Attendees at the first day of AHIP 2023 on Tuesday heard about the importance of restoring trust in health care from Dr. Anthony Fauci, who, in his 38-year career with the National Institute of Allergy and Infectious Diseases, helped lead the country through the HIV/AIDS and COVID-19 pandemics. Fauci, an empathetic champion for public health and policy, has had an outsized influence in that sphere. He served under seven presidents in his 50-year public service career, played a critical role in preventing, diagnosing and treating immune-mediated and infectious diseases, was awarded the Presidential Medal of Freedom, and also oversaw medical and public health responses to Ebola, pandemic influenza and Zika.
Here are some other highlights from Tuesday:
Leading from the front
AHIP President and CEO Matt Eyles kicked off AHIP 2023 on Tuesday afternoon by highlighting challenges the US health care system faces, including access to care, the cost and financial strain of care for patients, mergers of hospitals in the same coverage areas, health equity and public trust, and ways that attendees can make strides toward solving them.
Eyles cited several AHIP initiatives, such as the Connecting to Coverage Coalition, a central repository of trusted information to help payers, providers and patients navigate the Medicaid redetermination process, to ensure continued coverage and bridge care gaps. The uninsured rate in the US stands at the lowest rate in its history – 8% — “progress that we must maintain, given the stakes,” Eyles said.
AHIP is also committed to improving health equity in the US as one of the founding members of the Rise to Health Coalition, a consortium that is “working to improve equity and justice within the health ecosystem,” Eyles said. The coalition also aims to remove barriers to care and foster diversity, equity and inclusion within the health care system.
Trust – particularly, restoring trust in the public health system – is paramount to improving overall public health, particularly after the COVID-19 pandemic. Eyles said that AHIP has joined the Coalition for Trust in Health & Science, which is dedicated to curbing myths and misinformation in health care and medicine.
All of these measures are being taken with an eye on the ultimate goal: A healthier country and society.
“When individuals thrive, we all benefit,” Eyles said. “Simply, when people do better, we all do.”
The value of value-based care
Uptake of value-based care has slowly yet steadily increased since 2010, and its framework can provide significant benefits to the health care system, said Andrew Jackson, director of strategy and product marketing for Milliman, during the session “Enhancing Value-Based Care Through Digital Transformation.” Over the past 10 years, about 35 million people in the US, or roughly 10% of the population, are covered under some type of value-based insurance, Jackson said.
VBC allows payers and providers to leverage data to improve outcomes for the overall US population, as well as subsets of it, such as people with diabetes and historically underrepresented communities. Tools such as artificial intelligence, machine learning and large language models provide significantly faster analysis of data, which can help inform diagnoses and treatments, spot population trends and curb social determinants of health, according to Rich Moyer, a product manager with Merriman. This, in turn, spurs innovation, Moyer added.
“You can try things and fail,” Moyer said. “As an industry, we’re so afraid of failing, but the big picture is, we fail all the time.” Trial and error can lead to discoveries and breakthroughs.
So, what do stakeholders need in their arsenal to continue to evolve and improve VBC? The first – and most important – step is reducing fragmentation of care and data, Moyer said. A patient can see different providers and deal with several health plans for just one episode of care, and oftentimes, a patient’s history gets lost in the shuffle.
“All of this generates data, but not one clear picture of the patient,” Moyer said.
Aligning care and data helps stakeholders find and mitigate gaps in care easier and faster. “Connecting all these analytics to the front line ultimately creates the ability to use digital transformation,” Moyer said.
Commitment from all levels of an organization is key, too. The pivot to digital transformation and VBC requires an all-in mentality from senior leadership, reskilling existing staff and keeping an open mind. VBC “is here to stay, not some niche thing,” Jackson said.
Organizations that invest in VBC will see a return on investment not only financially, but for their patient populations, as well.
“The more you use data, the more valuable it is,” Moyer said.
Lessons learned from COVID-19
Although the pandemic laid bare some of the shortcomings of the health care system, it also showed how well it works when public health and VBC are part of the equation, according to Greg Adams, chair and CEO of Kaiser Permanente. Coordinated efforts coupled with data analysis and sharing helped identify SARS-CoV-2 outbreaks within the population, while collaboration between the public and private sector helped deliver millions of vaccine shots into arms, which protected and reduced the severity of sickness for many.
These efforts highlight how crucial the public health system is, said Adams, who added that he learned the importance of public health growing up in rural Georgia. Investment is vital, but it needs to be in the right areas, such as public health initiatives to combat SDOH, for example.
Shifting the thinking toward VBC and understanding how care is funded enables stakeholders to “own what public health systems have done and shape it,” said Adams, adding that the money is there “for us not to just do sick care” but to also make inroads to invest in “doing health” for people.
The pandemic forced a reaction from the health care system that is still being felt today – and will continue to be going forward, Adams said. “We don’t always get to choose the moments we need,” he said. “Sometimes, the moments choose us.”
COVID-19 also provided an inflection point, and perhaps a rallying cry, for health care leaders, Adams said: “It’s our moment to say, ‘We can do this differently.’”
Takeaway quote of the day
“As leaders of health care, we have a social obligation to help this nation and our communities be healthy.” — Greg Adams, chair and CEO of Kaiser Permanente