Part 1 Here Part 2 Here If you take a look at the comments under part two, you will see I took some shots, for my article listing the losers.  It is clear this is an issue that generates a lot of heat and with good reason, it will in one way or another, impact each of us.  Even when I get taken to task (and sometimes I even deserve it) I really appreciate the dialog and will continue to allow the comments to stand.

Healthcare Delivery System Under ObamaCare

In my mind, the biggest question we need to ask is, What will the healthcare payment and delivery system look like 10 years from now?  It seems that we are headed toward one of two scenarios:

1. Health Plans for Everyone 

  I think this is the more likely of the two scenarios.  Direct payment by the government to providers will cease to be.  Rather the government will pay those dollars to health plans, who will then manage the care of the people they are responsible for.  This will mean an end to Medicare as we know it today.  Essentially what will happen is everyone will be forced into an HMO type plan,  some will function like true HMO’s and others will look more like preferred provider networks.  I also see the Medicaid system moving in the same direction.

2. Medicare For All 

 There are a significant number people who would like to see the Medicare system expanded to include everyone and this would be true universal care.  There are many barriers to this, not the least of which, is a formidable insurance political lobby. Probably not in my lifetime, but it would likely lead to an even more uneven distribution of services, and delays in getting appointments, treatments and procedures as measures to control costs.

Senior Housing

I see opportunities in these areas:

1.  Skilled Nursing (SNF) Costs less than an Acute Hospital 

 Under the old system, hospitals caring for patients with Medicare, received a specified lump sum payment for a particularly diagnosis.  The faster the hospital could get that patient discharged the more money they would make.  As a result, patients got discharged to skilled nursing or or other levels of care earlier than what was optimal. This is being changed so that if a patient is readmitted within 30 days of discharge, the hospital will be penalized financially.  Hospitals will be looking to create tight relations with SNF’s that will take extraordinary steps to make sure those readmissions won’t happen.

2.  Assisted Living Costs less and Skilled and Acute Care

  Assisted living stands to be the biggest winner of all senior housing options.  Assisted living communities need to build tight relationships with hospitals.  In order to develop those relationships they will need to demonstrate they can accept these post acute patients and provide for their medical needs at a lower cost and in a much better environment.  And most importantly, keep those residents from going back to acute care in that 30 period. Along this same line, those assisted living communities that develop relationships with senior HMO’s will tap into another source of post acute care opportunities.  The big win here is that in effect, these HMO’s are allowed to spend money that formerly could only be used for skilled nursing.  The HMO’s have a single goal, getting their members better at the lowest cost.  If your assisted living community can do that, you will win. While many of these residents will be relatively short stay, some will convert to longer term residents.

3.  Independent Living costs less than Acute, Skilled and Assisted Living 

  The reason independent living needs to pay attention is that there will be residents who can successfully return to an independent living setting if appropriate resources are made available.  This is why the management needs to have a good rolodex of these resources and be willing to work with the residents and the resident families to access these services. What other opportunities do you see?  What risks do you see?

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Finally: If you know anyone who is looking at emergency call systems I would appreciate the opportunity to talk with them about Vigil Health Solutions.