How to overcome it
Hafner advises focusing on what’s already known. “We actually know quite a bit about where things are headed; we just don’t know exactly what form they will take,” he says. “Most importantly, customers (i.e., consumers, employers, and both state and federal government entities) are not willing to absorb continued increases and are being proactive about pulling every lever at their respective disposal to manage costs. We also know that performance-based payment will increasingly be the norm, evidenced by the Medicare Access and CHIP Reauthorization Act (MACRA) passing with broad bipartisan support, and that unwarranted care variation drives higher costs—which no one is willing to pay for.”
Regarding the ACA, Julie Stone, North American health and benefits specialty practice leader, Willis Towers Watson, a healthcare advisory company, says executives should continue to plan for multiple scenarios. These range from legislative and regulatory status quo to full repeal with no replacement and several flavors in between. At press time, there is uncertainty about federal subsidies to offset individual out-of-pocket expenses for people who qualify continuing into 2018, as well as the potential impact on enrollment of reduced federal funding both prior to and concurrent with the open enrollment period.
Hafner advises proceeding with caution when it comes to the ACA. On the payer side, the public exchange is an important channel, but it will require continued government support to be sustainable. He also sees the potential for a sizable market opportunity for an individual healthcare product, since he says 22 million Americans stand to lose healthcare coverage if the ACA is repealed.
For providers, he advises focusing on delivering consistent, integrated, high-quality care. In the short term, the economics will have some volatility but over time, the rewards (i.e., customer loyalty, strategic partnerships, and expansion opportunities) will accrue to organizations demonstrating the greatest value propositions.
Stone points out that the pace of change in healthcare continues to accelerate on multiple fronts with a significant lack of transparency in the national legislative dialogue. “Developing a variety of scenarios and related business plans and having the ability to execute them fairly rapidly in response to meaningful change is mission critical,” she says.
Repeal of the ACA continues to be possible; the results of the mid-term election could be a game changer as could the White House shifting focus elsewhere—including tax reform.