Churchill’s Prescient Comments…On Healthcare Reform

Winston Churchill: “However beautiful the strategy, you should occasionally look at the results.”

As of this writing, hundreds of millions have been spent and 106,000 have come.  Most of them have flocked to the relative safety of known health insurance brands or state-run exchanges.  For those of us who toiled many hours under the extremely tight deadlines required for compliance, this is like preparing for the ball, only to have a handful of guests attend. 

Left with no invitation to the ball are millions of Americans whose benefit plans, while perfectly suitable to their definition of “essential health insurance,” do not meet the compliance guidelines established in the ACA.  Much of the effort of health plans “preparing for the ball” centered on creating systems and product configurations needed to administer the benefit plans required by ACA.  At the average health plan, it takes about 60-100 days to get an approved health benefit offering from paper to production.  Legacy technologies require painstaking configuration of each benefit and plan separately.  Enterprise testing the configuration across all the legacy systems takes weeks.  What’s more, at best, that work delivers about 80% claim adjudication accuracy.  In that context, comments like this one in a recent NY Times news story, are no surprise:

Insurance companies, already deeply worried about the low enrollment in the plans they are offering on the insurance exchanges, say congressional proposals to force them to allow canceled policies to be reissued could be disastrous. Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, the industry’s lobby, said insurers “have significant concerns on how it would work operationally.”

So… there is a better way.  Leading health plans have invested in product lifecycle management (PLM) technology that allows them to create a model for their products where reuse of compliance-tested benefits is safe and controlled, creation of product variations is easy, and automating the configuration of enterprise systems that do everything from generate contract documents to adjudicating claims is inherent.  Healthcare PLM systems bring the power of model-driven product development, a leading technology construct, to health insurance.  This technology construct, dating back to the 1980s, has powered everything from the integrated circuit revolution to its latest frontier – health insurance benefit plan creation. 

With product lifecycle management solutions for health benefits, implementing new or revised mandates will take mere minutes, not months.  The potential cost savings of this agility are enormous.  Perhaps part of the revisions of ACA should include mandates on technical capabilities that our healthcare model needs.  That kind of mandate just might save us enough to throw a big party – one that everyone attends.