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Precision medicine, predictive analytics, and the rise of the “payvider”: 3 themes from this year’s AHIP Institute

Lacy Clark, PA healthcare expert and Florence Williams, PA healthcare expert

Attending the AHIP Institute & Expo 2017 in Austin, Texas was a welcome opportunity to reconnect with health insurance colleagues across the industry. As US Senators were contemplating the future of US healthcare and drafting their version of the American Health Care Act (AHCA), many AHIP speakers shared commentary on potential outcomes of the AHCA.

One consistent theme was apparent—staying the course towards value-based care and achieving the triple aim of delivering better care, improving health outcomes, and lowering costs no matter the politics of the day is critical for all healthcare industry players. Aptly put by Mike Leavitt, former Utah Governor and former Secretary of Health and Human Services, a value-based care system is and should remain “the north star" of payers, providers, policymakers, and employers. With this mind, our team identified other emerging topics to watch for in the second half of 2017.

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Precision medicine

Precision medicine takes into account variability in genes, environment and lifestyle to diagnose, prescribe and treat the individual patient rather than the scientifically “average” patient. The promise of precision medicine is to create a more customer-centric, individualistic healthcare system. Historically, the healthcare industry hasn’t focused on customer-centricity to the extent of other industries or evolved into a Customer 4.0 approach. Now, an individual’s healthcare data is increasingly in their own hands, as direct-to-consumer genetic testing becomes cheaper and faster with companies like 23andme, the ubiquity of wearables remains constant, and online health communities such as PatientsLikeMe grow in popularity.

At AHIP, the conversation revolved around how healthcare professionals could effectively tap into this trove of data to provide more precise healthcare, reduce costs, and ultimately save lives. It was acknowledged that growth in this space is largely limited by traditional reimbursement models, but the opportunity to innovate is necessary and exciting.

Predictive analytics 

Consistent with the market, “predictive analytics” had a wide range of definitions and implications at AHIP. During the conference, the term predictive analytics was used in reference to a regression model, a machine-learning algorithm, artificial intelligence, data visualization (in general), and even interchangeably with “big data.”

While it’s clear that predictive analytics is essential to bending the cost curve and improving quality of care, it lacks specificity as payers seek to purchase or develop internal capabilities. A few presenters advocated caution and realistic expectations when looking to purchase a predicative analytics platform, emphasizing instead the importance of high-quality and comprehensive data. Irrespective of the predictive analytics platform, acquiring more than episodic “sick care” data is key to getting a complete picture of the patient and truly being able to predict patient behavior.

The rise of the “payvider”

Increasingly, the line between traditional payers and providers is blurred in the effort to deliver value-based care. The growth of this “payvider” space is only limited by the ability of hospital systems to figure out the “secret sauce” of key healthplan capabilities such as actuarial and operational delivery functions.

As population health management and accountable care organizations continue to rise, there are more opportunities for payers and providers to either directly partner (like the recent partnership of Cleveland Clinic and Oscar Health) or for hospital systems to purchase healthplan capability modules from the payers themselves. This “payvider” space will be a source of innovative partnerships and capability acquisitions—a key area to watch in the industry.

We are keen to see how these three themes continue to grow and emerge in conjunction with AHCA developments. We will be closely monitoring the AHCA, precision medicine, predictive analytics, and “payvider” spaces in the lead up to the 2018 AHIP Summit in San Diego.

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