The future is now.

Just as the relatively new managed-care industry is taking tips from other businesses, so other businesses are learning from managed care.

It's 2015. Sixty-two-year-old John Smith and his 12-year-old grandson, Billy, have just left Cyber Sports, where they teamed up to capture the annual Virtual Reality Super Bowl. John Smith is elated and slightly worn out. As he slips behind the controls of his hovercraft, he feels a gripping pain in his chest, followed by shortness of breath and a cold sweat. Soon he's slumping in his seat.

Billy quickly calls the emergency room via the car's voice center. Instantly, a medical triage officer appears on the car's screen, confirms the victim's name, locates the hovercraft by means of the Global Positioning System, and accesses John's universal health record. Made aware that John Smith has a pacemaker, the triage officer turns the pacemaker into a telemetry unit, transmitting signals through the hovercraft's communications system. The pacemaker appears to be malfunctioning, but through another mechanism in the unit, the triage officer administers a life-saving shock to John's uncontrolled heart beat.

Meanwhile, the medics arrive and begin to deploy a dizzying array of high-tech procedures. A small cellophane strip attached to John's lower eyelid serves the purpose once assigned to old-fashioned blood tests. A lab monitor shows the results, compares them to all of John's past laboratory work, and graphs abnormalities and important trends for the medics to see. Through computer algorithms monitoring the call, an emergency room physician, John's primary care physician, and his cardiologist all appear on a multi-screen TV; they have assembled in a virtual consultation room and are monitoring the progress of a perfectly blended isotope being administered by the medics. Also on a help-voice line is the pacemaker manufacturer, which already has John's particular model and specifications pulled up on its computer.

The rescue hovercraft departs for the tertiary medical facility less than 15 minutes after John's problems began.

Sound far-fetched? Not really. Not with rapidly developing medical and information technology. "The future is now," says physician Jonathan Edelson, chairman and CEO of Advanced Health in Tarrytown, NY. "This information technology is here, and it is dramatically altering the way physicians treat patients."

Still, the questions remain: High-tech or not, how will we pay for this care? What role will managed care play in this brave new medical world?

Matthew Holt, a director of the Institute for the Future in Menlo Park, CA, predicts that as Americans move inexorably from light to heavy managed care, the managed-care industry will double in size - despite lingering resistance from some hospitals and physicians. But the focus of that care, he says, will shift increasingly toward prevention and wellness.

Joe Coates, a futurist with Coates & Jarratt in Washington, DC, has a less sanguine view of the continued growth of managed care, however. Arguing that quality is still taking a back seat to cost-cutting, Coates envisions a future in which doctors, constrained by rigid guidelines, will dispense limited, assembly-line medicine to fewer and fewer people. He believes that more and more people will be denied health insurance as science identifies genetic predispositions to additional diseases. The result, he claims, will be greater employee disaffection and more union activity.

Gerald Celente, director of the Trends Research Institute in Rhinebeck, NY, echoes Coates' pessimism. "People will continue to be offered fewer benefits," he says. "The standard of living will continue to decline. The financial health of HMOs will surpass the health of the nation." However, while he, too, predicts more union activity, he adds that eventually, HMOs will learn to devote more of their energies to keeping people healthy.

Many observers, however, see managed care as simply a waystation on the road to a greatly improved system of health-care service delivery. John L. Colley Jr., a professor at the University of Virginia's Darden Graduate School of Business, for example, believes that untaxed personal medical savings accounts will be the next step. And David Pearce Snyder, a futurist with Snyder Family Enterprise in Bethesda, MD, and lifestyles editor for Futurist magazine, suggests that "managed care" will be replaced with "precision care," a practice already being used in some emergency rooms in Maine. While managed care imposes tight protocols after a diagnosis, Snyder explains, precision care uses information-driven guidelines to diagnose a problem and to develop a treatment plan. Snyder cites Rand Institute studies showing that two-thirds of unnecessary or botched medical procedures result from incomplete medical histories or the physician's failure to keep up with the latest developments in the field. With the advent of smart cards that encode a patient's entire medical history on a computer chip, he notes, doctors will make fewer mistakes, quality of treatment will improve, and costs will decrease, making managed care irrelevant. Additionally, he says, people eventually will diagnose and handle their own routine medical problems with voice-activated computers dubbed "cyber docs."

