Five Trends to watch for with 2010

by Clive Riddle, December 17, 2009

As the first decade of the millennium closes, and the new year is just  a limited number of sunrises and sunsets away, the time has come to consider some major health care business trends that should deliver an increased impact for 2010 and beyond.

The big “duh” of course is the health care reform package still being tossed around in Congress, but in fact, much of the anticipated legislation won’t kick in until after 2010 anyway. So, what else is there to consider?

1. Regulation for starters. As the focus shifts from legislation, assuming the reform package finally passes in early 2010, implementing regulations will take center stage. But increased regulation won’t stop with the health benefit coverage-dominated reform package. The Obama Administration has signaled an objective to enhance oversight of health plans, particularly with programs such as Medicare Advantage, and to further crack down on fraud and abuse. And assuming a reform package that improves coverage is adopted, there will be increased pressure from most vantage points to start addressing costs via regulations. So expanded regulation should be a big trend emerging in 2010.

2. Expanding Primary Care Access will gain considerable attention. While coverage from Health Care Reform won’t fully kick in until well after 2010, the debate and discussion about who is going to treat all these people with new or enhanced coverage, and where are they going to treat them? Medical Home Development should gain ground, with altered and enhanced primary care reimbursement mechanisms that help motivate practitioners to stay or train for primary care practices and incorporate information technology and infrastructure that can handle increased patient loads. Retail clinics, while continuing to fluctuate in growth and contraction spurts, will likely serve as an increased marketplace response in urban areas. Programs to develop, train or import more primary care physicians into the pipeline will increase.

3. Provider Information Technology Readiness will grow as a concern during the year, and other stakeholders will be squeezed to help get lagging physicians to where they need to be. While vendors and health plans appear reasonably ready for ICD-10 conversion, providers in general, and medical groups in particular appear to be well behind where they need to be. While hospital and health plan EHR initiatives progress at a reasonable rate, large segments of physicians continue to lag. For health plans, hospitals, vendors and government, their own respective positions will suffer due to the state of readiness of a significant segment of physicians, particularly small practices, and these other stakeholders will undoubtedly have to commit and contribute increased resources in 2010 to help move things along.

4. Integrated Health Care Delivery will continue to expand and evolve with a greater number of regional health systems, as a strategic response to the above issue. A greater focus from all stakeholders on costs will move more systems in this direction, new health reform coverage provisions may motive them in this direction, the need to expand primary care access may force them in this direction, and the infrastructure needs of medical groups may necessitate the move in this direction.

5. Developing and Monitoring Pilot Programs will command significant attention as 2010 progresses. Reform legislation, and Obama Administration initiatives will stimulate numerous pilot programs, and various organizations and stakeholders will scramble to get in on the action. But everyone will have their eyes on the status and progress of these projects, given the implications their success or failure may bring.

Oh, and here’s wishing all of you, a happy new year, and a more prosperous decade ahead.