Winners and losers from inevitable health reform

A tsunami is coming and only its size is yet to be determined.

Whether or not a health reform bill passes Congress, change is coming.

Insurance carriers are as anxious as the government to save money. The argument is over who might pocket the savings. (Picture from CBS News.)

The general trend is to use more computers and networks, more primary care and wellness, fewer tests and specialists. Whether you're on Medicare, a private health insurance plan, or your employer is self-insuring these trends are now being baked into the system.

As to what that means specifically, here's a brief run-down:


  1. Software companies -- Most of the $19 billion in health IT money already approved will go to create Electronic Health Records (EHRs). This takes software. If you make this kind of software you will sell a lot of it. But you know what software makers will do best? Those offering security and audit software, thanks to the HIPAA law, whose reach is actually expanding.
  2. Networked hosting -- Whether you call this Web hosting or "the cloud," EHRs will move among doctors, payment services, and patients over networks and into large computers. People who host this data will need to follow HIPAA rules, which serve as a barrier to entry, but the same rules also protect profits.
  3. Primary Care -- There is enormous demand coming for primary care of all sorts, and in time economic incentives will have to respond. There is far more demand coming for physicians to meet in time, so expect physicians' assistants, nurse practitioners, and a host of non-traditional "coaching" professionals -- diet coaches, chiropractors, foot therapists -- to do well.


  1. Proprietary Systems -- Growing demand means trouble for the proprietary vendors who have dominated the EHR segment in the past. Standards and interoperability are now market requirements. Those who don't respond will disappear and their wreckage will cost standards-based companies a fortune to clean up, maintaining high prices on health IT for years to come.
  2. Radiology -- One key way to save money is by reducing tests. Old CT scanners are also subjecting patients to dangerous levels of radiation. So expect pressure on the people who make the gear as well as the professionals who buy and use it. Expect old machines to be scrapped and a lot of professionals to just retire.
  3. Specialists -- Market incentives for decades have pushed doctors into specialties, where more services mean more fees. But per-patient or per-outcome pricing means a lot less demand. Even if prices don't decline revenue will, with all bills getting a lot more scrutiny. If you're in medical school now you might want to think about changing majors.

All this is going to happen whether or not the Obama Administration passes a health care reform bill. These are trends baked into the industry, with demand for change and savings coming from big employers and the medical profession.

The size of these changes, moreover, is going to be massive. You're talking about one-sixth of the economy. At best, limiting government involvement might slow the pace of change a little bit. Some will say this makes change more manageable. If procrastination means management maybe they are right.

But the industry winners are going to be those firms, in computing, in devices, in pharma, in insurance, and among hospitals and doctor groups, that embrace these trends and try to get ahead of them.

A tsunami is coming and only its size is yet to be determined.

This post was originally published on


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