Over 42,000 healthcare professionals recently convened in Las Vegas for the 2018 Healthcare Information and Management Systems Society (HIMSS) conference. This year’s exhibit hall featured roughly 1,400 vendors showcasing a diverse array of healthcare IT solutions. The tradeshow floor and education sessions buzzed with the latest news on everything from interoperability to artificial intelligence and machine learning in healthcare.

The gathering drew executives and clinicians from throughout the continuum of care, each eager to identify ways healthcare IT can benefit care delivery and business efficiency. Among the healthcare constituents in attendance were conference-goers and presenters from payer organizations. HIMSS18 offered a Payer Forum session track highlighting “examples of how payers and providers are working together to reduce administrative burdens, lower costs and improve both the physician and patient/member experience.”

A core theme emerged in these payer-centric education sessions:

In the pivot to value-based care, health plans and providers are stronger together than they are addressing healthcare’s challenges independently.

United Healthcare Market Medical Director Julie Daftari, MD, and Parkland Health Chief Clinical Integration Officer Greg Johnson, DO, kicked off Payer Forum sessions with their joint presentation entitled “Better Together.” The session showcased the accomplishments and challenges the healthcare partners encountered on their now-three-year journey collaborating to bring greater value to the healthcare consumers they manage. Daftari and Johnson touted the importance of transparency, communication and real relationship building as the two organizations came together to improve patient outcomes.

Johnson offered insight into the health system’s work with United to identify at-risk patients and then facilitate co-branded outreach to health plan members to help drive member engagement in closing care gaps. He cited the growth the health system has seen in colorectal cancer screenings among patients when health assessment prompts come from both the payer and provider together. He also openly addressed the “storminess” that can emerge between the two business facets as payers walk the fine line of recommending care program protocols without stepping on physicians’ toes.

Blue Cross Blue Shield Association Vice President Jody Voss and Highmark Health Senior Vice President Sarah Ahmad echoed the important role that payer/provider collaboration plays in delivering value in their session on “Clinical Innovation Acceleration.” Voss and Ahmad provided examples of ways the health system has helped match clinician needs to value-based program solutions from best-in-class technology manufacturers to deliver care in a way that enhances member outcomes and experience. Presenters emphasized the role that scalable, commercially-available solutions can play in accelerating care transformation in the healthcare industry. Their presentation noted measurable improvements in clinical outcomes, cost savings and patient satisfaction as a byproduct of the health plan and providers’ efforts together, and how various technologies factored into the success of targeted engagement programs.

Another session from Anthem, Newman Regional Health and the Kansas Health Information Network outlined ways the health plan leveraged financial incentives to encourage provider participation in health information exchange. Presenters pointed out that high-cost patients typically see more than ten providers annually with data spread across multiple care settings. The session included a look into ways Anthem is using expanded data access to support HEDIS reporting and care management initiatives.

Payer appeal wasn’t limited to the Payer Forum sessions at HIMSS18. The conference hosted a bevy of additional education sessions covering topics that are top-of-mind for health plan executives, including consumer/patient engagement, population health and user experience design. The Patient Engagement and Experience Summit, specifically, highlighted two trends highly relevant to the payer market:

  1. The need for a comprehensive health record that combines clinical data, claims, lab results, prescription data and patient-generated health data, along with insight into the social determinants of health that may impact a member’s care plan.
  2. The need for more personalized patient communication that motivates members to action by effectively engaging them via digital and other outreach mechanisms that extend beyond the traditional walls of institutionalized care.

Health systems’ personalized patient engagement efforts are largely still in infancy today and are most often tied to clinical quality measures the healthcare organization is required to report on. This represents a great starting point for providers who should seek partnerships with payers and IT vendors that can help the healthcare organization quickly implement and scale targeted engagement programs.

It will be interesting to see where healthcare technology coverage at HIMSS heads as the direct-to-consumer movement trickles into the industry. As key stakeholders in the healthcare consumer journey, payers are in a unique position to help providers tie these resources to existing care delivery models. As the paradigm shift to value-based care continues, greater collaboration between providers and payers working together to address shared challenges and to co-develop strategies to reduce the cost of care while improving outcomes will undoubtedly benefit both parties and the healthcare consumers they each serve

Share This