Today is Boxing Day and St. Stephens Day for people who celebrate Christmas, so I share this post as a holiday gift with well-wishes for you and those you love.

The tea leaves have been brewing here at THINK-Health as we prepared our 2019 forecast at the convergence of consumers, health, and technology. Here’s our trend-weaving of 4 C’s for 2019: costs, consumerism, cyber and care, everywhere…

Health care costs will continue to be a mainstream pocketbook issue for patients and caregivers, with consequences for payors, suppliers and ultimately, policymakers. Legislators inside the DC Beltway will be challenged by the newly-elected Democratic leader of House, Nancy Pelosi, and her party which has healthcare top-of-mind.

We know that a top issue driving American voters to the 2018 mid-term polls was health care, in at least two dimensions: direct costs to the voters (as patients and taxpayers); and, personal and collective concerns about losing coverage due to pre-existing conditions. More people became aware of that wonky term, taking it to heart and to the polls in 2018. Expect health care costs and access to be at least as important to U.S. voters through 2019, and on the Presidential debate stages for both Democrats and Republicans leading up to the parties’ nominees for 2020.

A key health care cost focus of Congress will target prescription drug costs. Expect pharmaceutical companies to raise prices in 2019 — “with a wink to Trump,” Bloomberg News characterized last week — prompting Congressional health care activists (particularly Democrats in the House) to come together on legislation and collaborate with President Trump on this issue which he promised would be a priority when he took office.

An example of legislation newly-crafted to hit the House floor in January 2019 comes from Elizabeth Warren (D-MA) in the form of the Affordable Drug Manufacturing Act. This bill would create a government-run drug company to produce and distribute generic medicines. In 2018, we also saw a response to high drug costs in the form of CivicaRx, a consortium of hospitals coming together to manufacture drugs in short supply at hospitals. To hedge an uncertain pricing future, pharma and life science companies will also be reorganizing (admittedly a perennial strategy for several of the biggest pharmaceutical manufacturers) as well as getting bolder about adding value “around the pill.” GlaxoSmithKline is one example, with its plan to combine its consumer brands with Pfizer’s, making that combo the largest seller of over-the-counter medicines at the start of 2019. On the Rx side of the house, GSK expanded its alliance for the company’s respiratory franchise with Propeller Health (acquired by ResMed in 2018). So the pharma-plot will thicken in 2019 with acquisitions, divestitures, and alliances to both manage an uncertain pricing future along with managing costs (downward) and enhancing innovation.

Employers will endeavor to artfully design consumer-directed benefit plans (CDHPs) that nudge insured workers toward healthier habits, while integrating a broader definition of wellness. There’s evidence that companies who cover health insurance are baking more financial wellness into a broader culture of health in the workplace, along with more attention to mental health. Greater awareness of the opioid epidemic, pain and financial stressors drive that trend, along with realization that student loan debt is very serious for both younger workers and, what may surprise you, Boomers who have taken on student debt on behalf of younger family members. Costs are also motivating employers to adopt telehealth coverage, en masse, and also behavioral economic designs to incentivize workers to access care in lower-cost settings like retail clinics, urgent care centers, and those Skype-type visits for care that don’t require a trip to the emergency department or bricks-and-mortar doctor’s office or hospital outpatient clinic.

Worries about health care costs, now crossing over into higher-earning households, underpins the growth of consumerism. It is difficult to behave like Rational Economic Man and Woman as a patient in the American health care labyrinth; but that doesn’t mean people aren’t exercising new muscles and choosing services delivered in newer, lower-cost sites. The retail pharmacy, for example, is a popular choice for receiving vaccines for flu and filling the childhood immunization schedule; and, the proliferation of web-based telemental health providers is providing an on-ramp for people to access behavioral health in a non-taboo, accessible mode.

We are also witnessing green shoots of understanding across the many layers of health literacy for:

  • Personal health financial literacy, a greater appreciation among consumers about the tax benefits of conserving funds in a health savings account, and what “coinsurance” shares mean
  • Digital health literacy, greater adoption of wearable tech and tracking apps, FDA-cleared devices that measure medical metrics like heart function, and people going online to sign up for health insurance
  • Nutrition literacy, with more clinicians prescribing food and recipes to promote self-care and healthy eating for patients and their families.

