2015年讓我們知道，有些獨角獸公司需要在“牧場”里生活更長時間，才能獲得神奇的力量，人們依舊喜歡記錄步數(shù)，丙肝可以像流感一樣得到有效治療。我們根據(jù)這些觀察結(jié)果，對2016年做出了預(yù)測。下面是我們對明年醫(yī)療保健行業(yè)的10大預(yù)測。

美國聯(lián)邦貿(mào)易委員會將阻止大型醫(yī)院合并。原因很簡單：有明確的數(shù)據(jù)表明，合并帶來價格上漲的可能性將超過質(zhì)量收益。

“可穿戴設(shè)備”變成“醫(yī)療穿戴設(shè)備”。一類新的可穿戴設(shè)備將在2016年上市，取代價格昂貴的醫(yī)藥療法。它們將提供高效的微創(chuàng)療法，采用基于醫(yī)療價值創(chuàng)造（而不是健康、娛樂和教育）的商業(yè)模式。

臨終關(guān)懷受到關(guān)注，責(zé)任制醫(yī)療組織與獨立執(zhí)業(yè)醫(yī)師對臨終關(guān)懷醫(yī)院的使用率將翻一番。為了應(yīng)對日益昂貴的藥物治療、高自付額保險和新支付模式，醫(yī)生會邀請患者參與臨終討論，共同做出決策。未來，這種轉(zhuǎn)變將對藥品定價形成壓力，來自患者的凈推薦值(Net Promoter Scores)更高，醫(yī)生的收入也會提高。

在經(jīng)歷了嚴(yán)重虧損，避免采取基于風(fēng)險的報銷模式之后，大型醫(yī)院系統(tǒng)將取消聘用制醫(yī)生。結(jié)果將導(dǎo)致醫(yī)院開始剝離過去五年內(nèi)收購的虧損診所，這跟上世紀(jì)90年代，醫(yī)師診所管理公司紛紛破產(chǎn)時的情形非常類似。

2015年的保險創(chuàng)新熱潮將在2016年陷入低迷。多個著名的提供者發(fā)起的醫(yī)療保險和初創(chuàng)公司，將很難提供有競爭力的保費，因此也就無法吸引到太多成員，并且會損失大量現(xiàn)金。雖然引人注目的軟件體驗很炫，但醫(yī)療保險的“物理定律”偏好規(guī)模龐大的保險計劃，后者可以利用強大的市場支配力，獲得更高的提供者折扣，并利用其專案經(jīng)理大軍，更有效地管理高成本的患者。

精準(zhǔn)醫(yī)學(xué)降溫，類似于1999年的人類基因組計劃，并將在十年后急劇增長。媒體的關(guān)注并未轉(zhuǎn)化成太大的直接影響，因為生物學(xué)太過復(fù)雜，而護(hù)理的可靠性又不足以從精準(zhǔn)醫(yī)學(xué)設(shè)想的“細(xì)調(diào)”中獲益。今天，更高的投資回報來源于一般他汀類藥物處方，保證患者依從性，實現(xiàn)一般低密度脂蛋白目標(biāo)值<100的目標(biāo)，而不是花3000美元進(jìn)行基因測序，再次確認(rèn)這種“循證指南支持的”一般方法還不錯。

大眾健康理念開始普及。一些著名的分析公司將消失，或轉(zhuǎn)型成為醫(yī)療服務(wù)提供者，因為他們目前的客戶沒有能力從其人口健康分析工具中獲得足夠價值。事實上，目前該類工具的價值大多來自虛報醫(yī)療費用和在風(fēng)險方面玩花樣——與防治并發(fā)癥截然不同，這些工具只是針對更高回報的調(diào)節(jié)系統(tǒng)。此外，多數(shù)供應(yīng)商已經(jīng)知道了哪些患者的風(fēng)險更高，因此這類工具變得可有可無。

按需上門出診服務(wù)陷入低迷。高客戶獲取成本以及大多數(shù)人沒有能力支付高昂的費用，決定了按需上門出診和處方藥給藥市場的規(guī)模非常小。相反，視頻遠(yuǎn)程醫(yī)學(xué)將提供另外一種方式，使患者可以用很少的費用，迅速獲得診療。不過，至少在2016年，我們還得繼續(xù)在零售藥店排隊購買處方藥。

前蛋白轉(zhuǎn)化酶枯草溶菌素9（PCSK9）讓處方藥Solvaldi看起來更便宜。實實在在的死亡率數(shù)據(jù)，使醫(yī)生希望將膽固醇降到最低水平，而只有PCSK9能夠?qū)崿F(xiàn)這一效果。此外，患者認(rèn)為每周一次注射比每天服用藥片更加方便。每周一次注射成功保證了患者遵從醫(yī)囑，這將帶來給藥策略的更多創(chuàng)新，減少患者忘記吃藥的風(fēng)險。

雇主開始重視醫(yī)療保健成本，將其與差旅費用同等對待。雇主會強制規(guī)定首選差旅合作伙伴和每日出差費用補貼，同樣，他們也將更積極地制定政策來管理醫(yī)療保健成本。大公司可以選擇員工就醫(yī)的醫(yī)生和醫(yī)院，要求員工在接受高成本醫(yī)療項目或治療之前提供第二種治療意見，在員工前往急診室之前建議進(jìn)行遠(yuǎn)程醫(yī)療，或者要求使用在線工具管理其身體狀況和實際支出費用。

我們不是預(yù)言家。這些預(yù)測在2016年能否實現(xiàn)，且讓我們拭目以待。（財富中文網(wǎng)）

本文作者鮑勃?柯歇爾和布萊恩?羅伯茨為風(fēng)險投資公司Venrock的合伙人，該公司致力于尋找醫(yī)療領(lǐng)域的投資機(jī)會。

譯者：劉進(jìn)龍/汪皓

審校：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 “l(fā)aws 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.