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 http://www.altfutures.org/pubs/RWJF/IAF-HealthandHealthCare2032.pdf.

1. Health and Health Care
in 2032
September 18, 2013
Eric Meade

2. Health and Heath Care in 2032
Introduction to Futures
Studies
Four Scenarios for
2032

3. Health and Health Care in 2032
INTRODUCTION TO FUTURES
STUDIES

4. Futures helps you find what you haven’t
thought about
?
?
?
?
?

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. 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. 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. IAF’s approach:
Aspirational Futures

9. Health and Health Care in 2032
FOUR SCENARIOS FOR 2032

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Thank you!
Scenarios available at:
http://bit.ly/13m995o
Eric Meade, Vice President & Senior Futurist
703-684-5880
www.altfutures.org
emeade@altfutures.org