Out-Of-Pocket 2021 Predictions

the future is easy to predict right

Here are some of my predictions for 2021:

1) Cybersecurity becomes a focal point - What do you get when you combine the fallout from the Solarwinds hack, the new HHS secretary being the person that implemented California's Consumer Privacy Act, patient data becoming more easily available and vulnerable to third parties due to the interoperability rules, and a carve out in the new Stark/Anti-kickback rules allowing for shared cybersecurity software between providers? A year that drives uptake in healthcare cybersecurity software. I would even guess we might see a large-scale ransomware attack that cripples certain hospitals (similar to WannaCry) that catalyzes this.

2) Nursing home overhaul - Nursing homes were by far the hardest hit during COVID and trust in them being able to handle the health of their residents is low. Home care is getting more reimbursement models, studies measuring quality of care, and is becoming a much more viable care option. Because of this, nursing homes will likely see new/overhauled facilities that sell themselves on their new monitoring capabilities, point-of-care testing, and in-house clinical teams. Patients that need assistance will then have choices on which setting to get theri care instead of really only being able to default to a nursing facility.

3) Walgreens or Rite Aid gets acquired - Pharmacies have become a center point of discussion in the COVID rollout and becoming key hubs in the delivery of services/immunizations/etc. Walgreens has struggled over the last 5 years to transform from its core pharmacy business and Rite Aid has now gone through 2 failed M&A attempts. I can see them both being attractive targets for companies trying to add a pharmacy fulfillment/benefits product to their stack (e.g. Amazon, a large payer, etc.)

4) Cancer and substance-abuse disorder increases - Post-quarantine we'll unfortunately discover an uptick in the number of people with cancer (with a larger delta in later stage cancers which may have been caught with regular screening) and substance-abuse disorders. There will be second-order effects of this including the need for more support services for these issues, increase in usage of certain pharmaceutical products, potentially new reimbursement structures for payers to lean into (e.g. oncology care bundles), etc.

5) Telemedicine companies start acquiring in-person care assets - Telemedicine companies will race to build the online-offline handoff faster than hospitals can build telemedicine workflows. Ro acquiring Workpath was the tip of the iceberg. Next year as care starts transition back to in-person, telemedicine companies flush with cash will start acquiring clinics, ambulatory surgery centers, outpatient facilities, etc. in areas where they have high patient densities. In a hail mary, one of them might acquire a small hospital and turn it into a Center of Excellence. Idk.

6) Algorithm Backlash - Last year the backlash against big tech hit hospitals that were working with Google, etc. to develop software to help the hospitals operate/use patient data in different ways. This year, the algorithms used to prioritize vaccine rollouts and decision making in the hospitals during a resource scarce period will cause people to further question how algorithms work and what oversight/validation processes they should have before moving into the clinics.

7) Decentralized trials try moving into interventional drug trials - Despite a lot of money going into fully virtual trials, I think these companies will struggle to move past digital therapeutics trials and some low-risk assets (e.g topical derm) and into more complex interventional drug trials. Instead they'll start wrapping around existing sites to help turn them into "hybrid" sites for certain slightly higher risk trials which will include a suite of home monitoring solutions.

8) Cityblock-esque competitors take off - The massive numbers of enrollment in Medicaid means states and Managed Medicaid plans need help actually addressing the needs of their population. Companies like Centene have been acquiring left-right-and-center to bring these capabilities in-house, but smaller or less organized plans will likely look to third-parties to help. Cityblock's successive fundraising is probably going to alert more companies of the opportunity, and we'll see variations of companies that provide clinical services to low-income communities and utilize community leaders/resources to do that.

9) Surge of early stage digital health fundraising activity - 2020 was the year of the mega-round for digital health companies, and I think 2021 will be the year you'll see a lot of new digital health entrepreneurs. Several will be from recently exited companies from 2020 now off to build their new venture, or they'll have been forced to pivot into healthcare during COVID and see opportunities in the space. Combine that with typically non-healthcare investors now thinking more deeply about the space, and I think you'll see more fundraising at the early stage in 2021.

10) Healthcare conferences return more lit than ever - Everyone is pent up and people miss the face to face hang. Sure JPMorgan kind of sucks, but I actually sort of miss the frenetic energy of taking 5 back-to-back meetings in a hotel lobby before shuttling into an uber to a hotel penthouse of some non-profit health system I'd never heard of. Idk I think a lot of the corporate real estate budget that's potentially been cut with the shift to (semi)-remote work will be re-allocated to other areas, including conference attendance and marketing.

