Jeff Goldsmith

What Makes a Health System?

Health care organizations have grown steadily larger and more complex over the past thirty years. Most of them call themselves “health systems”. But are they really systems and have patients and those who pay for care benefited from this growth and complexity? Why has “health system” operating performance deteriorated sharply since the historic Affordable Care Act coverage expansion? How can health systems make changes in their operations and management that patients notice? What does it mean to be a health system? Opiate Crisis: Tip of a Population Health Iceberg: In 2016, more than sixty thousand Americans died of drug overdoses, 42 thousand from opioids. Drug death are the SuperStorm Sandy of public health threats, likely to claim more victims than the AIDS Epidemic. Yet it is the most visible manifestation of a more troubling trend-declining American life expectancy. In both 2015 and 2016, American life expectancy declined, the first two-year decline since the early 1960’s. During the same two years, the US spent nearly $7 trillion on healthcare. What are the underlying drivers of this deeply troubling trend., and what can policymakers and the care system do about it?

What Will the Trump Presidency Bring to Healthcare?

Donald Trump won an unexpected Presidency in part by promising to repeal ObamaCare, the landmark 2010 Obama administration health reform law. This law provided coverage for 20 million formerly uninsured people and hundreds of billions in new funding for hospitals and care systems. How will unwinding and replacing this law affect those who render care? What role did poor health play in Trump’s election? How will a divided Republican Party decide where to cut and how to restructure Medicare and Medicaid, the twin mainstays of public funding for health services? Where will Trump succeed and where will he fail? What strategies best position hospitals and physicians to cope with a new wave of policy uncertainty?

2037: A Healthcare Odyssey

In 1986, in Hospitals’, Jeff Goldsmith looked ahead fifty years to the US healthcare system in 2036. In 2016, Jeff revisited these forecasts, noting both accurate and inaccurate predictions, and looked ahead yet again to the health system in twenty years time. In 2037: A Healthcare Odyssey, Jeff examines the digital health revolution he foresaw in his 1986 piece, and how it is likely to affect care. He also looks at the concluding chapter of the baby boomer’s saga, as well as promising new progress in the neurosciences and produces a fresh forecast for the US health system in twenty years.

The Tragedy of Health Reform

Despite compelling unmet needs, the bold health reforms enacted in 2010 in the Affordable Care Act appear to be faltering. A lethal combination of political controversy, flawed design and incompetent implementation have put health reform in peril. What went wrong? How will the unfolding of expanded health coverage, increased regulation and new models of care and coverage affect the health system and society? Will employers abandon health coverage and push their employees into the Exchanges? Will the Exchanges revitalize or destroy private health insurance? How will health reform affect caregivers and patients? Will the Medicaid program sustain a 20% increase in enrollments? Can or should health reform be saved? A veteran health policy analyst looks at ObamaCare and looks ahead. Slouching toward Value: The Future of Health Care Payment: One major theme of health reform has been to change how healthcare is paid for to reward higher value care. In a $2.8 billion industry, the uncertainty about future payment models has created confusion about strategic direction in hospitals and systems, physician communities and health insurers, as well as anxiety among patients and their families. Ironically, a Democratic health reform has produced Republican outcomes- high degrees of consumer economic exposure, narrowing networks, and a welter of confusing new choices. Meanwhile, new payment models- pay for performance, bundled payment, accountable care organizations, patient centered medical homes- have been given fresh impetus. How will all these experiments turn out? How SHOULD healthcare be paid for? This talk focuses on the winners and losers in the search for more accountable and affordable care, and the models and strategies that are likely to prevail.

Can Hospitals Survive? Hospital Strategy in a Maturing Market

After decades of seemingly continuous expansion, hospital inpatient utilization in the United States has fallen for five years in a row. Despite forecasts a decade ago of significant bed shortages, many hospitals and systems find themselves with excess capacity. At the same time, the uncertainties surrounding ObamaCare and the pressures created by the recession have stressed hospitals, resulting in declining earnings and increased pressure from physicians and patients. Merger and acquisition activity spiked after 2010’s health reforms, and continues unabated. How will the private insurance reforms contained in ObamaCare affect hospitals’ financial futures? Can hospital systems that have sought to become “unavoidable” through mergers survive the transition to narrow network insurance products and rising transparency and consumer choice? Can hospitals survive this transition? How can hospitals become the “hospitals of choice” in their communities and regions.

Changing of the Guard: How the Impending Generational Transition among Physicians will Change Medicine and Health Services

The present US health system is 'powered by baby boom physicians'. As these physicians gear down or retire outright, they are being replaced by younger physicians with different values, practice goals and communications styles. How will this generational transition affect medical practice, as well as hospital/physician relations? How will policymakers cope with the impending scarcity of practicing physicians as the baby boom itself enrolls in Medicare?

• FUTURECARE: The Future of Healthcare