Accelerating Change
The healthcare system in the US is changing rapidly. The Affordable Care Act (ACA) introduced regulations requiring insurers and providers to change at an unprecedented pace. Whether these changes are for the better or the worse depends on your perspective. But actors not able to adapt to the new lay of the land are going to be left behind.
So what has changed? The ACA is or was politically very contentious. So it might be surprising to some, that if not the ACA, something similar would have been put in place. Looking at the history of health care reform in the United States it becomes clear that the main trajectory remained the same. All these reforms are increasing the pressure for improved health care with a market based philosophy in mind.
Health care is becoming more complex and competitive along with more government involvement and oversight. We have seen the government opening up Medicare to private players. Now the ACA extends parts of this model and experience into the commercial space. The pressure to participate in these markets will increase and things like preventive care, measuring quality of care, risk adjustment, and health care effectiveness are becoming increasingly important. This trend is accelerating and it does not matter if it is driven by Republicans or Democrats. The core of the problem remains fundamentally the same. As lifespans are increasing, care becomes more expensive and we have a resource constrained environment trying to address rapidly increasing complexity. Addressing comorbidity is a next step and will catapult us into another dimension of complexity.
The health care system, with all its legacy systems and inefficiencies, has issues coping with this accelerated rate of change. This opens up opportunities for innovation and disruptions in the industry.
How can Enterprise Architecture help?
Enterprise Architecture (EA) enables meaningful adaptation to change for organizations. In this context meaningful means that the enterprise is able to evolve according corporate objectives and strategy.
The practice of modeling and abstraction is essential to be able to properly reason about change. Just being able to look at a high level and holistic design goes a long way. EA helps to understand risks and opportunities and develops a common understanding within the organization.
The following shows how EA can be used to align business with IT by looking at a subset of an EA model for a health plan. This model is generic enough that it can be applied to Accountable Care Organizations (ACO) or other similar types of organizations.
Future posts will detail this model further. So stay tuned!