Our current healthcare system is fragmented. We even have a name for this system–the “Third Party” system. The first party is the patient, the second party is the provider and the third party is the insurance company. In our post, we talked about the effects of the Supreme Court’s ruling on patients. In this article we touch on the effects on providers and the health plans. For physicians and other health professionals, the high court ruling means they can move full speed ahead on preparing for the law’s provisions. They need to continue (or start) to discuss their roles in the Accountable Care Organizations (ACO) and health exchanges. They also have to be ready to face confused patients who will want to know how the Court’s decision affects them and their place in the insurance marketplace. Then, providers have to help coordinate care for the newly insured.
Meantime, the most pressing task for the health insurers will be to prepare to offer plans on the exchanges and comply with all the deadlines pressed on them by the law.
Until the court ruling, many states were waiting to make decisions on whether they would sponsor state-run exchanges or let the federal government administer one for their residents. Even if a state does defer to a federal exchange, it must decide what essential health benefits exchange plans will offer, within federal guidelines. Those decisions will affect what health insurers decide to sell on the exchanges. Between now and 2014, insurers also will adjust their business models to place more emphasis on the individual consumer rather than employers who traditionally had been their most important customers. This makes the sale to the individual and small-group market very important. And, since insurance plans cannot apply the preexisting condition exclusions or a person’s health status, there will be an influx of new subscribers. The question remains wide open, how would the providers and the health plans take care of the millions of new subscribers?