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I am back home in Denver and catching up on all my thoughts from AHIP 2008. Every year I come back wishing I could divide my time exponentially. After all, a quick count of this year’s session tells me that I could only scratch the surface. In total, the Institute offered 6 Keynote/General Sessions; 6 Workshops ranging form 2-6 hours in length; 31 concurrent 60-90 minute sessions and 11 breakfast symposiums. You do the math. Nevertheless, I hope you’ve found this blog around AHIP 2008 to be informative, insightful and useful.

As there was only one of me, you tell me – What was your “moment of insight”?
What sessions did you find of most value?

Will there be substantive change in the healthcare system come the next administration?

What do you see as being the definition of “Healthcare 2.0”?

What are you tired of as far as topics at these huge healthcare conferences? What do you crave more of? Should conferences seek to always address healthcare quality, cost, outcomes, and satisfaction? Should more or fewer conferences be targeted for both payers and providers?

What will it take to get the Plan and Provider communities to collaborate better? Do they need to?

Must P4P and Tier-Networks take a backseat in order to first advance measurement of adherence to Evidence-Based Medicine?

I missed Steven Levitt’s “The Freakonomics of Health Care”! The cab ride to the airport was a necessary but pathetic substitute. What did you get out of it? What should I know?!

Keeping constructive and insightful thoughts to oneself never contributes to collaboration. Please post your comments and I will continue thru the year to share bits and pieces of relevant insight as they come across this “healthcare 2.0” yet “50something” brain!

Cheers!

Twice this year, I have been privileged to hear Clayton Christensen outline the principals around disruptive technologies and their impact on redefining industries. I left Friday’s closing day general session, “Diagnosing the Disease: A Disruptive Remedy for Health Care”, equally excited, reenergized yet perplexed. AHIP, again, did not fail to provide that “moment of insight” for me.

What will be the disruptive technology to bring out the shift so needed in healthcare? How quickly might it occur and result in lower cost of care? Will I be a part of a new entrant’s technology, therefore ensured a winning formula, or I am already an incumbent and destined for replacement? How can we participate in driving the ability to diagnose diseases precisely and, therefore, establish the disruption? If you attended this session, hopefully, you are nodding your head and scrambling back to your notes to further get your thoughts composed. If you missed this first-rate presentation, know that Professor Christensen admitted he needed more than his hour to fully share all within this context but keep reading and I will gamefully outline my takeaways from his morning presentation:

1. Industries have always experienced substantive shifts in methodologies, costs, price and delivery thru the introduction of a disruptive technology. It seems the industry incumbents fall prey to enhancing their capacities such that they outstrip the customer’s ability or need to use the progressed capacities. Even in healthcare this can occur, though I am concerned that almost always the entrant offering the disruptive technology is most successful by offering a capacity slightly less to-begin-with than the capacities offered by the incumbents. Does this mean we must sacrifice existing medical quality & performance (though not necessarily always affordable & accessible) in the short-term to advance healthcare? Are we as a society willing?
2. Disruption among healthcare institutions is underway via the evolution from Hospitals to Outpatient Clinics to Patient Home Centers. Another point of view is the shift from the Specialist Physician to General Physician to Nurse Practitioner to Patients & Family. Embedded within this disruptive shift is reality that one cannot expect the Specialist to offer affordable or lower cost of care.
3. Business models tend to shift from Experimentation & Problem Solving (“Intuitive Medicine” by “Solution Shops”) to Pattern Recognition (“Experimental Medicine” by “Process Businesses”) finally to Rules-Based (“Precision Medicine” by “Facilitated-User Networks”).
4. As Solutions Shops (hospitals) were founded on the principal of “figuring out what’s wrong”, the business value prop of doing everything to everybody is extremely difficult to maintain as payment (Fee for Service) cannot be contingent on outcomes. In the Process Business around medical procedures, the process, rather than people, drives the outcome and is predictable. Fee for outcomes is acceptable. Yet I not convinced evidence-based medicine doesn’t take a back seat. Finally in Facilitated User Networks the focus is on precision such as individual disease management, personal genomics and prescriptions.
5. Professor Christensen asserts that many high-potential reforms in healthcare have been destroyed by trying to force the technology into the existing system when creating a new dimension or delivery would better be served. Integrated care givers will have significant advantages over the existing plane of delivery.

Some heady material but yet a discussion that I believe must be kept at the forefront. How many good ideas have you been involved in around medical payment, delivery, cost, price and methods but you blamed “execution” for its failure to evolve? Perhaps we’d all be better served by working to create that new dimension or system? Does this mean the Democrat’s general proposals for healthcare is that system? Or, perhaps we would be better served by nurturing new patient/consumer behavior & attitudes to drive a disruptive entrant into healthcare? Can we leverage advanced analytic approaches in other industries to redirect the course health providers and payers are on? How can you ensure that the results of analytics are used in decision-making?

