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April 7, 2010


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The Robert E. Nolan Company is an operations and technology consulting firm specializing in the health care industry. For 35 years, we have helped clients redesign processes and apply technology to improve service, quality, productivity, and costs.

Our staff members are all senior industry experts with 15+ years in the industry. Visit www.renolan.com to for health care articles, white papers, and client success stories.

Drinking From a Waterfall

Merit Smith
Vice President & Director, Health Care Practice

In this edition of Nolan's Trend Line, we offer some tips to help executives track and manage the vast amount of information that is emerging following the passage of the health care reform package. This is the first in a series of Trend Line e-news that will help health care organizations understand and respond to reform.

Begin by thinking about health care reform as a "Public Policy Life Cycle." This is a simple model with key phases:

  • Policy Development. This is the phase where ideas are developed by think tanks, trade groups, and advocates. It is the land of white papers, books, and speeches. This phase focuses on "what should be done and why." At some point, ideas come together and move into…
  • Legislation. This is the process that reduces ideas into very specific proposed legal text and then uses a political process to decide if the text will become law. This phase of the model is the most complex because it mixes "what should be done, why, and how it will be done."
  • Rule Development. Increasingly, laws aren't the end of the process but rather an input to another process where laws are implemented via rules and regulations. This stage of the process has many of the characteristics of the first two phases: advocacy, hearings, multiple proposals, deal cutting. This stage is the most detailed and focuses largely on questions of "how will the law be implemented?"
  • Litigation. The courts can get involved in a variety of ways but most frequently they come into the process as rules are being developed or implemented.

What we've described here is an ideal model, but health care reform is currently a bit of a jumble. Even with a final law in place, there is still an ongoing debate about Policy and this is impacting future Rule Making. All phases of the model are in play and that makes it harder for executives to follow issues.

Use this model to bring some order to the chaos:

  • Begin by creating an 'issues' list. You'll find it easy to think of dozens of topics but start with only a few, and then gradually expand the list to include others.
  • Suppose you need to better understand "exchanges." What do you do?
    • Get an e-clipping tool like Evernote. As you come across relevant items, Evernote them. Label your Evernote categories Exchanges: Policy, Exchanges: Legislation, and so on.
    • Set up a Google Alert on "Insurance Exchanges." It will find articles, speeches, and all sorts of Web items. Briefly scan them. If you want to keep any of them, clip them to Evernote. You will find that scanning the Alerts can be done very quickly, and you can modify your Alerts to make them more or less specific.
    • You will be amazed by the volume and diversity of items that are flowing to you. If you aren't getting enough information, perhaps your alerts need fine-tuning or you may need to seek out new publications or information sources that are directly focused on your topic of interest. Fee-based subscriptions typically yield higher-quality information, but I encourage you to try before you buy.
    • If you aren't getting a consistent flow of information on your topic, a ten-minute Google session with your key words can yield a great deal. You can also call your trade group, your actuary, law firm, or Nolan (800-248-3742) for help in finding the best available information on your topic and identifying sources of information that will keep you current.

In the coming weeks, we'll give you ideas on applying the information you gather. We will offer our perspectives on where to look for the opportunities and challenges that will arise, and how elements of the reform package may impact your operations and commerce model.

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