Health and health care 2032


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A presentation of a set of four scenarios of health and health care in 2032 which the Institute for Alternative Futures (IAF) developed for the Robert Wood Johnson Foundation. The scenarios are available at

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  • Normative vs. Exploratory
    Relies on Emotional Intelligence
    Emphasizes Process of Creating a Preferred Future
  • Health and health care 2032

    1. 1. Health and Health Care in 2032 September 18, 2013 Eric Meade
    2. 2. Health and Heath Care in 2032 Introduction to Futures Studies Four Scenarios for 2032
    3. 3. Health and Health Care in 2032 INTRODUCTION TO FUTURES STUDIES
    4. 4. Futures helps you find what you haven’t thought about ? ? ? ? ?
    5. 5. Change comes faster than we expect What we think may only be plausible within: May actually occur in only: 2-5 years 5-20 years
    6. 6. Scenarios: What and Why Alternative stories about the future They bound uncertainty and explore major pathways Used to: Understand change Identify emerging challenges and opportunities Clarify assumptions Consider alternatives Develop vision
    7. 7. Scenarios Should… Consider what’s likely and what’s preferable Aid in understanding and creating the future Lead to enhanced focus on vision, visionary success, and sensitivity to opportunities Be constructed around archetypes: Expectable Challenging Visionary
    8. 8. IAF’s approach: Aspirational Futures
    9. 9. Health and Health Care in 2032 FOUR SCENARIOS FOR 2032
    10. 10. Four Scenarios for 2032 Scenario 1: Slow Reform, Better Health (Zone of Conventional Expectation) Scenario 2: Health If You Can Get It (Zone of Growing Desperation) Scenario 3: Big Data, Big Health Gains (Zone of High Aspiration) Scenario 4: A Culture of Health (Zone of High Aspiration)
    11. 11. Scenario #1 Slow Reform, Better Health ACA largely implemented, wide state to state variation ACOs work, including prevention, but costs continue to rise, especially with/for aging Baby Boomers Shift in focus to health (environmental, behavioral, psychological, and spiritual forms of wellbeing); health in all policies
    12. 12. Scenario #1 Slow Reform, Better Health Personalized medicine – genomics, biomonitoring, zip code, clouds of data More diseases prevented or slowed; treatments for Alzheimer’s and many cancers
    13. 13. Scenario #1 Slow Reform, Better Health Disruptive innovations: digital health coaches, modeling, adaptive trials Despite growing focus on health and the social determinants of health, SDH inequities also grow along with health disparities
    14. 14. Scenario #2 Health If You Can Get It 2013: Budget sequestration prompts recession; draconian cuts to Medicare and Medicaid 2017: Medicare converted to vouchers Gulf grows between “haves” and “have-nots” Political oscillations between extremes Pronounced pessimism and psychosocial burden
    15. 15. Scenario #2 Health If You Can Get It 2020: 75 million uninsured, many more underinsured Business ethics trump medical ethics For affluent: Medical advances through genomics, proteomics, and microfluidic diagnostics For the poor: Box-store “minute clinics,” overcrowded ERs, and questionable online advice
    16. 16. Scenario #2 Health If You Can Get It 2027: Gulf between rich and poor prompts outcry Growing U.S. activity of global NGOs becomes source of national shame Congress passes single-payer health care system, but leaves details to CMS 2032: Many remain skeptical that the U.S. will never be able to afford the level of disease it has created
    17. 17. Scenario #3 Big Data, Big Health Gains Profound cultural shifts that affect health, policy, and health care, paralleled by major changes in communities and local economics Focus on betterment/success: ending food deserts, Harlem Children’s zone as a model Political implications lead to rapid change; shared vision; cooperation
    18. 18. Scenario #3 Big Data, Big Health Gains Local economies transformed – food, manufacturing In health care, these social Personalized Vital Signs movements and technology advances combined - “big data”, with rich clouds of individual and community data Digital health Advances in preventing or controlling many disease, with agents, gaming, social accelerated testing and networking patient/group involvement
    19. 19. Scenario #3 Big Data, Big Health Gains From Patient Centered Medical Home to Community Centered Health Home Most providers integrated, capitated Healthier communities, more effective personal health care, and more sophisticated self care  Decreased the demand for physician services and hospital care Community Centered Health Home Triple Aim Effective self-care
    20. 20. Scenario #4 A Culture of Health The human being is a profoundly resilient organism with an innate drive for healthy growth Systems biology evolves into health ecology encompassing all health domains Leaders learn to unleash human potential by creating environments for health
    21. 21. Scenario #4 A Culture of Health Boomers’ existential crisis creates societal focus on youth Reality TV show prompts societal discussion of what a “good death” looks like Health care increasingly incorporates the patient’s values
    22. 22. Scenario #4 A Culture of Health Health care spending is capped Avatars, enhanced self-care, and transparency reduce demand for medical interventions 2025: Unified Biological Systems Theory explains how biological systems evolve toward higher consciousness
    23. 23. Thank you! Scenarios available at: Eric Meade, Vice President & Senior Futurist 703-684-5880