Industry

Gearing up for the PPAACA following Supreme Court Ruling

Today the Supreme Court upheld the constitutionality of the “individual mandate,” the requirement for all U.S. citizens to acquire health insurance coverage or pay a tax for non-compliance. This mandate is a central variable in the overall healthcare equation and if taken out of the equation, it would not have been possible to implement the Patient Protection and Affordable Care Act in a manner that actually delivered affordable care. The CBS News site offers lot of information on the politics of the decision, or you could read the Supreme Court decision yourself but, the bottom line is that it’s time to get to work.

The PPA and ACA, and particularly the individual mandate, require fairly massive internal changes for Health Insurers: new product development, new billing solutions, direct-to-member marketing and communication solutions and new governance policies covering communication with individuals. More of the communications will now be sent direct to the individual member instead of to group coordinators within corporations – a process that it not well understood within many health insurance organizations. In addition, while  decision adds a degree of certainty to federal health care policy, federal and state governments still need to fully implement the law and it is not at all likely that the states will implement the law in a uniform fashion. In fact, there are aspects of the law such as expanded Medicare eligibility requirements that some states have said that they will not accept (the Supreme Court ruling made provisions for this.)

With so many systems in flux in response to regulatory changes, there is a need to make systems more flexible and adaptable  (and of course Mitt Romney has vowed to strike down the law if he is elected – so make sure you can back out all your changes!) however, in my experience this is exactly the situation in which changes end up being very narrowly defined and hard-coded because “there is no time.” Another common problem is that there is focus on product development and administration/recordkeeping systems while the supporting aspects such as document design and production processes are overlooked until much later in the game. (It’s just print right? How hard could it be?)

Given that one of the major changes to come from the PPA and ACA will be need to communicate and sell directly to individuals, perhaps communication should be the true focus of the individual mandate. Consider what needs to be communicated (regulatory) and where the opportunities lie to communicate more effectively (plain language, more channels, transpromo) and ensure that those requirements can be met as requirements are drawn up for changes to billing and claims systems. Print and electronic document systems require the same lead times as other systems changes – and when the proper care is not taken then the results are obvious to every customer who received a document.

Elizabeth Gooding

Elizabeth Gooding is the editor of the Insight Forums blog and president of Gooding Communications Group www.GoodComm.net

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