Social Determinants of Health, APMs Coming Up at AHIP Institute

June 19, 2019 - NASHVILLE – AHIP’s Institute & Expo (AHIP Institute) conference always promises to bring the top experts from payer organizations to share how their plans and providers are adjusting to the evolving healthcare environment. This year is no exception.

Thousands of the brightest minds in healthcare are currently heading into the Music City to hear some of the most influential payers and industry experts, including Cigna Corporation’s president and CEO David M. Cordani, Merck’s chairman and CEO Kenneth C. Frazier, and former acting CMS administrator Andy Slavitt.

The speakers come from all over the healthcare industry, but the experts appear to share key priorities this year. Their sessions, exhibits, and presentations at the 2019 AHIP Institute center around three major trends: social determinants of health, alternative payment models, and consumer experience.

Why address social determinants of health?

Payers and providers are in the business of delivering medical care. But highly-cited statistics reveal that medical care only contributes to 10 to 20 percent of patient outcomes. The remaining 80 to 90 percent are what the industry broadly refers to as social determinants of health (SDoH).

SDoH are health-related behaviors, socioeconomic factors, and environmental contributors impacting outcomes. And payers are looking to learn more about how the factors are impacting their members and communities.

READ MORE: Addressing Healthcare Consumerism a Top Priority for Docs in 2019

At AHIP Institute, attendees will explore why payers and providers should be addressing SDoH.

Notably, the second day of the conference heavily prioritizes presentations that will explore how SDoH are impacting outcomes, emotional health and well-being, and healthcare disparities. The line-up includes former senior White House policy advisor for nutrition Sam Kass, president and CEO of the National Hispanic Medical Association Elena V. Rios, MD, MSPH, FACP, and Vivek H. Murthy, MD, 19th Surgeon General.

Painting a comprehensive picture of the impact SDoH have on beneficiaries and the healthcare system at large is key to making the business case for tailored programs.

Many payer and provider organizations are still identifying which SDoH to target. But bringing back data, statistics, and expert opinions can move payers and providers to the next step.

Some industry leaders at AHIP Institute will address how organizations can implement programs.

READ MORE: Exploring Two-Sided Financial Risk in Alternative Payment Models

For example, leaders from Gateway Health and Centene Corp. will share how using organizational transformation is a key way to tackle SDoH. Later, on June 19, a panel comprising experts from Healthfirst, Care Oregon, Pharmacy Quality Alliance, and Avalere Health will discuss how combining clinical and SDoH data is the key to improving outcomes while reducing disparities.

On June 20, AHIP Institute will also host “Realizing the Potential of Social Determinants: An Intelligent Payer Panel,” which will go over strategies from the Aetna Foundation and Centene Corp. for reversing the negative consequences of SDoH.

Advancing APMs, value-based care

The healthcare industry is well on its way to implementing alternative payment models (APMs) and value-based care. In fact, more than half of all healthcare payments (59 percent) made by 61 plans, three states, and Medicare fee-for-service were tied to value in 2018, revealed the Health Care Payment Learning & Action Network (HCP-LAN) recently reported.

Payers and providers have laid down the foundation for APMs. Now, they are looking to optimize their models to not only improve patient outcomes, but also to reduce costs, enhance patient experience, and improve provider satisfaction. AHIP Institute reflects that.

 At this year’s conference, attendees specifically interested in enhancing their transition away from fee-for-service can follow the “Advancing APMs & Value-Based Care” track. During each concurrent session period, AHIP Institute will hold panels and presentations from payers and industry leaders who are entrenched in value-based care.

READ MORE: Social Determinants of Health Key to Value-Based Purchasing Success

For example, on June 19, attendees can hear from Michael Drescher, director of value-based contracting at Blue Cross Blue Shield of Tennessee, and two leaders from the Practicing Wisely campaign. The panelists will discuss how to address unnecessary utilization and inappropriate care by incorporating appropriate use measures into alternative payment models.

Later that day, leaders from Fallon Health, UPMC Health Plan, and the National Patient Advocate Foundation will cover patient engagement in APM development.

HCP-LAN will take the stage on June 20 to share their roadmap for designing and implementing high-performing APMs. Following their presentation, representatives from leading payer organizations will explore the role of electronic prescribing and behavioral health in APMs in two separate panels.

On the final day of AHIP Institute 2019, leaders from Fresenius Medical Care’s Integrated Care Group will share how the integrated provider created an APM for patients with complex chronic conditions.

Creating a healthcare consumer experience strategy

Like the Advancing APMs & Value-Based Care track, the 2019 AHIP Institute will also offer a “Health Care CX Strategy and Execution” path for attendees looking to learn more about developing a strategy for addressing consumer experience.

Healthcare consumerism is taking the industry by storm. Deductibles have risen over 150 percent since 2018 and more individuals paying the fees under high-deductible health plans, according to data from the Kaiser Family Foundation.

With increased financial responsibility, healthcare consumers are expecting more from their providers and payers. Consumers expect a retail-like experience from healthcare providers, including convenient care and payment options, digital engagement tools, and price transparency.

Unfortunately, traditional healthcare organizations have been sluggish with adopting the capabilities to provide excellent consumer experience.

Industry leaders at AHIP Institute 2019 realize that healthcare consumer experience (CX) is becoming more important for the bottom line. Payers and providers must align their business with consumerism to remain profitable and competitive.

Through the Health Care CX Strategy and Execution, attendees will learn how to enhance consumer experience through member-facing technologies, artificial intelligence and next-generation digital tools, 24/7 access, and retail-like marketing.

While attendees will hear how leading payer organizations, such as Kaiser Permanente and BlueCross BlueShield, are optimizing the consumer experience, they will also learn from leaders in the retail industry. For instance, Nic Vu, former general manager and senior VP of Adidas Group, will sit on a couple of panels to share how retail techniques can apply to healthcare.

Healthcare consumerism, APMs, and SDoH are all major topics in the healthcare space. All three trends reflect a shift in the current healthcare market. How the industry pays for medical care and what consumers expect are changing.

Payers and providers must respond to consumerism, value-based care, and social determinants to survive in the changing market. Developing strategies to address the trends and executing programs are at the top of industry leader minds.