Executives from the nation’s largest insurance companies gathered in Nashville last week at the annual America’s Health Insurance Plans (AHIP) Institute & Expo conference. We attended the event, and here are our thoughts on what was (and wasn’t) discussed.
More than 20 sessions at the conference focused on social determinants of health (SDoH)—proving that this once-emerging field is now mainstream. It makes sense: Research suggests that a majority—about 80%—of a person’s health is determined by socioeconomic factors.
By embracing SDoH as a critical issue, health plans can focus their outreach efforts on caring for the most vulnerable populations, such as people who do not have access to healthy foods, transportation (to and from medical appointments), or a good network for emotional and physical support. AHIP launched Project Link during the conference in partnership with health plans to develop sustainable, scalable programs that address SDoH.
But challenges remain. For example, there were many talks on how to collect SDoH data, and its impact on health outcomes, but it’s still unclear how to interpret and use the data at scale.
In his address at the conference, David Cordani, president and CEO of Cigna and chair of the AHIP board of directors, used the term “consumers” rather than “members” when he referred to Cigna’s 95 million customers across 30 countries. That reflects a change in mindset. He spoke passionately about building a company that’s laser-focused on the end customer. For Cigna, this means integrating a Net Promoter Score (a tool for measuring customer experience and predicting business growth) into performance management metrics, as well as seeking to treat “the whole consumer,” acknowledging that “mental and physical well-being cohabitate.”
There also were several sessions on the continuing evolution of sites of care. Both Kaiser Permanente and Health Care Services Corporation (HCSC) described their expanded presence in new care settings. Their approaches to reaching consumers varied. For example, Kaiser is building “branded clinics” within Target stores while HCSC’s venture capital arm recently partnered with primary care provider Sanitas USA to open primary care clinics.
Health plans acknowledged that their main problem right now is not a lack of data; the volume and variety of data at their fingertips is enormous. The problem they have is knowing what to do with it: How to integrate, analyze and curate it effectively.
For example, everyone agrees that healthcare systems want to move to a data-driven and analytics-driven value-based care model. However, conference-goers’ questions signaled a keen interest in examples—including metrics used and results achieved—of how alternative payment models are working and where plans go next in delivering value-based care.
On a separate note, non-profit organizations such as the Health Care Cost Institute (HCCI) are attempting to fill data gaps by providing access to de-identified medical claims sourced from multiple organizations. But as payers realize their data sets can be a source of competitive advantage, that’s becoming problematic. In January 2019, UnitedHealthcare said it would no longer provide its claims data to HCCI. According to Axios, HCCI partner Humana is also heading for the exit.
In another session, a BCBS plan in the South described its journey toward deploying advanced analytics. The plan spent two years focused solely on integrating data: voice-based call center data, claims data and electronic health records. Once the data was integrated, the plan started adding use cases and building AI models. Without that integration, the analytics wouldn’t have been useful.
Amazon’s healthcare play and prescription drug pricing. These issues get a lot of attention in the lay press, but they weren’t discussed in much detail at this year’s AHIP Institute.
Last year, Atul Gawande spoke at the conference days after being named CEO of Haven, the healthcare venture led by Amazon, JPMorgan and Berkshire Hathaway. This year, there was little follow-up. We’re not sure if that was due to the relative secrecy surrounding Haven’s activities or the fact that they’ve had some setbacks.
The relative silence about prescription drug spending was somewhat surprising. Outside of a closed-to-the-press fireside chat with Merck Chairman and CEO Ken Frazier, the issues of drug pricing and cost constraints did not come up. One explanation is that AHIP tends to be more concerned with the overall affordability of health plans, and prescription drugs account for only about one in five dollars spent. While a couple of costly, one-time, curative cell and gene therapies are approved, they address relatively small patient populations, and health plans have been able to absorb the costs on an ad hoc basis. As the number of advanced therapies multiplies, the topic of pricing will likely become more prevalent.