AHIP Institute Takeaways


Last week, health plan executives from across the country assembled in Nashville, Tennessee for the AHIP Institute & Expo to learn from their peers and discuss issues affecting the industry. As a silver sponsor, HealthEdge was immersed in the event, and brought back these three key takeaways from the conference:

Social Determinants of Health Start (And End) at the Community Level

37211-0001 is just one of hundreds of nine-digit zip codes in Nashville, TN where AHIP Institute took place. When looking at social determinants of health (SDOH) data, we need to be looking at this level of specificity. One nine-digit zip code may only represent a few city blocks but consumers in those few blocks may face issues not faced by others on the other side of town. We know that 70% of a person’s health is determined by socioeconomic and behavioral factors, but we don’t have a standardized way of collecting this data, nor do we have a government mandate to do so. Traditionally, elements of what are now SDOH programs were front-office activities, but in order to be successful, SDOH must be a cultural and operational activity that goes through not just the organization, but the ecosystem. But it is up to the organization to collect the data, share the data, and develop and agree to Key Performance Indicators and take ownership of the scorecard that determine success.  

As much as we like to compare ourselves and our organizations to others to see how we stack up, we must throw that mindset away when it comes to SDOH. We can’t compare or aggregate national SDOH measures, not only because we don’t have a process in place, but because social determinants are specific to one state, one region, one nine-digit zip code and sometimes one block. In the new world, health plans must leverage value-based models to encourage physicians to identify SDOH gaps and create goals or incentives around them.

Social Determinants of Health - What are Payers Doing?

Social Determinants of Health (SDOH) was a bleeding-edge concept 20 years ago but today, healthcare payers and providers are starting to incorporate SDOH factors to predict the impact on an individual’s health. SDOH are activities or circumstances that are part of your holistic person that a doctor may not consider but are critical in determining the state of your health. 

Social Determinants of Health

Value-Based All Around, We See You Specialty Health

Many specialty health (behavioral, vision, hearing, dental, etc.) cases still start in the primary care space. In fact, Cigna spoke in a breakout session and shared that 32% of mental health related visits are with primary care providers. Specialty care is very much woven into the fabric of healthcare, and yet value-based programs have historically excluded them, until now. It is estimated that up to one third of consumers with a chronic condition also have symptoms of depression. When we place members into value-based programs, we must not only pay special attention to their specialty care needs but ensure specialty care providers are part of the program. The case is similar with dental care. Dental coverage rarely receives the same level of attention as health coverage, and yet in a 2014 study of the National Association of Dental Plans it was uncovered when adult Medicaid recipients had preventative dental care, medical costs for seven chronic health conditions, such as diabetes and coronary heart disease, were lowered by 31% to 67%, respectively. As our industry shifts to a whole person outcome, we can not leave specialty care behind.

We Have People, Now It’s Time for Process & Technology For VBR

The new generation of health plan leaders are here and ready to work and are not afraid to rock the boat. According to many panelists at AHIP Institute, what is now missing are the processes and technologies to support these innovators. In many cases, leaders feel that they have good processes in place within their organization but are still missing communication and processes with their provider partners. In other cases, they feel their organizations are still performing too many manual tasks that take up precious resources. Regarding technology, health plan leaders spoke about the importance of having information available in real-time. Real-time information means they can make course corrections sooner than waiting three, six or twelve months to view analytics or performance reports. This point is equally true for providers in value-based agreements. Real-time information available on-demand allows providers to identify a problem immediately as well and use self-service to do it.

HealthEdge is excited to see how health plans learn from the information shared at this year’s AHIP Institute & Expo and subsequently work together and with their stakeholders to create new opportunities and improve healthcare.

Value-Based Reimbursement: How we got here, what’s working, and who’s doing it well

Payers, providers, the U.S. government, and other entities have made initial investments in value-based reimbursement. And while these initial investments have, in some cases, made great strides in the march toward quality-based care, costs are still increasing, payers and providers are no closer to a trust-based relationship, and fee-for-service is still a large part of reimbursement.

Value-Based Reimbursement

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