The Forum

The 5 things that surprised us in health care in 2019

by Vidal Seegobin and The Global Forum research team

One of our favourite traditions is year-end lists, which can spark debates during this season's slew of holiday parties. And while we hope the majority of your cocktail chatter will focus on topics outside of health care, for the few times it does come up, we wanted to share some of the trends, challenges, and stories that caught our eye this year.

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1. Governments of all ideologies are pursuing the same health care transformation

2019 saw a number of governments return to power. Many were politically conservative. And all appear to pursue a similar system reconfiguration strategy. What does that mean? With little appetite for increased health care spending and a broad recognition of the long-term impact of chronic conditions, health systems at the national, state, and local level are creating "networks of care." All of it is voluntary. With none—to date—attempting to change the way payment is structured.

The good news is that health care around the world is starting to look very similar, which means we can all learn from each other even more. The downside is that—as of now—there doesn't seem to be a plan B for health care's cost conundrum. We're watching this one with great interest.

2. The ethical questions of AI

We predict that AI will continue to be one of the hottest topics in health care (and across the economy, to be honest.) But that's not particularly revelatory. Instead, after discussing AI with CEOs across the world, two related questions come to the fore:

  • The first is a realization that the question to answer about AI in health care is "not if, but where and when?" The next three years? Five? In patient flow management? Chat bots? Clinical decision support?

  • The answers here depend on a second question: "What is our risk-appetite to allow a machine to play a greater role in clinical care?"

We think the real question of AI adoption boils down to ethics, and we don't think it will be answered quickly or easily—but it's the question that will dictate the speed of AI's adoption.  

3. Health care getting serious about the social determinants of health

The realisation that health care organisations need to bridge the gap between clinical and non-clinical services is probably the trend in 2019 that caught us most by surprise. Not because we don't believe it's important or that the evidence isn't clear. But we imagined two prevailing beliefs would prevent the industry's uptake:

  1. Most providers don't get paid for the non-clinical work and so think it's not their job

  2. Most health care leaders assume that if they're going to get into this work, they need to lead the charge and start from scratch

And while we won't pretend these mindsets have completely disappeared, our research consistently shows that from Canada to Australia to Europe, providers are overcoming these misconceptions to form deeper and interconnected partnerships—and payment arrangements—to tie clinical and non-clinical services together. And we're very happy about it.

4. Is England's Primary Care Network model the way forward on primary care transformation?

England's health system has been in flux for a number of years. It might be easy to argue that bigger policy forces crowded out any good work in health care. But you'd be wrong. Among one of the earlier adopters of a population health management approach, England has undergone a slow and often inconsistent transformation. But what we're particularly excited about is Primary Care Networks (PCNs). These are geographical groupings of primary care practices designed to manage populations of roughly 30-50,000 patients with multi-disciplinary teams.

Across the world, primary care remains an entrepreneurial and independent part of the health care ecosystem. But England's PCN work is one of the most promising initiatives to create more scalable, accessible, and industrialised business units in primary care. The world should be watching this model.

5. The global language of value-based care

The last trend that caught our interest is the differing ways health systems are defining "value-based care." It's one of those terms that sounds aspirational, but a little fuzzy. Some consider it short hand for new payment models. Others describe it as the next wave of quality-based reporting. Even more talk about it through the lens of what the patient wants and values.

The term "value-based health" started in 2006 and now more than a decade later—across health systems of all types—the race is to define what it really means.

To be sure, there's no universal definition. But with technology putting greater decision-making power in the hands of patients and consumers, we think their definition of value is the one most likely to prevail.

What was the trend or news story in health care that caught your eye this year? Let us know at gfhi@advisory.com.

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