Visiting my father, who is in his late 70’s and impressively nearing 50 years as a practicing ophthalmologist, presents me with two options. I can either regress to my former teenage self, borrowing the car and whining about how life is unfair, or engage with dad in a multi-session discussion about the nation’s healthcare crisis. If my father has a hobby, armchair healthcare politics is it. Yet the “armchair” label does my father a disservice – he has provided care to a largely blue-collar clientele in downtown Cleveland for five decades, witnessing and wrestling with all the problems that vex the system.

Rather than simply enumerate the many and obvious flaws in our healthcare non-system, I challenged my dad to think with me about what technologies, products and services might come out on top as the country stumbles toward reforms that aspire to improve healthcare quality while reducing costs. Change inevitably creates new winners and losers – who will the winners be?

So dad and I debated whether healthcare reform will translate into more, or fewer, hip and knee replacements (and related sales of hardware). My dad made the good point that growth in the number of insured patients will have minimal impact on treatment of age-related disorders like arthritic hips, which mainly hit the already insured Medicare population (or at best shift the demand a few years earlier). So we tried to think of the medical needs largely hitting the pre-Medicare population – a hodge-podge of preventative care and management of chronic conditions.

If we think roughly of these two groups, the aging Medicare population with their exploding costs and the younger population with greater access to care, my dad and I agreed on two “hot” areas (calls to stock brokers pending).

The Home

As a country, we do a great job fixing up folks that show up in the ER, land in our critical care units, and occupy our ORs and interventional suites. Our acute care institutions are increasingly incented to get patients in and out as quickly as possible, often sending patients home with complex instructions for medications, wound care, pain management, follow-up testing, dietary restrictions, rehab, etc… In the aging population, these myriad patient responsibilities are piled on a life context that may include physical and cognitive impairment, immobility and inadequate caregiver support. Small wonder that readmissions are cited as a major source of preventable healthcare expense.

To control this cost, we will have to figure out how to protect our investment in acute care with some sort of a home maintenance program. Traditional Medicare has been operated in silos, with home care the poor, underfunded stepchild. Under healthcare reform, hospitals will be penalized for patients that rebound back to the hospital, and may fully take the risk for patients’ care if they become accountable care organizations. This could well catalyze investment in technologies and services for monitoring, and managing, patients in their own homes.  GE and Intel have joined forces to place big bets on the “connected home” to tackle the “increasing global burden of chronic Disease and age-related conditions.

Wellcare and patient self-care

In younger patient groups, success in the brave new world under healthcare reform is preventing the onset of expensive chronic conditions, and better managing those people with chronic conditions. To do this effectively, we cannot rely on the already strained primary care providers and current model of periodic, haphazard office visits. So who, or what, will step into the gap? All signs point to the patients themselves, and technologies that empower patients to facilitate their own wellness. Once the balance truly shifts from rewarding visits, procedures and tests to rewarding successful maintenance of health, funding should flow to technologies and services for promoting fitness and weight loss, addressing mental health and substance abuse problems, and detecting onset of problems before they become acute.

Technologies being adopted by large employers with self-funded employee health plans preview potential winners in the wellness game. They not only must manage the risk of their insured pool, but the productivity of a workforce.  Healthrageous, a company promoting wellness with patient self-monitoring and “personal connected health”, actually conducted an IRB-approved clinical study at EMCCorporation to demonstrate the benefits of remote blood pressure monitoring.

The billions of dollars question is the pace with which reforms will take hold in the US, and thus when these new winners may get their day in the sun. In the meantime, my dad remains comforted by the little device on his nightstand that acquires and sends information from his fancy new pacemaker, though we really aren’t sure who is on the receiving end…