How to Manage Through the Challenges of the Affordable Care Act

acaMajor national health insurers have been projecting losses on their Affordable Care Act (ACA) plans for 2016. In fact, earlier this month, Aetna Inc. stated that it expects losses of more than $300 million for the year and announced that the company would be re-evaluating its participation in the plans and may even cancel discussed expansions. Aetna’s Chief Executive Mark T. Bertolini said that the insurer planned to “completely reconsider its current 15-state exchange footprint and either fix the business or exit the business.” Aetna’s discouraging perspective on the ACA business follows similar sentiment expressed by the UnitedHealth Group Inc., who confirmed it will largely withdraw from the business next year.

This trend suggests that next year, fewer insurers will be participating in the exchange and we will see higher premiums for the average customer. One might even speculate that the marketplaces aren’t sustainable long-term based on recent events and projected losses for major health insurers.  Large provider groups and hospitals may find that the level of coverage will shrink with more out-of-pocket costs and deductibles for members. For large insurance carriers, there may be new requirements for certain states to participate in the marketplace in order to sell employer plans or other changes to price more appropriately. For large employers, there will be a focus on attracting and retaining good talent as healthcare costs rise.

So what does this mean for healthcare leaders as they face ongoing challenges and adjustments related to the ACA? Healthcare providers need to remain committed to patient care in the midst of variations in pricing and reimbursement structures, and how those factors impact their organization’s business processes and areas of focus. Insurance companies need to carefully assess their business approach, making sure to drive efficiency as changes to the exchange take place.

Navigate works with a number of clients in the Healthcare industry to help them assess their current operations through Business Analytics and other measurements, and identify ways to improve their performance and sharpen their decision-making – perhaps through a new approach to Enabling Technology or Enterprise Systems, or a fresh perspective on Implementing Strategy.

With Navigate’s deep industry expertise, healthcare clients are able to proceed with their business knowing that they are operating efficiently and seamlessly, no matter what changes might come in the marketplace.

Feel free to contact us to learn more about how we might be able to help your company manage through the impact of the ACA.

Jackie Kahn, Senior Consultant

Jacqueline Kahn

Change Management Done Right
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