As I write this blog post, my final of 2009, the Senate has just passed the $871 billion health bill, 60-39. There is still reconciliation to be done, so it ain’t over ’til it’s over.

Even as a health reform bill passes, remember Confucius – a journey of a thousand miles begins with a single step. Changing health care clinically, adminsitratively, and politically in the U.S. is a more-than-thousand-mile trek: a marathon to be sure, and not a sprint.

So what can we expect while we’re expecting Federally-legislated health reform?

Lots of action on the ground, in States and in the private sector. Here’s a list of Great and Not-So-Great Expectations to consider for the U.S. health scene in 2010…

The employer-based health financing system will continue to be challenged by double-digit health cost increases from health insurers. We heard often throughout 2009 from the health insurance sector, via broadcast and print ads as well as YouTube videos that promoted AHIP’s principles of health reform. We heard less from the business coalitions, who found a louder voice in the autumn as Congressional votes were about to be counted.

Some 58% of Americans receive health insurance through workplace plans. Employers who continue to cover health insurance will use health benefit designs to seek more value from them; part of this approach will be to allocate more financial responsibility to workers and dependents through cost-sharing of premiums, copays for visits and prescription drugs. Expect more cost-sharing in 2010 as employers face continued market and pricing pressures from Wall Street, supply chains, and customers. But also look for the most health-innovative employers to incorporate wellness programs and “nudging” that encourages healthier behaviors among workers and families.

Another certainty is that health information technology will drive further mainstream in physician practices and in less-wired hospitals given that (1) the stimulus funding to adopt HIT in the ARRA legislation looms closer and (2) meaningful use gets clarified. Vendors will offer innovative financing programs to foster HIT adoption — think about the first generation of innovative leasing, and imagine the next-gen of that applied to managing the risk of HIT adoption. What will be key here in making adoption successful is implementation — and here I expect a growing, emerging job category for HIT evangelists responsible for acculturating providers and staff to the glories, benefits and workflows of HIT.

As consumers continue to do more online in their non-health lives, they’ll continue to demand more tools online and via mobile connections for health.
Participatory medicine
/health is evolving
and we’re well into the pionerring, first adopter segment on the S-curve of technology adoption. With the emergence of e-Patient Dave and Regina Holliday in 2009, expect their visible mentoring to spawn more uber-engaged patients who tweet, use Facebook, WEGO Health, the start-up My Bridge 4 Life, and other social networking tools to emerge as Patient Opinion Leaders for the newer-engaged to learn from. It’s all about paying-it-forward and the Wisdom of Patients.

Sisters and Brothers are doin’ it for themselves and in collaboration with providers. Here, The Center for Connected Health, the Mayo Clinic, Cleveland Clinic and other pioneering health institutions want patient participation. Highly engaged patients will flock here, and those providers who don’t take steps to engage will miss this train.

More health collaboration will happen via mobile networks
. iPhone apps are fast-growing in health and medicine, with the earliest apps being reference for on-the-go. Keas and other mobile apps that help health citizens make sound micro-decisions 24×7 will take hold among pioneering patients who want to both know and act on their numbers.

Health Populi’s Hot Points: With the U.S. still in recession, the issue of managing costs will be Job #1 in health care for institutional and business stakeholders, from health plans and employers to pharma and medical device companies. PricewaterhouseCoopers’ forecast for 2010 points this out, in their report appropriately entitled, “Squeezing the juice out of healthcare.”

Given that Realeconomik underpinning, health citizens need to become their own health economists and, absolutely, their own health advocates, in 2010. If they can’t be their own, they must partner up with friends, family, and networks on- and offline. Participatory medicine isn’t only real with providers — it’s potent with fellow patients like me, and other supports we meet along our personal health journeys.

I wish my Health Populi readers a healthy, joyful, peaceful and peace-filled 2010. I have an embarassment of blessings in my own life, and wish you all abundant blessings as well.