The End of Obamacare? Oliver Wyman’s Stone on what’s next for healthcare and the ACA under Trump


During the highly contested 2016 U.S. presidential election, Donald Trump made dismantling Obamacare—the Affordable Care Act—a cornerstone promise of his campaign. Now with him in the White House, everyone on the healthcare continuum, from the insured themselves to providers to the payers are anxiously waiting to see what’s going to happen. Consulting sat down with Terry Stone, Health & Life Sciences Lead for Oliver Wyman, to talk about what comes next for healthcare consulting amidst the uncertainty ahead.

Consulting: If the Affordable Care Act goes away what will be the immediate impact on the Healthcare consulting market?

Stone: The biggest immediate impact is the amount of uncompensated care that essentially gets thrown back on the books of the healthcare delivery system. Tens of millions of who had insurance and the health systems were being reimbursed are going to go back to using the ER. Hospitals have to pay for that, and they pass it along in the form of increased costs to the insurers, and eventually it hits the economy in the form of the wallets of the employers who are providing health insurance. That’s going to put a real strain on hospitals, but it’s going to put even more pressure on cost and efficiency, and there’s probably going to be a lot more strategy work around portfolio optimization; how much of what they have is Medicare patients reimbursed at a certain amount versus how many commercial patients.

Consulting: How does Trump’s back-and-forth on the issue present unique challenges?

Stone: There could be a freezing of action in the market due to uncertainty. There are timelines upon timelines for developing products, filing with regulators, making sure they’ll be viable in the market. With the flip-flopping all over, we can wind up in another situation where there isn’t enough clarity soon enough. So there’ll be some initial work where people are trying to analyze and assess impact, but then there will be a little seizing and freezing when no one’s sure what they’re actually building towards. They’re talking about fundamentally changing benefit structures, fundamentally changing what the tax benefits of employee-sponsored healthcare look like. All these things have huge impacts on what our clients’ products look like, and those are the types of things that could cause people from a consulting standpoint to not move forward until there’s more clarity.

Consulting: What should healthcare stakeholders prioritize knowing that changes are coming but not knowing what they will be?

Stone: Fundamentally driving for greater efficiency and lower administrative costs in any capacity in healthcare is critical regardless of what happens moving forward. Whether you’re a hospital system or a payer, a focus on improving your value proposition to consumers and individuals being better at differentiating your service offering, the value you deliver, those will all be critical components of standing out in a future market. People will be voting more with their feet. There will be more transparency eventually, and having higher quality ratings and consumer satisfaction will be unquestionably important where people like you and I wind up spending more of our own dollars and have more information available for choosing doctors.

Consulting: What are some of the biggest consulting opportunities or challenges clients will face in this climate?

Stone: Where to focus. And some of it is daunting. One of the things we have today I call the “throwing spaghetti against the wall” phenomenon. There are lots of tools, apps, services, coaches, resources etc., but rather than configuring them and creating perfect-built solutions for different segments of consumers and making it easy to know what you’re going to get and meet expectations every time, most of what’s available in the market is we throw it all against the wall and it’s a little bit like “I have stuff for everybody!” But the burden is all on the consumer to connect the dots. The biggest opportunities lie in helping people understand where are the areas you can differentiate on for what type of target customers where they’ll actually choose to pay a premium or select X over Y. Part of it will be taking a whole bunch of stuff that healthcare is already invested in and making it work together and smarter. There are a lot of tools out there that plans and systems have spent a lot of money on, but they aren’t wired together in a way that feels seamless to the consumer. Healthcare needs to do a couple of things. It needs to continue to put a focus on quality of care and cost and work on making the consumer experience simpler and easier, and less of a burden for the consumer to connect all the dots. Right now there are lots of tools and options, but they all feel fragmented and piecemeal, and so a lot of the consulting will be in connecting those pieces together.