Make sure to attend Reid Rasmussen's Education Track session,“Shifting Sands: Navigating Today's Coverage Gaps,” April 18 at1:30 p.m.

We're in conference season in the health care industry. I'vebeen at three in just the past two weeks—in the West, North andSouth. And I'm looking forward to the Benefits Selling Expo in FortLauderdale in April (best weather prospect of all of these).

All around the country, brokers ask where the industry is going.They want to know if other states are seeing the same changes theyare; and, of course, they want to know about the great solutionsthat are popping up elsewhere. We feel the sands shifting, and arelooking for solid footing.

Here are five trends that I believe will drive much of theindustry change in the future:

1. No End In Sight for Medical CostIncreases

Is this worthy of being prediction number one? Well, it's thedriver of most of the other trends, so it's appropriate. While thegood news is that the percentage increase is less than it was 10years ago, it's still many times the rate of inflation. And the“compounding interest” plays out every week with Americanfamilies

• 2016 individual rate increases averaged 10 percent over2015.

• 81 percent of employers will raise out-of-pocket costs withinthe next couple of years.

2. Carriers Consolidate

The power is concentrating into fewer places. While we've seensome hospital plans develop or merge with regional health plans,the real news is the shrinkage.

• The five largest health insurance companies are reducing tothree. Aetna (#3) buys Humana (#5),and Anthem (#2) absorbs Cigna(#4).

• Assurant sold off their medical insurance business lastyear.

• 22 of 23 PPACA-created co-ops lost money, and half closed. Sothat didn't create real alternatives.

3. Less Plan Options

As plan costs rise, increased mandates and compliance rules pushoff opportunities for innovative approaches to plan design. We keephoping to find them as we scout around the U.S., but too often, wesee signs of less medical plan options. For example:

• In Texas, a state that doesn't exactly embrace HMOs, BCBS of TXdropped all individual PPOs and moved everyone to their HMO.

• In Alaska, Moda Health's retreat from the market leaves only oneindividual medical plan serving the whole state.

• In a kind-of-related turn, many carriers (such asUnitedHealthcare, Humana, Cigna, and Oscar) now limit which plansthey will pay brokers to sell. This is another way to drive membersinto specific plan designs.

4. Shrinking Access to Physicians

Driven by rate increases, a common carrier response is to reducethe size of the physician network. By driving the same number ofmembers to a much smaller number of physicians and hospitals, thecarrier can negotiate much better rates. Back in the 1990s, thiswas common. Now, we see this is a growing trend in about half thestates. Another side of the access issue is that there just won'tbe enough doctors:

• The Association of American Medical Colleges latest surveyreveals that by 2025, the U.S. will be short 46,000-90,000physicians. And nothing is being done to increase the number ofmedical school graduates.

5. Pharmacy Cost Increases Skyrocket —Again

Prior to 2010, the pharmaceutical industry was the whipping-boyfor trend increases. Have you noticed the silence on this topic forthe past few years? Driven by major drugs moving to generics, Rxspending increases were low in recent years.

However, there are no more good trends in drugs turning genericon the horizon. And all we see on the horizon are amazinglyexpensive “specialty drugs.” It's what has driven prices to rise inthe past year or so. And there's no end in sight for this trend.One VP of pharmacy for a major carrier predicted, “By 2025, upto 40 percent of the medical plan cost will be drugs.”

So where does this leave us as an industry? If these are thetrends, then how should we respond? What solutions should carriersdevelop? What strategies can be used to best round out future plandesigns?