Bob Mook is the editorial manager of the Colorado Health Foundation.
Like other futurists, Eric Meade thinks of the future in the plural.
"We say we're a 'futures' organization because there isn't just one," said Meade, senior futurist and vice president of the Institute for Alternative Futures, based in Alexandria, Va. "You need to consider the alternatives, the risks and challenges and the plausible aspirations."
Meade developed scenarios of primary care in 2025 for the Kresge Foundation as well as a report on health and health care in 2032 for the Robert Wood Johnson Foundation's Futures Symposium. That event, which took place last summer in Kansas City, brought together leaders in health care delivery, government, academia and industry to explore different scenarios and identify areas of opportunity between now and 2032.
Meade's approach invites participants to view the future through both objective and subjective lenses that when applied together, help people identify what he called "the shared hopes and fears that we often project onto the future." He replicated the workshop on Dec. 20 in front of a small group of Colorado Health Foundation staff and grantees.
With the new year upon us and the future of health and health care weighing heavily on the minds of health professionals, policymakers and the general public, here are the scenarios Meade brought forth for discussion:
Scenario 1: Slow Reform, Better Health – Meade said this scenario falls under "the zone of conventional expectation" (or what most people expect will happen). In this scenario, Meade said the Affordable Care Act will be largely implemented – with some states opting in (or out) of Medicaid expansions or health insurance exchanges. This scenario also assumes that individuals will take a more active role in their own care due to enhancements in risk-behavior management, new cures, therapies and technology. For example, Meade foresees apps on smart phones or pads that would let people interface with a digital health coach to provide assistance.
Scenario 2: Health If You Can Get It – Meade categorized this scenario under "the zone of growing desperation." In this scenario, the federal Medicare and Medicaid programs experience severe budget cuts, leaving most Americans underinsured. Meanwhile, medical tourism increases, epidemics spread and health and inequality within the health care system intensify. "With the growing disease burden, there is pronounced pessimism. People don't want to go out and the economy suffers because if you have multiple chronic conditions, you don't want to go out to a vibrant environment." Meade projects the number of uninsured under this scenario will grow to 75 million. On the upside, the crisis in health will trigger a public outcry and (later) fundamental change.
Scenario 3: Big Data, Big Health Gains – As one of two scenarios that fall under "zone of high aspiration," Meade said the scenario represents a massive effort to transform information into knowledge and understanding, promote health and improve behaviors. Under the scenario, there are profound cultural shifts that affect health policy and health care, as well as initiatives on the local level that are driven by emerging technologies. As an example, he cited a number of "cool mapping tools," including one from San Francisco's Department of Public Health which maps everything that might impact a community's health for better or worse (including hospitals, clinics and dentists offices, as well as grocery stores tobacco retailers and fast food restaurants). Combined with better use of Medicare and Medicaid reimbursement data, such tools could give health professionals a thorough understanding of communities to focus their strategies. "We're developing a granular understanding of our communities," Meade said. "And that drives action to promote health." The increased use of technology would empower more individuals to take charge of their own health and decrease the use of physician and hospital care.
Scenario 4: A Culture of Health – Meade said this scenario, the second under the "zone of high aspiration," represents a shift from the medical model of "fixing" what's wrong with the human body to viewing the human body as "a profoundly resilient organism with an innate drive for healthy growth." Similarly, the emphasis on health professionals shifts to empowering the human body and encouraging systems for that to occur. The approach taps into all domains of the human experience from the physical to the emotional to the spiritual, fostering an environment where the normal is health. Under this scenario, health care spending is capped, with enhanced self-care and health education reducing demand for medical interventions. People in this scenario would view mortality differently – even refusing cancer treatments in some instances in favor of what Meade characterized as "a good death."
If some of these scenarios sound familiar, Meade said that's because one person's futuristic scenario might be another person's present-day reality. He acknowledged that all of the scenarios are "an abstraction of the present projected onto the future."
"To some extent, this is an exercise to differentiate different futures and provoke different discussions," he said. "In reality, some patients are living in [Scenario 2] right now."
Where do you see health and health care going 20 years from now? Share your thoughts in the comment box below.