As we near the end of the year, it is again time to go to the crystal ball and issue predictions for what the year 2020 holds in store for health care. This year, I consulted three well-known Venice Beach astrologers, two reputed Chakra healers, and an old Ouija board to arrive at 10 predictions that have a 50/50 chance of being correct.

In all seriousness, here is how I see the dialog around our nation’s health care system evolving in 2020.

1) The push to deliver home-based care will continue. An under-appreciated driver of costs in U.S. health care is the price of hospitalization. The average hospital bed costs more than $2,000 a day, and in many areas of the country more than $3,000. This big price tag, combined with enabling technologies and evolving patient preferences, is creating pressure for health care delivery organizations and health plans to think differently about how and where care is delivered. Home-based primary care, urgent care, palliative care, and even hospital-at-home care will continue to grow in popularity for patients. Meanwhile, it will get a mixed reception from the people who deliver care; while they may value the intimacy afforded by home-based care, they may not appreciate the windshield time and the relative inefficiency of traveling to homes instead of working out of clinics.

2) The balance of power will begin to shift from hospital systems back to physician groups. All around the country, physician groups who face acquisition by hospital systems are looking for an alternative. One of the most promising is being offered by Aledade, the venture-backed company that organizes private physician groups into accountable care organizations (ACOs). Likewise, within specific specialties, such as oncology and cardiology, private equity companies are beginning to roll up provider groups to drive performance, negotiate more favorable contracts, and leverage purchasing power. Companies like One Oncology—an emerging oncology roll-up—will grow in number as physicians seek ways to remain independent of hospital systems. Of course, as markets evolve, it remains a distinct possibility that even equity-backed physician groups will eventually end up acquired by large hospital systems.

3) Drug pricing will continue to be a front-page issue; at the same time, pharmaceutical innovation will also dominate headlines. We are entering a phase where drug prices will continue to draw negative attention, but that attention will be balanced by the breathtaking innovation coming from biotechnology and pharmaceutical companies. When I was a medical student, cystic fibrosis would lead to certain death for patients in their 20s or 30s—even with intensive management. Today, a series of drugs from Vertex Pharmaceuticals—yes, expensive drugs—has transformed cystic fibrosis from a fatal disease into a chronic disease. As these breakthroughs like these multiply, expect the national dialog to shift focus from the high cost of drugs to finding new and different ways to pay for them in order to expand access to the most innovative products.