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An Industry in Flux
As organizations go about responding to the Affordable Care Act there is a mandatory and irreversible change in the industry, not governed by the ACA anymore but by market forces, new healthcare models and new stakeholders. However, change for healthcare payers is not predictable organizational change. It impacts the GDP all the way up and individual behavior all the way down, both not in the control of any one organization or industry. In other words, organizations are not in transformation towards an ideal state defined by regulatory and market forces. The entire eco system is changing towards an unknown future and organizations must respond to externalities, and rapidly and iteratively build models based on market acceptance and rejection
Concepts in Flux
Specifically for health plans, there is a lot of research, debate, planning and implementation in concepts such as consumerism, population health management and payer-provider convergence. New players such as co-ops and ACOs could be potent disruptors as well. Each of these new challenges can be implemented with different goals and different expectations in outcome for different organizations. There will be a few features of each concept that succeed and a few that fail. This will cause a round of correction based on the analyses of the short history of implementation followed by more rounds of corrections. Some of these corrections may even need complete directional change. For example, the concept of population health management may look completely different five years from now as opposed to how it is visualized today. The idea then is that Health Insurance companies should not wait too long or spend too much money on concepts in flux but quickly and iteratively make changes based on market response.
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In the same way, each process in the health insurance world can be broken down into modules by department or functions such as the front, middle and back office. Each affects different outcomes in the key metrics of the organization and will need to be transformed differently for different implementations such as consumerism, population health management and narrow networks.
USA 1720 Carey Avenue Cheyenne, WY 82001 Phone: +1 888 249 2958 Extn: 812
INDIA 70 Ritherdon Road, Vepery Chennai, TN 600 007 Phone: +91 44 4555 8333 Extn: 18