At AHIP Institute, collaboration is the name of the game

Many relationships in healthcare can best be described as adversarial.

Patients often distrust payers and don't understand how the healthcare system or their own provider organization works. Providers constantly clash with payers and vice versa. And everybody's regard for the Centers for Medicare & Medicaid Services and other government bodies can perhaps be measured in varying levels of disdain.

If the message of America's Health Insurance Plans AHIP Institute is any indication, though, these relationships may finally be changing. Nearly every keynote, educational session and conversation featured some form of the word collaboration.

  • Aetna, Anthem and Kaiser Permanente described their work with the Council for Affordable Quality Healthcare (CAQH) to streamline business processes such as bill coordination, electronic file transfer and data maintenance. These insurers shared their lessons so that the industry as a whole could cut into an estimated $800 million in wasted administrative costs associated with coordination of benefits alone., according to CAQH Executive Director Robin J. Thomashauer. 
  • Prudent payers recognize that predictive analytics can drive care decisions and control costs across the healthcare system--but only when they have access to all the data they need when it's time to start crunching the numbers. This has proven to be a challenge, particularly when it comes to electronic health record (EHR) data, but it has helped show providers and customers the causes of certain hospital readmissions or the costliest comorbidities associated with diabetes.
  • Cigna's provider directory shows customers the doctors covered by their specific plan--not just Cigna at large--along with patient satisfaction ratings and details about out-of-pocket costs for 1,100 common medical procedures, according to Raj Davda, M.D., the insurer's national medical director for network performance evaluation and improvement. That directory has been years in the making, Davda said, not least because it requires input and buy-in from many players.
  • Former President Bill Clinton advocated an inclusive and collaborative approach to solving the world's problems, whether they pertain to healthcare, climate change or income inequality. (Former Massachusetts Governor and Republican Presidential candidate Mitt Romney also called for solutions to these and a variety of other global issues, but his tone was less "Let's work together" and more "Let's get it done.")

These examples--except, perhaps, for Romney's plea to send ships to defend the South China Sea--take a fairly conciliatory approach. Whether that lasts remains to be seen.

In a conversation with FierceHealthPayer, Gregory Scott, vice chairman and U.S. health plans leader at Deloitte, said that, right now, payers (and healthcare organizations in general) see value in collaboration. In due time, as the industry continues its march toward value-based care and pay-for-performance reimbursement, this will become an imperative to collaborate, if not partner or integrate outright.

Certainly, this offers opportunities; Scott specifically mentioned improvements to analytics and care coordination, echoing what other AHIP speakers said.

However, healthcare and integration don't always mix, as the decades-long struggle to get disparate EHR systems to share data illustrates all too painfully. Nor is there any guarantee that consumers, physicians, nurses or claims representatives will reap the same benefits from industry consolidation as executives or shareholders.

At any rate, collaboration is a start. It opens a door through high, thick walls that the healthcare industry has erected to separate its major players. In some cases, it even opens a window into how these entities operate and can learn from each other.

It will be a long time before the walls come down--and, even then, large piles of rubble will still stand between providers, patients, payers and government agencies. Then, though, it will be easier for everyone to see that their struggles are the same and that they need not view each other as adversaries. - Brian (@Brian_Eastwood and @HealthPayer

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AHIP: Use predictive analytics to drive decisions, control costs
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