By Paromita Ganguly, Consultant, Infosys Limitedbaconvention.com/.../12/...Wicked-Problems-Paromita-Ganguly-Infosy… · © 2014 BA Convention 4 Click to edit Master text styles Click

© 2014 BA Convention

By Paromita Ganguly, Consultant, Infosys Limited

© 2014 BA Convention 2


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Wicked problem requirement and risk management

Wicked problem resolution techniques

Wicked problem identification




Yes, wicked problems seem complex

…. And their complexity may be a lot more than meets the eye!!

They often trigger a chain reaction.




Complex issues comprising of a set of interlinked problems.

Changing requirements.

No unique and permanent solution rather only a temporary resolution.

Stakeholders have different views of the problems and contradictory solutions.

Problems of a social nature with a great impact on people’s lives.





Mess Mapping

• Stakeholder identification

(viz. stakeholder matrix)

• Information collection (viz. surveys)

• Visual representation of stakeholder perspectives (viz. rich pictures)

• Deriving inter-relationships between perspectives

Resolution Mapping

• Prioritizing outcomes in case of conflicting stakeholder requirements. (viz. MOSCOW methods)

• Selecting the desired end state to be the current state.

• Determining the events leading to the end state

• Deciding upon the relevant actions to achieve the End state.

Solution assessment & validation

• Assessment of the potential risks and changes to the problem domain. (viz. maintenance of issue logs, risk to risk mapping)

• Iterative implementation of the ‘plan, do, check, act’ cycle.





Expanded healthcare coverage

Improved Quality

Reduced Costs





Ever increasing costs

Quality issues

A large number of the

un-insured



Click to edit header Pain Points





End

C

ust

om

er • Reduced purchasing power

• Reduced coverage

• Slow growth in wages

•Reduced economic security

Hea

lth

In

sure

rs •Depleting profits/ surplus

and increased business risk.

•Increased competition to design and offer affordable plans

Pla

n

Spo

nso

rs •Higher cost of employee

recruitment

•Reduced profitability

Hea

lth

care

P

rovi

der

s •Increased costs of service and reduced income

•Increased liability and risk.

Go

vern

men

t •Increased costs and reduced availability of funds for other developmental activities.

•Public discontent and loss of faith.





• Higher cost of employee

recruitment and reduced

profitability.

Plan Sponsors

• Reduced purchasing power.

• Reduced coverage.

• Slow growth in wages.

• Reduced economic security.

End Customer

• Depleting profits/ surplus

and increased business risk.

• Increased cost of coverage.

• Increased competition to

design and offer affordable

plans.

Health Insurers

• Increased costs and reduced

availability of funds for other

developmental activities.

• Public discontent and loss of faith.

Government

• Increased costs of service.

• Reduced income.

• Increased liability and risk.

Healthcare Providers





Broadened Insurance Benefits (EHBs).

Guaranteed issue and renewal.

Financial assistance (APTC and CSR).

Health Insurance Exchanges for greater transparency.

Focus on Preventive and Wellness care; prescription drug formularies.

Ban on annual and lifetime limits as well as on deductibles in the small group market.

No variation in premium based on gender or pre-existing health conditions.

Appeals and claim processing guidelines.

Taxation in both individual and group markets.

Individual and employer mandates.




Obamacare offerings US Healthcare Objectives

Improve Quality

Expand Coverage

Reduce Cost

Essential Health Benefits

Guaranteed issue and renewal

Financial assistance

Health Insurance Exchanges

Preventive and Wellness care; prescription drug formularies

Annual and lifetime dollar limit bans, plan deductible limits set.

Restrictions on rating based on gender or pre-existing conditions.

Appeals and claim processing guidelines

Taxation policies

Individual and Employer mandates








Expanded healthcare coverage

Improved Quality

Reduced Costs

PLAN

DO

CHECK

ACT




Postponement of the Individual Mandate for 2014

• Owing to technological challenges, the SHOP module implementation in health insurance exchanges (HIX) was delayed in 2014 and therefore all such potential SHOP enrollees who missed coverage in 2014 were exempted from the Individual Mandate. Exemplifies a temporary change in solution to handle a change in requirement.

The Small Business and Family Relief Act

• Introduced to delay the health insurance tax for two years starting 2014, providing immediate financial relief to those impacted by the tax.

Introduction of PPACA safe harbors

• Introduction of look-back/ stability periods for determining full time employees of small employers.

• Introduction of the 90 day limit on waiting periods.

• The original proposition of a payment through the HIX each time an enrollment or a renewal happened was later amended due to payer and end customer requirements.

Direct payment at insurer’s site for renewal of enrollments




Wicked problem requirement and risk management

Wicked problem resolution techniques

Wicked problem identification

© 2014 BA Convention

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By Paromita Ganguly, Consultant, Infosys Limitedbaconvention.com/.../12/...Wicked-Problems-Paromita-Ganguly-Infosy… · © 2014 BA Convention 4 Click to edit Master text styles Click

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