Dr Nick Looks to 2024

By Dr. Nick van Terheyden aka Dr. Nick
X: @drnic1
Host of Dr. Nick: The Incrementalist – #TheIncrementalist

The year Skynet/Mednet became active – not really but that was the fear with everyone calling it the Year of AI. For the rest of us it was not so much the year of AI but rather the year that everyone else became aware of AI.

First off let’s assess my predictions for last year and see how I did:

PBMs and Drug Pricing – renewed focus – ✅ Right on target

Blockchain – the excitement might subdue – 🤔 Plausible

Meta bah humbug – virtual worlds are way too far over their skis – ✅ Right on target

Speech enablement – ✅ & 🤔 We see more but limited biomarker progress

Now for this year’s predictions for 2024

AI (broadest use of the term to encompass everything under this umbrella): Consolidation on all the pop-up wannabe companies but underneath this consolidation will be true progress, spearheaded by adding efficiency in existing inefficient and administrative heavy and eas(her) to solve areas but expect some impressive breakouts in more complex AI tools

Consolidation in Healthcare: This has been on a tear but I expect a backlash and just ‘owning’ doctors is not going to make an efficient process or workforce especially when the system attempts to force behavior that runs counter to clinical drivers and are burnout positive. Much like PBMs from last year, I think we will see a big focus and reactionary swing away from this as the efficiencies promised fail to materialize and are replaced with higher cost poorer quality care

Telehealth: Telehealth continues to limp onwards after its breakout thanks to the removal of economic barriers to national-based practices. While many pull back on payments for care the inequity burden and repeated wins by intelligent and flexible approaches will win out but it will take far too long

Mental Health, Burnout, and Social Media: The public health crisis around youth and social media addiction continues to gain prominence and will attract even more scrutiny as the issues bleed out into the burgeoning burnout of clinicians and the mass exodus of doctors and nurses

Prior Authorization and Denials: While the health plans continue to inappropriately impose bureaucratic prior authorization policies that conflict with evidence-based clinical practices, waste vital resources, jeopardize quality care and harm patients the backlash is gaining steam, especially in Medicare Advantage programs misbehavior is seen as profit motives deliberate delay while patients decline. Meanwhile, in the background, a nuclear arms race of AI technologies will grow as companies use the technology to fight the denials and the health plans use the same technology to introduce new and unique hurdles

Ransomware/Cybersecurity: It’s inevitable and continues unabated. The nuclear arms race of attack and defense plays out with healthcare among the biggest losers with their target-rich data environment. Even when this rises to the highest levels of attention we are still so far behind in mitigation and protection that it will be years before we see this pendulum swing back toward trust

Rural healthcare: Continues to struggle, with ongoing closures of rural hospitals leading to health access issues and damage to local economies. No easy solutions. Yet in Sri many places the heart and soul of communities.

PBM: Drug pricing remains opaque and inconsistent, with the same drugs costing vastly different amounts. If this system does not buckle and the public outcry overwhelms the massive lobbying efforts of the small minority of interest desperate to keep the backroom deal status quo then we have missed a huge opportunity to bring real and genuine change to a big cost area of our healthcare system

mRNA Breakthrough Treatments: With multiple trials in-flight expect at least one and maybe more breakthrough vaccines and therapeutics based on this technology with Sickle Cell Anemia just the first of many