What If My Forecast Is Wrong?

Because I was a weatherman before becoming a health futurist, I am accustomed to questions about consequences if a forecast completely misses the mark.  Getting wet is the worst that might happen if it rains on a day expected to be clear, but health care executives don’t want to go to all the trouble of preparing for a storm if I am wrong in my current 80% expectation that health care will be battered by economic tempests for at least two more years.  (Admittedly, this forecast can alternatively be interpreted as a 20% possibility of desirable conditions, such as rapid economic recovery or unexpected support for increased federal health spending in a Republican-controlled House.)

Refusing to fall into the proverbial trap of talking about the weather but doing nothing about it, I have been clearly suggesting how health care’s executives and caregivers should prepare for a perfect economic storm.  The essential keys to battening down the hatches are rapid, enterprise-wide adoption of IT-based performance improvement processes and long-term, multi-stakeholder partnerships for capturing wasted resources and reallocating them to activities that produce more health per dollar already being spent. 

Providers and purchasers must implement pervasive business processes that identify unexplained variations from expected performance and then make sure the deviations don’t happen again.  This is harsh medicine for an industry that has been free to operate for 50 years without budget constraints or direct performance monitoring.  Nevertheless, I believe that brutal economic restructuring—not rational health reform—is putting an end to the medical economy’s halcyon era. 

So, what if my forecast is wrong?  What if medical expenditures actually do rise from 17% of GDP in 2010 to 20% by 2015 as other experts have predicted?  Should decision-makers breathe a sigh of relief and plan to carry on with business as usual?  I certainly don’t think so, but neither did the leaders of several dozen integrated health care systems that decided to become accountable for consistently good performance long before an intractable economic downturn was on anyone’s radar.  The success of these game-changing systems ought to suggest a new and different path for tradition-bound providers and payers. 

Besides, health professionals should be working to create the best health care system that 17% of GDP can buy, even if I believed we’d see nothing but blue skies from now on!  In the very unlikely event that the economy turns around early next year and House Republicans decide to increase health spending, shouldn’t our top priority still be to do health care right all the time, as inexpensively as possible?  In other words, providers and payers should be making the same changes, whether my forecast is right or wrong.  If you disagree, please propose feasible alternatives.