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All systems are a GO. Is it ready or will it blow?

ACA - Affordable Care Act

The healthcare industry has never been a stranger to significant change. However, the next few years will sorely test the capabilities of even the best organizations when it comes to responding to the enormous changes coming.

A tidal wave of potential new members will join the market as a result of the expansion of Medicaid, subsidies for health insurance available to millions of formerly uninsured Americans and the rapid movement of Medicaid long-term care into managed care. An explosion of new regulations on virtually every aspect of healthcare ranging from hospital payments to quality measurement to data interfaces will take effect. Add to this the extreme competitiveness facing health plans on public and private healthcare exchanges, new bidders on RFPs and new entrants to the healthcare arena attracted by the incredible market opportunities – we are in for a tremendous level of change.

Preparing for the myriad of changes has companies scrambling to hire people with the right skill sets, develop new capabilities and intensify marketing efforts. Many health plans have already, or are planning to, forge partnerships with providers, vendors and even other health plans as a way of confronting the challenges they face. Other companies have leveraged their assets to get access to additional capital for increased reserves, new product development, technology enhancements or acquisitions. Many of our clients have parallel tracks for all of these different efforts and spend a great deal of time coordinating and building interfaces between them.

Taking the time to ensure that all the initiatives are on track and ready to go is probably one of the most critical roles that executives can play and one of the biggest reasons they’re not sleeping at night.

Whether or not you use outside consultants, we recommend taking time to pressure test current action plans and initiatives related to these multiple development and implementation efforts against a series of potential scenarios, including:

  • Emerging provider challenges

  • Competitive threats

  • Regulatory impacts

  • Healthcare exchange issues

  • Operational capabilities

  • Curve balls – those things that are the most unexpected

Taking the time now to determine whether all systems are “really a GO for launch” gives you some time to adjust or implement new efforts to get to a “GO”.

Through our approach to pressure testing, we meet with a company’s leadership team, review action plans and initiatives and then lead the executive team through scenario pressure testing. We follow this up with a written assessment of the plan's readiness for 2014-15 and including the identification of gaps in the preparations and recommendations for addressing the gaps.

If you would like to additional information related to our scenario pressure testing approach, please contact us.

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