Review of American Health Insurance Plans conference Jun 2011 in San Francisco

1. Accountable Care Organizations and the Collaboratives Mantra by
Jim Bloedau of Information Advantage Group
By Jim Bloedau of Information Advantage Group
It was my first time at American Health Insurance Plans (AHIP-
June, 2011) in San Francisco and although it is the leading
conference for the health insurance industry, attendance was
rather small, when compared to HIMSS, and didn’t seem to have
much energy that went past their keynote speakers which
included Tim Pawlenty and Tom Daschel.
The agenda was surprisingly shallow. For a time when
collaboration is the current mantra of this side of the healthcare
industry, it didn’t include any providers talking about what they
needed or offering perspectives – content was pretty much the
basic blocking and tackling of the insurance/reimbursement
process.
A couple of insurance executives and former provider cohorts now working the payer side I spoke with
characterized the overall industry’s demeanor as being more than a bit concerned about what reform is going to
do to them –“How much will the government take away?” was the common fear. They also though that most of
the sessions were “the same old stuff” when I asked about what was exciting or new at the conference…not very
positive. Here are my major observations.
Collaboration:
Collaboration the “NEW Way” was clearly an understated theme by speakers and confirmed by all senior
management that I spoke to at the conference as the only recognizable offering that would qualify as the buzzword
of the conference.
This notion that collaboration within the payer/provider/consumer continuum is the emerging model of the
healthcare insurance industry’s conversation flavored a number of sessions that I attended, but I wouldn’t call it
the “hot sauce” of the conference…there just wasn’t any. The recognizable flavors of this strategy were:
• Collaboration with the patient during the entire “episode of care.” This would not just take the form of reacting
to a “disease crisis” that calls for admission to an acute care facility and is common to the fee-for-service
model. It is a continuance of care management until the conclusion of the “disease episode “ that eventually
ends at home with a cure, stability or may become chronic and continues on until end of life - a major tenet of
the burgeoning value-based, shared-saving models of reimbursement.
• Collaborating with the patient/consumer to promote health and wellness. This flavor of collaboration seemed
to be a competitive design to meet a reported call by customer companies and consumers to move past
patient completed Health Risk Assessments (HRAs) which are very subjective. HRAs have been around for some
time and BC/BS stated that they are hearing from their customer that they want to move past subjective
assessments to biometric data collection - a plus for the mobile, hand-held and participatory healthcare
advocates.

2. Both of these are measures that could be seen to be part of promoting coordination of care or better outcomes
and may fall under HHS’s plan and definitions of “activities that improve health care quality” under Medical Loss
Ratios (MLR) rules that include efforts to:
• Improve health outcomes
• Prevent readmission
• Encourage wellness and prevention programs
• Improve safety and reduce errors
• Use health IT for quality improvement
BUT, these are the early days and all are doing their best to figure out when and how reimbursement will flip from
fee-for-service to quality-base episodic reimbursement with shared savings. Certainly all realize that an increased
level of cooperation between payer, provider and patients is called for. The big challenge will be creating this level
of trust in an environment that will include FFS for some time and after decades of payer-provider antagonism.
Accountable Care Organizations:
Shockingly, only one session had “Accountable Care Organization” in its title and
was mentioned in passing in several others I attended and sparsely on the exhibit
floor. The one session that did was hosted by Deloitte which cleverly included a
real-time survey of the attendees using texting. The survey of session attendees
showed:
• What was causing their interest in ACOs: 56% stated premium rates and
margins, 40% outcomes - it’s about money first and then the "care" thing.
• What was the best way to stand up an ACO: again, 56% thought medical
home, 32% thought an Integrated Delivery System and 27% diagnosis (CHF,
diabetes, etc.) specific or boutique ACOs was the way to go. Early pilots of
medical home have been very positive in controlling costs - again, it’s about
money first.
The host of this session clearly and wisely encouraged the reality that the tighter
the analytics the more competitive you can be. No mention of the complexity of
the infrastructure required by the provider, many whom will be virtually starting
from scratch, to do so was heard.
With physician consolidation, ICD 10, EHR, MU, HIE and now ACO/Medical Home
infrastructure filling the plates of providers, seeking collaborations that fosters
better data analytics, reimbursement dissemination and qualifying for MLR rules
may be problematic. Combine this with the notion of building trust in the face of
an adversarial history between payer and provide and we can expect some
spectacular failures by payers trying to merely “collaborate.”