Health Reform, Disease Management, Patient Centered Medical Home and Health Insurance Preditions for 2010
Posted Jan 03 2010 2:15pm
The Disease Management Care Blog is really looking forward to 2010. And why not? Fergie’s ubiquitous media presence is only bound to grow, Washington’s work of fixing all that ails us has only just begun and the DMCB hasn’t made any predictions yet. Well, at least we don’t have to wait for the predictions, because they have arrived. Concocted with a witches’s brew of post-party cogeners, caffeine, ibuprofen and tomato juice, the crystal-gazing and prophesying DMCB offers up these horseshoes of the future, because close is good enough.
Without further ado: Here are the DMCB Ten Predictions for 2010......
1. Things are not going to change much. What you say? After the continuous cacophony of talking heads, political duct tape and late night votes, it’s going to be the same old same old? Alas, the parallel with most first-time acts of, er….intimacy will be uncanny: after so much… anticipation, so much… passion, the first insight afterward will be ‘is THAT all there is to it?’ When the sun goes up, insurance rates will increase, busts for Medicare fraud with continue, the academic elite will continue to publish clueless articles dealing with more and more about less and less and the number of uninsured will remain stubbornly high.
2. The battle has only just begun. Whatever bill gets passed, look forward to continuing mortal combat over the regulations that shape the real authority when it comes to the Fed’s foray into its new vistas of health care. Most of us will miss it though, thanks to the news spotlight moving on to really important stuff, like the yet-to-be-discovered foibles of other sports stars and whether Jack Bauer’s bone marrow transplant really cured his Prion Disease.
3. The market has decided. Disease management will continue to thrive in its niche. Or rather multiple niches, offering a cafeteria-style suite of low cost and mostly remote care management, prevention and wellness offerings for commercial insurers and self-insured companies. Prevention and wellness will lead the way because most insurers and employers want it but few know how to deliver it. They already have the disease management and will want to keep it.
4. The growth of registries as a source of new medical knowledge. Sure, the academiverse will continue its infinite expansionism thanks to Federal funding bloat, but the rise of terrabyte servers containing all (and the DMCB means all) demographic, claims and medical data will enable startling insights about correlations that were impossible last year and will become routine the next year.
5. The line between insuring and providing will continue to blur. Insurers will provide care services that could be done by the providers in their networks, such as case management and home monitoring. In the meantime, providers will assume partial levels of risk that put them on the financial hook if claims expense exceeds target thresholds.
6. The advent of PCMH Ver 2.0 or rather Ver 2.a-z. The PCMH will remain more of a concept than any implementable or operational model of care. As the return-on-investment bloom comes off this rose in the many national pilots, its architects will appropriately scramble to tweak the model, perhaps by adopting some of the lessons from disease management. In the meantime, insurers will continue to be simultaneously pressured and stymied in their efforts to create a uniform benefit that includes a ‘PCMH.’
7. Social media will expand. Docs will ‘tweet’ each other in hospitals, insurers will push all sorts of web-enabled messaging and the disease management industry will find ever novel ways to combine industrial psychology with cell phone communications.
8. Little to no insurer consolidation. Barring the usual short-term hiccups, the fact that it will be a crime to not buy what the health insurers are selling will give all insurers some breathing room. For now. In the meantime, the health insurers will stick to their knitting: no new lines of business.
9. Republican allegations of the unconstitutionality of health reform bill will have legs. Speaking of which, the DMCB suspects there may be an outside chance that the courts will get in the way of a bill that requires U.S. citizens to buy insurance. Never mind this article in the oppositionally minded Wall Street Journal. The DMCB wouldn't have paid attention if the Manager’s Amendment didn't curiously have a lot of lot of language (starting on page 67) defending the constitutionality of the bill. Doth it protest too much?
10. The Electronic Health Record (EHR) will continue to disappoint. This one is easy, especially now that the same folks that brought us TARP, mortgage relief and undie bombs are involved.