Ten Predictions for 2011

The Disease Management Care Blog was interviewed today on blogradio by Gregg Masters of ACOWatch. If you missed it, the podcast is linked below. The audio can be accessed by clicking the "play" arrow button toward the left side of the badge. Think of it as informative background talk complimenting that extra cup of caffeine as you clean out your email inbox.

In the podcast, the DMCB makes a brazen prediction:

1. CMS will delay the targeted January 1, 2012 start date for Accountable Care Organizations. Note that none of the proposed enabling regulations have been released as of this writing. The DMCB calculates that the a) time required by CMS to solicit, digest and respond to the follow-on public commentary to the proposed rules, plus b) the the inability of most ACO wannabes to plan and organize in the time remaining, makes the current ten month window a daunting proposition. Toss in hostile Congressional meddling as well as growing uncertainty over the fate of the ACA and the deadline has now become practically impossible.

While it is at it, the prescient DMCB has some other audacious predictions for 2011:

2. While healthcare-based social media will continue to expand, its full potential as a catalyst of personalized patient behavior change will be hampered not only by the uncertainty imposed by the privacy restrictions of HIPAA, but "no you can't" Homeland Security concerns over Twitter encryption.

3. Donald Berwick will be confirmed by the U.S. Senate as Administrator for CMS. Republicans will use Dr. Berwick as the poster boy for their newfound - if cynically opportunistic - bipartisanship because a) it's just a matter of time until the Administrator's independent streak begins to vex the Obama Administration, b) the shrewdly targeted use of CMS' grants will curry favor with key individual Senators and c) health care reform is enough of a target rich environment without picking on Dr. Berwick.

4. Reality will not only continue to intrude into the naive enthusiasm over the electronic health record but rear its ugly head in the emerging evaluations of the Patient Centered Medical Home. Both will disappoint when stakeholders seek "proof" of increased quality and lower costs.

5. Speaking of health care costs, they will continue to go up a rate that exceeds the general rate of inflation. That's because, despite health reform, the twin inconvenient truths of our advancing age and voracious appetite for technology refuse to go away. That being said, opportunists will continue to blame the health insurance industry.

6. The population health management (PHM) née disease management industry will continue to hold its own thanks to the grudging acceptance of nurse-based care management as part of the suite of services required to manage insurance risk. Vendors will also have the advantage of being able to couple or decouple PHM with other sophisticated wellness, prevention and health promotion programs.

7. The term "disease management", despite the DMCB's vast supportive readership, will not be resurrected in policy parlance. It will, however, also refuse to die.

8. A political stalemate will prevail as socially-minded progressives and market-minded conservatives battle for the hearts and minds of the body politic. Conflicting public opinion surveys, a divided government and the slow march of the ACA through the appeals process will not lead to any winners or losers. Deciding that will have to wait until 2012.

9. Ours is a time of "Black Swans." Despite our scientific modernism, our worldwide interconnectedness has ironically made us ever more vulnerable to unknown unknowns like pandemics (H1N1), economic dislocations (mortgage meltdowns) and political revolutions (Egypt). Compounding our budgetary travails, another **Big Event** is going to further distract the Administration and Congress from taking constructive action on health reform.

10. The Disease Management Care Blog will not achieve the popularity or the revenue potential of the Huffington Post, leading to further DMCB spousal skepticism over the merits of this whole blogging thingy. She will be unimpressed by the hundreds of thousands of hits, the thousands of return readers, the growing number of links to media outlets such as New York Times, The Washington Post and the Wall Street Journal and vast blogging income amounting to the tens of dollars.

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Health Reform, Disease Management, Patient Centered Medical Home and Health Insurance Preditions for 2010

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.

A Review of the Disease Management Blog's Predictions for 2009: How Did It Do?

The Disease Management Care Blog is not above the blogosphere's emerging tradition of marking the end of an annum with bloggy predictions. Unlike many other corners of the blogmos however, the DMCB is also willing to publicly review its earlier predictions and conduct a blogopsy. Just how did the DMCB do, or rather, how much did the DMCB readers benefit from it's blognostications?

Here's the post. In it, the hopefully prescient DMCB said:

The death of the Disease Management Business Model will turn out to be greatly exaggerated.

The DMCB sure got that right. All of the big disease management organizations, save one, are still standing and, for example, looking healthy. The one bankruptcy was not due to any market forces but rather, some strange dysfunction of the Federal government. Who could have predicted that? Lesson learned.

The first reports from the multiple insurer sponsored pilots on the patient centered medical home (PCMH) will be a mix of reality-checking reports that show modest gains in quality and disappointing lack of savings, failures, lack of uptake among many of the non-entrepreneurial primary care sites.

Once again, the DMCB got it right with its doubts over the business case of the current generation of the Ver 1.0 PCMH. There are reports of quality gains, but no proof of savings and no spontaneous uptake outside of money-sweetened pilots or collaboratives, especially among small physician owned practices. In fact, the DMCB wonders if the lack of any peer-reviewed publications showing definitive savings doesn't mean the research is pending, but that the studies are negative and subject to publication bias.

The rise of Disease Management Lite (defined by the DMCB as any remote intervention that doesn’t principally rely on expensive nurses).

Well, while the DMCB predicted a groundswell, this particular trend turned out to be more of a wavelet. However, the future for this still looks bright. For example, iPhone aps.

The Medicare Medical Home Demonstration will lumber along.

The DMCB was too generous. While others expected great things, it lumbered along, alright.... right into a corner where it curled up and died.

Blogs will become even more important in the shaping of health care policy.

What better example than the President having a phone conference involving the big liberal bloggers to whip up support for health reform?

Early reports of health care reform will be tempered by vexing unhappiness over lack of progress for the middle class. Testy impatience will drive a political/policy mandate to include all that looks good, including disease management (and electronic health records).

The DMCB says bingo! Unfortunately, this was powered by the economy unpredictably tanking and allowing too many in the middle class to lose their employer-based insurance. The rest of us have come to realize how close we were to having to personally pay $1500 a month for insufficient health insurance. What the DMCB missed was how subsequent reform would include all that looks good, fair or resembling a kitchen sink in demos and pilots.

Lacking any credible short term fixes, primary care shortages will spike.

Well, it didn't quite spike, but interest in the topic certainly did. Folks have come to realize that health insurance reform won't help access to primary care.

Not 100% accurate, but pretty good. The DMCB takes a lesson from the President and awards itself a B plus.

Next posting: the DMCB's predictions for 2010.

In the meantime, here's wishing you a Happy and Healthy New Year.