Consumerism and payor pressure will grow the landscape for care, everywhere. As employers and commercial payors support the growing use of telehealth and virtual care among insured workers and plan enrollees, so too will patients-as-consumers choose to more frequently receive care in convenient places and, increasingly, at home. The home will begin to emerge, in a pioneering phase, as our health hub. Peoples’ growing adoption of voice assistants like Alexa is already providing a platform for health assistance at home, with skills for a range of self-care like medication adherence, mental health support (say, through music and humor), and healthy recipe suggestions.

Outside of the home, I note the growth of retail health options well beyond (but including) the retail pharmacy. The grocery store is an important destination for health and wellness, along with Big Box retail, schools, church, and other community-based locations where people can create health — where we live, work, play, pray, and learn. The new “front doors of healthcare,” a term smartly coined by Oliver Wyman’s team, will emerge from combinations of stakeholders, such as the CVS + Aetna combination, Walgreens allying with Humana for primary care and Verily (Alphabet, Google) on data-driven chronic care, Cigna + Express Scripts vertical integration, Walmart’s work with a long list of health/care players, Apple branching into health clinics and hiring physicians, and Amazon reaching across the entire ecosystem to cover the landscape. This list, and other names we’ll see creating on-ramps to primary care and self-care to the consumer, will expand in 2019.

We’ll see more edgy digital technologies that speak to sex, drugs, rock ‘n roll: real life, EveryMan and -Woman issues. As I finalize my meeting agenda for CES 2019, I see more invites to developers of techs for adult “toys” (a growing category of sexual health and wellness), mental health and mindfulness, addiction and substance use, and consumer breathalyzers. One new development I find both provocative, sobering and highly useful is the SipChip, a disc roughly the size of a casino chip, which embeds a diagnostic test to check if one’s drink is spiked with common date rape drugs [e.g., Flunitrazepam aka “Roofies,” Xanax, and Diazepam (Valium), among others]. This innovation was developed by a team of college students at NC State University to help stem the college campus epidemic of drug-facilitated sexual assaults.

Investment, too, will come from unexpected places. The announcement this week of Morgan Stanley’s capital influx into Medsphere, an EHR company, is a hint of what more is to come in 2019 as an example of investors’ expanded interest in health IT and new-and-improved healthcare services and business models.

Greater attention paid to the social determinants of health, by payors (both public in Medicaid and Medicare, and in private sector benefit plans) will promote peoples’ access to care, services and social support outside of traditional, legacy healthcare nodes. This will continue to put pressure on the margins and business models of hospitals and doctors’ practices.

To more effectively manage these tight margins, health care providers will continue their use of augmented and artificial intelligence to mine data from both traditional claims and electronic health records, combined with consumer-generated data from wearable tech, surveys, and third party data sources that collect information on social determinants of health, personal finance, and retail transactions.

As consumers take on more self-care through apps, remote monitoring at home, and using social networks for health, people are also becoming more aware of these interactions creating data points. So much of these data flows aren’t covered by HIPAA. At the same time, Americans are more aware of data privacy challenges in the post-Facebook/Cambridge Analytica era, and U.S. Congress’s greater attention to Big Tech’s privacy gaffes and gaps.

Cyber-security and personal data breaches are now front-page (or -screen) news in mass media, as people live lives online and share all kinds of daily experiences with friends and family. More people have come to realize that personal information shared online isn’t seen by “just” friends and family, and can be scraped and re-purposed by third parties. Personal data, too, gets breached — notably, quite frequently, in healthcare provider organizations. It turns outs that medical breaches are quite valuable to hackers, so the frequency and severity of cyber-hacks in healthcare will be  an ongoing phenomenon in 2019.

Don’t be surprised for a major hack in or closely adjacent to healthcare to occur in 2019 that could reach the scale of the Equifax breach. This would prompt Congress, driven by Democrats and moderate Republicans, to propose more stringent privacy legislation which industry will try to rebuff. It will be a wild card whether sufficient voter pressure could motivate the Congress and President to usher in a U.S.-style GDPR (the General Data Protection Regulation promulgated in the European Union).

Health Populi’s Hot Points:  There is one hot point that’s most important on Boxing Day and, truly, Everyday. That’s that love is the killer app — and our positive social connections bolster our health. May you delight and thrive in those loving touch-points in your life, and be mindful of minimizing the negative ones.

Here’s to your health, to love, loving kindness, and peace in 2019. I wish you very well…