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Winners and losers from inevitable health reform

By | September 1, 2009, 11:19 AM PDT

Whether or not a health reform bill passes Congress, change is coming.

Insurance carriers are as anxious as the government to save money. The argument is over who might pocket the savings. (Picture from CBS News.)

The general trend is to use more computers and networks, more primary care and wellness, fewer tests and specialists. Whether you’re on Medicare, a private health insurance plan, or your employer is self-insuring these trends are now being baked into the system.

As to what that means specifically, here’s a brief run-down:

Winners

  1. Software companies — Most of the $19 billion in health IT money already approved will go to create Electronic Health Records (EHRs). This takes software. If you make this kind of software you will sell a lot of it. But you know what software makers will do best? Those offering security and audit software, thanks to the HIPAA law, whose reach is actually expanding.
  2. Networked hosting — Whether you call this Web hosting or “the cloud,” EHRs will move among doctors, payment services, and patients over networks and into large computers. People who host this data will need to follow HIPAA rules, which serve as a barrier to entry, but the same rules also protect profits.
  3. Primary Care — There is enormous demand coming for primary care of all sorts, and in time economic incentives will have to respond. There is far more demand coming for physicians to meet in time, so expect physicians’ assistants, nurse practitioners, and a host of non-traditional “coaching” professionals — diet coaches, chiropractors, foot therapists — to do well.

Losers

  1. Proprietary Systems — Growing demand means trouble for the proprietary vendors who have dominated the EHR segment in the past. Standards and interoperability are now market requirements. Those who don’t respond will disappear and their wreckage will cost standards-based companies a fortune to clean up, maintaining high prices on health IT for years to come.
  2. Radiology — One key way to save money is by reducing tests. Old CT scanners are also subjecting patients to dangerous levels of radiation. So expect pressure on the people who make the gear as well as the professionals who buy and use it. Expect old machines to be scrapped and a lot of professionals to just retire.
  3. Specialists — Market incentives for decades have pushed doctors into specialties, where more services mean more fees. But per-patient or per-outcome pricing means a lot less demand. Even if prices don’t decline revenue will, with all bills getting a lot more scrutiny. If you’re in medical school now you might want to think about changing majors.

All this is going to happen whether or not the Obama Administration passes a health care reform bill. These are trends baked into the industry, with demand for change and savings coming from big employers and the medical profession.

The size of these changes, moreover, is going to be massive. You’re talking about one-sixth of the economy. At best, limiting government involvement might slow the pace of change a little bit. Some will say this makes change more manageable. If procrastination means management maybe they are right.

But the industry winners are going to be those firms, in computing, in devices, in pharma, in insurance, and among hospitals and doctor groups, that embrace these trends and try to get ahead of them.

A tsunami is coming and only its size is yet to be determined.

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Dana Blankenhorn

About Dana Blankenhorn

Dana Blankenhorn was a contributing editor for SmartPlanet from 2009 to 2010.

Dana Blankenhorn

Dana Blankenhorn

Contributing Editor

Dana Blankenhorn has written for the Chicago Tribune, Advertising Age's "NetMarketing" supplement and founded the Interactive Age Daily for CMP Media. He holds degrees from Rice and Northwestern universities. He is based in Atlanta.

Follow him on Twitter.

Dana Blankenhorn

Dana Blankenhorn

Dana Blankenhorn has been a technology reporter since 1982, a business reporter since 1978, and a writer for as long as he can remember. His Schwab IRA has a few tech stocks in it, most notably some Intel and Applied Materials bought over 10 years ago. But the vast majority of his tiny fortune (emphasis on the word tiny) is invested in mutual funds. He presently writes for no one else but ZDNet, SmartPlanet and himself. But if you've got an opportunity let him know. If he takes the gig he"ll first add it to this disclosure page.

He writes for SmartPlanet and is not an employee of CBS.

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RE: Winners and losers from inevitable health reform
Very good insight indeed, the technology is moving non stop, but we need to somehow get the government moving on this before they are left in the sand. Devices are moving quickly and so is the software that goes with them to work with non-proprietary and some private software, but integration is the big key here.

