Embrace Data; Focus on Consumers

America’s Health Insurance Plans (AHIP) is the national association whose members provide coverage for healthcare and related services. AHIP strives to improve and protect the health and financial security of consumers, families, businesses and communities, working together to make healthcare better.

I recently attended the AHIP Institute and Expo 2019 in Nashville, where the best minds in healthcare gathered to discuss current trends and larger-picture issues. As expected, I came away with an even clearer vision of four pressing topics facing our industry today. These themes covered a broad range of issues, and I’d like to examine each one a bit more closely and share my thoughts.

Embracing the Importance of Data

The first topic was data and the importance of it in AI, predictive analytics and consumer management. Simply stated, what exactly is needed to implement Al within an organization? The answer is in understanding the significance of data, finding the right people to manage the data and aligning implementation within the specific structure of the organization. Smaller companies will adopt Al quicker than larger organizations; just look at Silicon Valley as an excellent example. It is also important to note that data and analytics must be achieved in real time, and the data exchange among healthcare entities should be made possible so we can look at it ethically and understand that data sharing will make a positive difference to patients. In addition, consumers can dictate what they need to help them overcome the hurdle of data problems.

In partnering with Epic, Apple is giving full control of data to consumers. Members now have control of their data and can manage when the data is shared from one entity to the other. The key is to build something within your company that others can adapt to and learn from quickly.

Meeting Consumers’ Needs

The second theme was the necessity to focus on the healthcare consumers’ needs, zeroing in on significantly improving access and affordability, and eliminating surprises (such as an unexpected bill in the mail several months post doctor’s visit). David Cordani, President and CEO at Cigna Corporation noted that “the biggest distractors for consumers are surprises.” He went on to share, “Society demands more value from us sooner, and they should as it relates to more personalized affordable, predictable services. Consumers are basically saying to healthcare companies: know me, help me and make it easier and simplify it.” He added that “we need to pivot from solving things on average, or explaining things in aggregate, and come back to the individual consumer level.”

Cordani noted that up to 30 percent of ER visits are potentially unnecessary, and three in 10 adults ration their prescriptions. It is truly about connecting individuals and providers, treating the whole person and driving change through innovation. Says Cordani, “Cigna is betting that the future of health insurance is managing the whole person — not just their medical benefit or their pharmacy benefit, but the totality of their care including behavioral health and dental.”

Understanding Behavioral Health

This comment provided an excellent transition to the third theme, behavioral health and the importance of addressing the issue of loneliness. In his speech “Social Determinations of Health,” physician Vivek Murthy, who served as the 19th Surgeon General of the United States, shared that a patient told him “he won the lottery and it was the worst thing that happened to him, as he became very lonely.” Murthy noted that approximately 20 percent of the population is feeling loneliness, and individuals live shorter lives if they are lonely. He stressed that the use of technology has an impact on loneliness. In addition, the session “Confronting the Growing Impact of Loneliness and Social Isolation” provided insight on three specific health plans that are reframing the conversation around mental wellness and using innovative care management strategies to demonstrate their commitment to the communities they serve.

Making Healthcare Better in the U.S.

The fourth topic centered around how we can make healthcare better in the United States, focusing on home care, virtual healthcare services and diabetes management – and the need to treat the individual as a whole person, and not in isolation for one specific condition or ailment. Industry leaders shared their insights on how they are taking preventative steps to keep people healthier at home – including diabetes management, making home healthcare more affordable and focusing on providing housing for the homeless, all which have a direct impact on rising healthcare costs.

We need to remember that we’re all in this together. We know that change in the healthcare industry is particularly slow, yet we have seen some positive transformations in our healthcare system in just the last few years. I believe we are making good progress in ultimately having the consumer be the focus of each and every healthcare experience, and know we have the industry leaders and tools in place to get us there.

Chiraag Shah is VP of Payer Business at emids. He has extensive experience in provider and payer applications and technology transformation.

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