The America’s Health Insurance Plans (AHIP)  Expo and Conference was held in San Diego from June 20-22. I wanted to share some observations from the conference on some of the challenges and opportunities facing the health insurance industry.

The Opioid Crisis

The devastating impact of opioid addiction was part of many of the presentations.  Discussions examined causes of addiction, social determinants the spread of the crisis, and the effectiveness of treatments. As a health insurance conference, it was clear that there is a lack of consensus in the industry on the treatments that should be covered.  The effectiveness of treatment approaches  often drives what is covered, and the opioid crisis is putting significant pressure on healthcare providers and insurers to determine what really works.   

An Emerging Crisis

Something that I had not considered, but was touched upon by several speakers, was loneliness as an emerging crisis. Studies have concluded that loneliness has more detrimental health impacts than diabetes. It seems paradoxical considering we are more "connected" than ever, but loneliness is on the rise.  

Value-Based Care

Provider reimbursement is shifting from fee for service to value-based care. Health plans are challenged by this new payment model because, as one speaker stated, the underlying legacy policies, processes and technology still have a fee for service chassis.  There are numerous approaches being taken and considered, but in short, my observation is that no one has fully figured out an operating model for value based payments.  

Customer Centric Design

Also known as design thinking, customer centric design is driving how health plans are envisioning how to best serve their members. Essentially, this approach starts with the member and examines the various interactions or touchpoints a member can have with a plan. Utilizing UX (user experience) techniques can help these interactions:

• Meet the member where they are
• Be seamless transactions
• Generate positive feelings for the member

Net Promoter Scores (NPS) are being used more and more by health plans. The approach is important as it was also presented that the majority of people cannot tell the difference between plans among different companies.  Service will be the differentiating factor, not the plans.

Conclusion

Healthcare remains in a state of flux.  This provides both opportunities and challenges to all that are involved. With the right Advanced Analytics strategy in place, your data can prove to be a valuable resource as your organization works through these industry challenges. If you are interested in learning more, contact us today.