Washington, DC has been a hotbed of healthcare-related activity for the past few months. After several advancements and setbacks, the administration's pursuit to repeal and replace the Affordable Care Act (Obamacare) ultimately did not move forward. Now, many are left scratching their heads at the thought of what is currently happening and what to expect next.
Although we can't predict the future, we can help you get up to speed and brace for what is likely to happen next. Here are some important things to consider with recommended IT actions for healthcare payers and providers.
America's Health Insurance Plans (AHIP), the largest health insurance lobby in the country, warned the Senate against repealing the individual mandate unless some other legislation that pressures citizens to maintain coverage is included. The Blue Cross Blue Shield Association had similar views. Why? Possible changes to the individual mandate threaten business for insurers across the country.
The effects of legislative change around this mandate are already unfolding: Molina Healthcare, Inc. has said it would stop selling Obamacare plans in select states; Anthem, Inc. has pared back offerings or even exited several states. Negotiations between local governments and insurers in key states where the exchanges are under stress are anticipated.
There is opportunity for smaller, nimbler local plans. Appian, The Digital Transformation Platformô, can help with these challenges.
Medicare is America's biggest government insurance program. Open enrollment for fiscal year 2018 is quickly approaching, running from October 15 to December 7.
By 2018, Medicare will provide health insurance to 60 million individuals who are age 65 or older, disabled, or have end-stage renal disease. In fiscal year 2018, the Office of the US Actuary estimated that gross current law spending on Medicare benefits will total $704.6 billion. Of that, Part A (hospitalization) claims $202.8 billion and Part B (outpatient supplemental) will consume $201.9 billion. Part B coverage is voluntary, and about 91% of all Medicare beneficiaries are enrolled in Part B. The remainder is spent in Part C (Medicare Advantage) and Part D (prescription drug coverage.) This is a lot of money and a lot of covered lives.
Despite all of the uncertainty, one thing is guaranteed: a flexible application development platform that allows you to be agile and responsive to whatever happens next is critically necessary.
Appian has a low-code approach to application development that allows organizations to build powerful apps up to 10 times faster than traditional development, so you can react to changing legislation in a nimbler way. Plus, process automation, including a new Appian RPA with Blue Prism robotic process automation offering, cuts operational costs while spurring efficiency and the ability to develop more innovative business models. This gives competitive differentiation and confidence to organizations in a market that is consumed by uncertainty.
Learn more about our platform and how it can be used to quickly and securely help healthcare organizations by visiting our healthcare resource site, and send me an email at Cate.McConnell@appian.com to discuss how Appian transforms healthcare organizations facing digital (and political) disruption.
Practice Leader, Healthcare Payers
Appian is a software company that automates business processes. The Appian Platform includes everything you need to design, automate, and optimize even the most complex processes, from start to finish. The world's most innovative organizations trust Appian to improve their workflows, unify data, and optimize operations—resulting in better growth and superior customer experiences.