Decisions made by health insurance executives impact the entire health care industry. Decisions that determine reimbursement policies, billing practices, and which technologies to adopt impact members, physician practices, hospitals, and health systems. The Biden administration has embraced several reforms to the health care system, including reducing the cost of drugs to treat chronic diseases such as type 2 diabetes. But the administration also wants to improve pre-approval to make it more efficient.
These will be discussed during three panels in the Payer Insights Program, hosted in partnership with MedCity News, at the ViVE 2024 event from 1:00 to 3:00 p.m. PT on Sunday, February 25, at the Los Angeles Convention. Some of the topics. Center in room 408A on the 2nd floor. Sessions will explore policy developments around prior authorization and price transparency, interoperability and data sharing, the use of digital tools to promote fair and accessible CarePlus, technological innovation, automation, AI, and more.
For ViVE 2024's Payer Insights program, we asked some of our speakers and sponsors for their insights on digital innovation in the payer space and responded via email.
Lyric CEO Rajeev Ronanki said he is encouraged by the potential of AI to reduce fraud and waste and make healthcare more predictable for healthcare providers. Lyric is a sponsor of the Payer Insights program.
AI-powered innovations are showing great promise in the areas of payment integrity and accuracy. Expect to see improvements in the risk of fraud, waste, and abuse. Ronanke said he can expect reimbursements to be faster and more predictable for providers. Payers unlock greater levels of value through increased savings and reduced administrative costs. Most importantly, patients can benefit from increased transparency, greater predictability of medical costs, fewer billing errors, and improved levels of communication with healthcare providers. I believe that AI innovation in payments is a winning experience for healthcare professionals.
However, implementing digital health presents many challenges that healthcare institutions must address.
Shawn Gremminger, CEO of the National Alliance of Healthcare Purchaser Coalitions, says promoting transparency in health care is easier to achieve on paper than in reality.
Sean Gremminger, president and CEO of the National Alliance of Healthcare Purchaser Coalitions, said some providers and plans, especially hospitals and PBMs, refuse to provide transparent information to the public and their customers. He said that they either continue to do so or make access extremely difficult. The information available is so complex, dense, and difficult to decipher that even sophisticated employers struggle to make the data understandable and actionable.
Gremminger added that there is optimism that health technology will make transparency more manageable and that better access to data will lead to better purchasing decisions.
We are encouraged by the growing number of vendors like Turquoise Health who are helping make data understandable and actionable for not only employers but also consumers. This will take time, but there is information in the market that employers can use to make better purchasing decisions and protect themselves from the types of lawsuits recently filed against Johnson & Johnson. exists.
Shruti Kothari, Director of Industry Initiatives at Blue Shield of California, spoke about the need for collaboration to ensure medical technology addresses structural barriers to care and the need to improve collection of patient self-identification data. emphasized.
Blue Shield of California recognizes that strong collaboration across the industry is needed for digital tools to fully realize the opportunity to address structural barriers to care, Kothari said. Additionally, we need a way to capture self-identifying data such as language, race, ethnicity, gender, and sexual orientation to better meet patients' individual health needs. California's Data Exchange Framework (DxF) represents a major step forward in the ability to collect and share data. To realize the full potential of statewide data sharing in California, it is critical that all eligible parties fully participate and comply with DxF.
Ronanke added that achieving payment innovation in the healthcare sector requires replacing outdated processes and technologies, increasing efficiency and increasing trust among stakeholders. AI and blockchain will serve as key drivers of this long-overdue change and transformation.
This is a preview of the Payer Insights program agenda that is included when you sign up for ViVE.
Click here to register!
Navigating the pre-authorization landscape
Prior authorization is complex and plays a critical role in ensuring appropriate and cost-effective access to health care services. Explore challenges and opportunities for improving data sharing, workflow efficiency, quality measurement, and decision-making for better patient care and outcomes. Learn practical strategies for adapting to recent and proposed regulatory changes designed to streamline the prior authorization process, enhance seamless data exchange, and promote interoperability.
Moderator: Katie Adams, MedCity News Senior Reporter
David Dobbs, Chief Data Officer, Hawaii Department of Health Services Timothy Roe, Vice President and Director of Integrated Care Delivery, Highmark Health Ginny Whitman, Senior Manager, Public Policy, Regional Health Planning Alliance
The future of payments innovation
As the healthcare industry adapts to coverage transparency rules, there is increased focus on revolutionizing payment systems. Learn about the changing landscape of healthcare payment, including the latest compliance requirements for cost-sharing data disclosure and broader implications for payment accuracy, efficiency, and innovation. A deep dive into how health plans are responding to these changes, navigating the complexities of data sharing, and leveraging AI to transform payment models.
Moderator: Marissa Plescia, MedCity News Reporter
Shawn Gremminger, CEO, National Alliance of Healthcare Purchaser Coalitions; Tawfiq Bajjali, General Manager, Lyric Platform Solutions
Transforming healthcare with digital tools and AI
Innovative technology not only improves health outcomes, but also increases patient satisfaction and engagement. Hear about cutting-edge approaches, challenges, lessons, and opportunities as health plans leverage the power of digital transformation and AI to create a more patient-centric and effective healthcare ecosystem.
Moderator: Arundhati Parmar, Medcity News Editor-in-Chief
Shruti Kothari, Director of Industry Initiatives, Blue Shield of California
Check the agenda here to stay up to date on speakers from the Payer Insights program.
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