The decisions health insurance executives make reverberate across the healthcare industry. Reimbursement policies, billing practices, the decisions that govern which technologies to adopt affect members, physician practices, hospitals and health systems. The Biden administration has embraced several reforms to our health system including reducing the cost of drugs for chronic conditions such as Type 2 diabetes. But the administration also wants to improve prior authorization so it can be more efficient.
These are some of the topics that will be discussed in three panel discussions at the Payer Insights Program, hosted in partnership with MedCity News, held at the ViVE 2024 event on Sunday, February 25, from 1-3 PM PT in the Los Angeles Convention Center in Room 408A on the second level. Sessions will explore prior authorization and price transparency policy developments, interoperability and data sharing, the use of digital tools to advance equitable, accessible care plus, tech innovation, automation, AI and more.
In the runup to the Payer Insights program at ViVE 2024, we reached out to some of the speakers and sponsors for their insights on digital innovation in the payer space and they responded via email.
Rajeev Ronanki, Lyric CEO, said he’s encouraged by the potential for AI to reduce fraud and waste and make healthcare more predictable for providers. Lyric is a sponsor of the Payer Insights Program.
“AI-driven innovation is showing strong promise in the areas of payment integrity and accuracy. We can expect to see improvement in the risk of fraud, waste, and abuse. We can expect to see reimbursement become faster and more predictable for providers,” Ronanki said. “Payers will unlock greater levels of value through increased savings and decreased administrative costs. Most importantly, patients stand to benefit through greater transparency, more predictability in care costs, fewer billing errors and greater level of communication with healthcare organizations. I see AI innovation in payments as a win-win—elevating experiences for healthcare stakeholders.”
Yet there are many challenges for digital health implementation that healthcare organizations have to contend with.
For Shawn Gremminger, CEO, National Alliance of Healthcare Purchaser Coalitions, the push for transparency in healthcare is easier to achieve on paper than in practice.
“Some providers and plans, particularly hospitals and PBMs, continue to either refuse to provide or make it very difficult to access transparent information for the public and their clients,” said Shawn Gremminger, President and CEO, National Alliance of Healthcare Purchaser Coalitions. “The information that is available is so complex, dense and difficult to decipher that even sophisticated employers struggle to make the data digestible and actionable.”
Gremminger added that he also sees reason to be optimistic that health tech will make transparency more manageable and that greater access to data will lead to better purchasing decisions.
“We are encouraged to see a growing number of vendors such as Turquoise Health that are helping make the data understandable and actionable for employers and even consumers. While this will take some time, the market is there for information that employers can use to make better purchasing decisions and to shield themselves from the kind of lawsuits recently leveled against Johnson & Johnson.”
Shruti Kothari, Director of Industry Initiatives, Blue Shield of California, emphasized the need for collaboration to ensure that health tech addresses structural barriers to care, as well as the need to improve collection of patient’s self-identified data.
“Blue Shield of California recognizes that we must have strong collaboration across our industry to fully realize the opportunity digital tools provide to address structural barriers to care,” Kothari said. “Additionally, we need a way to ingest self-identified data such as language, race, ethnicity, gender, and sexual orientation so we can better meet patients’ individual health needs. California’s Data Exchange Framework (DxF) represents a great step forward in our ability to collect and share data. Having all eligible entities fully participate and comply with the DxF will be critical to realizing the full potential of statewide data-sharing in California.”
Ronanki added that achieving payment innovation in healthcare will require “replacing antiquated processes and technologies, driving greater efficiency, and facilitating greater trust between stakeholders. AI and blockchain will serve as key drivers for this long-overdue change and transformation.”
Here’s a preview of the agenda for the Payer Insights Program, which is included when you register for ViVE.
Navigating the Prior Authorization Landscape
Prior authorization is complex and plays a crucial role in ensuring appropriate and cost-effective utilization of medical services. Explore challenges and opportunities for improved data sharing, workflow efficiency, quality measures, and decision-making for better patient care and outcomes. Hear practical strategies for adapting to recent and proposed regulatory changes designed to streamline the prior authorization process, enhance seamless data exchange, and promote interoperability.
Moderator: Katie Adams, Senior Reporter, MedCity News
Speakers:
- David Dobbs, Chief Data Officer, Hawaii Medical Services Administration
- Timothy Law, Chief Medical Officer and Vice President Integrative Care Delivery, Highmark Health
- Ginny Whitman, Senior Manager of Public Policy, Alliance of Community Health Plans
The Future of Payment Innovation
As the healthcare industry adapts to the Transparency in Coverage rule, there’s a growing focus on revolutionizing payment systems. Learn about the changing healthcare payment landscape including the latest compliance requirements for cost-sharing data disclosure and broader implications for payment accuracy, efficiency and innovation. Delve into how health plans are navigating these changes, addressing data sharing complexities, and leveraging AI to transform payment models.
Moderator: Marissa Plescia, Reporter, MedCity News
Speakers:
- Shawn Gremminger, CEO, National Alliance of Healthcare Purchaser Coalitions
- Tawfiq Bajjali, General Manager of Platform Solutions, Lyric
Transforming Healthcare with Digital Tools & AI
Innovative technologies are not only improving health outcomes but also enhancing patient satisfaction and engagement in health care. Hear about cutting-edge approaches, challenges, lessons learned and opportunities that arise when health plans leverage the power of digital transformation and AI to create a more patient-centric and effective healthcare ecosystem.
Moderator: Arundhati Parmar, Editor-in-Chief, MedCity News
Speakers:
- Shruti Kothari, Director of Industry Initiatives, Blue Shield of California
Keep posted on speaker updates for the Payer Insights Program by checking the agenda here.
Photo: HLTH
