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HOUSTON, Texas – Being a healthcare futurist is easy.  The hard job is being a futurist that gets it right.

The truth is that anyone, me included, who attempts to paint a picture of what the future of healthcare holds does so at their own futurist/forecasting peril.  No one knows for certain what, specifically, is going to happen, or what the healthcare delivery system will look like, in 10 years.  We do know, however, that every 8 seconds a new person joins Medicare and that there is a $200,000 shortfall between the amount Medical participants pay in over a lifetime of working and what they take out.  We know too, that the overall government budget tab will grow from $550 billion to $1 trillion inside of 10 years.

The predictions that I and many others have made, from a shortage of primary care physicians, to a significant decline in the number of big box hospitals, to the rise of integrated networks with a portfolio of services that incudes pre-emptive population health management, hospitals, outpatient care, including home health and long-term care, may well be dead bang right, but it is too early to tell.  Even healthcare systems that are sprinting to the head of the line for value-based reimbursement cannot predict when the tipping point will be reached.  One organization that has invested millions of dollars on this strategy reported that only 15 percent of their total current reimbursement came from that futuristic model.

Healthcare CEOs and candidates for senior leadership positions have something in common:  they do not know what the future will bring, what the business model will look like, or what products, services and leadership skills will be necessary to succeed.

My advice is begin to plan and be very, very flexible.  Do not lock in on one pathway prematurely because as long as “the grand benevolent asylum for the helpless” — Congress, as Mark Twain was fond of saying — remains locked in two warring camps, repeal and replace the Affordable Care Act versus protect the law at all costs, they cannot, and will not, take steps that will provide us any clarity for the future.

So, the futurists continue to roll the prediction dice and healthcare executives are watching and listening, trying to figure which way to break, strategically speaking, to ensure their organizations survive and their careers thrive.

There is one prediction upon which I would bet the farm:  Congress will not act until we have a four-plus Medicare/budget crisis and then, and only then, will they act.

I also bet that a meat cleaver will be involved.