One of the driving goals of the Affordable Care Act after it became law in 2010 was to increase access to healthcare. Instead of securing populations through employer negotiation, the health insurance exchanges “represent a significant shift toward engaging consumers on an individual level,” writes Kimberly Whitler in Forbes.
The transition to consumer-focused, value-based healthcare is in full swing. According to statistics as of March 2016, 20 million Americans have gained health care through the Affordable Care Act.
Healthcare risk management consultant Eric Campbell speaks of the “pent-up demand” in the wake of passage of ACA.
The availability of coverage for preexisting conditions, many people took advantage of the opportunity to “get the pain in their back looked at,” as Campbell explains it.
The current challenges facing the ACA, including the departure of Humana, UnitedHealth, and other providers from many ACA exchange markets, is due, in large, measure to an unbalanced assumption of risk by insurers over a relatively short period of time. Risk cannot be managed until it is assessed, and risk assessment requires a controlled intake process through which a relationship is established. Such a process, requires capacity.
The “rush for services” brought about by the ACA, and the financial and operational challenges that ensued, highlights the weak links in the healthcare industry. It is also an opportunity to establish new methods, procedures, and tools better adapted to today’s healthcare environment. Onboarding 20 million customers and new members is a challenge for any system.