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Looking to a day of better health care at lower cost

During open enrollment season, working families make some important decisions regarding spending for health-care services in the coming year. It seems a good time to make some predictions about what this arcane process might look like in 2020 - just five years from now.

During open enrollment season, working families make some important decisions regarding spending for health-care services in the coming year. It seems a good time to make some predictions about what this arcane process might look like in 2020 - just five years from now.

Today, families sit at the kitchen table and try to translate "insurance speak," including words and phrases like coinsurance, deductibles, co-payments, reinsurance, consumer-directed health plans, and accountable care organizations. Even in my family, in which my wife and I are both physicians familiar with health-care policy, we find the process opaque at best and heartburn-inducing at worst.

Most of us who work choose a health-care plan based on a wholesale market. That is, provider organizations sell themselves to insurance companies, and then employers make decisions on behalf of thousands of individuals and their families. This is known as a "defined benefit" structure. The newer model that many employers are using is known as "defined contribution," in which employees are given a certain amount of money and sent into the marketplace to somewhat blindly choose their doctors and hospitals.

I predict that by 2020, we will see a complete retail model in which individuals working for big companies will make decisions based on their particular needs, the benefits of the plan, and the doctors and hospitals who participate. Employees will customize all aspects of this selection process based on their families. We will do this because of the explosive growth in private exchanges, which are insurance marketplaces operated by private employers based on the same model as the Affordable Care Act's exchanges.

In addition to these private exchanges, the health-care consumers of 2020 will go online and pick doctors and hospitals just as they pick a restaurant, refrigerator, or new car. In other words, they will read doctor-specific reviews on a Yelp-like platform; they will look at how doctors fared with regard to their communication skills with patients; and they will go onto a government website to see how hospitals fared with patients in their age group. This will be especially valuable for those of Medicare age.

And the list goes on. We will have complete price transparency and total public accountability online 24/7 regarding the outcomes of the care that doctors and hospitals deliver. In fact, I think a four-word mantra will guide the open enrollment of 2020: "No Outcome, No Income" - meaning that people will buy insurance based on getting good outcomes from various providers, and those providers will do better economically by achieving better outcomes.

According to leading consultants and health-care brokers, we are already on the road to this vision of 2020. Nearly 40 percent of companies are interested in shifting to a defined-contribution model, and many are already moving to a private exchange plan.

Walgreens is one of them. It employs nearly 25,000 pharmacists nationwide. These are highly educated and competitive workers who know a thing or two about health care. Their move to a private exchange could be the societal "tipping point" from defined-benefit and defined-contribution plans all the way to a true retail model for purchasing and consuming health-care services.

I predict that this 2020 scenario will be fueled by good data on outcomes of all kinds - clinical, economic, and social. The 24/7 availability of this information will facilitate decision-making and help families make better purchasing decisions. In the end, we will all get better care at a lower cost, or what every other industry calls "value."