Matthew Holt

The five things to pay attention to in 2010

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?

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.

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A. Lanine ProEffie BerryHealthcare Job Fair and ExpoNathan J. IsbellSong Recent comment authors
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A. Lanine Pro
Guest

It was only a few weeks ago that this was a big talking point on the left. If insurance didn’t make a difference, no one would care if they didn’t have it. No one would bother trying to insure everyone.

Effie Berry
Guest

Hi, great post there! I like it very much. This is my fav part: 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… Read more »

Healthcare Job Fair and Expo
Guest

Healthcare IT will definitely experience a growth in 2010, visit our Healthcare event page for job opportunities in healthcare IT.
Miami, FL

Nate
Guest
Nate

jd, wouldn’t a bill addressing cost which would lower insurance premium which would increase percentage of those insured have been the way to go? Instead they passed a bill that will explode cost and make it even more unaffordable. Nothing in the current bill is about fixing access or cost and 100% about taking control. Why do you beleive anything positive can be built on this? Last year Medicare increased at almost twice the rate of private insurance, this will continue until Medicare passes more cost onto private insurance at which time the left will again crow about how efficient… Read more »

Nathan J. Isbell
Guest

Give unto Caesar what is Caesar’s. Give unto God, that which belongs to God.
It’s a simple fix. All we have to do is re-instate birthrights. There are a lot more dead people than live. If they set up foundations before they die, they will create a propagating, everlasting, taxable income stream that will pay for socialized health care, create jobs and rebuild social security. Not to mention the heirs will receive Legacy checks until they die. Go figure, God is always the answer.
http://godslegacytrust.blogspot.com

Peter
Guest
Peter

jh, I gave up on health insurance when Blue Cross/Blue Shield of NC fought me for 6 mths on a $1500 claim (my first in 6 years of being covered by them) that they eventually paid after I contacted the State dept. of insurance. They did not appreciate that I was one of their few premium payers who did not overuse the system and didn’t go to the doc for every little sniffle and also looked after my health with exercise and good eating habits – I was a money maker for them. After that experience and their 6% to… Read more »

Song
Guest
Song

Good point on the Health IT opportunities and challenges brought to the forefront by the EHR Meaningful Use incentives. I also wrote about this same topic. I think SaaS will indeed become the name of the game, especially for smaller medical practices which are still still on the sidelines as far as EHR/EMR is concerned.

jd
Guest
jd

Peter, Thanks for the vote of confidence, and I’ve always looked forward to your posts as well. It’s certainly true that insurance is only valued as a means to an end, or ends. These ends have been primarily financial (protection from catastrophic costs, smoothing of costs to make them more budgetable, etc.), but the effect of the financial benefits is to improve access to care, compared to the uninsured. I agree this round of health care reform focused too much on insurance. Some of it was to demagogue private insurance as a convenient whipping boy to try to rally the… Read more »

jh
Guest
jh

Today we had a benefits meeting at work. My cost for a family plan would set me back a little over $600.00/month…and I don’t smoke! (Smokers have higher rates) And, allegedly, my company is picking up 50% of the total premium. Needless to say, it is completely unaffordable. People like myself who just want to raise their children, enjoy the fruits of our labors, and play by the rules get costed out of what should be available to everyone who works and contribute to their communities. What I don’t understand is why so expensive? Something that should really be a… Read more »

Peter
Guest
Peter

jd, first you are one of my most respected posters and I do not forget that you support more government control of healhcare. But people don’t really want access to insurance, they want access to healthcare. In other industrialized countries they get access to healthcare and the private insurance portion (if any) is secondary to needed care. We could “easily” give people the access without the private insurance. By concentrating on insurance we miss the point entirely. Access to care with insurance is certainly better than without it, but insurance is a business that will only allow access if you… Read more »

Dr. Tom Bibey
Guest

jd, Enjoyed your comment. I’ll be the first to tell you I don’t know anything about money or care about it either, but I do know this: The day we gave up and were acquired by a corporate outfit our rates jumped up 30%. The patient was still out the same co-pay amount, but the insurance companies paid more to our new outfit. This was not because we delivered any better care; we were the same docs we always were. It was only to pay for the machinery of two powerful entities who fought with each other. I never saw… Read more »

MD as HELL
Guest
MD as HELL

inchoate but ernest,
Arizona was an “in your face” action. The earlier actions were economic, as was this one. Did you have a point? They still are going to be bell weathers for not playing ball with this Obamanation.

jd
Guest
jd

Peter, I thought it was clear among the regulars here that I’m a fan of government intervention to fix the market problems in health care. The Dutch model holds the most appeal to me of existing systems, but the French model isn’t far behind and both clean the clock of our mis-organized system. Also, I like your final paragraph, but I would change “eliminates” the bulk of private insurers to “transforms” and I think you do overestimate a bit how happy most insurers are to just skim a fraction of the rising cost off the top. After all, their customers… Read more »

inchoate but earnest
Guest
inchoate but earnest

MD as HELL – clueless again. Mayo FL hasn’t accepted Medicare for 2 years, and has been non-participating in some parts of the state for over 7 years.
If you really think their AZ decision was prompted principally by reform legislation, you’re as dimwitted as RushBeckOReilly.

Nate
Guest
Nate

Peter everyone in the country has the ability to buy low cost Nate TPA instead of high cost insurance company. It is against everything America stands for to tell people you can’t spend your money “stupidly” you must buy Nate. As much as I would love the additional business that is not the country I live in nor is it one I want to live in.