Health for life

With atypically little fanfare, the Disease Management Care Blog gazes into the crystal ball and offers ten health care predictions for 2012:

1.  After Mitt Romney secures the Republican nomination for President, he and Mr. Obama will mutually try to find ways to avoid debating the issue of health care orm.  Both will calculate that there’s little advantage to reminding voters of the messes they’ve made.

2.  As a result of 1 above, the election will not hinge on health care orm, which, thanks to an improving economy, will otherwise be very close and not be a erendum on Obamacare.

3. Yet, the U.S. Supreme Court will stir things up with a ruling that the Affordable Care Act mandate is unconstitutional because, among other reasons, Congress should have used its power to tax, not impose a penalty.

4.  There will be no generalizable and published peer reviewed studies on the Patient Centered Medical Home or the electronic health record that conclusively demonstrate that either reduces health care costs.

5.  Even though CMS will have trouble providing timely claims data feeds to its newly established ACOs, we’ll hear little about it in the public domain.  ACOs have every incentive to not cross CMS.

6. Speaking of ACOs, the least recognized Achilles heel as they start up will be a pervasive physician culture that trumps patient perence over shared savings.

7.  We will learn that, thanks to their complexity, the deadlines for implementation of health information exchanges will need to be pushed back.

8.  Congress will "kick the can" of the Sustainable Growth Rate conundrum down the road and past the 2012 election with another temporary patch.

9.  More academic medical center faculty will find that it’s far more professionally rewarding to post on line than to publish in paper-based journals.  Department Chairs will reluctantly find ways to use web statistics in promotion and tenure.

10. Piqued by Mr. Obamas recent recess appointments, the Republicans will respond by holding the up the appointment of Ms. Tavenner as CMS Administrator.

While the Disease Management Care Blog is pretty good at spotting current health policy silliness, its track record at predicting the future has been rather spotty.  Regular readers have undoubtedly forgotten this brazen attempt at 2012 health care augury, but the transparent DMCB uses to bury its mistakes.

So how did it do with its Ten 2012 Predictions?

1. Mitt Romney will win the Republican nomination and avoid discussing health care.  The DMCB got some of this right, but who would have predicted that the President would cleverly upend his opponents by embracing the term "Obamacare?"

2. A close election will hinge on an improving economy, not on Obamacare. In the end it wasnt really that close, but the DMCB was correct in foreseeing that Mr. Romneys candidacy would be undermined by dropping unemployment levels and the bottoming out of the comatose housing market.

3. The Supreme Court will rule Obamacare unconstitutional: Boy, the DMCB got that wrong.  But in its defense, few foresaw that SCOTUS would ignore the Affordable Care Acts statutory language and rule that a penalty was really a tax all along.

4. There will be no generalizable and published peer-review studies on the electronic record of the medical home that conclusively show that either saves reduces health care costs.  "Bingo!" says the DMCB.  It hopes 2013 is different and that a p value is < 0.05.

5. ACOs will not criticize CMS about the tardy delivery of claims data necessary to manage its assigned populations. The DMCB says the silence over this issue is deafening, which means either a) CMS has overcome its dismal track record on providing timely information or b) the ACOs are reluctant to go public with any concerns.  The DMCB has heard rumors that the latter is true.

6. Speaking of ACOs, their physicians will trump patient perences over savings.  The DMCB says the jury is still out on this, but time will tell if its call about this ACO Achilles heel is as important as it thinks it is.

7.  Health exchange deadlines will be pushed back. To the DMCBs knowledge, CMS is holding firm on the fall 2013 implementation date.  The DMCB takes some credit, however, for being among the first to spot this issue and bring it to its readers attention.

8. CMS will kick the Sustainable Growth Rate (SGR) down the road. "Bingo again!" says the DMCB.  It got his one right and looks forward to how Congress will deal with this in 2013.

9. Medical academics will increasingly turn to social media instead of print to make their mark on the scientific world. The DMCB believes this trend is continuing but has yet to reach a tipping point.

10. CMS Interim Administrator Tavenners status will remain in recess limbo.  OK, it wasnt all that hard to bank on continued partisan bickering, but the DMCB got this one right too.

Will the DMCB offer up predictions for 2013?  Stay tuned!

In the beginning of 2011, the Disease Management Care Blog amazed, astounded and impressed itself with a series of health care system and industry predictions.  Unlike those lesser blogs that post predictions and conveniently neglect to report back to its readers, the DMCBs commitment to being transparently outcomes-based prompted it to pose the awkward questions that few in the blogsphere are brave enough to ask:  how did its prognostications perform? What accuracy did its augury attain? How did its foretelling function?
Here are the DMCB hunches and brutal self assessments:

1. CMS will delay the January 1 start date for the CMS Shared Savings Program.  The DMCB got that one right.  The usual bureaucratic inertia plus having to respond to the consternation over the initial proposed rule pushed the start date back to April 1.  By the way, this is only one of many missed Affordable Care Act deadlines, so this wasnt all that hard.

2. Despite its luster, adoption of social media in health care settings will not attain a tipping point:  The DMCB got that one right. It knew that front line administrators in clinics and hospitals dont see a financial return on investment for social media and remain notoriously paranoid over HIPAA.

3. Berwick will be confirmed as CMS Administrator.  The DMCB blew this one but should have known that too few U.S. Senators and their staffers regularly read Disease Management Care Blog.  With time, that should change.

4. Naive enthusiasm over the electronic health record and PCMH will bump into painful reality: The DMCB will call this one a draw because use of the EHR has been boosted by the CMS "meaningful use" bribes payments.  Without them, the EHR business case would have to be based solely on spotty quality and phantom claims of cost savings. The PCMH, still lacking any consistent and statistically significant proof that it reduces costs, is still very much alive because of its growing link to ACOs. Thats appropriate, because ACOs likewise lack any proof that they reduce costs.

5. Despite the advent of a new health care era courtesy of Mr. Obama and the ACA, health care costs will depressingly continue to go up.  Bingo says the DMCB.  According to this report on how things are looking for 2011, medical costs are expected to hit 9%.  Thats less than 2010 but still far outstripping the general rate of inflation and evidence that more and more of our GDP is being gobbled up by health care.

6. The population health management industry will continue to thrive:  The DMCB got this right too.  The Care Continuum Alliance is as big as ever and there has been no abandonment by commercial insurers of their commitment to patient coaching and support. 

7. The term "disease management" will use to die.  To the many experts and consultants the DMCB interacts with, purchasers and buyers know that a rose by any other name still smells as sweet.  Call it "care management" or "population health" or "disease management" and no one really seems to care. because they know "disease management" has matured.

8. The political stalemate will continue.  Talk about a no-brainer but even the DMCB underestimated Mr. Obamas reliance on his liberal progressive roots to the detriment of bipartisan compromise.  Yes, theres plenty of blame to share on both sides of the aisle and while it may not be the Presidents fault, the DMCB thinks hes still responsible.

9. Greater interconnectedness will make us more vulnerable and unpredictable "black swan" events will preoccupy Washington DC: while there were no unexpected health care events, who would have foreseen the Arab Spring, the near death of the Euro, the impact of the Tea Partiers and the downgrade of U.S. debt?

10 The DMCB will reach a critical mass - more on that in a future post but its 2011 annual report suggests the DMCB juggernaut is well on its way.