I took a look through your predictions too, which took a while because there were 1200+ of them lol but I read them all!!!! Also I wrote my predictions down first before looking through these in case you think I just straight up robbed your idea.

Here are some of the common themes from you all:

  • ICHRAs will take off
  • Telemedicine either crashes or takes off, people seem split here. But generally people believe we'll see virtual specialty groups proliferate.
  • People were also split on whether there will be a significant antitrust movement forcing hospitals to break up or heavy hospital consolidation as they buy up struggling practices.
  • More cash pay patients generally, and as a result more cash pay primary care/wellness hybrid clinics
  • Interoperability rules set off a wave of API-first companies
  • Behavioral health consolidation especially across different customer and condition types
  • mRNA vaccines become commonplace for more diseases and variants of COVID that come up.
  • Home care takes off as the infrastructure for home care comes into place and evidence comes out that patients forced home due to COVID are treated as well (if not better) for less money
  • Most people responding are very jaded and don't think anything is going to change

For fun, here were some predictions people made about me:

  • I will be married (lol)
  • I will dye my hair pink (probably)
  • I will have a feature length film? (I tried making a 3 minute youtube video at the beginning of quarantine and scrapped it because it was too hard lol)
  • I will get acquire by a large healthcare content production company and forced to pump out memes till I cry (I'm down idk)

A few highlights from people I thought were interesting:

"Drug pricing reform efforts will continue to stall, but pharma companies will pursue new strategies (value based pricing, subscriptions) due to the threat of it all" - Anonymous

"1) Big tech rolls out their own health insurance (moonshot prediction)

2) The first virtual hospital is built.

3) Employers share anonymous health data to build a mega consortium that reduces health costs and improves preventive care." - Leah Cohen-Shohet

"Using note cards to document COVID vaccination will enrage enough parties to start solving for proper interoperability / portability of EHR data" -  Ruthvik Malladi

"The pharma market will challenge historical norms and expect all trials to be expedited (significantly, even if non-emergency vaccine now that the industry has broken the Bannister/Four Minute Mile) and conducted as virtual as possible, at a non-linear rate of change on both time (shorter) and %-virtual (% offsite: tele-health, home health nurse, at-home wearables, mail order lab kits, etc.) from 2019, to 2020, to 2021, and beyond."  -Anonymous

"House calls (Heal, Dispatch, Medically Home) and on-site employee clinics both see significant growth, further fracturing the continuum of care. Payers and risk-bearing providers will respond with digital unified patient experience architecture that aims to build connective tissue and on-demand value for patients/members." - Anonymous

"Surgeon General revives Loneliness (social isolation) as a public health agenda item" - Anonymous

"Major need for increased patient financing options due to massively increased OOP in 2021. Driven by growing surgical backlog and disease progression/severity due to never before seen levels of delayed care caused by covid (checkups, follow-ups, diagnostics/imaging pushed out 12 months+ due to hospital capacity constraints and general discomfort around receiving care). While obvious, I feel the negative impact of this is vastly underestimated." - Anonymous

"Waste and fraud due to medical billing for PPE and COVID testing/treatment will be a HUGE issue as providers attempt to normalize their revenue cycles with ongoing shutdown and a reduction in elective services. All third parties and consulting firms will be mass marketing this problem and cause more financial bleed as well." - Austin Gray

"Low intervention models in child birth gain momentum (ie. Oula) building better birthing center models that take advantage of consumer sentiment re entering a hospital during covid, depressed commercial re available and today's ability to better serve the customer through a longer, digitally guided journey" - Marco DeMeireles

"1. Controversy over large payers (perhaps some life insurers) who can provide the covid19 vaccine to its members putting them in front of any queues.2. Provider fighting to drive usage of in-person/physical assets 3. Consolidation in telemedicine" - Anonymous

"With the recent interoperability rules, there will be a wave of API services (ex: price transparency, ADT) which are very likely to be winner take all as they create a marketplace of other apps that build on top of these API services (and are able to do more interesting analytics / ML)" - Neil Batlivala

"A bit of a long shot, but I think Best Buy gets bought for its healthcare assets (GreatCall never gets enough credit), Geek squad (setting up remote health monitoring equipment in people's homes - especially the elderly), and national footprint (can turn poor performing locations into either grocery stores or warehouses to support same day/next day shipping)" - Josh Mark

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