"The data piece is so important. I don’t think it’s widely known or recognized how important it is for us to get data standards right in order to make a difference in health equity." — Matt Eyles, AHIP CEO and president.
Led by CEO and president Matt Eyles, AHIP senior executives highlighted multiple areas: affordability and access, mental health and health equity, health tech expansion and its data privacy implications, as well as post-pandemic priorities and the next generation of value- and outcomes-based care. Here are snippets from AHIP's leaders on each of these areas.
1. Affordability and access
The AHIP panel highlighted the top 2022 Congressional issues, all of which relate to affordability and access: the need for continued marketplace subsidies and continued actions around telehealth and The No Surprises Act.
"We need to address the underlying cost drivers of care … We need to encourage technology solutions that we know will improve efficiency, reduce waste, and move us toward a truly interoperable, consumer-centered healthcare system."—Eyles
"Post pandemic, eligibility and the affordability of healthcare [marketplace and Medicaid] will be one of the biggest issues. Millions could lose coverage when Medicaid redeterminations resume."—Mark Hamelburg, SVP of federal programs
2. Mental health and health equity
Equity founders when there aren't enough professionals to provide care. This is particularly true for mental health treatment, where parity remains an issue, more support channels are needed (e.g., telehealth, primary care touchpoints), and stigma remains an issue. But equity spans more than behavioral health, with data, quality, and standards high among the priorities.
"Need is exceeding supply [in mental health] … We must integrate behavioral health and primary care for screening and referral, and improve quality measurement, which lags compared to other areas."—Kate Berry, SVP of clinical affairs and strategic partnerships
"Data must be used to reduce disparities and improve quality, not increase discrimination even inadvertently."—Danielle Lloyd, SVP of private market innovations and quality initiatives
"The data piece is so important. I don’t think it’s widely known or recognized how important it is for us to get data standards right in order to make a difference in health equity."—Eyles
3. Technology, data, and privacy
The AHIP panel addressed health tech opportunity and risk related to data collection, sharing, access, use, and sale. HIPAA's limitations were highlighted, including AHIP's efforts to expand
regulations to more entities.
"There has been an explosion in the use of technologies … And so much regarding privacy is being left up to the tech companies."—Eyles
"Technology outside of HIPAA needs protection. There is a hole in the national privacy framework that Congress needs to act on."—Llo
4. Post-pandemic priorities
COVID-19 has highlighted the delivery system's continued gaps and inequalities, as well as exacerbated need, but also accelerated solutions. Telehealth and the regulatory and reimbursement changes that support it are one of those solutions. But it will take more than virtual visits and products for payers to navigate pandemic fallout.
"CMOs are thinking, 'How do we integrate telehealth with the healthcare system more broadly … This is much more likely to happen with VBP arrangements."—Berry.
"CMOs are also focused on getting people caught on preventive services, especially where there is no-to-low cost-sharing."—Berry
5. Value and outcomes
Prescription pricing and reforms will remain Congressional hot buttons. Industry players increasingly seek drug cost ROI through outcomes and advanced payment arrangements.
"The first gen of value-based purchasing [VBP] between plans and providers largely carved out drugs, but the hope and expectation is that outpatient drugs will be rolled into those programs."—Lloyd
"Regarding prescription drugs, there are situations where CMOs simply don’t believe there are safe, effective, affordable treatments available."—Berry
"On the retail side, outcomes-based pricing is hard, but plans are working to create flexibilities to expand these programs."—Lloyd
“Post pandemic, eligibility and the affordability of healthcare [marketplace and Medicaid] will be one of the biggest issues. Millions could lose coverage when Medicaid redeterminations resume.”
Mark Hamelburg, SVP, Federal Programs, AHIP
Laura Beerman is a contributing writer for HealthLeaders.
AHIP senior executives highlighted multiple areas of focus for the health insurance industry.
Key topics include affordability and access, mental health and health equity, health tech expansion and its data privacy implications.
The execs also listed post-pandemic priorities and the next generation of value- and outcomes-based care.