I love to attend Health 2.0 and listen to the parade of innovative solutions being developed by entrepreneurs who see the gigantic problems in the health care system and are trying to solve them. Until recently, adoption by the major players in the industry was slow to non-existent, but this year I see a big change: providers and insurance companies are here in force, and it has finally dawned on everybody that if the consumer is put at the center of his health care experience, he might be convinced to take some personal responsibility, make some lifestyle changes, and ultimately drive costs down. “The average person spends 30 minutes choosing his insurance and 4 hours choosing a flat screen TV” –Cigna.

Obama’s health insurance reform efforts are the back story for the conference, which was kicked off by Aneesh Chopra, now America’s CTO, formerly a health care consultant who worked on the state employee health benefit plan for Virginia. Chopra convinced Governor Kane to direct the legislature to introduce public/private partnerships to decouple the customer-facing experience from the analytics. Health care analytics are pretty solid; everyone knows how to bill and collect, and what the utilization is of health care services. And we even know how bad some of our outcomes are. So the focus has shifted to “bending the cost curve” by altering the outcomes. Thus, we involve the consumer at long last..

Everyone at this conference, including Chopra, wants to answer the question “what does it take to engage me to make my health care outcomes better?” Chopra says he is deeply committed to the role entrepreneurs play, and thinks great ideas will always find the way to get started. He says the next wave of Fortune 500 companies will be founded in this downturn, and will be in either health care or energy.

While we wait, the government is doing what it can to both streamline the system and improve outcomes. New standards for bundled payment to hospitals are coming, to shift incentives from procedures to outcomes: these incentives will discourage re-admissions rather than encourage them. Right now, hospitals get paid by the procedure, not by patient outcome, so if they re-admit you they make more money. And Medicare still does not reimburse for virtual physician visits, but it will soon.

The providers all know this, and many physicians are beginning to write the applications they need. On the payer side, insurance companies know how they can lower costs, so some like Blue Cross, are investing in application development of patient tools. Payers feel that if they can shift health care into the home, away from the traditional “portals” to the system (physician offices and hospitals) things will be faster, cheaper, better.

Roy Shoenberg from American Well said he works with insurance companies that are praying for this to develop and partnering with him to bring about online home health products. Every other player in the system is now engaged, and the patient is slowly becoming aware of his responsibility in the equation.

The vision for the future is one of modular apps, like the iPhone’s, that interoperate. Called clinical groupware, this vision has spawned a clinical groupware collaborative to resolve issues of interoperability. Since these are all online, it’s easy to make them interoperate, and everyone hopes this will eventually replace legacy EHRs, some of which don’t even have a built-in email function.

Younger docs are asking how their patients can do things like interact with them, their personal trainer, nutritionist, chiropractor, and other patients, using social media to foster collaboration among patients to control chronic illnesses like diabetes. People right now still love their physicians, and anything that extends the reach of physicians through social media will be accepted by both provider and patient. Fortunately, government stimulus funding promotes meaningful use of Health IT, and opens the window for engaged patient apps under meaningful use.

Everyone’s goal is to eliminate the under-coordination of care that everyone knows drives over-utlization of services.The system overhaul that’s needed is a core care team with an engaged patient at the center, known as the “medical home, ” a much friendlier term for the gatekeeper of the 80s and 90s. Judging from today, we’re about 3-5 years out from real patient/provider online collaboration.