Transformational change and sustainability in health care will only happen through coordination, collaboration and cooperation, health care leaders said during a keynote session at AHIP 2025 on Tuesday.
The panelists focused on four key areas to foster change and sustainability: data accessibility, effective resource allocation, payer-provider partnerships and community investment.
Data accessibility
The issue is not the volume of data available in health care but how payers and providers act on it, said David Holmberg, president and CEO of Highmark Health, who added that the industry is “data rich and insight poor.”
“We have more data per capita – 7 million lives – than pretty much anyone in the country,” Holmberg said of Highmark. “And the challenge is, how do we take that information from insights that clinicians can use, that payers can use and, more importantly, that individuals can use to address their own issues? We’ve got to find a way to take this information and make it useful.”
Data interoperability has long been a sticking point in health care, and work needs to continue on that front. Mike Jones, president and general manager of the payer division at Inovalon, said the focus must remain on data interoperability and access across the care continuum.
“Whether it’s the provider, the pharmacist, the health plan or life sciences companies, we need to be able to access that data in such a way that we can drive insights,” Jones said.
Leveraging and enabling technology is also critically important, said Dawn Maroney, president of Alignment Health and CEO of Alignment Health Plan.
“Technology, when you think outside of health care, it’s so advanced,” Maroney said. “There’s a challenge in the health care system today with why we aren’t doing more around that technology piece.”
Omar Lateef, president and CEO of Rush University System for Health and Rush University Medical Center, shared a personal story about how it was easier for him to navigate a challenging trip home to Chicago from New York via the use of travel apps than it was to be seen by a doctor in his own health system. Lateef had to fill out reams of paperwork and relay the same personal information to three different people at his appointment.
“I could travel without telling somebody or seeing anybody without a single problem [in] one of the most secure environments there is,” Lateef said. “But I can’t go in the hospital I work at without giving my birthday three times to strangers? Why haven’t we been able to adopt the technology that every other industry has been able to adopt?”
Resource allocation
One reason tech adoption has lagged is the slow pace of change in health care. Lateef likened health care to navigating “a cruise ship down a small river.”
“It’s very hard to change,” Lateef said. “And we’ve all read the same playbook on how we have to change health care. We’re going to increase revenue, decrease expenses. Go here, go here, go here. What we need is a transformational acceptance of change.”
Finances also play a role, along with how those funds are allocated, Lateef said. Hospitals operate on razor-thin margins, and some technological solutions can eat into – or wipe out – those profits in one fell swoop. And providers don’t have the funds to invest in technology that other industries do, Lateef said.
“So, we have to figure out ways to partner with [health plans], partner with industry, partner with technology in such a way where we can share that burden of cost to deliver a better outcome to patients, and then all celebrate the wins together,” Lateef said.
Administrative burden is also unwieldy – the US spends five times more on it than any other developed nation, Jones said.
“We need to simplify our system, but we also need to adopt. Invest in and adopt,” said Jones, who added that technology exists to ease administrative burden costs.
Lateef also cited how “misdirection” of resources hinders transformation and change, pointing to the fact that as a nation, the vast majority of health care spending occurs in the last six months of a patient’s life. Not only that, but the US spends more per capita than any other industrialized nation in the world on health care and consistently ranks near the bottom in patient outcomes.
“There’s nobody in this room that would agree that’s the right way to do this,” Lateef said.
Payer-provider partnerships
Change will require a concerted, collaborative effort, Lateef said.
“Making a change right now can’t be done by one person. A payer is not going to be able to reorganize how we’re spending money, and a provider is not going to be able to reorganize how we spend money,” Lateef said. “But there’s a lot of collective power in this room to get together and say, ‘What are the health care priorities of a nation, and how can we get together to establish those in a more meaningful way?’”
The longitudinal cost of health care is “far too great” in the US, Lateef said, but redistributing that and focusing more on preventive care can make a far bigger impact.
The ideal health care model is one where “everyone is at the table,” Holmberg said.
“You’ve got to have the docs there. You’ve got to have the payers there,” Holmberg said. “You have to have government there, and we’ve got to simplify this and make it so that we do what’s right for the people we serve.”
Jones highlighted the role that technology vendors can play in fostering collaboration.
“We have programs and data solutions and platforms for the pharmacy world, for the provider world, for the payer world, for the life sciences,” said Jones, who added that he’s been encouraged by recent conversations he’s had among these entities around cost collaboration, data sharing and value-based care arrangements.
Community investment
Rush University sits in an area of Chicago in which the average life expectancy of residents there is 16 to 25 years less than their wealthier counterparts just five elevated train stops away from them, Lateef said. Rush went beyond just treating patients in the area and became an “anchor hospital,” focusing on hiring locally and working with local businesses. The premise, Lateef said, is that financial investment in the neighborhood can help spur better health outcomes.
The hospital also stopped outsourcing its laundry service and worked with community leaders to build a commercial laundry facility near the hospital in “one of the most violent ZIP codes in America,” Lateef said. The facility is staffed by people who live in the neighborhood. In addition to saving $1 million annually on laundry expenses, Rush also helped create connections and build sustainability within its community – and make inroads to combat social determinants of health.
“It’s profitable to everybody, increases the net worth of the community and will improve the health of the environment we’re in,” Lateef said. “We can only do that by partnering with the neighbors around us.”
A patient-centric focus
Fostering change and sustainability in health care will be best accomplished by putting the patient first, the panelists said.
For Maroney, it involves four steps: being patient-centric, supporting clinicians, enabling technology and having a “serving-heart culture.”
Jones said putting the patient “in the driver’s seat of their own health journey” and empowering them with platforms and technologies that allow them to make informed decisions is paramount.
“If we look back and we have made a seismic shift in how the consumer takes care of their own care journey, that would be a success,” Jones said.
Ultimately, it starts with action on all fronts, Holmberg said.
“The people in this room have the capacity, the capability, to solve these problems, and if we’re waiting for government to do it, you’re going to wait for a while,” Holmberg said. “If you’re waiting for somebody else to do it, you’re going to wait for a while.
“We’re all very fortunate because we’re in roles that can make a difference. And it’s time to show up.”
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