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The healthcare industry is evolving. Learn how leaders are pivoting to better meet the needs of their members.

The 2023 Health Evolution Summit (HES) brought together healthcare CEOs, policymakers, and industry experts to explore the latest trends and innovations in health systems.

Throughout the conference, three key themes emerged:

  1. Using technology to support scalability in a growing market
  2. Driving more ecosystem collaboration through interoperability
  3. Utilizing advanced analytics to support a member through their entire health journey

Presenters from multiple lines of business consistently referred to those three themes as key drivers of growth.

Here are the highlights from particularly impactful sessions.

Using technology to support scalability in a growing market

Adapt or be left behind.

Sudden upticks in membership rates have some coverage providers struggling to scale to the demands of the market. A growing Medicare-eligible population, Medicaid redeterminations, and expansions to subsidized coverage are just a few trends leading to growth in government-sponsored markets.

Sachin Jain, MD, CEO of SCAN Group and SCAN Health Plan, spoke to the challenges that rapid industry growth presents in his session “The New Medicare Advantage Majority – Where Do We Go from Here?

Medicare Advantage’s growth in popularity outpaced expectations. With Medicare Advantage enrollees accounting for nearly 50% of the Medicare-eligible population, health plans must focus on both scalability and optimization.

Jain promotes the simplification of the member journey and back-end processes. Stripping solutions down to what works while reducing manual overhead both improves current offerings while fostering scalability.

In addition to rapid growth, government-sponsored markets are subject to sudden changes that can lead to disaster for static infrastructures.

Andy Slavitt, healthcare advocate and former Acting Administrator for the Centers for Medicare and Medicaid Services, led a discussion about the future of Medicare Advantage. Key stakeholders clash over audit rules, star ratings, rate increases, and other logistics. As Medicare Advantage continues to establish itself as a dominant presence in government-sponsored markets, sudden regulatory changes should be expected.

Having the infrastructure to accommodate regulatory changes will enable health plans to stay compliant without impacting the member experience.

Driving more ecosystem collaboration through interoperability

Happier members come from collaboration between both technology and people.

In a session hosted by McKinsey & Company, the link between improved patient outcomes and integrated care ecosystems was explored. The discussion highlighted the importance of collaboration between strategic stakeholders and technology innovators to craft ecosystems.

Automation and composability promote cross-platform communication, which is essential for a seamless member journey.

The composable architecture approach breaks down the traditional silos of computing, storage, and networking.

For example, integrated reporting grants greater insight into the member journey, including enrollment, financial management, and retention efforts. Once a collection of disconnected processes, an interconnected web of composable solutions provides a holistic view of the end-to-end member experience through automatic data exchange and cataloging.

Inherent flexibility and scalability allow for rapid membership growth. Composability allows for the quick implementation of member-facing solutions. Rapidly responding to the demands of members and effortlessly adapting to shifting market trends improves both effectuation and retention rates.

An effective composability plan arises from the collaboration between internal stakeholders, industry experts, and technology vendors.

Peer-to-peer collaboration was highlighted as essential at multiple sessions during the HES. Aneesh Chopra, former U.S. Chief Technology Officer, led a roundtable with CEOs from various segments of the healthcare industry. Forums such as these encourage candid discussions and sharing of best practices and new ideas.

Having representatives from various points of the member journey makes sticking points easy to identify. These types of cross-industry discussions are luckily becoming more common.

The Softheon Executive Advisory Council (EAC) is a think tank of healthcare’s most innovative minds. Senior executives from national and regional health plans, representing more than 50% of the U.S. population, meet in a collaborative, small-group setting to discuss how to improve healthcare affordability and accessibility.

Download a whitepaper detailing health plan executives’ definitions of success in government markets and their strategies to achieve it.

Using advanced analytics to support whole-person engagement

Enrolling members is no longer enough.

The success of health plans is determined by how members are engaging with their coverage. Advanced analytics can provide insights into how to improve everything from retention rates to the use of preventative care interventions.

Paul Muret, VP & GM Google Health – Care Studio, led a discussion about improving care outcomes with actually useful data. The issue is not always bad data; data overload can also cause a fragmented member experience.

Health plans are seeing success in utilizing AI and machine learning to close data gaps and arrive at actionable insights.

For example, using member data to identify the causes of high termination rates allows health plans to make informed decisions about retention and ultimately improve membership and coverage utilization rates.

Softheon’s predictive model identifies members at risk for termination due to non-payment immediately upon enrolling. Focusing efforts solely on at-risk individuals could improve retention rates while minimizing spending.

In addition, health plans are using insights from member data to improve care accessibility. Aetna/CVS initiated a payment program that targets members with volatile incomes. Aetna now accepts cash premiums at any CVS location through Softheon’s payment platform.

When implementing this program, Aetna understood that application would be minimal. Most members prefer paying from the comfort of their homes. But member data showed a dire need for a new payment option in specific groups with high termination rates. Those with a true need take advantage of the offering.

The newfound competitive nature of the ACA Markets means health plans must put their data to work now more than ever. Consumer acquisition costs are rising, and no health plan can afford to lose members out the backdoor.

In conclusion, the 2023 HES brought to light critical themes in improving healthcare delivery. Using technology to increase scalability, driving more ecosystem collaboration, and using advanced analytics to support whole-person engagement are crucial components of delivering a seamless and integrated healthcare experience.