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For what is now an annual tradition, we are once again attempting to be healthcare soothsayers. We are proud to share with you our 10 healthcare predictions for 2018. But first, we look back on our 2017 predictions.
In 2017, amazingly, eight of our 10 predictions came true. We did a good job predicting public policy outcomes: while we never could have predicted the political drama of the “repeal and replace” debate, we did get right the status quo outcome. We also correctly called the spiking of insurance premiums brought on by the Trump administration’s antipathy towards managing the Affordable Care Act (ACA) and we predicted that drug prices would continue upward unabated.
In the private sector, our expected slowdown of hospital admissions and reduction in retail pharmacies occurred. In life sciences, our prediction that single cell genetic diagnostics would go mainstream was validated by the Human Cell Atlas project. We fell short on our scientific predictions that gene therapy would cure a common disease and that carbohydrates will become scarier than cholesterol. We still believe the last two predictions will come true, but our timing was too optimistic.
For 2018, we are betting on the following:
We think at least one healthcare information technology company with an enterprise value of more than $1 billion (not including Outcome Health, which we could not have predicted tanking so spectacularly quickly) will be exposed as not having product results to support their hype. It will also expose embarrassed investors, who did not do careful diligence, and founders with poor integrity.
After a decade of sustained hiring every month, hospitals will stop. Many will downsize their administrative staffs as admissions continue to slow down and reimbursement pressures intensify. We expect multiple months with net healthcare job losses, which would be the first time this has occurred since the Bureau of Labor Statistics started tracking the data.
Successful HCIT exits
After a long wait and more than $10 billion of venture capital invested in start-ups over the past five years, we will begin to see some successful IPO and M&A exits. These will reassure growth investors to keep pouring money into companies with traction.
Amazon does not disrupt PBMs
Despite daily rumors, we think Amazon will not shake up pharmacy benefits managers. Instead, Amazon will limit its health-care market footprint to its existing consumer products and distributing non-regulated health-care goods to health-care providers, meaning it will adopt a business-to-business and not a business-to-consumer strategy.
AI makes a big impact
While we don’t think bots are going to replace doctors anytime soon, we are bullish that AI and machine learning are going to go from an R&D project to meaningfully improving cancer diagnostics, pathology and image recognition. We think that training data sets and technical capabilities have gotten to the point where new products will be created that begin to make a difference.
The ACA is repaired, finally
In 2018, a bipartisan effort will pass to improve the functioning of the ACA, and we predict that Congress will act to help stabilize marketplaces and premiums. We will move on to focus more on MACRA and bending the cost curve, which is beginning to bend in the wrong direction.
(MACRA is legislation signed in 2015 that replaces the current Medicare reimbursement schedule with a new program that rewards health providers for performance.)
Medicare Advantage gains popularity
We think Medicare Advantage will gain in all dimensions. Seniors will increasingly choose it since it is more affordable; start-ups and incumbents will make big bets on growth; policy makers will enact favorable policies and margins for payors and primary care providers will grow.
Payors become acquirers
With the crumbling of the Anthem/Cigna and Aetna/Humana mergers, and emergence of Aetna/CVS, we think that Anthem, Humana, Cigna, and Optum will all aggressively acquire higher margin, less-regulated businesses.
CRISPR has been one of the great technical advances in biological and medical research in a long time, and the CAS-9 enzyme that enables it is the source of much IP litigation and conflict. In 2018, it will become obvious that there will be many enzymes that can enable gene editing and the CAS-9 IP limitations will fall away.
Big Pharma gets bigger
We think that after a few years of smaller acquisitions, the mega-mergers will ramp back up in 2018. We predict that both BMS and Astra Zeneca will get acquired by other big pharmas.
We look forward to seeing what happens in 2018 and hope that we can resist regression to the mean!
Bob Kocher and Bryan Roberts are both health investors and partners with venture capital firm Venrock.
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