The Affordable Care Act: How 15 false beliefs can prevent innovative solutions

Your company may be missing an opportunity to save millions of dollars in healthcare costs by failing to implement innovative, low risk healthcare benefit design solutions.

That’s because there are some very common beliefs that keep HR and C-level leaders from finding solutions to their healthcare benefit problems, and these beliefs are so fundamental to how people think that they are unaware of them.

Many organizations have gotten locked into cycles of increasing costs and disappointed employees, and they respond by doing the same thing –tweaking the same variables — and expecting different results.   This approach can be fatal in today’s healthcare reform environment.  Payers are adapting strategies, policies and coverage plans, providers are creating new and different partnerships, processes and care services, so businesses have to generate (or borrow) innovative solutions to today’s new challenges or be driven to financial ruin.  Rather than just reacting to new regulations, effective companies are finding opportunities and introducing innovative responses.

There are consistent pattens within the groups that fail to generate or consider alternative solutions to healthcare benefits challenges.  Working with decision makers has led me to identify 15 common assumptions that block innovative thinking.   The first four are mistaken beliefs about healthcare in general.

 1.    We have to fix this mess.    

Health care benefit professionals doom their own thinking by approaching the problem too broadly.  Yes, US healthcare probably is too big and complex for you to fix, but you don’t have to fix the whole thing!  Think smaller!  Ask yourself  “Given this company in this context, what are some of the things that we can do to provide great care at affordable prices?   How can we manage care and costs?”  Turn off the “healthcare is doomed” media and think smaller and locally.  Think selfishly of only your organization and forget the rest of society, take care of your own.   Fully understand your own company’s situation, define what you want your corporate culture to be, decide how your benefits strategy can impact that and generate as many ideas as you can to get there.

 2.    There are no good solutions, only least bad options

Highly tenured benefit professionals are especially guilty of this belief.  They  have worked in the business for so long and settled for the least bad option so often that they have given up believing that there are actually good solutions to be found.  After years and years of defensively raising deductibles and co-pays, adjusting coinsurance levels, increasing maximum out-of-pocket limits and other methods of cost shifting to achieve the smallest possible increase in premiums – that they have stopped looking for other ways to fix the problem.   In Psychology the term “learned helplessness” refers to the trained belief, after long exposure to only aversive outcomes, that any (all) behavioral choices will lead to unpleasant results.  It’s the belief that the action really doesn’t matter because it’ll turn out bad anyway!  Unfortunately, this pessimistic view is quite common when dealing with healthcare decision makers.

 3.    We should wait until this gets clearer or things settles down.

You cannot wait for things to become better defined or settle down.  This is the new normal of healthcare benefit design…like it or not, it’s extremely unlikely that things will settle down.  You must have or know people who understand PPACA past, present and future and intimately understand what your company is trying to accomplish with its benefits.  (See my earlier blog about the importance of establishing clear objectives and success criteria for your benefits).  Due to healthcare reform (and other factors) today’s  business environment is turbulent and uncertain, yet decisions must be made before any more settling or clarity emerges.  Work with experts, get up to date information, and know that some decisions will have to be made despite the uncertainties, unknowns and undefined terms!

 4.    SSDD:   Same Stuff Different Day. 

If your company is approaching healthcare benefit design in the same way it always has…if you think you’ve been here before…think again.  There are new variables, new players, new rules, new requirements, new options, new everything.  This is not the same problem solving decision-making situation you’ve faced before, so the same solutions won’t fix this new challenge.  It’s time to think differently.

 What’s next?

Next up in my blog I’ll address  how benefits decision makers approach the problem solving process.  SPOILER ALERT: most companies make the very important, very costly healthcare benefits decision in surprisingly undisciplined, haphazard ways.

Then, after reviewing the 15 common mistakes that badly damage how companies make their healthcare benefit decisions,  I’ll offer a few simple, inexpensive methods that can save companies millions of dollars in unnecessary healthcare spending!