"We are very carefully watching the development of the HIX and Medicaid expansion in each market, implementing strategic responses accordingly. We do a whole lot of monitoring and modeling to see what each specific market's situation means to us. You have to continue to adjust," he says.
Jenny Barnett, CHE Trinity Health's executive vice president, finance, interim chief financial officer, and treasurer, says the implementation of healthcare reform is not helped by the fact that many of the changes and delays that are occurring are politically driven.
"We operate in 21 states, each different politically and with different positions on health insurance exchanges and on Medicaid expansion. It's very dynamic, and every day is a new day, whether it's a delay or another development. It is difficult to predict. Planning is very difficult these days," Barnett says.
"We are also struggling with predicting what the healthcare model really is going to look like—and I don't think we are alone. All providers are wondering what the new model is going to be and how quickly they will be able to adapt. We also have to consider how we will prepare for more bundled payments and more capitation," she adds.
Carter agrees that the political nature of healthcare reform is adding to the challenges provider organizations are facing and says he doesn't expect that to change any time soon.
"Things change day-to-day, and we have to watch for these changes," he says. "They each have a different impact in terms of what it means to us."