As organizations go about responding to the Affordable Care Act there is a mandatory and irreversible change in the industry, not governed by the ACA anymore but by market forces, new healthcare models and new stakeholders. However, change for healthcare payers is not predictable organizational change. It impacts the GDP all the way up and individual behavior all the way down, both not in the control of any one organization or industry.

1. GL BAL
Iterative Transformation for
Health Insurance Companies
An Industry in Flux
As organizations go about responding to the Affordable Care Act there is a mandatory and irreversible change in the
industry, not governed by the ACA anymore but by market forces, new healthcare models and new stakeholders. However,
change for healthcare payers is not predictable organizational change. It impacts the GDP all the way up and individual
behavior all the way down, both not in the control of any one organization or industry.
In other words, organizations are not in transformation towards an ideal state defined by regulatory and market forces.
The entire eco system is changing towards an unknown future and organizations must respond to externalities, and
rapidly and iteratively build models based on market acceptance and rejection
Concepts in Flux
Specifically for health plans, there is a lot of research, debate, planning and implementation in concepts such as
consumerism, population health management and payer-provider convergence. New players such as co-ops and ACOs
could be potent disruptors as well. Each of these new challenges can be implemented with different goals and different
expectations in outcome for different organizations.
There will be a few features of each concept that succeed and a few that fail. This will cause a round of correction based on
the analyses of the short history of implementation followed by more rounds of corrections. Some of these corrections may
even need complete directional change. For example, the concept of population health management may look completely
different five years from now as opposed to how it is visualized today. The idea then is that Health Insurance companies
should not wait too long or spend too much money on concepts in flux but quickly and iteratively make changes based on
market response.
Manage the Flux
The new norm will be Iterative Transformation until 2018 to 2020. Iterative Transformation will shape the future of
healthcare to bring balance and value to all players in the healthcare value chain.
To be ready for Iterative Transformation, the entire organization needs to be nimble. One way to drive flexibility and
nimbleness through the organization is modularity. While the concept of modular technologies has been around for a while,
the modular organization has not been explored in its purest form.
We understand now that it is difficult for one technology to service all aspects of a payer’s needs. Provider enrollment and
engagement, member enrollment, consumer engagement, case management and the core system may come from
different providers but will have to be modular which means that they can be plugged into a core system and interact with it
in real time.
Reach us at:
www.globalpayerresource.com
marketing@globalpayerresource.com
Fax: 800 571 8284
USA
1720 Carey Avenue
Cheyenne, WY 82001
Phone: +1 888 249 2958 Extn: 812
INDIA
70 Ritherdon Road, Vepery
Chennai, TN 600 007
Phone: +91 44 4555 8333 Extn: 18

2. GL BAL
Iterative Transformation for
Health Insurance Companies
In the same way, each process in the health insurance world can be broken down into modules by department or functions
such as the front, middle and back office. Each affects different outcomes in the key metrics of the organization and will
need to be transformed differently for different implementations such as consumerism, population health management and
narrow networks.
Modularity and Iterative Transformation
Modularity improves the speed of change in the function of Iterative Transformation through very focused Change
Management efforts within a module, while still delivering coherent Business As Usual services that benefit the current
organization.While, the need for coordination and collaboration across business functions is not to be under estimated and
will need serious consideration, modularity will deliver hyper innovation, speed and accountability at the department or
function levels while both owning and de-risking the effects of change in other departments or functions..
As quoted by PWC, the mantra for the coming years should be “Fail fast, frequently and frugally”. The operations model for
this future is Iterative Transformation with the ability to respond with flexibility and nimbleness to new requirements.
About the Aurthor
Satish Ponnaiya
President, Payer Services
e.mail : satish@globalpayerresource.com
Satish is a strategy professional and has held leadership positions in provider and payer BPO services organizations for
over 18 years. He is responsible for evaluating market trends and developing the strategic vision and roadmap for Global
Healthcare Resource (Global). Satish is also responsible for developing thought leadership, innovative service models for
Global’s clients and creating a differentiated value chain that support market needs and client goals. He now leads Global
Payer Resource, Global’s payer arm. Satish has expertise in business strategy, service delivery strategy and
implementation, value chain analysis and Business Process Improvement.
Reach us at:
www.globalpayerresource.com
marketing@globalpayerresource.com
Fax: 800 571 8284
USA
1720 Carey Avenue
Cheyenne, WY 82001
Phone: +1 888 249 2958 Extn: 812
INDIA
70 Ritherdon Road, Vepery
Chennai, TN 600 007
Phone: +91 44 4555 8333 Extn: 18