Professor Helton identified several challenges for providers and insurers following the implementation of ACA including:
- Millions of new enrollees
- Insurers (with government involvement) may struggle to obtain the subsidized portion of the premium
- Providers may earn less under a Pay-for-performance model and they may have difficulty understanding what ‘quality’ means and how to achieve it.
- New and challenging delivery models
- Providers must coordinate with each other to keep patients healthy (I think providers should do this naturally to provide the best possible care)
- Payments shared between providers which may create issues around distributing pay fairly
- Fraud and abuse
With each government mandate, argument, and court challenge, the health care industry scrambles to keep up often at great financial expense to the organization. Health care leaders are challenged with responding to regulatory changes while continuing to provide the best care possible and make a profit.