There’s no doubt that despite my thoughts that Obama wouldn’t (and shouldn’t) have pushed health reform in 2009, it was a very big year for health care. Death panels, public options et al—one hundred thousand visits to THCB in August don’t lie.
So what should you look for next?
- The finish is the start: It looks like some version of the Senate bill will be a done deal by sometime late January. That means that there’s about two years of health care industry players figuring out what it all means. The biggest two questions are; what will the types of plan sold in the exchanges look like? (high deductible with some preventive care thrown in is most likely), and what will the cuts and changes in Medicare payment actually look like in practice? (More of the same or real re-alignment around some kind of bundling). All these changes need reactions from the incumbents to reorganize around the new revenue streams.
- The economy and the politics: Sometime around now, the Bush recession is becoming the Obama slump. Despite the Tea Party/Palin/Beck implosion of the Republicans these last 14 months, we’re almost certainly going to see Democratic losses in the Senate and House in 2010. Whether those losses are bad enough to cost Democrats control of Congress depends on whether the end of the recession becomes a weak recovery or Japan in the 1990s. Given the unremitting support from Republicans for policies any logical business-minded group logically should oppose in health care, and how much the current bill leaves undone in future changes to Medicare and more, the 2010 elections really matter.
- Complications and opportunities in the IT rollout. I have great respect for the good folks at ONC who have done wonders in a relatively short time. I also think that the “new” focus on interoperability and patient access to data is a very important part of meaningful use. But it’s clear that we are not going to simply see mass adoption of the mainstream EMR vendors’ products. Instead physician organizations are also going to dip their toe in SaaS based Health 2.0 tools, or remain too confused to actually do anything before 2012 or 2013. Meanwhile, ONC initiatives (like Beacon and Extension Centers) are going to be very important in this transformation. And don’t forget, most private sector health care players aren’t very used to working with the government in the manner of their defense and agriculture counterparts.
- Patients will continue to get rowdy. 2009 was the year of patients demanding access to their data and moving from meeting online to actually starting to see (and even exchange) their data. A combination of new “unplatforms” (iSlate?), better data exchange, technologies for social organization (Facebook, Twitter, Foursquare), will continue to force its way into health care. We’ll of course be covering this in Health 2.0 over the year (including in a brand new report coming out this week). But the distance between a patient’s advocate disputing access to their records and appearances on NPR (and in legislation) is getting shorter and shorter all the time. Health care providers and organizations are just starting to wake up to this.
- An evolving discussion about quality of care, especially concerning dying. Ten years after To Err is Human argument about quality of care is now public. What’s coming up next is a discussion about who should be in control, and what should happen, with patients who are much closer to death. It’s unclear as to whether throwing many more medical services at very, very ill people does them any good. It’s clear that many many people think that we do too much, not too little. There’s been little discussion in the court of public opinion about this issue. But as more baby boomers see it happen to their parents expect the “automatic” setting in ICUs across the country to be challenged much more.
These are just some of the many issues we’ll be following on THCB. And soon (no promises exactly when) we’ll be doing it in a brand new format. Welcome to 2010. For you health care junkies it’ll be even more fun.