Making predictions about the future is a common practice among experts. Inevitably, some turn out to be more accurate than others over time. Back in 1999, Glenn Robert, now Professor of Healthcare Quality and Innovation at Kings College London, published predictions for healthcare science and technology to 2015. Published as part of the Nuffield Trust’s Policy Futures for UK Health Project, his predictions seem to have stood the test of time.
More recently, over in the US, the 2015 American Hospital Association Environmental Scan provides insights into market forces likely to affect healthcare over the next year or so. The two documents show remarkably similar trends and predictions.
Trends and predictions
The aging population and particularly the rise in the number of people with chronic diseases, was predicted, and continues, to put both US and UK healthcare systems under pressure. In particular, the rise in new technology, often at high cost, puts pressure on new technology and drug evaluation and resource allocation systems.
In the US, one response from insurers has been to try to shift costs towards consumers, with the average deductible rising hugely. Almost half of employers have recently indicated that they may in future offer only high-deductible plans. Alternative responses include narrowing the network of available providers and/or treatments available. This behaviour is expected to have serious effects on some of the more expensive hospitals and providers, who could find themselves excluded from networks and plans. Add value, rather than higher volume, may be the only way out.
Both countries are also looking to technology to improve prevention. Behaviour is widely recognised as having a much bigger impact on health status than any amount of money poured into health services. This, together with the rising cost of delivering care, is leading to new models of care, away from hospital, and towards community and prevention-based models.
In the UK, the solution has been, as Glenn Robert predicted, to centralise technology and specialist expertise in a smaller number of centres, with chronic conditions generally being treated locally and even at home. This local treatment is not without specialist support, however, as technology is already being used to link remote care to specialist centres. It’s perhaps not as widespread as predicted at this stage, but there are several pockets of good practice.
The model in both countries is moving towards delivering the best possible outcomes for a given cost, which means a stronger focus on what really matters to patients. Alongside this, the rise in the ability to personalise healthcare to individuals offers huge opportunities, both in treatment and prevention.
The increase in mobile health solutions means that supporting changes to behaviour to prevent lifestyle-related diseases and provide support for compliance with tailored healthcare solutions is possible. This will help and support both clinicians and patients to improve care. But only time will tell whether this will mean higher or lower costs in practice. Certainly, technology is improving patient engagement and involvement on both sides of the Atlantic, and that can only be a good thing.
The AHA Scan notes that interoperability remains the biggest challenge to a robust infrastructure to support new care models. Co-ordination of care looks like the best way to manage care for patients with chronic conditions, so this is an issue which really needs attention, not least in terms of document sharing. Progressive organisations are starting to use IT and better analytics to facilitate evidence-based and personalised care, and these also have implications for management of population health.
Evolution or revolution?
The thinking is not only remarkably similar on both sides of the Atlantic, but also astonishingly close across the 15 year time difference in publication dates. This is at least partly because both countries face similar demographic and financial challenges. Both countries are looking in the longer term towards personalised medicine and particularly, personalised prevention, to defuse the ‘demographic timebomb’ as much as possible. Technology has been, and remains, an enabler of new systems of care.
However, when the two documents are examined side by side like this across the time gap, what emerges really strongly is that technology is almost entirely being used in ways that are in line with existing models of care. We have not yet seen the emergence of any genuinely disruptive models, along the lines of the rise of the low-cost carriers who have so changed the airline business. Maybe these models won’t emerge; perhaps our current models of care are the best possible ones. But looked at like this, technological changes look very much like evolution, not the revolution they are sometimes painted.