More 2022 predictions

Last post I gave you my 2022 predictions - everything from the No Surprises Act being a shit show to celebrity doctors running for office and starting their own practices.

I asked you to send your 2022 predictions in. Here is a list of my favorite ones that were sent in + some memes I made to illustrate them as per usual.

The Dawn Of A New Obesity Treatment Paradigm

“I predict that 2022 will be a pivotal year for the pharmaceutical treatment of obesity. While approved in 2021, initial uptake of Wegovy (semaglutide 2.4 mg) has been limited by supply constraints. As far as I can tell, Wegovy has the broadest FDA indication ever written (~40-45% of American adults as far as I can tell; statins are indicated for more like ~1/3 of patients, for comparison). While the history of weight loss medications is littered with failures, there is a strong chance that This Time Is Different. Extensive diabetes focused outcome trials of semaglutide (as well as alternative medications in the GLP-1 class) demonstrate cardiovascular benefits and it is reasonable to expect that obesity outcome trials will either show cardiovascular neutrality or cardiovascular benefit. Though Wegovy will almost certainly remain expensive and payor coverage will continue to be extremely uneven, I expect a growing consensus that an overwhelming number of patients would pass an individualized risk benefit assessment for GLP-1 assisted weight loss and we will begin to grapple with the clinical, financial, and cultural implications of that shift. To add to the momentum, 2022 will likely see the approval of tirzepatide (initially for diabetes, but later for obesity alone) and the start of meaningful price competition. It's an exciting new era.”

- Patrick Spoutz (Twitter, LinkedIn)

Unvaccinated to alternative medicine pipeline

“As the vax mandate for private sector employers goes into effect, those who are terminated for vax refusal will lose group health insurance…  (too obvious, I know).

Those newly terminated employees who are eligible for Medicare due to age will request Medicare Part B and start shopping for Medicare plans to cover what Original Medicare does not. New MAPD plans will continue to flood marketplace and Medicare Supplement plans will relax their underwriting guidelines to attract new business.

Those not eligible due to age will either purchase their own plan on healthcare.gov, their state’s exchange, end up on Medicaid, or go without health insurance …… expanding marketplace for “alternative medicine” providers.

*Question remains whether COVID pre-existing conditions will be acceptable risk for insurance carriers.”

-Anonymous 

Headless products, and heads unavailable

“A few predictions on our end…

1. Headless healthcare will become the new headless commerce. Legacy players in particular will go all-in on digital, supported by third-party APIs, in an effort to close the growing digital gap.
2. The future of healthcare will look and feel social as we better incorporate a broad base of personalized social determinants of health (SDoH) into our course of care, particularly for previously disenfranchised patient populations.
3. Medicaid and rural patient populations will emerge as new hotbeds of innovation driven by federal and state support as well as the opportunity to leverage technology to deliver more cost effective care and access through innovative delivery models.
4. Human capital will continue to be the greatest supply constraint across healthcare. A provider-first orientation and optimized talent utilization through the use of algorithms and smart routing systems will become critical drivers to scale for industry leaders.” 

-Meera Clark (Twitter)

New License and Who Dis?

“Beyond just the Ryan-Haight laws, I think 2022 will bring to light a handful of legislation faux paus we've been dealing with in America for decades that COVID "canceled." First and foremost, state licensure laws - the boom of start-ups post Ryan-Haight pause will inevitably lead to them lobbying to modernize licensing. That or they will battle-royal for these 14 docs. Second, would be a miss to not expect a national patient identifier debate - especially after this change in legislation.”

