The 'Edge Report Blog

Key Takeaways from the AHIP Institute & Expo 2016

June 20, 2016

This week we attended, and exhibited at the AHIP Institute & Expo 2016, along with nearly 2500 attendees and exhibitors. The event featured dozens of sessions held by experts in the industry, many of whom are leading the way with disruptive innovations, consumer experience insights, health and wellness programs, and data and analytic business solutions. A few common and familiar themes were discussed within multiple sessions and highlighted below.

Consumer-Driven Healthcare

Historically getting consumers engaged meant going through employers. The ACA has changed that dynamic and consumers are now much more actively involved in all aspects of their healthcare. Kyle Rolfing, President of Bright Health asks “to take a step back and look at what’s important to consumers – affordability and experience.” Health care is one of our highest costs, representing 17.5% of total US GDP and consumers have high expectations. We want our experience to be as seamless as interactions with Amazon or Google. Mario Schlosser, CEO of Oscar has had success within the first technology-driven health insurer. He believes you need to “build trust with the consumer, guide their member care and provide real-time health insights.” Vivek Garipalli, CEO of Clover Health believes they are a “software company in a people business. It is a “team-based effort in managing care.”

Question: how do we enable payors, providers and consumers – is it data, innovation, or something so completely disruptive as to become the next Google?

Challenges with Value-Based Implementation

You’ve read in the past few blogs that value-based reimbursement is coming, that it’s here, that it’s progressing – the viewpoint depends on who you listen to. McKesson shared their findings from a 2016 commissioned study in a white paper “Journey to Value: The State of Value-Based Reimbursement in 2016.”  Some highlights presented at AHIP include:

  • 58% of payors surveyed are along the path to full value based reimbursement, up from 48% in 2014
  • 61% of payors surveyed have changed their network strategy since 2014
  • Only 50% of providers surveyed have moved incrementally down the path to full value-based reimbursement, up from 46% in 2014

There are clearly obstacles to flipping the traditionally Fee for Service model on its head to value-based care:

“Payers and providers agree they’re least ready for bundled payment.”

“Providers say patient confusion [about their cost-share] is the greatest obstacle to operating within these networks.”

Andrea Gelzer, CMO AmeriHealth Caritas states, “successful value-based arrangements between payers and providers require more fluid and timely exchange of information. Sharing data, being transparent. Data needs to be understood and actionable.”

Beth Ginzinger of Anthem “[we’re] too big to tackle a collaborative model. Start with smaller markets. Start with understanding markets.”

This was the theme among most presentations. Start small. Experiment. Be Agile.

Transparency and the Need for Data

The third theme discussed in many sessions was transparency and the need for data.

Andrea Gelzer, CMO AmeriHealth Caritas, “…don’t see many providers who are ready willing or able to take downstream risk [without] transparency, proactive care management, and information exchange.”

Beth Ginzinger of Anthem, “Members are asking to get away from the “gotcha”. Copay only, really clear out-of-pocket expense.”

Transparency to the provider means implementing provider portals that are easy to navigate. They also want dashboards updated in near real-time so they know how they are performing. Most complain of latency in claims data and statistics.

From the member side transparency requires a collaborate model: quality, better member experience and outcomes. More than a narrow network. Reduced administrative redundancy results in clear, accurate information across all relevant channels.

Whether the perspective is the payor, provider or employer, competition is not effective in today’s marketplace without moving the needle, being agile and transparent.