First movers may sometimes fail, but last movers don't survive
On Thursday, June 28, 2012 the United States Supreme Court (SCOTUS) upheld the provisions of the Affordable Care Act (ACA), including the Medicaid eligibility expansion (with a caveat that Congress may not rescind existing program funds if states choose not to participate in the eligibility expansion of their state’s Medicaid program). The Court affirmed the controversial mandate provision, putting the penalty for not having insurance in terms of a tax which falls under Congress’ taxing authority. As a result, nearly all Americans must obtain insurance coverage or be penalized (aka taxed), and health plans must operate under the rules set forth in the 2700 page ACA law (e.g., accept all comers, rate restrictions, tax credits, ACO development, Exchanges, premium subsidies).
The SCOTUS decision brings a new degree of certainty to the future of health reform…and certainty is a good thing. While the November elections remain a factor in the ultimate fate of PPACA, over the next several months health plans should expect slew of new regulatory definitions to be delivered by HHS which will further solidify many components of the legislation. The general consensus among health plan leaders is that even with a November shift in the White House or Congress, much of health reform is here to stay…the train has left the station.
By failing to prepare, you are preparing to fail
KBM Group: Health Services believes a health plan’s ability to anticipate market shifts and prepare for strategic and tactical execution has reached a new level of urgency. Informed decision-making will rule the day. This means identifying, defining and acting on strategic market imperatives:
- Know existing and prospective customers better than any of your competitors.
- Build an actionable plan to secure a differentiated, believable market position.
- Establish an arsenal of B2C marketing tools to reach, motivate and bond with consumers.
- Integrate & optimize your sales outlets (broker, worksite, telesales, online, mobile, retail).
- Design a high engagement customer experience to drive retention and loyalty
It is expected that Exchanges (either State or HHS run) will come on-line in the fall of 2013 for open enrollment, with benefit activation starting January 2014. A year and a half is not a lot of time to get ready. Using the months that remain to optimize market position and value proposition is a critical success factor for every health insurer.
SCOTUS decision resources: