The House Leadership Bill: Affordable Health Care for America Act (H.R. 3962), October 29, 2009 establishes a clear mandate for healthcare coverage for all Americans.  Beyond this, it leaves much of the current insurance and delivery system unchanged, with studies and recommendations regarding payment and some delivery changes to be addressed later.  Although a new public health insurance option to be delivered through a National Health Insurance Exchange is included, no specific mandate for competitive efficiency, delivery or value is provided.  Many of the directives toward reducing costs and increasing quality require studies to be executed during the first year or two (2011 and 2012) of this reform Bill.  As more consumers are engaged in US healthcare insurance coverage, healthcare costs continue to rise and best practices for reimbursement and service delivery are restudied, focus will undoubtedly be the next industry theme and watchword.

Recent surveys in the past year have corroborated decades of previous research indicating that tremendous savings occur with better management of the top five chronic illnesses.  As one example:  Dr. Earl Ford of the Centers for Disease Control and Prevention completed a study of 23,000 Germans, and found that a healthy lifestyle (never smoking, healthy weight maintenance, an exercise program and a healthy diet) had a huge impact in preventing or delaying chronic disease.  (reuters).  Compared to those without any of these healthy factors, individuals making and sticking to these life choices had reportedly an 93 percent lower risk of diabetes, and 81 percent lower risk of heart attack and a 36 percent lower risk of cancer.   We also know that adherence to treatment and therapeutic protocols lowers costs significantly for those with chronic diseases. And furthermore, this week a Rand Corporation study suggests that bundled payments for chronic disease care and management could save over $1 billion/year if used for all Medicare services; much more if applied more broadly into the commercial market.

There is little in the current reform legislation to address unmitigated cost increases. Furthermore, cost constraints will require healthcare payers and provider to focus attention on the most significant opportunities.  In this context, Health Insights expects technology investment in 2010 and beyond to begin to reflect two market priorities:  1. Investment in quote to card technologies and analytics to improve and automate marketing, sales, underwriting, product selection and enrollment processes.  2. A focus on care and cost management of chronic illness over other strategies.  This means that deployment of PHR, EHR alerts and triggers, telemedicine, cell phone technologies, product customization and incentive programs will move from a broad brush incentive strategy (everyone gets one). Instead, the market will move toward a strategic and focused investment by population characteristics – with the first target those populations with the highest health risk, costs and opportunity for cost savings and improved health.