Forget the past, they say, because the past can take care of itself. That bumper-sticker wisdom seems appropriate when you are trying to figure out what is going to happen in the year ahead, as we are with Managed Care’s Year in Preview, our listicle of what we believe will be some of the major stories affecting the cost and delivery of health care in 2016.
But in putting our list together, another aphorism came to mind, this one the famous quote from Faulkner: “The past isn’t dead and buried. In fact, it isn’t even past.”
Sure, the calendar turns in a few weeks, a psychologically comforting inflection point. But the underlying forces at play don’t suddenly pivot in the same way. One year bleeds into the next and into the one after that and so on. The Romans were right about Janus, the god of transitions. He faces forward and backward.
We believe that consolidation, which came in at number 1 on our list, is going to continue to reshape the health care landscape in a fundamental way in 2016, just as it did in 2015. It’s awkward and lurching but the movement toward value-based payment (our #2) is ongoing, although the experts we spoke with differ on how much progress will be made. Like it or dump it, the ACA (#3) can’ be ignored and if enrollment is anemic, the consequences for the law and the health care system will be major.
This isn’t to say all happenings, in health care or otherwise, are on some deterministic continuum. There are points of departure—places where the timeline spikes or takes a turn. What would we be talking about if either NFIB v. Sebelius or King v. Burwell hadn’t gone the ACA’s way? If antitrust regulators nix either the Aetna–Humana or Anthem–Cigna deals, it will be Consolidation, Interrupted, not Consolidation, the Sequel. And next year, we also have the regularly scheduled fork in the road of a presidential election.
So we launch our Year in Preview with fingers crossed that we’ll be mainly right and wrong where few would have predicted.