The Three Legged Stool

It was almost serendipitous that I began my new journey at BIF with a conversation on the possible repeal and replacement of the Affordable Care Act; a law whose creation and implementation had been the cornerstone of my career to this point. This dynamic discussion hosted by The Kaiser Family Foundation in collaboration with the Committee for a Responsible Budget was the focus of only my second day at BIF.

Before the ACA; health insurance business models relied on risk aversion and reduction, which made coverage cost-prohibitive or unavailable to the people who needed it most. Most high costs were avoided, but 40 million people were denied access to care. As an attempt to move beyond this model, we passed the single largest piece of health care legislation since the inception of Medicare.

Let’s look at the ACA as a three legged stool, with the legs being coverage, access, and cost.

As the ACA began to take shape, it guaranteed the right to coverage and provided 16.9 million previously uninsured people with some form of health insurance ( Leg #1). The law also increased access by eliminating the pre-existing conditions, and age barriers to care (Leg #2), and provided cost subsidies for the lowest-income participants (Leg #3). However, while uninsured rates dropped, the market lacked true choice which limited access, and led to increased costs across the system.

So we are left with a three legged stool with two broken legs and if a single leg breaks, the stool falls down. This seems like a fundamental flaw in the way the stool was designed in the first place.

We now enter a time where the ways in which we provide and pay for health insurance are uncertain. What will the new business model be? What does the new stool look like? What are all the ways to build a system that not only delivers quality care, provides coverage for all, but also makes it affordable?

It is clear that Washington can’t answer these questions alone, and that true collaborative effort will be needed to solve this problem. At The Business Innovation Factory (BIF), we have started our own conversation for ways to engage businesses with health care in an attempt to transform a entrenched policy into a market-driven and customer facing product that puts the end-user; the patient, at its center and straight up does healthcare differently.

The Healthcare landscape is not often perceived as a business but, If we take the entire system of Health care from insurance provision to care delivery, we can see a social system that is meant to deliver a product to a consumer as efficiently and effectively as possible. By allowing willing and able participants, such as BIF an opportunity to impart the principles of business model innovation at a policy level, we can pursue change and success through a new lens.

BIF is excited and ready to help partner and prototype solutions for this dynamic and timely challenge. We do this every day in several ways; First by identifying and framing the problem we are trying to solve; Second by focusing on human centered needs and co-creation with end users; and Third by defining areas of opportunity for doing things differently to add new value — our version of innovation.

The possible repeal of the ACA and the unknown aspect of its replacement present an array of innovative possibilities and opportunities to prototype and BIF is ready to help get this off of the white board and into the real world. BIF sees likely changes to how we provide for Medicaid as an incredible opportunity for new provider payment structures to be attempted with States having increased flexibility in how they regulate their own insurance industries, and deliver new methods of care that can drive a consumer based healthcare marketplace.

The Future of the ACA, and the future success of its possible replacement are yet to be seen. What we do know is that the need for BIG systems change maps well to innovation and exploration. Here at the BIF, we have already started ‘thinking and talking’. Now we are eager to get involved and help Washington start ‘doing and making’ the future of care and coverage.

We also welcome hearing how you are getting engaged on this critical path to the future and perhaps we can do it together.

Video and podcasts of the event can be found here: Major

Considerations for Repealing and Replacing the ACA

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