To many experts, the relatively new industry of managed care has been playing catch-up with other businesses and industries on the learning curve. Only recently, they note, has managed care developed an appreciation for the need to consolidate, the virtues of "bottom-up" management, the importance of measuring quality and concentrating on customer service, and the value of re-engineering to eliminate waste and add value. And while new information technology has allowed all sorts of industries to work faster, better, cheaper, and with fewer people for many years, managed care is just starting to catch on. For a while, in all these areas, health care lagged behind, says Watts Wacker, the Connecticut-based resident futurist for the Stanford Research Institute in Palo Alto, CA. "But when it was forced to keep up, it started doing so in a hurry." Which means there may be some lessons for other industries in the current activities of MCOs.

For example, while health care is learning about measuring quality from other industries, it is blazing new ground with its efforts to rate physicians. This will help consumers make informed choices rather than fish around for a doctor via the Yellow Pages or word-of-mouth, observes Jack McNamara, a health-care consultant in Virginia Beach, VA. The rating of doctors could provide a lesson for lawyers and automobile mechanics who soon may find themselves having to organize into legal HMOs and car maintenance organizations, McNamara says.

One broad lesson managed care is teaching, notes Mark Goldberg, a professor at the Yale School of Management, is that an industry can fundamentally alter the way it does business, just as health care is going from being an atomized business to a more coordinated one. "Maybe you can question, in an exploratory way, the assumptions you generally never questioned," Goldberg says. For example, he notes, it was the companies that purchased health care that spurred changes by demanding better outcomes measures and more efficiency for lower costs. As a result, other service companies might take a closer look at the role of those who purchase their services.

Holt says other industries would be wise to examine specific innovative practices within health care. He and other futurists note that just as managed care is embracing the notion of prevention, it's also moving toward giving its blessing to a host of alternative treatments and concepts from dozens of different cultures, many of which, until recently, have been dismissed as pseudo-medicine. These include chiropractic medicine, massage, acupuncture, transcendental meditation, t'ai chi chuan, yoga, laughter, love, faith, and prayer. Celente says some physicians already are "breaking the mold. They're taking a very different approach."

This type of rethinking is the kind of paradigm shifting that could benefit other industries, Holt says. The lesson: "You ought to be thinking differently about whom you're serving and what you're trying to do." For example, he says, the home-insurance industry could help support neighborhood crime-watch programs and insist that homeowners have smoke detectors, while the automobile insurance industry might sponsor safe-driving classes. Wacker suggests that automakers should be as concerned with ergonomic features such as the ease of getting into and out of cars as they are about safety features such as dual air bags.

The efforts at making consumers more active participants in health care hold another lesson. Holt cites a new interactive video that helps people with prostate problems choose the type of treatment they receive. The lesson there - "letting people make up their own minds about what they want" - also could be applied to the financial-services industry, Holt says. Rather than planners simply telling investors what to do, perhaps they should be providing information that will allow investors to make their own choices.

On the other hand, notes independent health consultant and author Ellen Morrison, the managed-care arrangement, with its uneasy bedfellows, could serve as a warning to businesses caught up in merger mania. The lesson, she says, is, "Don't put natural enemies together." As computer, telecommunications, and entertainment companies merge, they soon may discover conflicting interests and clashing power domains, much as doctors, hospitals, and insurers have, she says. Morrison believes the shaky healthcare relationship will play out differently in different parts of the country, depending on which of the groups has the most power and most loyalty from patients. She says the best relationships are those that developed with the patient's interest in mind. Those that are being forced by financial pressures will continue to be rocky, she says. "I don't see any of those groups coming together and doing it particularly well under this kind of pressure."

Meanwhile, back in the future, John Smith feels he's been well-served by his health-care delivery system. He's resting comfortably at home. His pacemaker's working. His records are updated. His bill's taken care of. And Monday morning, he'll be back at work.

Joseph Cosco, a Norfolk, VA-based journalist, has covered science, medicine, business, law, and politics.