Health plans are concerned that their investments in technology to comply with ACA demands will be wasted in the wake of the massive changes promised by the incoming administration.
The healthcare industry is trying to determine how the presidential election will affect the status of the Affordable Care Act and the way health plans do business, but the only solid conclusion so far is that things won't be the same under a Trump administration.
Promises to repeal and replace have been constant, but exactly how the ACA may change remains to be seen. Some analysts believe, however, that whatever changes are coming will come quickly.
President-elect Donald Trump campaigned on a platform that included overhauling Obamacare, and the majority Republican Congress will make it possible to implement any changes quickly. Tom Price, MD, Trump's choice to lead HHS, is a vocal opponent of the ACA.
The President-elect's pick for head of CMS, Seema Verma, MPH, helped then-Indiana Governor Mike Pence "[reshape] Medicaid by requiring recipients to pay premiums and tracking their compliance with healthy behaviors."
David Squibb, chief sales and marketing officer at Xpertdoc, a software company that provides document and communication management for health plans. Squibb says his company's clients are nervous about how a revamp of the ACA could affect them, and whether they will have enough time to prepare.
"If it were a mixed Democrat and Republican government, with Trump in office and a Democrat-controlled house or senate, the thinking is that any alterations to the current law would come more gradually," Squibb says.
"With a Republican majority we expect it to be more rapid. Our health plan clients are telling us they just hope it will be a reasonable, incremental change and not a radical change that leaves them unprepared to respond and serve their customers."
Health plans are particularly concerned that their investment in automation and technology to comply with ACA demands will be wasted, adds Eric Allen, the health insurance sales lead for Xpertdoc. Even if that technology is still useful, health plans still worry that any revisions to the law will require more resources to adapt, he says.
"A few years ago as the ACA came into play, health plans started looking into more automation options to eliminate manual processes," Allen says.
"With changes coming, the ability to be nimble and pivot will be critical for them. Some of our clients are starting to look more at how automation can be designed not only to make processes more efficient but also to allow them that flexibility to respond to changes."
The summary of benefits and coverage (SBC) is a good example of how health plans may find themselves revisiting compliance challenges that they thought had been dealt with already, Allen says.
"The SBC is a very data driven tool and template," Allen says.
"Our clients have done a number of things to automate production of that so that they can deliver in a timely fashion information that is pertinent to their members, and their particular plan. Our clients have already developed a digital form warehouse that allows them to provide that information as required, but will that be obsolete with any new changes? It's likely the SBC will continue in some form, but the impact on technology investments is still a question for health plans."
Gregory A. Freeman is a contributing writer for HealthLeaders.