Health plan execs: Data offers great opportunities, but even greater challenges

Data is the key to moving health plans to a consumer-centric business model and improving health outcomes, but information sharing isn't easy in a healthcare system that often prioritizes profits, health insurance executives said Tuesday during a World Health Care Congress panel discussion.

That has to change if health insurers want to compete in an industry that is increasingly taking its cues from other customer-service-oriented businesses, according to Aneesh Kumar (right), Cigna's vice president of enterprise product solutions. Amazon is a great example of a company that's faced a slew of criticism for its practices, he said, but has succeeded because "they work for the consumer."

"The model we have today of payers really letting the consumer hang out to dry when they start paying bills and when they start to make choices about where to go for healthcare--that is not going to work," he said.

What's more, Kumar said, benefit designs must be cognizant of members' health status and life stage, as well as focus on coordinating care and improving outcomes for those with chronic conditions.

Riverside Health, a managed care organization that serves Medicaid enrollees in Maryland, is trying to do just that, said Jose Vazquez (left), vice president of solutions for University of Maryland Medical System Health Plans. In doing so, its leaders realized very quickly it was vital to share data with providers--and that frequency of data-sharing matters.

"Sending them something quarterly or even monthly doesn't work," he said. Providers need frequent, actionable reports that help them understand how they can improve outcomes.

The use of data analytics also helped Riverside from a business standpoint, allowing it to maximize its footprint in the state and take advantage of the expansion of Medicaid eligibility. And Vazquez said that the state's health information exchanges have been a vital resource in efforts to leverage care-quality data, as they contain clinical information from multiple sources.

But that's not the case everywhere in the country, noted Kristen Miranda (right), Blue Shield of California's senior vice president of strategic partnerships and innovation. In her state, HIE adoption "is sort of the Wild West," she said, with regional efforts here and there but no widespread adoption or coordination.

That's why Blue Shield took the unlikely step of working with major competitor Anthem Blue Cross to create Cal Index--a nonprofit entity aimed at developing a statewide HIE to act as a "public utility" of sorts, Miranda said. The organization now has its own leadership team and is in talks with UnitedHealth and accountable care organizations about participating.

Developing Cal Index revealed what Miranda deemed the "fascinating" politics surrounding the ownership of data, as it led to many spirited discussions about what organizations were--and were not--willing to share. Providers and payers alike have long been programmed to hold onto their data, believing it gave them a competitive advantage, she noted, but that has to change if the healthcare system doesn't want to continue on an unsustainable path of rising costs.

"Somehow, we've all got to stop maximizing our share of the pie," Miranda said, later adding, "I think the key for all of us is to figure out where our interests intersect."