15 Big Health Care Business Questions for 2009 and beyond by Clive Riddle

by Clive Riddle

The impact of reform, recession, technology and emerging initiatives

Here’s a list of 15 questions to ask as we start to ponder the upcoming new year which will close out this decade:

1. Reform: What final health care reform package will emerge from the new administration and Congress, what will be the timing, and what portions of it will get adopted, given the current recession/financial crisis?


2. Regulation: Will significantly increased regulation ensue, with the compliance environment become even more stringent?


3. Medicare Advantage: Assuming Medicare Advantage health plan compensation is further targeted, will plans accelerate mass market withdrawals as they did prior to the MMA increases?


4. Consumer Driven Plans: Will the Democratic congress and the new administration diminish the viability of account based consumer driven health plans?


5. Patient Collections: How deep will be the impact of provider collection problems with higher consumer cost sharing in the current financial climate, and will there be any new initiatives from the hospital industry or other provider in response?


6. Patient Deferral of Care: In a recession environment, will consumers further defer and adjust their health care utilization and spending, even at long term detriment to their health?


7. Funding Wellness: Will immediate health benefit cost pressures trigger reduced support for initiatives that require longer term ROI, such as wellness incentives?


8. Tighter Managed Care: Will health benefit cost pressures fuel a demand and acceptance for a return to more stringent managed care delivery and care management?


9. Payment Reform: How widespread will provider payment reform initiatives evolve, advance and be adopted?


10. Medical Homes: To what degree will medical homes take hold, and how different vs. standardized will medical home initiatives evolve?


11. Fights over the Shrinking Pie: Will specialty physicians associations organize to more actively combat medical home, p4p and other payment reform initiatives if they are perceived as realigning distribution of physician compensation more towards primary care or further reducing income?


12. Investment Income: How deep will the ultimate impact of reduced investment income be upon health plans and health care institutions, and will it cause fundamental changes in investment portfolios, rate increases or reduced staffing or services?


13. Mergers and Acquisitions: Will the fallout of financial pressures cause an acceleration in Mergers and Acquisitions in the various health care industry components, or will tighter financial markets and conditions combined with increased regulatory scrutiny dampen the M&A environment?


14. EHR spending conundrum: A conundrum exists over the need for massive infrastructure and conversion spending on EHR initiatives and related issues such as ICD-10 coding in order to make the health care system more efficient, versus the immediate need to reduce cost pressures in the current financial climate: So will these initiatives lose or gain momentum?


15. Health Portals: Will one or more consumer health portals/web personal health records, such as Microsoft’s Healthvault or GoogleHealth emerge to achieve the same level of consumer significance as online banking/bill payments or social media such as Myspace/Facebook?

So what questions can you add to the list for 2009?