2016医疗保健领域十大预测

2015年让我们知道，有些独角兽公司需要在“牧场”里生活更长时间，才能获得神奇的力量，人们依旧喜欢记录步数，丙肝可以像流感一样得到有效治疗。我们根据这些观察结果，对2016年做出了预测。下面是我们对明年医疗保健行业的10大预测。

美国联邦贸易委员会将阻止大型医院合并。原因很简单：有明确的数据表明，合并带来价格上涨的可能性将超过质量收益。

“可穿戴设备”变成“医疗穿戴设备”。一类新的可穿戴设备将在2016年上市，取代价格昂贵的医药疗法。它们将提供高效的微创疗法，采用基于医疗价值创造（而不是健康、娱乐和教育）的商业模式。

临终关怀受到关注，责任制医疗组织与独立执业医师对临终关怀医院的使用率将翻一番。为了应对日益昂贵的药物治疗、高自付额保险和新支付模式，医生会邀请患者参与临终讨论，共同做出决策。未来，这种转变将对药品定价形成压力，来自患者的净推荐值(Net Promoter Scores)更高，医生的收入也会提高。

在经历了严重亏损，避免采取基于风险的报销模式之后，大型医院系统将取消聘用制医生。结果将导致医院开始剥离过去五年内收购的亏损诊所，这跟上世纪90年代，医师诊所管理公司纷纷破产时的情形非常类似。

2015年的保险创新热潮将在2016年陷入低迷。多个著名的提供者发起的医疗保险和初创公司，将很难提供有竞争力的保费，因此也就无法吸引到太多成员，并且会损失大量现金。虽然引人注目的软件体验很炫，但医疗保险的“物理定律”偏好规模庞大的保险计划，后者可以利用强大的市场支配力，获得更高的提供者折扣，并利用其专案经理大军，更有效地管理高成本的患者。

精准医学降温，类似于1999年的人类基因组计划，并将在十年后急剧增长。媒体的关注并未转化成太大的直接影响，因为生物学太过复杂，而护理的可靠性又不足以从精准医学设想的“细调”中获益。今天，更高的投资回报来源于一般他汀类药物处方，保证患者依从性，实现一般低密度脂蛋白目标值<100的目标，而不是花3000美元进行基因测序，再次确认这种“循证指南支持的”一般方法还不错。

大众健康理念开始普及。一些著名的分析公司将消失，或转型成为医疗服务提供者，因为他们目前的客户没有能力从其人口健康分析工具中获得足够价值。事实上，目前该类工具的价值大多来自虚报医疗费用和在风险方面玩花样——与防治并发症截然不同，这些工具只是针对更高回报的调节系统。此外，多数供应商已经知道了哪些患者的风险更高，因此这类工具变得可有可无。

按需上门出诊服务陷入低迷。高客户获取成本以及大多数人没有能力支付高昂的费用，决定了按需上门出诊和处方药给药市场的规模非常小。相反，视频远程医学将提供另外一种方式，使患者可以用很少的费用，迅速获得诊疗。不过，至少在2016年，我们还得继续在零售药店排队购买处方药。

前蛋白转化酶枯草溶菌素9（PCSK9）让处方药Solvaldi看起来更便宜。实实在在的死亡率数据，使医生希望将胆固醇降到最低水平，而只有PCSK9能够实现这一效果。此外，患者认为每周一次注射比每天服用药片更加方便。每周一次注射成功保证了患者遵从医嘱，这将带来给药策略的更多创新，减少患者忘记吃药的风险。

雇主开始重视医疗保健成本，将其与差旅费用同等对待。雇主会强制规定首选差旅合作伙伴和每日出差费用补贴，同样，他们也将更积极地制定政策来管理医疗保健成本。大公司可以选择员工就医的医生和医院，要求员工在接受高成本医疗项目或治疗之前提供第二种治疗意见，在员工前往急诊室之前建议进行远程医疗，或者要求使用在线工具管理其身体状况和实际支出费用。

