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I had the privilege of attending this year’s Health Evolution Summit, where I connected with both old friends and new partners from health plans, health systems, and the broader healthcare ecosystem. The focus was on how to be a driven and forward-thinking leader in healthcare, how to steer clear of buzzwords, and how to resist the allure of quick fixes in favor of developing long-lasting growth strategies rooted in member and employee satisfaction.

Let’s dive into relevant takeaways, insights, and highlights.

Leadership and Courage During Industry Shifts

At the Summit’s outset, Bruce Broussard, outgoing CEO of Humana, set the tone for the next three days. (Side note: I had a chance to meet and chat with him and he was an incredibly gracious, kind human!)

Broussard urged his peers to make decisions based on strategic value rather than purely financial motivations, underscoring the importance of sustainable business practices. His views on the Medicare Advantage market highlight his commitment to long-term potential over immediate profits. Medicare Advantage, he noted, could become one of the greatest offerings in healthcare due to the competitive nature of the market. Although health plans may not see a return on investment (ROI) for 2-3 years, Broussard sees its growth on a “J” curve—investing in Medicare Advantage today means investing in local communities. I loved his message of focusing on the long-term win for members and the ecosystem as opposed to short-term profit.

He compared leadership in healthcare to the methodical efforts required in health treatments; success is not achieved with a narrow focus. True legacy and success are built by enhancing people’s lives and making lasting impacts on community health. This includes taking care of oneself and finding healthy outlets and ensuring proper work/life balance. I’m currently in the midst of coaching two of my sons baseball teams, and while it’s intense and time-consuming, it is a space that takes me completely away from work and allows me to see my boy’s grow in so many ways and have smiles on their faces (most of the time 😊).

Both Broussard and his peer Wright Lassiter, CEO of CommonSpirit Health, echoed the sentiment of great leaders being driven by causes greater than themselves. As the son of two healthcare professionals, I’ve always felt a strong pull to healthcare, but it hasn’t been until the last few years that I’ve begun to understand the cause that drives me: impacting access to care in a positive way for as many people as possible.

Disruptive Market Insights from Mark Cuban

A standout session at the Summit was a fireside chat featuring Mark Cuban, led by Andy Slavitt. Cuban offered candid reflections on his experiences as an employer contending with hidden fees from benefit consultants.

Cuban humorously remarked on his legacy, “he f**&ed up healthcare for the better, put it on my tombstone!” In an industry as slow moving as healthcare can seem, this passionate and driven approach to change is refreshing, and while his stint in healthcare is short and his understanding may not be focused through a panoramic lens, it was impactful nonetheless.

Overcoming Challenges in the Highly Concentrated Medicare Advantage Market

The discussions at the Summit delved into the strategic complexities facing today’s healthcare sector. With vertical integration on the rise, retail giants entering the market, and demographic shifts impacting demand, leaders shared their strategies for navigating these changes across various markets.

They explored the pressures of Medicare’s growing population and the operational challenges it presents. Every day, approximately 11,000 people become eligible for Medicare. By 2030, the Medicare-eligible population will outnumber children for the first time ever.

Warner Thomas, President & CEO of Sutter Health, expressed his frustrations with operating in the highly concentrated Medicare Advantage market, where the top five insurers control about 80% of the market, while the top 20 health systems hold less than 50%. This has led to greater consolidation of provider-sponsored plans simply to remain viable. Thomas highlighted the challenges Sutter has faced in managing risk with its 200,000 Medicare Advantage lives, asserting his refusal to revert to fee-for-service, which does not align with member preferences. Instead, he advocated for health plans to improve their risk management strategies.

A highlight of the session was witnessing health plan leaders express differing viewpoints and engage in lively debates on stage. For instance, Iselin voiced her frustration with point solutions, noting the impracticality of overseeing the integration and maintenance of 50+ separate solutions that comprise the member experience. She called for a more holistic and consolidated approach and noted the challenges of today’s investment market driving high volumes of “disruptors” that operate in silos.

We also heard about the promises of in-home care, but several of them appear to be taking a more specialized approach. My friend Brian Lobley, CEO at tango, highlighted how they’re able to deliver higher quality care in post-acute situations which leads to impacts across the board for higher STAR ratings, better care gap closures, and lower costs. While their approach is holistic across all managed care, other vendors with home health or other specialized offerings were limited to specific types of post-acute or disease states (and I expect we’ll see more of this), which will present a challenging sea to navigate for payers looking to right the ship and stabilize their (medical loss ratio) MLR.

The key takeaways for me were:

  1. We’ll continue to see specialization that will make it hard to adhere to the idea of consolidation and admin savings so many payers and health systems want.
  2. We’ll likely continue to see M & A play a critical role in the market, helping position payers and systems to afford navigating the complex financial seas.
  3. It’s time to start breaking down those silo walls within payer organizations!

The Cool Part of AI Finally Creeping into Our Industry

One of the things that made me happiest in speaking with both payers and other vendors was hearing about the number of AI pilots in our space. These range from forward-thinking AI nurse voice solutions to practical uses in claims and chart reviews.

We’ve been talking about AI for so long, and there have been many applications of it, but it’s felt mostly behind the curtain; not anymore!

Simplifying Member Experiences for Market Success

My vision for simplifying the member journey involves providing a consistent experience across multiple coverage and plan types. Whether it’s Medicare or Marketplace coverage, members should not struggle to navigate shopping and enrollment processes, and neither should those helping support them, whether brokers, family members, or others.

On a more granular level, missteps in automated workflows due to integration gaps are increasingly prevalent and unacceptable in a market where members consistently demand more and get more from every other industry. One of the most significant areas for improvement that I consistently observe is the reconciliation process. Disjointed enrollment and billing platforms lead to payment delays, member frustrations, and, in the worst cases, wrongful terminations. What seems like such a simple and straightforward workflow can undue not only experience but can also impact coverage.

To discuss any of the topics covered in my recap or how your health plan can start building a holistic and consolidated tech ecosystem, reach out to me at tcohen@softheon.com or connect with me on LinkedIn.