2007 will be another challenging year for health care providers. We have a system of care in our country with which no one is happy. Misaligned incentives and flawed economic strategies have crippled our well-meaning system. So where are we going in 2007? I dont have a crystal ball, but like many others, I have an opinion. Here is what I see as we look ahead.
No State Left Behind
As the federal government stalls under a lame duck congress, the weight of the uninsured is falling on our states. The timing is perfect for universal health care coverage initiatives. Massachusetts will require the state’s 6.4 million residentsincluding the 550,000 uninsuredto obtain health care coverage by July 1, 2007, and their new law will subsidize premiums for people earning below 300 percent of the federal poverty level. The Vermont Legislature in May created a comprehensive health insurance plan for uninsured residents under which the state provides premium assistance to lower-income individuals to keep premiums low. And the state of Utah is using a Medicaid waiver to provide primary care and preventive services to low-income adults who otherwise would lack health insurance.
Universal coverage is an option being seriously considered by virtually every state. Why? Because they are reacting to 46 million uninsured in our country and the reality of $1,000/month premiums for those fortunate enough to have private coverage. Reactive solutions are symptom-focused and fail to address system flaws. But this one is gaining a great deal of momentum.
The “Big Boys” Make the Plunge
IBM recently joined the myriad of healthcare technology vendors with plans in the coming year to develop systems to overhaul medical payments by using small personal devices to trigger financial transactions (Smart HealthCare Payment Systems) and will make the leap into the word of electronic medical records. The timing is good. 2007 will be a breakout year for physician adoption of electronic health records. The stars have aligned and the big boys are seeing dollar signs. Microsoft has finally rolled out the Vista operating system and freed up some intellectual resources. In addition, we will see more general acceptance by physicians of decision support databases that will facilitate evidence-based medical decision making.
Employer-Driven Health Plans
If providers wont invest in health care, some employers say they will. Intel, Wal-Mart, and British Petroleum are creating a joint effort to provide their employees with portable electronic health records that they hope to link with records from hospitals and pharmacies. These three companies could be joined by several others in a CDC co-sponsored project intended to reduce medical errors and improve quality in a transparent environment that stresses performance data. Toyota is taking a different approach by building a health clinic for employees and dependents in its new factory in San Antonio. They will go a step farther than Wal-Mart and offer medical care, dental care, eye care and physical therapy services in addition to technology infrastructure.
The Medical Home Model for Primary Care
We have a daunting task before us. How do we provide high quality care to our aging population composed of chronically ill seniors with multiple and often complex medical conditions? The answer derives from the concept that medicine is now a team sport with primary care physicians serving as captains. Access to primary care in the form of a “medical home” is a concept essential to success. In addition to expertise in the chronic care model, these physicians will require the efficiencies that can only come from a systems approach supported by technology infrastructure.
Outcomes-Based Competition
Precursors for this concept aboundpatient centered care, transparency, pay-for-performance, consumer-driven care and high performance networks. Through the work of groups like the Commonwealth Fund and thought-provoking books like Redefining HealthCare (by Michael Porter and Elizabeth Olmsted Teisberg), the next year will see more movement toward outcome-based competition. This is where we need to go for lots of reasons and our patients will provide the catalyst for this change as information about cost and quality becomes more available to them and more reliable. Physicians that embrace this concept now will reap the benefits while others are scrambling to catch up.
Hospitals Become Major Employers of Physician Providers
Hospitals are back in the physician employment business. This time, I think many of them will succeed. On the new list are not just primary care providers, but niche specialists (e.g., wound care, stroke centers) that support important hospital services. New physicians in training are being told that they can not be successful at starting and maintaining their own business. Most are looking for an employer that has the cash flow to support start-up and weather the lean times that may occur. The hospitals are getting the help they need from companies skilled in revenue cycle management and physician office systems. Early signs of success are encouraging.
The coming year will offer great opportunity for those who embrace change, create efficiencies, successfully implement technology and differentiate themselves based on quality. The rest will continue to swim as hard as they can against the rip current of “this is how we have always done it.” Sometimes it is not safe to go into the water.