我们不是预言家。这些预测在2016年能否实现，且让我们拭目以待。（财富中文网）

本文作者鲍勃•柯歇尔和布莱恩•罗伯茨为风险投资公司Venrock的合伙人，该公司致力于寻找医疗领域的投资机会。

译者：刘进龙/汪皓

审校：任文科

In 2015 we learned that several unicorns need more time on the ranch before they get their magical powers, people still love tracking their steps, and Hepatitis C can be cured about as effectively as the flu. These observations led us to speculate about what will happen in 2016. Here are our 10 healthcare industry predictions for next year:

The FTC will block a major hospital merger based upon unequivocal data that consolidation leads to price increases more than quality gains.

“Wearables” become “Ther-ables”. A new category of wearables will enter the market and become substitutes for costlier medical therapies. They will offer less invasive but highly effective treatments for diseases and adopt business models based upon medical value creation instead of wellness, entertainment, and education.

End of life care grabs headlines, and hospice usage doubles among ACOs and capitated doctors. In response to increasingly expensive medications, high deductible plans and new payment models, doctors engage patients in the shared decision-making around end of life discussions. Over time, this will lead to pressure on drug pricing, higher Net Promoter Scores from patients, and higher incomes for doctors.

A major hospital system will divest itself from its employed doctors after losing too much money and avoiding the move into risk-based reimbursement. As a result, hospitals will begin unwinding the money-losing practices they have been acquiring over the last five years, similar to the 1990s when the physician practice management roll-ups failed.

The insurance innovation craze of 2015 will be a bust in 2016. Several noted provider-sponsored health plans and startups will struggle to achieve competitive premiums and, as a result, attract few members and hemorrhage cash. While compelling software experiences are cool (and needed), the “laws of physics” of health insurance favor mega-plans that can use their market power to get far better provider discounts and apply their armies of case managers to better manage high-cost patients.

Precision medicine cools, à la the Human Genome Project in 1999, and surges a decade later. The headlines translate into little immediate impact because biology is too complex, and care is simply not reliable enough to benefit from the fine-tuning imagined by precision medicine. Today, greater return on investment comes from prescribing a generic statin, making patients compliant, and hitting a generic LDL goal of <100, instead of spending $3,000 for sequencing to reaffirm that this generic “evidence-based guideline supported” approach is just fine.

Pop Health goes Pop. Some notable analytics companies will disappear or pivot to become medical providers because their current provider customers are unable to derive enough value from their pop health analytical tools. In fact, most of the current value from these tools comes from upcoding and gaming the risk – adjustment system for higher payment as opposed to complication avoidance. In addition, most providers already know which of their patients are high risk, making these tools dispensable.

In-person on-demand flops. The laws of high customer acquisition cost and limited ability of most people to pay high prices collide to make the market for on-demand doctors and prescription drug delivery very small. Instead, video-telemedicine will be the way people access care rapidly and at a fraction of the cost. We will continue to stand in line, at least in 2016, at retail pharmacies for prescription drugs.

PCSK9 cholesterol drugs make Solvaldi look cheap. The positive mortality data will make doctors want to lower cholesterol to the minuscule levels that only PCSK9s can deliver. Also, patients will view the weekly injection as more convenient than daily pills. The success of weekly injections to assure compliance with doctor’s orders will lead to more innovation in drug delivery strategies that remove the risk of patients forgetting to swallow pills.

Employers start to treat healthcare costs as seriously as travel expenses. Just as employers mandate preferred travel partners and per diems for travel expenses, they will become equally active in imposing rules to manage healthcare costs. Large employers may choose which doctors and hospitals employees visit, require second opinions before high cost procedures or treatments, recommend telemedicine before going to an emergency room, or require online tools for managing their conditions and out-of-pocket expenses.

While we would never claim to be soothsayers, we look forward to seeing how each of these predictions unfolds in 2016.

Bob Kocher and Bryan Roberts are partners with venture capital firm Venrock, where they focus on healthcare and healthcare-related investment opportunities.