How Did the Disease Management Care Blog Do With Its Predictions for 2010?

Calling Dr. Blumenthal's faulty augury to task is one thing, but applying the same exacting standard to itself is another. While other bloggers are making predictions for the coming year, only the brave Disease Management Care Blog dons a retrospectivescope to conduct a post-mortem on its own soothsaying and ask: how did the Disease Management Care Blog do with it's ten predictions for 2010?

This is what the prescient DMCB foretold:

1. Things are not going to change much. When the sun goes up, insurance rates will increase, busts for Medicare fraud with continue, the academic elite will continue to publish clueless articles and the number of uninsured will remain stubbornly high.

The DMCB modestly suggests it nailed this one. Why else would Ms. Sebelius recast herself as a cost-fighting poly-state insurance commissioner, stuff like this is no longer suitable as front page news, the staid New England Journal is unable to stop itself from saying the Feds can do no wrong while the pro-reform Kaiser Health News would let this see the light of day?

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.

While the DMCB had it right on the regulations and mortal combat, it didn't predict the scorched earth warfare of "repeal and replace," defunding, and the prospect of hostile hearings spiced with a level of partisanship that includes dancing on the graves of your enemies.

3. 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.

Here's an example of what one insurer is doing, which is what greater than 95% of all insurers are doing. The Care Continuum Alliance is still going strong and had a 2010 blockbuster meeting. Even the skeptical Vince Kuraitis had nice things to say about disease management.

4. Registries will emerge as a source of new medical knowledge. 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.

Maybe not routine, but the Institute of Medicine would still agree. The inability to get at the unorganized and largely text data contained within the EHR is one factor that got in the way of succesful multi-source registry development. The DMCB underestimated the EHR's ability to gum this up.

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.

The DMCB nailed that one too. It's called Accountable Care Organizations and shared risk. Care to predict what the DMCB will have to say about the ability of provider organizations to manage risk? Stay tuned!

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.

As of this writing, the DMCB is still unaware of any good studies that conclusively demonstrate that a fully configured PCMH consistently, meaningfully and statistically reduces health care costs. That may be one reason why smarter states are looking at shared service designs that borrow heavily from modern versions of disease management.

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.

Well, maybe this has a way to go before it becomes routine, but that didn't stop the enthusiastic DMCB from increasing the concept's visibility.

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.

The DMCB got this right. As of this writing, profit margins are holding steady and only Dr. Renault would be shocked over the insurance industry's silence over the constitutionality of the ACA's insurance mandate.

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.

While health reform supporters were initially tut-tuting this DMCB scenario, what better evidence of its credibility than Kaiser Health News' publication of this?

10. The Electronic Health Record (EHR) will continue to disappoint.

It's too early to tell if the HITECH luster of tens of thousands of dollars will finally push docs past the digital divide and into buying EHRs, but there is no shortage of illuminating papers like this and this and this despite Dr. Blumenthal's serene confidence.