6 trends that took the spotlight at AHIP Institute 14

A lot of activity went on at this year's AHIP Institute in Seattle, and FierceHealthPayer editors were there to cover it all. After sitting in on sessions, interviewing experts, chatting with attendees and analyzing our experience, the FierceHealthPayer editors noticed several trends that took the spotlight during the annual conference--namely, that insurers should emulate the retail industry, become even more consumer focused and make sure information is integrated. Other topics of interest included care delivery, healthcare costs and value-based payments.

Here's a summary of the six topics that took center stage at AHIP Institute.

1. Retail revolution

The AHIP Institute opened its 2014 conference with a panel of experts from the retail industry. Former Trader Joe's CEO Doug Rauch said insurance companies looking to become more customer-centric must first look within. They should ask themselves "Why do we exist? What's our purpose?"

Rauch explained that being customer-centric requires "congruence in the organization, not just a separate department" that addresses customer needs. "It must be driven all the way down through the company so that everyone recognizes" the need of prioritizing the customer, he added.

Cambia Health highlighted the need for a retail-oriented perspective--with consumer-facing tools and enhanced transparency--to address the needs of the individual instead of the institution. That approach is what Rob Coppedge, Cambia's SVP of Strategic Investment and Corporate Development, called the health plan 2.0. To thrive as a health plan 2.0, Coppedge told FierceHealthPayer that insurers also must shift to value-based payments and better support caregivers and seniors.

2. Consumer-focused care

Experts at AHIP's Consumer Experience Forum focused on how to smooth the industry's transition to a business-to-consumer market. They offered guidance on how to ensure brand loyalty, engage new consumers and take the consumer experience beyond member acquisition to retention.

FierceHealthPayer learned that insurers selling Medicare Advantage plans must be creative when it comes to meeting the needs of their members and driving more engagement. Mike Funk, vice president of the Provider Development Center of Excellence at Humana, recommended insurers offer more flexible benefits and copays as well as tailor benefit designs around specific populations, such as diabetics.

Despite all the talk about consumer-focused healthcare, many insurers' websites still lack easy-to-access, simple information that consumers need to make smart health decisions. That's why upstart, for-profit Oscar Insurance Corp. created a completely new kind of online presence that's easy and transparent for consumers. The website provides a revolutionary online experience where consumers can get quotes for available plans in less than 30 seconds with just a few clicks.

But is it possible insurers have been going the wrong way about success in the consumer-driven environment? FierceHealthPayer editors questioned whether insurers should put their time, money and energy toward consumer engagement strategies. Many new consumers need coverage and access to healthcare services in an efficient, simple and affordable manner--all of which insurers can provide without engagement.

3. Health IT

The day before the general conference opened, FierceHealthPayer editors attended the data analytics forum. During one session, industry experts agreed that interoperability must be ubiquitous for health IT to really work. That means, for example, payers and providers must stand together to tell vendors they need shareable data, said Kevin Fickenscher, chief medical officer of New York-based AMC Health. The panelists also called for open-source capability to use big data in healthcare.

WellPoint Vice President of Health IT Strategy Elizabeth Bigham said during another Data Analytics Forum session that machine learning technologies, such as IBM's Watson supercomputer, will play a major role in getting patients the best care. Insurers can use such smart tools to aid providers in delivering proven, evidence-based medicine.

4. Care delivery

When it comes to accountable care organizations, aligned incentives, partnerships and shared decision-making are three key aspects of successful programs, according to a panel of experts at the AHIP Institute. Aligning incentives enables payers and providers to make investments that eliminate poor quality, said Matt Handley, medical director at Group Health Cooperative in Seattle. And shared decision-making that includes the consumer helps ACOs improve outcomes, because the only people who get surgery, for example, are those who really want it.

Focusing on care delivery models, FierceHealthPayer editors learned dual-eligible consumers, in particular, need coordinated care. As the fragmented healthcare system sees more chronic illness and mental conditions collide, behavioral and medical health must be integrated to streamline care and curb costs, psychiatrists from WellPoint and Molina Healthcare told an AHIP Institute audience.

5. Healthcare costs

Healthcare costs remain a top priority for insurers as well as policymakers and other industry leaders. To help insurers and providers remove waste from the healthcare system while doing as little harm as possible, Meredith Rosenthal, associate professor at the Harvard School of Public Health, recommended boosting price transparency efforts, implementing reference pricing and including payment reforms within new delivery models.

Rosenthal highlighted another method to control healthcare costs: Implement tiered networks--as opposed to narrow networks--so insurers can sort providers into tiers based on cost-efficiency and quality performance measures. Tiered networks incentivize providers and consumers to move toward lower costs and higher quality.

6. Value-based payment

As insurers continue shifting toward more value-based payments, they must collaborate with providers to break down silos. "It's the interaction between payers and providers that needs to change to get value and quality," Lili Brillstein, director of episodes of care for Horizon Healthcare Innovations in New Jersey, said during a session at the AHIP Institute. To improve interactions and enhance collaborations, insurers should launch new reimbursement methods with early adopters, provide doctors with several reimbursement options, share data and treat providers as partners.

This move away from fee-for-service to value-based reimbursement already is well underway, according to a McKesson study conducted by ORC International and published during the AHIP Institute. The study found 90 percent of payers and 81 percent of hospitals currently implement a mix of value-based reimbursement and FFS.

>> Click here to see our full list of coverage from this year's AHIP Institute.