6. The Internet and Social Networking is a Powerful Health Extender

Technology will empower patients in new ways during 2009. The increased information and growing patient-to-patient interaction over social networking platforms and web sites such as patientslikeme.com and americanwell.com are changing how healthcare is navigated and experienced by consumers, especially as electronic health records become more common.

7. Hospitals Must Perform to Get Paid

Medicare, Medicaid and insurance companies are increasingly basing reimbursement to hospitals on performance, and, despite resistance to it, pay for performance isn't going away. In 2009, healthcare providers will have to get serious about not only improving performance but documenting it.

The Centers for Medicare & Medicaid Services (CMS) has proposed adding a new index: the total performance score. It's part of Medicare's move to value-based purchasing. If Congress approves this measure, CMS would replace the current quality reporting system with one in which Medicare withholds between 2 percent and 5 percent of its reimbursements to hospitals. They will need to focus on process improvements to improve safety and avoid unreimbursed medical errors, known as "never events."

8. Payers and Employers to Give Incentives for Wellness Programs

More employers will give incentives to encourage responsible health behaviors and participation in wellness and disease management programs. Wellness programs don't work if employees don't participate, and most of them don't, according to research by PricewaterhouseCoopers' Health Research Institute which found that less than 15 percent of eligible individuals enrolled in wellness programs actually participate.

However, they found that workers are two to four times more likely to enroll in wellness programs if they receive gift cards or other incentives. In 2009, health plans will begin to play a more active role in wellness program design, tools and support.

9. ICD-10 Will Require a Major Resource Investment

The conversion to a new International Classification of Disease code sets, known as ICD-10, will be a painful and costly process that health organizations will begin in 2009. The federal government has proposed an accelerated timetable for increasing the number of code sets used for billing and clinical classifications from 17,000 to 150,000. In addition to clinical process changes, the entire healthcare system-- from quality of care, to medical records, to incentive salary systems, to reimbursement-- will have to be adapted.

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