By Chiraag Shah
Vice President, Payer Business
I recently returned from the 2018 AHIP conference in San Diego, and found it to be an invigorating experience, with participants discussing some of the biggest challenges and opportunities in healthcare.
Below, I’ve outlined five important themes from the conference along with some great examples of how healthcare organizations are making headway.
1. Healthcare spending looks grim.
Speakers at the conference were quick to cite depressing statistics about spending and waste in the industry. For example, our trillion-dollar national health care bill keeps growing, with the Centers for Medicare and Medicaid Services (CMS) predicting a 5.5 percent increase per year through 2026. We are not doing a good job of managing care for high-risk patients, either. Spending on care for the chronically ill comprises 86 percent of the national bill, according to the CMS.
Is there hope? Yes. Healthcare transformation is an enormous undertaking, requiring tight coordination between governments, providers, payers and consumers. At emids, we believe that innovative technologies and technology strategy will connect all parties and facilitate more informed decisions from everyone. A promising sign, participants noted, is that venture capitalists continue to expand their investments in healthcare technology.
2. Consumer engagement evolves.
Building relationships with consumers is a continuing priority for healthcare leaders, although panelists discussed ways that this should change. Some spoke about expanding our lens and looking to the success that Internet giants such as Amazon and Netflix have had in delivering personalized, convenient experiences to customers. They are the kings of customer engagement and healthcare can probably learn a lot. For one, healthcare executives talked about the need to move beyond analyzing claims and clinical data to a more holistic view. That means collecting behavioral, lifestyle and demographic data to better understand and serve consumers.
Another trend I heard about at AHIP is simplicity. In the past, a healthcare organization built several standalone portals or apps fulfilling discrete needs, such as scheduling or billing. Conference participants discussed building an integrated experience to meet all of the consumer’s needs in one place. One of the oldest University hospitals in Philadelphia has implemented a consumer experience platform that delivers a number of helpful hospital services via web, mobile, wearables, and more. It helps patients with where to park, displays a map to locate anything from a waiting room to a café, provides live scheduling, and offers them the ability to deliver real-time feedback on the in-hospital experience.
3. Machine learning reduces risk.
Data is king in many industries, including healthcare. There was ample talk at the conference about the potential to drive positive change with this technology. Combined with machine learning, payers can be proactive in identifying risk, preparing for emerging population health trends and gauging the success of wellness programs. In one session, one of the Blues shared their implementation of a solution which will identify new members who are high cost and where intervention is a must. The objective is to connect people with help before an emergency occurs. These are early days for such programs, as the industry needs to solve problems such as inconsistent data quality and poor systems integration.
4. Telehealth gains traction.
Telehealth has been around for more than three decades. The technology gained groundswell when these applications evolved from the expensive video conferencing room to a simple smartphone app. Yet reimbursement for telehealth services has been nearly nonexistent. Most consumers have had to go out-of-network—unable to see their preferred physicians—to use these apps. Now, however, consumers are about to get the best of both worlds. We heard about a great program underway at the second largest health system based in Pittsburgh. The program connects patients with physicians through a desktop or mobile app. This is convenient and affordable for patients, costing between $10 and $49 per visit. Wait times for a virtual visit are roughly six minutes. Healthcare organizations would do well to investigate this further. Telehealth is bound to grow in popularity, especially as 72 percent of adults ages 18–44 use these interactive technologies.
5. It’s time to bring payers and providers together.
Payer-provider collaboration is a topic that continues to show up at industry events, and AHIP was no exception. Healthcare plans and providers know that they need to work together, yet their processes and systems are rarely connected in ways to facilitate that. Patients can’t understand during the time of service what their out-of-pocket costs will amount to, nor do providers get insight into real-time claim status or changing reimbursement policies. This disconnect creates frustrations and delays on claims and other key processes. I think the urgency for change is upon us, particularly with the growth of value-based care, another trend people discussed at AHIP. Value-based care can’t succeed without significant collaboration between all parties. Healthcare networks that solve connectivity issues will be ahead of the curve.
The healthcare industry is amid a time of unprecedented change; payers, providers and manufacturers are grappling with lower margins and high risk. Yet we’re also at the brink of transformation. Intent is catching up with technology. I feel positive that by working diligently toward the goals of meaningful consumer engagement, systems interoperability and machine learning-powered tools, we can stay on track.
Chiraag Shah is VP of Payer Business at emids. He has extensive experience in provider and payer applications and technology transformation