Health Equity, Value-Based Care Major Themes at AHIP 2023

Verinovum joined thousands of thought leaders and executives from the public and private healthcare sectors who convened in Portland, OR, June 13-15 for the payer-focused conference AHIP 2023. The annual event brings together companies and individuals on the cutting-edge of healthcare trends to discuss the direction and future of healthcare as it relates to the health insurance plans and the members they serve. Several of Verinovum’s predicted healthcare truths for 2023 took center stage. Throughout the conference, analysis of actionable data was center stage as the key to improving how care is provided, member outcomes, and decreasing disparity.

This year’s event featured several influential voices, such as keynotes by Anthony Fauci, former head of the National Institute of Allergy and Infectious Diseases and advisor to seven presidents; singer-songwriter and mental health advocate Jewel; and former U.S. Representative Liz Cheney. There was also a keynote session on women’s health led by Alexis McGill Johnson, president and CEO of Planned Parenthood Federation of America, and Jocelyn Frye, president of the National Partnership for Women & Families.

The importance of data sharing and interoperability was a topic in Fauci’s keynote. In looking back on the U.S. response to the COVID-19 pandemic, he praised the scientific response but felt the public health response was lacking, partly due to the fragmentation of federal and local public health systems, noting, ”our data collection system wasn’t electronically connected.”

The question of data accessibility and quality also came up in other main themes of the event: addressing health inequities and optimizing value-based care (VBC) models. “The more you use data, the more valuable it is,” said Rich Moyer, Principal & MedInsight Chief Product Officer at Milliman, in the session “Enhancing Value-Based Care through Digital Transformation.”

Following are AHIP sessions that highlighted how data collection, curation, and quality are essential in supporting growing healthcare trends.

Business models

“The Power of Analytics: How Payers Are Reinventing Their Business Models”:

Health plans need to reinvent their business models to adapt to market trends. True transformation will require investment in the right analytics strategies. In this session, senior health plan leaders shared insights on using analytics to develop strategies for driving growth and improving value.

“Enterprise Capabilities to Maximize Business Value from Data and Analytics”:

In this session, attendees learned how technology breakthroughs will impact health operations and the critical capabilities needed to harness business value from data and analytics.

Quality of care/Value-based care

“Enhancing Value-Based Care through Digital Transformation”:

The pace of transitioning to fee-for-value is accelerating. This session featured actionable advice and insights on integrating enterprise data, using APIs and data lakes, formulating cloud strategies, and leveraging interoperability, analytics, and benchmark– approaches that can improve reporting, risk workflows, and overall efficiency, enhancing both revenue and patient care.

“Improving Efficiency: Surfacing Clinical Member Data in the Moment of Care”:

To improve healthcare efficiency, health insurance and healthcare providers require the ability to access clinical data in the workflow. In this session, Kimberly Hansen of Optum and Gregory LeGrow of athenahealth explored how to build value by surfacing care and diagnosis data in the moment of care to support both clinical and financial outcomes. There’s a decrease in provider friction and improvement in the quality of care when payers and health care providers can access patient encounter data.

“The Next Level in Quality: Closing Time Sensitive Care Gaps”:

This session covered how health plans can leverage HEDIS data and real time analytics to hone strategies to close time sensitive care gaps.

As these sessions indicate, time-to-value is critical for addressing member care needs and provider quality issues. Verinovum has explored overcoming barriers to value-based care, the care gaps created by missed screenings, and how to accelerate time-to-value. Complete, accurate, and standardized data is crucial for developing the analyses to identify gaps in care and understanding the clinical workflow.

Health equity

Improving health equity was also a key discussion topic across many sessions. These included:

“Prepare for the CMS Health Equity Index: Deep Dive on Disparities”

The development of the Health Equity Index (HEI) is a key initiative to enhance Medicare Advantage Star Ratings. This session explored how the HEI will be calculated and techniques MA plans can employ to understand performance on component measures, shared insights on how to identify disparities in populations with social risks and outlined best practices to address systemic inequities in care delivery.

“Advancing Equity through Quality Measurement and Accreditation”:

Quality measurement and accreditation have become key levers in addressing disparities and promoting health equity. Speakers in this session discussed numerous actions health plans are taking to identify and address disparities and promote health equity. Adrianna Nava represented NCQA on stage and shared details about its health equity measurement and accreditation work.

“Cacophony or Symphony? Eliminating Bias and Noise to Improve Outcomes”:

Roger Holstein, Vestar Capital Partners

This session used sleep and fertility case studies to examine how bias and noise in decision-making lead to unintended consequences and variations in care. Attendees learned how to leverage real-world data to improve outcomes at scale and undo the unintended consequences of bias.

“Improving Data Standards to Advance Health Equity”

This session highlighted health insurance provider, government, and other healthcare stakeholder efforts to improve sociodemographic data standards, collection, and interoperable exchange. It featured panelists Nebeyou Abebe of Highmark Health, Caroline Fichtenberg, of Social Interventions Research & Evaluation Network (SIREN), Maya Gumatay-Marmo of Health Net, and Marshall Chin. of the University of Chicago Hospital Health System. Speakers discussed challenges and lessons learned and considered what needs to be in place from a policy and infrastructural perspective to maximize data collection efforts for health equity.

Artificial Intelligence (AI)

Not surprisingly, AI was a popular topic at AHIP. The value of any AI application rests on the quality of its input data. Verinovum’s Data Curation as a Service (DCaaSSM) solution provides an actionable data foundation for analytics and applications.

“Will ChatGPT Change Health Care Forever (and for the Better)?”

ChatGPT and other generative AI apps can analyze large amounts of medical data quickly to identify patterns and make predictions, aiding in early disease detection, intervention, and personalized medicine. In this session, Jonathan Burow of Independent Health, Cora Han of UC Health, and Jackie Ejuwa of Blue Shield of California discussed what happens when medical knowledge and innovative technology converge, the applications and implications of this technology, and how it could shape the future of medicine.

“Unlock the Power of AI and the Cloud for Exceptional Member Experiences”

Amy Berk of Microsoft and Elio Yepez of Nuance explored how AI, data, and the cloud can optimize and personalize member interactions, resolve inquiries, and support self-service. The presenters provided examples of how providers and pharmacy benefit managers are integrating systems and leveraging AI and data to improve member satisfaction.

“Streamline the Payer-Provider Relationship: Leveraging AI for UR Transformation”

A panel of healthcare leaders–Jody Ranck of Chilmark Research, and Heather Bassett and Michael Drescher of XSOLIS–discussed how AI is accelerating decision making and enhancing collaboration, including improved UR workflows and automated status determinations. Collaboration platforms improve payer-provider relations and could deliver approximately $35 billion in annual savings.

The wake of COVID has hastened changes that were a long time coming in healthcare, and AHIP 2023 delved into these trends. SDoH, health equity, the importance of public health, value-based care, and advances in AI have all gained notable momentum in a few short years, and AHIP attendees met to plot the best course forward. Reliable, actionable data underpins the successful evolution of all these trends, and Verinovum can help. Our DCaaS can help payers get the most out of value-based care, maximize quality measures, and reveal and address health inequities. Payers and providers can share data, streamlining data integration for easier accessibility. Our DCaaS solution can assess and resolve your data challenges. Learn more with our no-risk proof-of-concept.