The ability to see into the future is a staple of the science fiction genre, offering the chosen individual unforeseen ability and advantage. To start with, how about tomorrow's lottery numbers?

But for us living in the real world, it comes down to individuals making educated predictions based on knowledge and experience. A healthcare software and IT company in California has offered its take on the future of some aspects of the industry.

The TriZetto Group (Newport Beach, California) has released six predictions for the healthcare industry by its founder/chairman/CEO, Jeff Margolis.

The predictions span a wide range of topical concerns, including healthcare reform, healthcare costs and developments in electronic medical records, evidence-based medicine and medical tourism:

1) Margolis believes there will be comparatively more aggressive investment in electronic health records (EHRs) and workflow applications by providers that will reignite the challenge for health plans to be recognized as "healthcare systems organizers." On a per-member or per-patient basis, we're seeing levels of investment in EHRs by hospital systems that dwarf spending by health plans in similar instruments, called personal health records, or PHRs.

Margolis expanded on this first prediction for Medical Device Daily, saying that: "[I] believe that in the near term, PHRs that contain diagnosis, procedure and pharma history stand to be more cost-effective and beneficial than physician-based EHRs. Because of this, I am wary of the provider-bias anticipated in upcoming healthcare legislation and the investment lag by the payer community.

"Payer-based PHRs hold two distinct advantages over EHRs. First, they are sourced by payers, who possess the single richest repository of benefits and care data in the U.S. healthcare system. Second, this payer data is already digital, unlike provider data which remains largely paper and fax-based. Hence, PHRs enable the sharing of rich information sooner and at less expense to federal and state government reform programs and, by extension, to taxpayers."

2) The scarcity of primary care physicians will spur higher growth in those health plan models that can systematically and effectively extend physician-patient physical interaction with evidence-based medicine media/instruction whether virtual (e.g. over the Internet) or in facilities.

3) Federal and state budgetary pressures will impede meaningful healthcare policy reform prior to 2010; however, healthcare information technology enablement/standardization containing a provider bias will be popularized in multiple bills.

4) A decade (post-1997) of expected annual increases in medical unit cost trends will give way to a decade or more of selective unit cost decreases in discrete items (e.g., pharmaceuticals, devices, common imaging and lab tests, specialty care procedures and basic bed-days) combined with new types of process-compliant reimbursement methodologies.

"Much like the recent housing market bubble, there's now a healthcare market bubble," said Margolis. "And just as people believed that housing prices would only rise, so too do pundits say that healthcare costs will continue to climb. I take a contrarian view: The healthcare bubble will burst. Too much spending for too little value cannot persist indefinitely. Fully insured premiums in 2011 will be less than 2010 rates, and even in 2010, some individuals and many groups may pay less for health insurance than they will in 2009."

5) Growth in off-shore medical procedures will be constrained by the development of more comprehensive and effective informed-consent methodologies to weigh risks and benefits and assess liability.

6) Health plans and brokers will be required to significantly drive down distribution costs of benefit plans to consumers in order to catch up to the efficiency of operational administration and shift a higher percentage of premium dollars toward care and wellness management.

"While the predictions, by their nature, highlight deficiencies in the healthcare system, I'm excited about the role of healthcare information technology to help reform and improve our country's healthcare," Margolis said. "If we take the necessary steps to make integrated healthcare management a reality – by using information technology to enhance information-sharing and to align incentives among healthcare constituents, particularly between providers and consumers–we can provide dramatically improved healthcare on a much more cost-effective basis. This will make the U.S. healthcare system the envy of the world," he told MDD.

TriZetto makes software and IT services that help payer organizations drive integrated healthcare management.

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