Navigating Health Care ReformFinance implications for the health plans sector |
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While uncertainty remains about the way health care reform ultimately will play out, its effects on health plans already are becoming evident. Nearly half of the 124 major provisions in the Patient Protection and Affordable Care Act (PPACA) of 2010 are expected to significantly impact health plans and the choices that health plans make today may have significant implications for their future success.
This article explores five key health care reform themes or “triggers” that are expected to drive health plans to re-think finance's processes, systems, and overall value proposition. Each area presents considerable implementation and financial challenges, as well as opportunities to use finance transformation to support value creation. The five themes are:
- Medical Loss Ratios (MLRs)
- Provider reimbursement and additional reporting
- Administrative simplification and ICD-10
- Health insurance exchanges
- Customer/product considerations (Medicare, Medicaid and employers)
The article also examines how finance transformation can provide the capabilities and focus that the finance function needs to help a health plan navigate the complexities of health care reform across the enterprise.
Navigating health care reform
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