by Tony Chen

2006 was the year of consumer-driven health care. Two years ago was the year of retail clinics. Last year was the year of health IT (with Google and Microsoft making big splash entries). So, what will 2009 bring? Here are some predictions sure to go wrong:

1. The number of uninsured and underinsured will increase dramatically.

Think about it: Unemployment was once close to 5 percent. At some point in 2009, it could get up to 10 percent. Add to that the many businesses that will be cutting healthcare coverage for the sake of business survival, as well as the folks who will decide to forego buying individual health insurance to make ends meet.

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2. Strong hospitals get stronger, weak hospitals get weaker and/or die.

For better or worse, this dynamic seems to be happening in every industry, and hospitals are no different. Well-managed, well-capitalized hospitals will see strategic opportunities in this market to acquire other hospitals, acquire land, obtain cheaper debt and strengthen their positioning. Weaker hospitals will be acquired and/or see already-precarious financials go further south. All of those big hospital chains will also shed underperforming hospitals and look for turnaround targets, making for an interesting M&A market in 2009.

Just think about the banking industry. Five years from now, my guess is the likes of U.S. Bank and JPMorgan Chase will be huge winners. Who will be the winners in your hospital market?

3. Hospitals will diversify further down the health care continuum.

In the new era, reimbursement will reward coordination of care and cost-avoidance. That means hospitals will become increasingly responsible for a patient's health (not just their health care). In fact, I sometimes wonder if this is our industry's dirty little secret, like credit default swaps for the financial industry. Okay, that's not a fair analogy, but it still makes me wonder. I think hospitals that are proactive in offering wellness and health management services will eventually be best positioned for the future.

4. Hospitals will focus (yet again) on physician integration.

As a corollary to the previous point, coordination between hospitals and physicians has never been more important, because bundled reimbursement is headed that way.

5. Legitimate health 2.0 companies will emerge as a new kind of competitor.

Follow Matthew Holt's The Health Care Blog for more on health 2.0. Social media and artificial intelligent technologies are developing very quickly and becoming more cheap to develop. I predict we'll see some really compelling and intriguing healthcare applications to those technologies in 2009. The main thrust of them will be better connecting patients with the information, providers, other patients and resources they need most.

6. The Obama Factor.

It still remains to be seen whether Obama will try to take advantage of his honeymoon period to address healthcare, or if healthcare falls too far down the list as economic and political crises are aplenty right now. Either way, a compelling pitch can be made: Without addressing health care, we are tying the hands of American businesses (Exhibit A: American automobile companies). $1,800 of healthcare cost in every Ford versus $200 for a Toyota. If the American business, big and small, is the engine of growth for the American economy, fixing healthcare is like finally changing the oil. My guess is if anything changes, it will be more symbolic in nature.

7. New (and old) competitors continue to innovate.

Specialized services will continue to be niched out into focused factories--off-site cancer centers, wound-care centers, surgery centers and wellness centers. Retail clinics, while not popping up as quickly as we once thought, still number 1,000. While 97 to 99 percent of the American population has yet to visit a retail clinic, let's not forget that 1,000 clinics is a drop in the bucket compared to the number of physician offices. Specifically, Walgreens seems to be repositioning itself deeper into healthcare services (anyone else see all the huge acquisitions they've made recently with worksite clinics).

What else do you see?