Affordable Care Act and Healthy Lives Innovation "Metals"
Posted by Joe Antle on August 8, 2020 7:00 AM EDT
My most recent blog posting focused of articulating the importance of putting others first and improving our understanding of what others want and need as a better.....
...."rule" for developing and implementing more lasting and sustained innovations in helping people and communities become healthier, grabbed my attention. The blog post basically boiled down to suggesting and then defining a new "rule", "The Platinum Rule", as a more valuable "metal" and a better symbol or metaphor than "The Golden Rule" for services innovations aimed at improving how people live, eat, work and play. And thus would be a more effective way to think about healthy lifestyle services innovation attributes to avoid longer term health issues and to improve their odds of sustained recovery from healthcare innovations, was both novel and interesting.
As a former employee benefits consultant turned lifestyle innovation practitioner, I found the blog was also a good way to build on the Affordable Care Act (ie: ACA), which was introduced in 2012. Passed into legislation in 2010, with phases built into its implementation path, the ACA was billed as an innovation in health insurance. When the most innovative aspect of the plan, the Internet-based Exchange or Markpetplace with its income-based tax credits to reduce the costs of plans bought by largely individuals and families (versus The Shop which was set up for small businesses and has not been a large succees) was implemented it popularized the use of "precious metals" as a way to put the spotlight on better, more valuable and richer health insurance policies.
For example, a Platinum Plan would be the richest in benefits and costliest. The Gold Plan, a little less so, the Silver Plan less rich and expensive down to the Bronze Plan, the least expensive with much less features and benefits. Needless to say as the various health plan designs went further down the scale of "precious metaphors", the use of increasingly higher deductibles was layered over the plan designs to yield lower and lower costs. For many self-employed adults or individuals who made more money (AGI-adjusted gross income) than was allowable or who worked for employers who did not offer an employer-sponsored and subsidized ACA plan, the Bronze plan was the minimal coverage-mostly a catastrophy avoidance plan. Depending on ones age, the monthly premiums could easily exceed $1,000 for plans with $6.500 individual deductibles. For these people, and I was one of them for more than three years, the only feature which was a benefit for my wife and me was the OOP Max (out-of-pocket maximum cost-a ceiling on what your total out of pocket expenses would be over the course of a year for severely expensive healthcare products and services.
So, how does this relate to the idea of precious metals as ways to define how "rules" around applying innovation to stimulate and sustain improvements in people in their wellbeing so as to reduce the risk and prevent longer term healthcare issues and/or to improve the efficiency and sustainability of their recovery efforts from healthcare interventions?
Here's my take:
Building on Thomas' blog post statement below for The Plantinum Rule being more valuable than The Golden Rule, I will offer two new "metals rules".
The Platinum Rule: "Do unto (or for) others as others would have you do unto (or for) them". (Personalization and Customization).
The Golden Rule: "Do unto (or for) others as you would have others do unto (or for) you" (Accountability and Engagement).
The Silver Rule: "Do unto (or for) others as you would have done unto (or for) others like them". (Equity and Fairness).
The Bronze Rule: "Do unto (or for) others as others like you have done unto (or for) others like them". (Minimum Standards and Best Practices)
While admittedly there is not much science to undergird these "metalic rules", there is the value of common sense. By thinking through a healthy living/ wellbeing services innovation idea and the best way to implement it in a way that will last, it is good to consider the metalic rules above as a useful guide to action.