As President Obama leaves office and Donald Trump prepares to take the reins, a Republican Congress has declared repealing Obamacare to be one of its top priorities. But what that will entail and what the resulting healthcare system will look like is anyone’s guess at this point.
With so much uncertainty in the health care market, you might expect Eugene Sayan, the CEO of PF Softheon, whose platforms are used by insurers and health plan exchanges to market products to and accept payments from consumers, to be worried. You would be wrong.
“That’s just Entrepreneur 101,” Sayan said. “Where there is chaos, there is opportunity.”
If that’s true, then there is a fair amount of opportunity inherent in transitioning a complex industry and its legacy way of doing business into a completely new model. But that’s exactly how Sayan sees what’s going on in healthcare – as an ongoing transformation.
“Our approach, when we look at it from a policy perspective, we did not see [the Affordable Care Act] as being just another program or another application that health insurance companies need to learn or operate. We look at this not as ACA, but more of a consumerization or ‘retailization’ of health care,” he said.
Sayan compares the changes in healthcare to other industries such as travel, finance and banking, where consumers are more aware of options and have taken on more of the risk.
He maintains that health care instruments that were developed to drive a shift to consumers, such as health savings accounts and high-deductible health plans, were growing before ACA was implemented, but the law and the subsidies that accompanied it sped that growth and brought many more people into the model.
“We felt that ACA was an acceleration of the transformation,” he said.
Sayan called this transformation a “supply chain transformation.” By selling their products on the exchanges, he said, insurance companies have become suppliers, with the exchanges serving as the retailers that deliver those products to consumers.
He acknowledges that any predictions of what is coming next amount to sheer speculation. But the information we know so far indicates that the replacement for Obamacare will move toward more privatization, he said.
This likely means more engagement and involvement from the consumer, continued need for platforms such as Softheon’s, and increased opportunity for a company that has so far been able to identify what health insurers need to help them adapt to their changing landscape.
Sayan credits his company’s ability to successfully navigate this changing environment in part to its vision for how health care payments can follow the same path of disruption other industries have taken. But there are other factors.
Softheon was originally commissioned to work on Romneycare – the Massachusetts health insurance reform program that served as a model for Obamacare – which gave it unique and invaluable experience building out an exchange. And its history working with health insurers for the past 15 years has also given it insight to the strengths and weaknesses of those companies’ core systems. This insight helped Softheon know how to fill in the gaps.
All of these elements have helped Softheon maintain its foothold in the market, and give Sayan confidence about his company’s position during this latest transition.
“I think there are going to be a lot more rules and requirements around how the next iteration of health care or health insurance exchanges should operate,” he said. “I would not be surprised if they take a serious look at how the companies or models that are operating functionally succeeded.”