-Vivian Neilley (Twitter)

Right Click Save, for mRNA

Setting aside one's opinions on the "safety" of the COVID vaccines that were distributed this year, it's undeniable that mRNA technology represents a potentially paradigm shifting advancement in pharmaceutical R&D. Being able to program our immune response based on the sequence of 4 known compounds allows for a cost-effective means of identifying, iterating upon and producing novel therapies. As we've seen across all facets of technology, when something has momentum and looks promising, it's only a matter of time before you see copycats and spin-offs. Imitation is the highest form of flattery and in this case it will provide healthy competition. The more people working on cutting edge technology, typically pushes the cutting edge further. In 2022, I think we'll see a host of mRNA pharma companies crop up, and maybe even a couple of unicorns in the bunch. We'll also hear about "promising Phase I trial results" as companies apply mRNA therapies to headline grabbing ailments like HIV, cancer and atherosclerosis. That being said, mRNA therapies are still nascent and there is a warranted level of skepticism toward their long term effects. I'm sure we'll one day have commercials for these drugs with a laundry list of rapidly read side effects, as is the status quo. The problem with skepticism and uncertainty- both warranted and unwarranted- is that it causes polarization (made worse by something we weren't skeptical enough about: social media), and that divisiveness will stifle the innovation/adoption in this space.”

-Arian Akhavan (LinkedIn)

Urgent Care: From Friend to Enemy?

“My healthcare prediction: Urgent Care usage will be at an all time high; and by the end of the year, expect new restrictions announced and more of the costs to move to the patient to discourage use.

You’ve written and tweeted about how urgent care is used by many as the front door of healthcare. But it’s obviously bad business for payers who want you to go to a PCP where they can better control costs. Expect them to finally push for usage changes and force people back to a PCP by making the costs more similar to an ER visit.”

-Anonymous

PCPs Get Paper

“Primary Care Doctors are gonna see huge salary increases with everyone trying to enter the DCE/MA/(other value based system) plan and need to contract with these physicians. CVS, Walgreens, and a slew of other companies are all entering this space and will try to scale quickly. While Congress tried to create more spots, that will take years of training, and so PCP shortage will become more important than ever. Perhaps some states will relax laws to expand the scope of responsibility for NPs, but I'm not so hopeful on that one for 2022 (maybe 2023?)”

-Anonymous

Payer Data Is Machine Illiterate

Despite the best intentions of the CMS, companies and consumers will find it very challenging and expensive to navigate and process what could be multi-terabyte monthly machine-readable files from payers and other issuers. Guidelines for these files are better organized than the low bar set by the hospital price transparency rule, which, a year later, has yet to be cleared by a large percentage of hospitals and health systems. However, there are still many open questions on the GitHub discussion forums (https://github.com/CMSgov/price-transparency-guide/discussions) with mere days to go before the initial compliance date. Building a consumer-friendly search tool will require a lot more effort than just indexing these files, as is, in a search engine and putting a UI on top of it. Patients generally don't think about personal medical services in terms of billable line items with cryptic codes and names.”

-Robert Stewart (Twitter)

Mental Health Turf War

"My predictions:

• ​Therapist wars heat up. It’s a supply-side issue. There are only so many therapists. Whoever can give therapists the patient types they want, the schedule they want, and the best benefits wins.
• Medication-assisted-treatment companies with value-based contracts continue to grow, while the current D2C companies battle to get payer contracts to help offset their high CAC. New G-codes (level 2 codes) don’t get new PCPs into the market of prescribing buprenorphine, even though it’s significantly more in reimbursement.
• Brick-and-mortar becomes a competitive advantage. Mental health providers focused on the employer-market win or lose based on access. Those that can continue to provide fast access virtually AND offer brick-and-mortar access differentiate themselves. There is little differentiation in this space, so small things matter.”

-David Ricupero (LinkedIn) 

Innovation Was Inside Us All Along

“I think this year we’re going to see a flurry of activity in gene editing inside the body and that going to be the main focus of research this year. It’s just natural the field is headed that way because the current method i.e. outside the body— is just too draining, expensive, takes too long and Intellia and Regeneron have already showed some human data that it could be done. I think Big Pharma is going to jump in on this space too and it's going to be by partnering with startups already working on improving on the existing CRISPR system.”

-Apoorva Srinivasan (Twitter)

Thinkboi out,

Nikhil aka. "start thinking of your 2023 predictions

Twitter: @nikillinit

IG: @outofpockethealth

Other posts: outofpocket.health/posts

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