Healthcare executive innovation required in a post Affordable Care Act world

The Patient Protection Affordable Care Act’s (PPACA) future is uncertain as the Republican Majority have spent the last seven years attempting to repeal the legislation.  While the Democrats and Republicans engage in a lively debate and political processes to substantiate their respective party’s platform on the legislation, this is the time for healthcare executives to evolve their organizations to meet PPACA 2.0. 

PPACA 1.0 was designed to address three elements of healthcare: health insurance reform, physician medical records electronic format (Meaningful Use), and expansion of healthcare coverage for sick and poor people.  Health insurance plans have adopted the reform except for the individual policies created through the exchanges.  Meaningful Use has evolved paper patient charts into electronic medical records for most providers.  The fundamental piece which Congress is debating on is the financially unsustainable model for creating the individual policies under PPACA.

The debate is over 13 million people’s health insurance and the costs throughout the system to fund their insurance.  This is a large number, but for a country of 321 million people, it is a small percentage of the insured lives in this country.  It is important as healthcare leaders to keep prospective on PPACA’s disruption and continue to innovate.

The economic model behind PPACA has not worked as it was implemented.  Opportunities to fix the gaps were lost to partisan politics.  The economic facts are that United Healthcare, Aetna, Anthem, CIGNA, and Humana have dropped ACA coverage or quit paying commissions for agents to help sell policies.  Additionally, 70% of the government backed healthcare exchanges are now closed due to the economic viability of the program.  In all the chaos, there were clear messages that whichever direction healthcare evolves, quality, patient engagement and financial risk will be part of the solution.

Any changes coming from Congress will be a slow walk to change even if PPACA is repealed in 2017.  Insurance companies will be starting benefit designs for 2018 in February of 2017.  Regulatory requirements with CMS or state departments of insurance surrounding benefit design have such long lead times that any changes will have slow implementations.  If President Trump would sign this legislation after May of 2017, the earliest a health plan could implement benefit changes would be 2019.  

Healthcare executives need to continue to evolve their businesses independent of Congress.  Regardless of what PPACA 2.0 looks like, there will be fewer dollars allocated for the care.  This will be done through shifting of risk to providers, patients, and insurance companies from the government. 

Healthcare executives need to take this time of uncertainty to continue evolving their organizations.  Fee for service medicine is not returning.  The successful healthcare organization in PPACA 2.0 will be the ones that plan for where healthcare is going, not wishing for healthcare to return to the way it was.

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