debate about the development and use of germline editing technology. One regards this as part of a continuum with existing gene therapies-thus, not a reason for raising novel ethical concerns. The other side considers CRISPR to be unprecedented, which demands new ethical and regulatory frameworks. Whichever school of thought is to prevail, the bodies tasked with devising global standards for governance and oversight must act quickly. A look at the global distribution of research activity shows the U.S. in the lead, with China in second place, trailed by Germany and Japan. Who will set the practical, ethical and regulatory standards for genome editing? Reports show clinical trials in China have moved to human applications, while trials in the U.S. are just beginning. My take: if America and Europe don’t seize the moment to establish some clear standards of experimental and clinical behavior, China will.

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More health tech startups may fold or consolidate as capital starts drying up by end of 2020

Tech startups have had a bumpy ride in the last year or two, and my feeling is that this turbulence will inspire caution, if not downright resistance, in investors. Recent IPOs have yielded tepid financial returns (Uber, Peleton, Spotify), and the spectacular implosion of WeWork. The health tech sector has seen its own blowups: the rise and fall of Theranos and the indictment of Outcome Health executives on federal fraud charges. There’s also the recent case of uBiome, where inflated user growth claims, unauthorized bills to customers with subsequent multiple insurance claims, and regulatory run-ins culminated in an FBI raid and forced administrative leave for the founders. I predict that health tech startups that can’t meet the scrutiny of more skeptical investors may fail or be forced to seek shelter in corporate acquisition.

The government option for health care will become a reality no matter what the outcome of the 2020 elections

As presidential candidates debate the shape of healthcare reform, there are legal battles moving through courts that could affirm-or undo-the changes mandated by the Affordable Care Act. However, a longer-range view persuades me that the U.S. will inevitably join the rest of the developed world in building a universal care system under government auspices. Long-term opinion tracking by the Kaiser Family Foundation shows that after years of fluctuation, a majority of people support a national healthcare program under which all Americans could get their insurance from a single government plan. Individual states, most notably California, are legislating their own single-player plans, and the momentum in the current election cycle is for some form of government-provided insurance along with other reforms. I’m watching to see how the California experiment goes, and whether other states follow suit.

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Big tech firms will try again to enter the industry through the consumer channel, but will not scale until they join with providers

In the latest ripple of the acquisition tide, Google has purchased Fitbit. Knowing that this might unsettle current users of Fitbit, the company promises they will have “the choice to review, move, or delete their data.” Some speculate that the deal has more to do with Google’s desire for a presence in the wearable device market than with the health data interests of their customers.

Facebook can monitor health and wellbeing through the language in posts and chats; Google can track the spread of influenza through its mentions in local searches. Popular consumer apps gather data on sleep, menstrual cycles, exercise sessions and the like. The WHO describes this realm as Social Determinants of Health (SDH): "the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” As valuable as it may be, SDH lies outside the quantifiable data points of individual health care records. Thus, it’s not a viable door for tech firms to gain entry to the healthcare industry.

I’m watching the corporate sector seek partnership-and in some cases compete with-providers and insurers. I expect that partnerships with the chance to achieve long-term industry success include innovative approaches to EHR, care delivery, supply chain management, employer power and insurance, as well as interoperability and data aggregation. 

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Taking the reins from marketing and digital teams, CMIOs and CIOs will design the next phase of digital innovation

I expect that CMIOs and CIOs will navigate digital healthcare business along two distinct courses. One path involves the digitalization of healthcare management, particularly administrative and financial aspects like accounting, scheduling, follow-up care, and supply chain management. The other path encompasses the digitalization of clinical capabilities. The greatest business advantage occurs when these two paths create value at the intersection of e-commerce and digital care delivery.

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The industry will come to concede that present-day EHR systems are not adequate and will plug in useful add-ons to solve complex problems 

Even though the adoption rate is now above 95 percent in hospitals eligible for the Medicare and Medicaid EHR incentive program, the usefulness of EHR data is limited by the amount of time spent creating and updating records, and the lingering problem of unstructured-and thus less useful-data that was imported from old EHRs into new ones. 

In my view, what’s needed is already moving from the development pipeline into the market: a usability revolution that returns patient care to the center of the EHR's function. 

Social determinants and behavioral health will take center stage to enable a holistic wellbeing program for patients

The current corporate model of wellness programs spans a spectrum from education programs, to on-site fitness facilities, incentive programs, and wellness initiatives developed with Human Resources as components of overall health and benefits programs. In the 2014 SHRM Survey of Strategic Benefits - Wellness Initiatives, 76 percent of surveyed companies had some form of wellness programs or resources. Among those, two-thirds offered some form of incentive or reward program. Now, and in the immediate future, the combination of an evidence-based, predictive, and proactive approach to wellness management (with wellness decisions adopted and acted on by employees) can form the foundation of an effective, personalized health platform.

Big Pharma will be a political talking point, but the focus will be on genetic precision drugs

The cost of prescription medications has attracted a lot of negative attention, along with attempts to legislate against opportunistic price increases, and political debates on the role of government in negotiating prescription prices. In 2020, while we will continue to hear all the noise, don’t expect any real change given the political uncertainty of the election year. 

On the other hand, impact will be seen through drugs that target disease at the molecular level while minimizing off-target side effects. Pharmacogenomics could cure diseases with a significant level of precision. I look for this transformation to forge a new hierarchy of firms in the pharmaceutical industry.

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Payor-Provider collaboration will deepen, with Payors taking on a larger role in clinical intervention

As healthcare systems move toward value-based care, collaboration between payors and providers should increase. Today, the delays, costs, and health consequences of service denial places payors and providers at odds, and leaves the patient stranded between them. A collaborative approach will move the focus from post-service, to pre-service or at-service, reducing denials. Payors and providers will work together to deploy technology, workflow tools, and analytics that encourage information sharing, to accelerate and empower good clinical intervention and decision-making. 

I look forward to an era where patients truly embrace prevention, and willingly devote time, energy, and money to getting and staying healthy.

That’s it – my list of 2020 predictions in health and healthcare IT. Let’s make a plan to check back next year to see what has been accomplished and discuss the next waves of progress.

^{Puneet Maheshwari is a co-founder and the CEO of DocASAP, the most advanced patient access and engagement platform for health systems, health plans and physician groups. As CEO, Maheshwari spearheads the company’s strategic direction and vision, while managing industry partnerships to drive and advance its intelligent enterprise-grade technology. With a deep understanding of healthcare’s complex infrastructure and processes across payors and providers, Maheshwari founded DocASAP in 2012 on a mission to streamline patients’ access to care by navigating them to the right provider and care setting at the right time.}