5 Big Ideas from the AHIP Conference

Last week's conference for America's Health Insurance Plans featured three days of workshops, networking breakfasts, appearances by Tom Daschle, Nicholas Christakis, Mary Matalin and James Carville, and more than 30 sessions devoted to making some sense of the business of healthcare.

By the end of the conference on Friday I was almost in information overload so it took a few days to sort out what I learned and what I think are the take away points. Here is my analysis of the big ideas presented at AHIP.

1. It's all about the individual.
In 2014 the health insurance floodgates will open and everyone will be required to have insurance. Health plans are a nervous about this because they don't really like to provide individual coverage. They'll tell you it's a money-losing proposition. But now they are going to have to get very familiar with the likes and dislikes of a market segment that they have been giving the back of their hand to for years.

For a change there's going to be plenty of competition trying to woo and win the individual policyholder and the market may resemble a free for all as individuals look for the best coverage at the best price. Even group policies may feel the pinch as individual employees, tempted by lower costs, jump ship to health insurance exchanges. Be prepared to invest some serious time and money into unlocking the key to the individual market. "It will take years for the healthcare industry to figure out how to influence consumers," said Sarah Rittman, a senior industry consultant for SAS, a Cary, N.C.-based business analytics firm.

2. Actionable intelligence is the way to go.
Actionable intelligence is the new buzz phrase. It's the information you need to have available to help make a decision. A doctor's AI might be a patient's test results. For health plans and providers, AI would be insights into a specific business problem that help make strategic or tactical business decisions. AI usually involves metrics, benchmarks, and complex predictive modeling techniques. The point is that there's a lot of information available out there, but it needs to be analyzed, and even then not all of it will get your company where it needs to be.

3. The payer-physician relationship is in transition...again.
The era of the ACO is upon us and it brings a new call for payers and physicians to work together. This time around a lot is at stake. Payers have an opportunity to step up and provide their physician partners with the tools they need – like robust data ? to develop successful outcomes for their patients. Health plans have deeper pockets than physicians and are more accustomed to working with the technologies and infrastructure required in this age of post healthcare reform.

4. Look for the influencers.
Donald Berwick, the CMS administrator, likes to talk about the "three-part aim" – better care for people, better health for populations and lower cost through improvement. To implement that type of systemic change requires the buy-in of disparate groups, which can be a bit like herding cats. That's where influencers – folks who can convince other folks to buy a certain car or prescribe a certain medication ? come in. How do you find an influencer? Ask Dr. Nicholas Christakis. The Harvard professor uses social network mapping to identify the three degrees of influence where most social influence takes place. The information can be used in a healthcare setting to identify physicians and others who may help reduce the use of healthcare resources as well as help cut costs.

5. It's game time.
Interactive health is an industry segment that employs gaming systems to make being healthy more fun. It's estimated that almost 70% of households include someone who plays games. Microsoft had Kinect for Xbox 360 set up at its AHIP booth and there always seemed to be a line of conference participants anxious to get in a little Kinect time.

For now the system is sports and exercise based but the big idea is to encourage consumers to achieve long-term health and wellness goals by incorporating the science of social gaming ? personal engagement, rewards and multimedia presentations. As Microsoft's Dennis Schmuland explains, "fun always takes precedence."

Aetna is set to launch later this year a social game to promote wellness that will be accessible through mobile phones, email and social media channels. There's even a group, Health Games Research, that's looking at how digital games can be used to help motivate treatment adherence and manage chronic health conditions.