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Overview

Between February 20 and March 12, 2019, a panel of U.S. healthcare leaders was surveyed on their views of the future of the industry. The results below reflect the views of 230 respondents in the first of the two-part survey.

Note: Respondents were asked about the likelihood of various policy changes using a scale of very likely, likely, unlikely, not at all likely or unsure. For purposes of this summary, likelihood is a combination of very and likely responses:

"Likely" = Very likely/likely

"Unlikely" = Very unlikely/unlikely

Federal policy

There is consensus among industry leaders that the federal government will play a bigger role in shaping the future of healthcare while maintaining it private.

Key findings

Influence will grow through the Justice Department, the Food and Drug Administration and the Center for Medicare and Medicaid Services.
Industry leaders think the federal government will intensify its regulatory oversight in two areas: price controls for prescription drug and limitation on consolidation among hospitals.
The majority think it unlikely that Congress will pass Medicare for All.

Congress will pass a Medicare for All plan.

Likely		19.1%
Unlikely		57%
Unsure		23.9%

The Department of Justice will set new standards for defining competition in consolidated hospital markets.

Likely		56.2%
Unlikely		16.9%
Unsure		26.9%

The federal government will turn Medicaid into a block grant program.

Likely		40%
Unlikely		30.2%
Unsure		29.8%

Congress will impose price controls on drugs.

Likely		60.2%
Unlikely		23.4%
Unsure		14.6%

The FDA will authorize the importation of drugs made in foreign countries.

Likely		56.1%
Unlikely		23%
Unsure		20.9%

Prices of hospital, physician and post-acute services will be imposed by federal/state regulators.

Likely		43.9%
Unlikely		38.0%
Unsure		18.1%

Insurance coverage

Industry leaders do not think there will be major changes in the structure of insurance coverage in the U.S.

Key findings

Insurance will continue to be a public-private marketplace with growing enrollment in Medicare a major factor in the shift from private to public coverage.
Medicare Advantage, offered through private insurers, will play a larger role.

The majority (80%) of U.S. healthcare coverage will come from government programs. (I.e., Medicare/Medicaid/CHIP, vs. private payers.

Likely		52.1%
Unlikely		30.3%
Unsure		17.6%

Private insurers will exit the individual insurance market

Likely		26.6%
Unlikely		56.5%
Unsure		16.9%

Medicare Advantage, offered by private insurers and funded by the federal government, will be the basis for Medicare for All.

Likely		43.8%
Unlikely		27.4%
Unsure		27.8%

Delivery system reforms

Industry leaders foresee continued pressure on the delivery system.

Key findings

There will be increased emphasis in primary care services.
Social services programs will be integrated with traditional provider services.
Expansion of alternative payment models will continue.

HHS will encourage the integration of health and social services programs and encourage its funding to address social determinants of health.

Likely		66.8%
Unlikely		15.0%
Unsure		18.2%

Market pressure and innovation in care delivery will slow annual healthcare spending growth to 1% above the GDP vs. 2% historical growth.

Likely		35.0%
Unlikely		51.7%
Unsure		13.3%

The majority of basic primary care will be delivered by advanced-practice nurses/nurse practitioners in retail/on-site clinic settings.

Likely		67.8%
Unlikely		20.7%
Unsure		11.5%

Medical education and its funding will be overhauled to address staffing pressures and changes in clinical innovations.

Likely		50.5%
Unlikely		25.2%
Unsure		24.3%

Alternative payment programs, like accountable care organizations and bundled payments, will fully replace fee-for-service as the dominant payment method for providers.

Likely		59.1%
Unlikely		22.3%
Unsure		18.6%

Discussion

Industry leaders think federal policy will play a larger role in the future of the U.S. health system. The majority think regulatory pressures will alter the way insurance coverage and the delivery of services are structured. While they do not anticipate passage of Medicare for All, they anticipate these reforms will be substantive and potentially disruptive.