This is the forecast that’ll be sent out today for FierceHealthcare for 2006, not my only forecast for the year but the only one I’m committing to posterity thus far. You could of course always look at what I said would happen in 2005! I’m not sure that too much has changed, but I was right to say that Chelsea would win the English Premier league, and that forecast is easily repeated!
Here are the top 5 trends to watch in 2006, along with some wild cards.
1) NHIN, RHIOs, and all that.
For those of you keeping score of activity in the National Health Information Infrastructure (with its plethora of accompanying acronyms): pilot projects have now been funded, early standards have been announced, and Brailer’s office has announced that it will attempt to properly count what the adoption levels of EMR, CPOE et al actually are. But this is the year that the discussions behind the 100-odd RHIOs will bear fruit or like the CHIN movement will they die on the vine?
Can we develop data exchange standards so that records and information can be exchanged? Almost certainly? Can we create a messaging infrastructure that allows open standards so that system A can communicate with system B to find patient Y’s data? Maybe, and with email and TCP/IP we at least know what that infrastructure might look like. Can we develop a business case for health care organizations to share data with each other? That remains most uncertain.
The concept of open and secure data exchange bears great promise for health care. If the NHIN is to be successful there must be some real "wins" from the emerging RHIOs and the time for that is this year.
2) How Medicare Part D, and health care plays out in an election year.
It will escape no one’s attention that 2006 is an election year,. Many hopeful Democrats are looking at the lousy 2005 "enjoyed" by the Bush Administration and have decided that 2006 is shaping up to be the reverse of 1994 all over again. While it’s hard to imagine the news for Republicans staying as bad as it’s been, there are at least three areas where health care will play into politics this year. The most obvious is the roll-out of Medicare Part D’s drug coverage, about which there has been much controversy. It may go well, but angry seniors are always a political force, and as they are faced with the prospect of signing up by May or seeing premiums increase, the pressure will increase.
The early news also suggests that employees who are "empowered" into high-deductible health plans are not that happy. And the number being moved into these plans will increase fast in 2006. Meanwhile, employers (led by GM) are getting increasingly vocal about looking for government help to solve the cost crisis. Finally middle-class insecurity about health insurance is also a potent political force.
It’s hard to say how much these factors will influence this coming election, but poll after poll shows Democrats doing better on health care issues. Health care organizations may wake up in early November to find that health policy is no longer more of the same. So they must start planning for that possibility
3) New technologies changing health care processes
FierceHealthcare will be continuing to track the evolution of new technologies as they are adopted by health care organizations. Here are a few that while not adopted much yet in America’s hospitals and clinics will see a great deal more prominence in 2006.
> Tracking technologies. A mix of active RFID, Wi-Fi, UWB and infra-red technologies are for the first time enabling cost-effective tracking of people and equipment in hospitals. More hospitals will adopt these technologies in the coming year, and they’ll find that it will not only help them save money on equipment losses, but will also change their fundamental work processes.
> ePrescribing has now been connected to pharmacies and formulary information by the Surescripts and RxHub networks. They are also available as standalone applications that a physician can adopt without needing to buy a full EMR. And Medicare is pushing ePrescribing as part of its Part D initiative. Expect to see more physicians coming on board in the next year.
> Remote monitoring has been gaining force for a while, notably in the ICU, with remote monitoring of patients by physicians down the block or across the world becoming popular. As the leader in this field, VISICU, prepares to go public, expect this trend to grow and spread to less intensive settings.
> Health plan PHR and CRM. To say that health plans are not known for their excellence in customer service is putting it mildly. However 2005 saw some of the first steps by major insurers to integrate what they know about patients’ clinical information with their administrative activity. Using technology from WebMD on an ASP basis, Empire BCBS has led the way here putting its members’ patient records online. It looks like the rest of the Wellpoint organization (which bought Empire last year) will adopt the technology this year. That will force competitors like United to follow suit.
> Clinical/Med-tech integration? Most diagnostic and imaging devices are now putting out digital signals, and more and more hospitals have clinical data repositories that can handle those files. The obvious center of activity is in the PACS world, but this overall trend is one that has seen GE, Siemens, Philips and other imaging powerhouses make moves into hospital information systems. The two sides of the technology "house" — the bio-medical and the IT shop are getting closer — and managing that merger is a challenge for hospitals as well as vendors
4 ) The evolution of consumer-directed health plans (CDHP)
There’s been much fuss about the HSA, with by some estimates over 1 million accounts opened this year. But the majority of those have been opened by people who already had high-deducible plans. But as companies like UnitedHealth Group, Aetna and Cigna push these consumer-directed plans to their mainstream employer clients, they are going to face two challenges. The first will be to educate Americans about how to evaluate the health care services they are asking for and receiving. The second will be to deal with the care for those sick people who have blown through the deductible, who account for the vast majority of health care costs.
Early indications are that plans will try to combine CDHPs with old style managed care techniques of restricting access to specialists and differential pricing based on network tiers. It will be interesting to see how far this goes, and more particularly what the reaction from providers and patients will be a decade after the "backlash against managed care".
5) Pay-for-Performance, and how Medicare pays for care
Pay for performance (P4P) is the latest panacea that’s supposed to overcome the cost problem, improve quality and remove practice variation. Medicare has leapt on this, following the examples of pilots in California and Massachusetts. It’s already rewarding hospitals (albeit only a tiny amount) for reporting quality information. This year we’ll see with a full year of reporting the impact that has had on hospital quality. A similar program for nursing homes had good success so far.
Of course the big issue behind all this is how physicians and hospitals will demonstrate quality, and how they will be paid extra for doing so….or paid less for failing to do so. While Medicare is taking a softly, softly approach so far, there’s at least one bill in Congress demanding the introduction of pay-for-performance for the whole of Medicare Part B. However, there are also some early indications that P4P may not be having as big effect on physician behavior as its backers would like.
Considering we’re talking about how health care gets paid for in America, this is definitely one to watch.
Some WildCards that are unlikely but would have a big impact:
> A serious bird-flu epidemic breaks out and spreads world-wide> Significant numbers of physicians stop taking Medicare after a fee cut> Bankruptcy of major for-profit hospital system> Malicious virus infects significant number of medical devices causing patient deaths due to inaccurate readings> FDA regulates health information software> Outbreak of hospital-centered bacterial infection like MSRA becomes major factor in North America> Uninsurance and cost concerns put single payer in center of political discussion and Democrats adopt it for 2008. (Remember Harris Wofford?)