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The Unintended? Consequences of Healthcare Reform – Opinion From Dr. Crounse at Microsoft

Posted Mar 24 2010 9:19pm

I think Dr. Crounse has some pretty good observations on where healthcare is headed and the word “change” is upon us.  He reiterates on the use of technology as a image means of survival, which is nothing new and many including myself have said the same thing in perhaps different words.  Below are a few of the highlights from his post.  Also mentioned is the growth of e-Health with the use of telehealth, kiosks, and telemedicine.  If you regularly read his column and watch the monthly series he produces called “Health Tech Today” you can see some of the latest technology being used both here in the US and in other countries.

One other point made and I have covered a lot of the same type of articles here is the mention of who is providing the venture capital for many of the eHealth ventures, it is the insurance companies.  The link below is one example and today United Healthcare is generating more profits from their “technology” areas than they do selling policies.  Those orange tablets from Phreesia that you may see being used at your doctor’s office are one example of where venture capital money from Blue Cross/Blue Shield goes. 

Basically the cost of preventive and normal physician office visits is being shifted back to the patient and a good reason to get a personal health record started as providers are becoming more mobile than ever with working in more than one location sometimes.  As Dr. Crounse suggests, if you don’t or can’t pay more than what is allowed, chances are you will be seeing a nurse and not a doctor.  Technology is impacting every area of our lives and the use of software for better health decisions is growing, and if no other good reason can come to mind,  it can’t reside in our heads or on reams of paper as we might either forget or spend wasted hours looking for information when a computer and software does it in a few seconds.  Healthcare needs business intelligence analytics and I remember just 3-4 years ago bringing up this conversation with some local hospitals and they thought I was crazy, and when you look today it’s everywhere and part of the system of survival.  

My own personal opinion on how we ended up here goes back to the creation of Medicare Part D arrived from completely outsourcing without the US government years back updating and creating their own infrastructure, so now we have no back up within the government at present to facilitate running a similar program for benefits and care, although it’s never too late to start planning and creating one. A good “tech geek” will always reiterate the need for back up, no matter where you are in the IT business, and to me this is especially true with Health IT.  There will always be a mix of both government and private infrastructures and the key for the success is balance and I hope someday we can reach the ultimate balance that works for all. 

I do ponder what would have happened if Congress would have created a “private” or “public” plan; would things have played out a little differently?  BD 

“While the Republicans and Democrats duke it out over the next several months one thing is clear, healthcare in America (and I should add around the world) is changing.  So what are the consequences of health reform?  And are these intended or unintended consequences?  Here are my thoughts on some of the trends we can expect to see in the years ahead.

Almost every survey I’ve come across lately suggests that large numbers of docs say they will soon throw in the towel on clinical practice. While I image think these numbers are exaggerated, I’ve noticed a surprising increase in email traffic from docs asking about jobs at Microsoft or wanting to pick my brain about alternatives to patient care.  Usually these are primary care physicians who have experienced a significant drop in income the past few years, but I’m perplexed by the number of specialists who’ve also contacted me.  Most pundits agree that the future of primary care is likely to fall into the hands of physician extenders such as nurses and nurse practitioners.  That’s probably OK since very few people will be dedicated enough to endure 7 or 8 years of very expensive, post graduate education for a wage that barely breaks six figures.

If you really want a primary care physician, be prepared to join a concierge practice or at the very least get your medical care from a large multi-specialty clinic where primary care is subsidized by specialists.  I expect to see a robust climate for a wide variety of concierge, monthly membership fee structured practices like MD2 , MDVIP , HelloHealth , etc.  If you are unwilling to pay more than your health plan or the government will provide, then you had better get used to seeing a nurse.  Or, you may decide to get your primary care from a retail clinic in your local pharmacy or big box store.  Either way, you’ll still be seeing a nurse.

At Microsoft we are working with a number of hospitals and healthcare provider organizations around the world on solutions that help them manage the patient experience end to end.   New rules penalize hospitals for patients that get readmitted within 30 days of discharge.  There is a huge incentive to keep these people out of the hospital by doing a better job of monitoring them at home or elsewhere and intervening before they end up back in the emergency room.  Chronic condition management   solutions rely on powerful data analytics that can help predict who is most at risk for readmission, and also on relationship management software that follows the patient from discharge to home and maintains regular, often automated contact for appointment reminders, medication prompts, symptom surveys, and patient and family education.”

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