Editor's Corner: A shifting definition of insurers at AHIP Institute

Business people mingling at the 2016 AHIP conference

headshot of authorReporters are always on the hunt for great quotes—whether they convey a powerful emotion or eloquently encapsulate an argument. Or sometimes, along comes a quotation that sums up an entire event.

Such was the case when at this year’s AHIP Institute in Las Vegas, I found myself scribbling down this gem from Bright Health co-founder Kyle Rolfing: “We’re at the precipice of a whole new definition of what a health plan can actually be.”

Rolfing may not have known it at the time, but his words aptly describe a trend I noticed throughout the conference panels I attended, though they covered a wide breadth of topics.

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There was the panel on which Rolfing spoke, when startup insurers detailed how they are disrupting a traditionally conservative industry through innovative ideas.

There was a presentation from Cigna CEO David Cordani, in which he discussed value-based agreements with pharmaceutical companies and providers that just a few years ago would have been unheard of.

Then there was a panel on managing medically complex members, which focused so much on patient care and community outreach you could swear you were at a conference about social justice, not one for the health insurance industry.

In fact, one audience member tellingly remarked that this was her favorite AHIP conference because of its increased focus on the social determinants of health—a phrase I’ve heard much more frequently at provider-focused events.

All of which raises the question, how do you define health insurers and health plans these days? Are they still the long-reviled companies that primarily pay medical bills, or has the business model truly become something different?

The answer, from my perspective, is yes. Of course health insurers are still in the business of managing claims, designing provider networks and collecting premiums, and that probably won’t change anytime soon. The back-and-forth with government regulators also is sure to be a constant. But it’s become clear the industry knows change isn’t optional for organizations that want to thrive in an era of health reform.

For some insurers, that means going the high-tech route. I couldn’t tell you how many times I heard the word “telehealth” during panel discussions and keynotes. Kaiser Permanente CEO Bernard Tyson, for example, made it clear the payer-provider system plans to invest considerably in virtual visits.

Others are responding by taking cues from outside the health insurance industry to reimagine the customer experience. No amount of consumerism will make insurers act like your typical retail business. But as Anthem Staff Vice President of Consumer Experience David Poole pointed out, other companies aren’t as different as you might think—the airline industry, for instance, rivals health insurance in terms of how highly it is regulated.

Additionally, the line between payer and provider continues to blur. Not only are insurers increasingly working closely with providers, but more and more, they are acting like them—and vice versa. Just ask David Bernd, CEO emeritus of the integrated system Sentara Health, who pointed out that the historical “head-to-head combat” between the two entities no longer works in today’s health system.

Similarly, as evidenced by the amount of time AHIP CEO Marilyn Tavenner spent lauding Medicaid managed care plans, care management—with a focus on the member as a whole person, not just a patient—is the future.

Today’s health insurers, then, must be nimble organizations that can keep up with a never-ending conveyor belt of new government regulations, work with providers and other stakeholders collaboratively, embrace innovative technology and make customer service a priority.

If those sound like lofty expectations, it’s because they are. But leaders at this year’s AHIP Institute seemed to all agree that today’s consumers expect more of their health plans, and despite all the challenges, they appear eager to deliver.

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