Conference Presentation, Panel, Fireside Chat
Closing Gaps in Health and Health Care | Future of Health Summit 2023
Milken InstituteEsther Krofah, AmirAli Talasaz, Susan Barlow, Meg Tirrell, Jaewon Ryu, Ashwin Vasan, Hubertus von Baumbach, Angela F. Williams, Ray Broughan, Bob Cramer, Diane Tai
- Life expectancy in the United States is expected to decline, potentially returning to mid-1990s levels of 76.4 years based on 2023 trends, driven largely by an epidemic of chronic illness and exacerbated by misinformation regarding overdoses, mental health, and suicides.
- By 2030, one in six people globally will be aged 60 or over, with low and middle-income countries experiencing the most significant aging population shifts, while the US mortality gap between rich and poor is projected to widen significantly compared to peers in Canada, France, and Japan.
- Healthcare investment and spending centers are forecast to shift from treating the sick ($3.1–3.2 trillion) toward wellness and preventive measures (currently $1 trillion) by 2035 or 2040, necessitating a move away from fee-for-service volume incentives.
- Regulatory and market timelines include a potential FDA approval for a Guardant Health blood test "sometime next year," sickle cell CRISPR gene therapy reaching the market "as early as December," breast cancer guideline updates every eight years, and colon cancer screening updates every five to six years.
- Significant medical breakthroughs are predicted for mental disease treatment within the "next five years" and for early detection of neurodegenerative diseases like Alzheimer's and Parkinson's within the "next 10 to 20 years."
- A critical opportunity to reorganize health data and address current challenges is expected to exist within the "next 12 to 24 months," after which the opportunity may be missed.
- Future care delivery is expected to expand beyond traditional settings to include homes, street corners, pharmacies, police stations, and fire stations, potentially supported by AI to overcome administrative silos and enable population health mindsets.
- The current labor-intensive healthcare system is expected to become unsustainable due to human body shortages, requiring a shift to longitudinal care and the use of wearables and self-generated engagement.
- Public and private entities are deemed "not adequately prepared" for aging challenges, with trust gaps persisting due to an "unregulated tech apparatus" and bad actors in the technology industry.
- Structural solutions proposed include an "industrial policy of health" comparable to the CHIPS Act, new financial instruments to liberate dollars from the current system, and a shift toward value-based payment models.
- The speaker anticipates that government intervention is required to set superordinate targets, as the "will to collaborate" is currently insufficient and data remains siloed in "pockets."
- Innovation is expected to fill the gap where government lacks consensus, with private sector, philanthropy, and non-profits required to execute a common vision, while "islands of excellence" currently exist within a "sea of need."
- Payment incentives currently favor commercially insured populations, creating inequities, while telehealth and virtual visits face challenges due to a reversion to limited billable scenarios post-COVID.
- Misinformation is identified as a massive issue creating a competitive disadvantage for public health officials, and the "last mile" of regulatory and coverage access remains the primary barrier to healthcare equity.
- The speaker expects that without "new financial instruments" and a shift away from episodic interactions, the system will continue to drive care "further downstream," while "more regulation" is anticipated to fail in improving delivery or outcomes.