Last week, I had the opportunity to attend AHIP Institute in Seattle, the largest gathering of health plans in the US. Over the years, AHIP Institute has been at the center of all discussions around federal / state health care policies, as well as trends that impact the delivery of health care in our county from the perspective of the Payers / Insurers. While that objective has certainly not changed this year, this event represented a dramatic shift in recognition that the three major stakeholders - the member, the provider and the payer - must somehow find ways to become much more closely aligned if we are to evolve a system that is in desperate need of change.
Never was the theme of collaboration and urgency more evident than during the last week in Seattle. In my mind, three themes emerged from the week: data analytics (from numbers to knowledge); defining the consumer experience in health care; and untapping the potential of Health Exchanges. These were all deeply intertwined with the concept of bringing the member / consumer into the active role of helping payers and providers address the challenges that have led to spiraling health care costs.
Over the last 10 years of attending this show, I have seen many changes – some positive, and some more challenging – with regards to turning words into actions. This year, however, has demonstrated sweeping changes and ideas around the risk / reward relationships between payer and provider, and a focus on the member as a consumer. This year was refreshing and exciting in that it seems as if the "sleeping giant" has awoken and is sincere in its recognition that the only way to truly impact the overall system is to do it through the users of the system. I believe this represents a real, substantial chance at true member engagement for the first time.
Member engagement lies at the core of the next transformative steps requisite in reforming an industry that has known no bounds or limits to its spending behaviors and transactional relationships, which were often solely focused on the individual stakeholder and not the system. Without members understanding and taking /accepting actions upon their personal responsibilities, all contemplated reforms will only find limited success.
The time is now. While big data – the phrase du jour – is helpful in identifying population needs and problems, it is still dependent upon the member taking corrective actions. Exchanges will create new competitive forces and necessary pricing transparency of providers and payers, but will still require members to find those groups that best serve their needs as they define them. And all of these concepts require methods and tools that allow the consumer to become informed, educated and encouraged into a sustained practice that works within their own personal capabilities, while modifying health habits that have been historically less than positive.
Novu is uniquely positioned, and already helping to define how and what those roles the member can and will take. The work we are doing for the member is essential, and the industry, which has not always appreciated the role of the member in making decisions around care, is officially aware and focused on understanding them. These are exciting times for the health care industry, the provider, the payer, and the members…and Novu.