Keeping up with PPACA worth your time investment


Convenient sound bites do not take the place of true intelligence.


And so it begins! The enormous gears of the Patient Protection and Affordable Care Act (PPACA) are locking in their pointy teeth and transmitting the torque of one of the most aggressive healthcare policies in the history of the United States.

We now have less and less justification for the excuse that we “don’t know” what will happen within the giant machinery of health reform. It’s happening right now, today, as the state insurance exchange marketplaces open and thousands of Americans sign up for coverage.

Industry leaders must make a special effort to analyze the daily reform updates over the next several months, even though it’s a time-consuming task. Your business success in 2014 will depend on being extremely nimble, and constantly watching the trends as they develop is the only way to figure out your next move.

What you don’t know

I am always surprised by the number of “don’t know” responses we receive in our annual Managed Healthcare Executive State of the Industry survey. This year, we specifically asked readers how well they personally understand PPACA. More than 17% said “not well.” The majority of respondents, however, said they at least know the major provisions, and it was good to see that more than 28% said they know PPACA rather well.

But once in a while, a reader will use the open-ended question field on our survey form to leave a comment indicating the multiple-choice questions we ask are too difficult to answer. That excuse is no longer valid in my book. Make the effort. Get the updates. Understand the nuances.

Paul Keckley, who retired from Deloitte last month and is the only person I know who actually read PPACA from beginning to end, made a great point in one of his final blogs:

“Most in the health care industry are busy, so we default to time-savers-PowerPoint presentations with speaker notes prepared by others, talking points that make good sound bites, trade associations’ legislative summaries and so on. Though helpful, they sometimes mask lack of personal knowledge about this full scope of this industry-the issues, challenges, innovations and constraints facing sectors other than our own. It takes ongoing, persistent personal study, nothing less.”

Hopefully the 2014 State of the Industry forecast that we’re presenting this month will be a starting point for you to consider exploring new ideas or researching ongoing trends.

For example, half of our more than 300 reader respondents believe over the next five years, newly enrolled health plan members will come into the system in worse health than current members. But a study in the September Annals of Family Medicine seems to indicate otherwise. If you’re operating in the exchange market, you at least have some risk protection and reinsurance to back you up if needed. Even so, adverse selection will be an issue indefinitely.

Consumer interaction-as I’m sure you’ve already noticed-has become more integral to daily business. It’s not just about marketing campaigns to retain and attract members either. Your call centers and even your network providers will become the face of your health plan brand.

Some day, when you look back on the journey of PPACA, I hope you will be able to consider yourself a leader who took the time to know and understand its implications.

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