AHIP 2024 in Las Vegas brought together key stakeholders in the health insurance industry, covering the spectrum of critical payer challenges and opportunities. We explored significant insights gained from our participation at AHIP, focusing on topics such as interoperability in healthcare delivery, value-based care, and the integration of artificial intelligence.
Embracing modernization through technology
One of the standout themes at AHIP 2024 was the significant focus on modernizing utilization management and care coordination through both existing and emerging technologies. The integration of advanced analytics and a member-centric approach were highlighted as crucial for enhancing care management practices. As healthcare continues to evolve, the adoption of technology enables providers and payers to offer differentiated care experiences that are both effective and personalized.
The ongoing role of interoperability
Interoperability, a key component in the modernization of healthcare, was highlighted as making significant strides. With its application in areas such as prior authorization, gap closures, and risk coding, interoperability is enhancing the efficiency and effectiveness of healthcare delivery. This progress is crucial for developing a more integrated and seamless healthcare system that can better respond to patient needs.
An enterprise approach can tackle interoperability issues. The recently enhanced MedInsight Payer Platform offers capabilities for integrating clinical EHR by utilizing ready-made direct connections to EHR/EMR APIs, beginning with Epic, or employing Milliman for nationwide network connectivity.
Themes surrounding value-based care
The concept of ‘whole health’ is an approach that breaks down the silos within healthcare systems, ensuring that all aspects of a patient’s care are interconnected. Through a unified source of data, healthcare organizations can improve access and affordability, ensuring that the right metrics are used to enhance patient outcomes. The move towards a holistic view of health emphasizes the importance of integrated care models that cater comprehensively to patient needs.
Another point of discussion was the rise of alternative payment models. Alternative payment models (APMs) continue to gain traction as effective strategies to manage healthcare costs while improving the quality of care. Effective contract management and the strategic use of data analytics are key to maximizing the benefits of APMs. These models encourage healthcare providers to focus on the value of care provided rather than the volume of services rendered, aligning incentives across the board.
APMs often focus on controlling costs while maintaining or improving the quality of care. By shifting away from fee-for-service models, which incentivize quantity over quality, health plans can better manage expenses and reduce unnecessary procedures. One way to address APMs’ rise is the MedInsight Value-Based Contracts application, which helps to manage these contracts, by showing a full picture view of plans performance across different types of VBC agreements.
Strengthening payer-provider partnerships
A recurring discussion at the conference centered on the need for stronger collaborations between payers and providers. The traditional model of pointing fingers is being replaced by a partnership approach that focuses on mutual engagement and shared goals. By working together, payers and providers can identify opportunities to support practice patterns that ultimately benefit patient care and optimize health outcomes.
AI integration
Digital health remains a pillar of modern healthcare, with artificial intelligence (AI) playing a pivotal role in shaping its future. The discussions at AHIP 2024 revealed a cautious but optimistic approach to AI integration, emphasizing that while AI will automate certain tasks, the human element remains irreplaceable in healthcare. The focus is on leveraging AI to enhance decision-making and efficiency without compromising the personal touch that is essential to patient care.
The Data Science Portal, an application within the MedInsight Payer Platform, alleviates the burden of time spent prepping data away, and empowers your data scientists and data analysts with more time to analyze the data and more quickly identify opportunities. It helps your organization achieve goals without taxing internal IT resources or outside developers.
The evolving role of health plans in care delivery
The conference also shed light on the evolving role of health plans in direct care delivery. More health plans are not only covering medical services but also actively engaging in providing care. This shift is part of the broader trend towards ‘payvider’ models, where payers are increasingly involved in direct patient care, blurring the lines between paying for and providing health services.
The concept of ‘payviders’—organizations that are both payers and providers—was also a significant point of discussion. These entities are leveraging their unique position to create compelling system brand stories that enhance their digital outreach. This dual role allows them to control more aspects of the healthcare delivery system, leading to better health outcomes and patient experiences.
Looking to the future, the question arises whether the strategies of traditional payers and payviders will converge or if they will remain distinct, serving as a defining differentiator in the market. As both models evolve, their paths might intersect more frequently, especially as each adopts more sophisticated digital health strategies and seeks to integrate broader health solutions into their offerings.
How we solve payer challenges
While health plans face ongoing challenges, there is opportunity to succeed in the changing market. Read our guide, “Accelerate data to insights: the enterprise analytics approach for health plans,” which outlines how Milliman MedInsight delivers actionable insights to the payer and payvider markets.
Additionally, check out our webinar, “Payer Market Outlook,” and explore key factors influencing payer strategies, regulatory shifts, and technological advancements that are redefining the payer-provider dynamic.