At the start of AHIP’s Institute & Expo Online, states were forging ahead on relaxing pandemic restrictions, even as some were seeing record numbers of new COVID-19 cases and hospitalizations. The pandemic wasn’t far from many minds, and it was a common theme among all the conversations.
Yet, stakeholders from health insurance and other sectors of health care were already clear on some of the lessons and silver linings of the pandemic, and they are already working to build a more resilient system that can better weather – or even prevent – the next crisis.
At the heart of a stronger system is a member-centric mindset that takes a holistic view of health, many speakers said. That shift is already under way, and it includes multiple dimensions, but for many of them the pandemic has acted as an accelerant to redefine health and how it is managed. Among the opportunities that stakeholders said must be seized:
Moving beyond episodic care
Humana Vice President Caraline Coats defined whole person care through the lens her company’s Bold Goal initiative uses: Primary care, social determinants of health, pharmacy, home health and behavioral health. Their work strives to help members in targeted communities enjoy more Healthy Days per month – when they feel physically and mentally well. A lot of their progress comes down to taking the time to ask members the right questions, and then having the ability to act on what is learned.
In an industry built around episodic care, “whole-person care is really different,” Coats said, and it is still being defined. So, her team’s work looks a lot like vetting of clinical interventions: rigorous testing, followed by publication of results so others may learn, too. Among their recent promising experiments is a partnership with Mom’s Meals to meet the needs of certain members with diabetes and a program with Papa (which provides companionship and help with everyday tasks) that measurably brought down loneliness scores among participants.
Making mental health a priority
Health care leaders have long acknowledged the importance of mental health in physical health, but care delivery models have largely kept mind and body care in siloes. However, as increased isolation, stress, economic worries and other burdens have fueled alarming increases in psychological distress, the need to lift stigmas and improve access to mental health care providers is clear. “Our society has been wounded by our need to help lower the curve,” Dr. Julie Gerberding, former director of the CDC, said.
Health insurance executives say they are committed to doing their part, and Emblem Health CEO Karen Ignagni says health insurance providers’ role at the center of health care delivery gives them the leverage to make a difference. “We should be proselytizers for the importance of mental health being connected to physical health,” she said, noting that “figuring out how to do that seamlessly and easily for people” also falls to health plans.
Health inequity and disparities in the spotlight
Research, regulatory changes and innovation have focused heavily on social determinants of health in recent years, but COVID-19 and the recent reckoning with systemic racism have sparked a new sense of urgency around inequity and the health disparities it feeds.
Cambia Health CEO Mark Ganz said those issues, coupled with the mental health challenges of this time, amount to a call to arms for insurers. Conference speakers seemed ready to heed it, uniformly conveying a commitment to take action against inequity and disparities.
“If leaders like us miss this opportunity to lean in, in a substantial way, to address social and health disparities, if we miss the opportunity around understanding mental health as being integrated with physical health … then we will really have missed the boat,” Ganz said. “Those two issues are key, and there is an opportunity to reorder the way the broader health care industry addresses each of those.”
Telemedicine is here to stay
Few topics at the conference got more of a resounding show of support than telemedicine. “We have seen more progress on telemedicine in the last few months than we have seen in the last 20 or 30 years,” said Dr. Mark McClellan, former CMS administrator. Health plan leaders uniformly echoed that sentiment, and physicians said they and their colleagues have been pleasantly surprised by how well certain types of care translate to telehealth formats. Above all, patient demand for convenience is sure to force a continued evolution.
The challenge, speakers said, is to adapt. Benefit design changes, permanent regulatory frameworks (as well as harmony across public programs) and integration of telehealth visit data into the EMR will be needed for remote care to fully deliver on its promise
“It’s really going to be a new way that health care is delivered moving forward. I wouldn’t want to see us go backwards on this,” said Jeanette Thornton, AHIP’s senior vice president of product, employer and commercial policy.
A new kind of health insurance provider
Hetal Kamdar of Capital District Physicians' Health Plan said her company is ready to do away entirely with the term “payer” and instead embrace the “population health organization” label. It’s an idea that underscores how far the industry has come from the health insurance model of the past, and a nod to insurers’ position at the heart of health care – which gives companies leverage to influence all of it.
The focus on holistic health, solving systemic inequities and healing a damaged country collectively painted a picture of what Avalere founder Dan Mendelson called a “socially conscious health plan” — one that with the right models and incentives could tackle some of our biggest challenges yet.
Melissa Turner is director of health care and life sciences content at SmartBrief. She edits science, medical and health care delivery newsletters and oversees development of content marketing pieces for SmartBrief’s health care clients.
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