Implementing the Affordable Care Act at the Nation's Largest Private Integrated Healthcare Organization

Since its passage in 2010, the Affordable Care Act (ACA) has expanded insurance coverage to more than ten million Americans. The law is centered on three primary mechanisms: 1) Market reforms, such as access to coverage for young adults, a ban on preexisting condition exclusions, coverage of a minimum set of essential health benefit, and a ban on lifetime limits for health care coverage. 2) The establishment of health insurance marketplaces where qualified health plans compete for consumers. And, 3) Medicaid expansion for low-income adults. This paper describes how the nation’s largest private integrated healthcare organization implemented the ACA and is integrating the provisions of the law into ongoing organizational functions.

 

We focus specifically on the first two years of the health insurance marketplaces. We describe: our approaching to preparing for the initial open enrollment period under the ACA; strategies of managing the technological challenges associated with the initial roll-out of the state and Federal marketplace websites; response to consumer confusion due to shifting deadlines and course corrections; and the resulting overwhelming influx of phone calls to our call centers.

 

We present membership results from year-one of the health insurance marketplaces and describe the demographic, health characteristics, and utilization profile of the enrollees who joined our plan via the marketplaces compared with those who joined via traditional methods.

 

Finally, we describe how we used the lessons learned from year-one as we prepared for the second open enrollment period under the ACA where our focus was on process improvement and member retention.

 

As ACA implementation transitions to ACA operations in our organization, our approach continues to be grounded in maintaining the optimal combination of people, process, and technology to ensure continued success.