Despite the outcome of the 2008 presidential election – whether it be Hillary Clinton, Barack Obama or John McCain – experts say healthcare is destined for a major change next year.
The inevitable change will be driven mainly by bipartisan interest in finding a way to cover 47 million uninsured, 15.8 percent of the total U.S. population.
According to Ned Moore, CEO for Portico Systems outside of Philadelphia, smart companies will plan now for the change to come. "Many companies still use paper enrollment, and that's not going to work when you start talking about open enrollment for 47 million people," he said.
Moore co-founded Portico, now a leader in providing network solutions for the provider side of companies such as Blue Cross Blue Shield, Care First and Centene.
"We talk to our customers and say, 'Start peeling the onion back, this is going to take a lot of technology ready to handle this in an efficient and effective manner,'" he said.
Moore said coverage for the uninsured is likely to be federally funded, but managed by states through private companies.
States will have to design products, submit plans and engage provider networks to administer the new system. "It's going to have a huge impact on our market," he said. "Independent of healthcare IT or anything else, any time you infuse that many people into a current system, it's going to have a major impact."
Moore said some argue that providers can't support that kind of influx, even if half of the 47 million uninsured were enrolled at one time, yet he sees it as a tremendous opportunity for healthcare vendors.
The three major presidential candidates have emphasized transparency and pay for performance. This, too, provides a tremendous opportunity for vendors, Moore said. Along with transparency comes the need to translate current complex billing code data into terms understandable to the public.
There is a lot of work to be done around the tactical part of data transparency, and that can't be done overnight, Moore said. Portico, he said, is already planning how to support those initiatives.
Moore predicts the president-elect will want to begin work on healthcare reform right away. It will take at least a couple years to get something up and running, and by then the president will be looking at re-election.
"We've got the perfect storm for them to take action," he said. "Healthcare improvement is front-and-center, and it's clear there is bipartisan support. Change would be a huge political win, beyond the fact that it's the right thing to do."
Robert H. Booz, vice president and distinguished analyst for Gartner, a technology research firm based in Stamford, Conn., said universal healthcare won't occur anytime soon, due to the gridlock it would face in Congress.
"Healthcare is comprised of a three-legged stool – cost, quality and access. Right now, we can only handle any two at a time. Hopefully, whatever healthcare system evolves will be able to address all three," Booz said.
Booz said quality will be tough to address because it lacks definition. Stakeholders are wrestling with elements such as outcomes, performance, process and patient expectations as they work to define quality. When one defines patient perception as a variable, he said, that starts to get very threatening.
Drew Altman, president of the Kaiser Family Foundation, said a new president will have to make healthcare an early and top priority and exercise real leadership to get some changes rolling.