This was presented at the BA Convention 2014 held in Bangalore, India on May 29 and 30, this year. It delves into Wicked Problems and their resolution techniques by studying the case of Obamacare in US Healthcare. Wicked problems are the opposite of tame problems. Their requirements change over a period of time and comprise of a set of interlinked problems. Stakeholder's have a silo perspective of these problems. It is not possible to derive a permanent solution, rather only a temporary resolution to such problems. They are faced both at a micro level (such as an application UI design) and a macro level (public policy making). The presentation demonstrates a technique involving Mess Mapping and Resolution Mapping (published by Robert E. Horn and Robert P. Weber in their paper 'New Tools For Resolving Wicked Problems - Mess Mapping and Resolution Mapping Processes') along with a Continuous Solution Evaluation and Assessment, to handle wicked problems. The technique is then mapped to the Obamacare Act to analyse how the wicked problem of the U.S. Healthcare was handled by Obamacare.

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By Paromita Ganguly, Consultant, Infosys Limited

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Wicked problem requirement and
risk management
Wicked problem resolution techniques
Wicked problem identification

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Yes, wicked
problems
seem complex
…. And their
complexity
may be a lot
more than
meets the
eye!!
They often
trigger a chain
reaction.

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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.

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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.

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Expanded
healthcare
coverage
Improved
Quality
Reduced
Costs

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Ever increasing costs
Quality issues
A large number of the
un-insured

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Pain
Points

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End
Customer
• Reduced purchasing power
• Reduced coverage
• Slow growth in wages
•Reduced economic security
Health
Insurers
•Depleting profits/ surplus
and increased business risk.
•Increased competition to
design and offer affordable
plans
Plan
Sponsors
•Higher cost of employee
recruitment
•Reduced profitability
Healthcare
Providers
•Increased costs of service
and reduced income
•Increased liability and risk.
Government
•Increased costs and
reduced availability of funds
for other developmental
activities.
•Public discontent and loss
of faith.

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• 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

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 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.

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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

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Expanded
healthcare
coverage
Improved
Quality
Reduced
Costs
PLAN
DO
CHECK
ACT

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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

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Wicked problem requirement and
risk management
Wicked problem resolution techniques
Wicked problem identification

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