Preparing business to handle Wicked Problems_ A Case Study on Obamacare

© 2014 BA Convention

Preparing Business to Handle Wicked Problems - a Case Study on Obamacare

By Paromita Ganguly, Consultant, Infosys Limited

© 2014 BA Convention 2

Introduction


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Session Takeaways

Wicked problem requirement and risk management

Wicked problem resolution techniques

Wicked problem identification




Wicked Problems

Yes, wicked problems seem complex

…. And their complexity may be a lot more than meets the eye!!

They often trigger a chain reaction.




Identifying Wicked Problems

Complex issues comprising of a set of interlinked problems.

Changing requirements.

No unique and permanent solution rather only a temporary resolution.

Stakeholders have different views of the problems and contradictory solutions.

Problems of a social nature with a great impact on people’s lives.


Business Analyst VS

Wicked Problems




How do BAs cope with Wicked problems?Mess Mapping

• Stakeholder identification(viz. stakeholder matrix)

• Information collection (viz. surveys)

• Visual representation of stakeholder perspectives (viz. rich pictures)

• Deriving inter-relationships between perspectives

Resolution Mapping

• Prioritizing outcomes in case of conflicting stakeholder requirements. (viz. MOSCOW methods)

• Selecting the desired end state to be the current state.

• Determining the events leading to the end state

• Deciding upon the relevant actions to achieve the End state.

Solution assessment & validation

• Assessment of the potential risks and changes to the problem domain. (viz. maintenance of issue logs, risk to risk mapping)

• Iterative implementation of the ‘plan, do, check, act’ cycle.


Case Study: The Obamacare (PPACA)




The three-fold objective of US healthcare

Expanded healthcare coverage

Improved Quality


The state of U.S. Healthcare The Problem




Pain Points

Ever increasing costs

Quality issues

A large number of the un-insured




Causes behind the issues

Pain Points


The state of U.S. Healthcare The Stakeholder




The Stakeholders and the Impacts on themEn

d Cu

stom

er

• Reduced purchasing power• Reduced coverage• Slow growth in wages• Reduced economic security

Heal

th

Insu

rers

• Depleting profits/ surplus and increased business risk.

• Increased competition to design and offer affordable plans

Plan

Sp

onso

rs • Higher cost of employee recruitment

• Reduced profitability

Heal

thca

re

Prov

ider

s •Increased costs of service and reduced income•Increased liability and risk.

Gove

rnm

ent

•Increased costs and reduced availability of funds for other developmental activities.•Public discontent and loss of faith.


The state of U.S. Healthcare The Mess Map




• Higher cost of employee recruitment and reduced profitability.

Plan Sponsors• Reduced purchasing

power. • Reduced coverage.

• Slow growth in wages.

• Reduced economic security.

End Customer

• Depleting profits/ surplus and increased business risk.

• Increased cost of coverage. • Increased competition to

design and offer affordable plans.

Health Insurers

• Increased costs and reduced availability of funds for other developmental activities.

• Public discontent and loss of faith.

Government

• Increased costs of service.

• Reduced income.

• Increased liability and risk.

Healthcare Providers

The Healthcare Mess Map


The state of U.S. Healthcare The Resolution Map




The Obamacare- Highlights

Broadened Insurance Benefits (EHBs). Guaranteed issue and renewal. Financial assistance (APTC and CSR). Health Insurance Exchanges for greater

transparency. Focus on Preventive and Wellness care;

prescription drug formularies. Ban on annual and lifetime limits as well as on

deductibles in the small group market. No variation in premium based on gender or pre-

existing health conditions. Appeals and claim processing guidelines. Taxation in both individual and group markets. Individual and employer mandates.




The Obamacare Resolution MapObamacare offerings US Healthcare Objectives

ImproveQuality

ExpandCoverage

ReduceCost

Essential Health Benefits

Guaranteed issue and renewal

Financial assistance

Health Insurance Exchanges

Preventive and Wellness care; prescription drug formularies

Annual and lifetime dollar limit bans, plan deductible limits set.

Restrictions on rating based on gender or pre-existing conditions.

Appeals and claim processing guidelines

Taxation policies

Individual and Employer mandates




The Obamacare Resolution – Prioritised End States

Expanded Coverage

Improved Quality

Reduced Costs


The state of U.S. Healthcare Obamacare Resolution Assessment and Validation




Solution Assessment and Validation

Expanded healthcare coverage

Improved Quality

Reduced Costs

PLAN

DO

CHECK

ACT




Solution Assessment and Validation in Obamacare

Postponement of the Individual Mandate for 2014• Owing to technological challenges, the SHOP module implementation in health insurance

exchanges (HIX) was delayed in 2014 and therefore all such potential SHOP enrollees who missed coverage in 2014 were exempted from the Individual Mandate. Exemplifies a temporary change in solution to handle a change in requirement.

The Small Business and Family Relief Act• Introduced to delay the health insurance tax for two years starting 2014, providing

immediate financial relief to those impacted by the tax.

Introduction of PPACA safe harbors• Introduction of look-back/ stability periods for determining full time employees of small

employers. • Introduction of the 90 day limit on waiting periods.

• The original proposition of a payment through the HIX each time an enrollment or a renewal happened was later amended due to payer and end customer requirements.

Direct payment at insurer’s site for renewal of enrollments




Conclusion-Session Takeaways

Wicked problem requirement and risk management

Wicked problem resolution techniques

Wicked problem identification

Preparing business to handle Wicked Problems_ A Case Study on Obamacare

Healthcare

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