I just wrote up the other day about CPT Codes that have been created to bill for physician time when remotely connected via Home medical devices too, and one even is just like Rosie the Robot from the Jetsons, never thought I would see Rose in my lifetime:)

http://ducknetweb.blogspot.com/2009/08/new-cpt-codes-billing-codes-for-robot.html

Healthcare as we have known it, face to face is going through some big changes and areas where our physical presence is not needed are going to see some really big technology advances, we just have to get used to using them pretty quickly.

Barbara Duck
Posted by MedicalQuack
1st Sep 2009
0 Votes
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The industry doesn't want government involvement
It's pretty clear from all the astroturfing that the industry doesn't want a bill that increases government involvement anywhere in the health care arena.

What kind of action would you recommend?
Posted by DanaBlankenhorn
3rd Sep 2009
0 Votes
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The people don't want government involvement
It's not just the industry that doesn't want government involvement. The people, as witnessed by the protests and the questions at the health care town halls, also don't want government involvement.

Sure, the government may need to keep it's dirty hands in the health care industry, but not for more than regulations. Control of the industry by government is not wanted by the majority of the people and certainly not by the industry itself.

For sure, the industry has many problems, but whenever the government gets involved in any industry, those problems become even bigger. The government is not going to solve any problems, it's just going to make them bigger and worse.

Whatever technology is needed can be done without government involvement. It's mostly a matter of the players in the industry getting together and deciding on what improvements and changes need to occur in order to make more efficient use of their resources. But, to do that, the government doesn't need to be involved other than for oversight and to make sure that regulations are not disregarded.

All in all, get the stinking government off the backs of the people and the industry. We can do much better without them.

Also, when has there been a government run agency or program that has been managed efficiently? Medicare and Medicaid are operating in the red, as is Social Security; the post office lost 7 billion dollars last year, and whatever the government has doled out to education almost always came with attached political strings, as when the unions get favoritism. The people who would be directing any government health care would very likely be political appointees. Nobody in his right mind should be wishing for that kind of nonsense. As it is, problems and all, we have in the U.S., the best health care system in the world; expensive, yes, but still the best. Why should we sacrifice the best system in the world just to bring down costs? And the costs could not be coming down at all. It's been said before and there's a lot of truth to it, that, "if you think that health care is expensive now, wait till the government takes over'. No thanks! Government control, whether total management of the system, or just the technology for managing records, is never a good idea.
Posted by adornoe
3rd Sep 2009
0 Votes
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People do want goverment health care!
If you don't believe that people want government involvement in their health care, try taking it away from a medical recipient or a veteran or even a member of Congress! And if you examine any of those systems you will find that, although they all have problems (like any large system) they are all effective, efficient, and valued by the Americans they serve. Even the members of Congress working against government offered health insurance (called the public option) use government health care. For example, Mitch McConnell leader of the Republicans in the Senate has been hospitalized twice while a Senator. Both times he went to a Naval hospital for treatment.

Lets look at a few facts. Consider that the Medicare systems has an overhead of 7% while the major private health insurers generally have overheads in the 20s%. If your reasoning had prevailed during the Eisenhower presidency, we would have a great system of private turnpikes now instead of the interstate highways we enjoy. Your idea that "the players in the industry getting together and deciding on what improvements and changes need to occur in order to make more efficient use of their resources" is naive. Almost every area of our economy benefited greatly from improved efficiencies and that drove much of the prosperity of the 90s. Insurance companies and, to a greater extent, medical practices have resisted the technologies that brought these efficiencies. And, you may be surprised to learn that while you are correct that we have the most expensive medical care in the world, we do not have the best. I can post studies that bear this out (using factors like life expectancy, access to medical care, infant mortality etc.) and I challenge you to name ONE that shows the US is tops in any of these important measures of health care. "We are the best" types of statements are just the regurgitation of political talking points. If you want to convince anybody on those points, post some facts.

Finally, concern that the government will control or 'ration' health care is no more true than the fact that the government controls what books we can read because we have public libraries or they control our movement because we have public roads. It makes good emotional slogans because we Americans are very independent but the fact is, those slogans are just propaganda put out by health reform opponents.

Be smart, get the facts, and you will see how a government health insurance options is our best chance of extending and improving health care for all Americans.
Posted by oldnetman@...
3rd Sep 2009
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