I do believe that healthcare has evolved such that it is ripe with receptiveness for an entrant with a disruptive technology to remedy healthcare. In Professor Christensen’s initial discussion of the steel and transistor industries, he refers to the teenager as the “Rebar of Humanity”, inferring their willingness to adopt the disruptive technology to accept a lessor quality sound for the personal advantages of the transistor radio. I just hope that the patient, provider & payer communities can redefine the traits that accept initial disruptive technologies so that we don’t sacrifice healthcare quality.

As I head over to Moscone Friday morning, I keep thinking about one statistic I heard yesterday as presented by Dr. Sobel, The Permanente Medical Group:

Who provides the largest source of care provision in the US?

You do! 80% of all primary care is self-care. In today's age of medical library's and internet sites and a generation much more comfortable with social networking for information. It's little wonder that increased focus on enabling value-add collaborative capacities must be moved to the forefront.

As I think about what that means to me, I want to be sure my sources of information between myself and my primary provider of care encompass leveraging all points of data, analysis for insight & relavance and getting information that I, as my first tier of care provision, can interpret and react to.

Next post will be written from a plane somewhere enroute back home to Denver. Alot to absorb and filter for sure.

AHIP brings each year a bit of a surprise. In my pre-AHIP posting, I discussed the dedication to improving the healthcare system all the while your industry is being painted as the “bad guy”. That point was driven home this morning. As I was getting charged-up learning about the opportunities to leverage social networking to further build a relationship with the patient/member, the masses were gathering outside the Moscone Center for a brief but large demonstration “for healthcare, against insurance” (somebody has deal with the cost) and for universal care. Too bad, I thought, that these individuals weren’t “flies on the wall” hearing the pervasive discussion inside around better engaging and improving relationships with the individual.

This morning’s breakfast was a good lesson in the danger of “case study” presentations without naming the subject. It’s always been my belief that the manner one leads a discussion is the best way to give credibility to one’s company. This morning I saw ¼ of the session’s time go to praising one’s own company, then rushing thru an unnamed case study where the basis seemed skewed from the beginning and results too-good-to-be-true. I’ll admit to a bit of self-satisfaction when the audience made it clear they were unimpressed. A good refresher for me and reminder of my beliefs.

So just what do the Democrats and Republicans feel is on the horizon? Two major general session panels today allowed political leaders like Bartlett, Breaux, Frist, McAuliffe, and Thompson (alphabetical) to give their versions of the crystal ball. Let’s just say all agreed to disagree and:

• Healthcare will take a back seat to Iraq and the Economy –or-
• Healthcare will remain an issue and exit polls will bear that out
• Congress, with 100 retiring members, will take on a much more “Blue” persuasion –or-
• Congress will not push forward substantive change
• The Republicans won’t state what they are for rather what they are against –and-
• The Democrats won’t state what they are against rather what they are for.

At the end of the day, I see a further public/private collaborative targeting the issue of making coverage more affordable, focusing on the 18-34 year old healthy population currently declining insurance purchase and some incremental series of programs to reduce the 47 million without insurance.

The session on leveraging social networking to build relationships is really what the coined phrase “Healthcare 2.0” is all about. I prefer to think of next generation healthcare being geared to the mindset, technologies and behavior of those 18-34 (anyone older is welcome to come along). Forrester’s Social Technographics Ladder is thought provoking and, by virtue of this Blog-Site, I fill the role of “Creator” “Critic” “Collector” and “Spectator”. You? Well if you are reading and giving feedback, you are a “Joiner” Critic” and “Spectator”….not sure if I like the description of a spectator being one lurking in the background though.

Bottom line, customers are and will drive your brand, your product and your services via social networking without your control. My reaction? - Join in and participate in thought leadership dialogue and build better relationships with your customers or be prepared to accept the blame when strategies fail. Whether you start with marketing automation, optimization campaigns are a have an existing social network strategy, analytics can only further enhance the relationship building.

One last takeaway this morning came from James Robinson, PhD around value-based purchasing. Not sure I fully comprehended the economic arguments to invest in increasingly expensive new medical technologies because it will ultimately result in less expense purchase prices for technologies delivering true value. However, I do believe the concept of episode-based pricing and packages-of-care pricing have merit. I just cannot accept such might be implemented without the predictive modeling capacity to forecast impact. (Must be the conservative CFO in me)

So……ala Healthcare 2.0., what do you think? Come on! Be a “joiner” and “critic” (or even “creator”), just don’t lurk!

An afternoon of sessions followed by the exhibit hall mania to the AHIP Opening Night Reception…..from the discussions to exhibits to the presentations, there is no doubt that the business of health insurance plans is changing…..but I am not convinced we are all on the same page as to how, where or why.

Anxiously awaiting the “Emerging Opportunities in the Global Healthcare Market, having presented at and attended both March’s World Healthcare Congress in Berlin and last week’s Irish National Healthcare Summit, I was anxious to hear other’s take on where the US can learn from European/Asian experiences and where the US experience can add value globally. I have to admit, I found the advice to 1. Offer private insurance globally; 2. Offer management capabilities, including re-insurance; 3.) Leverage EXPATS and 4.) Opportunities to direct members for cheaper better services outside of US networks (global tourism) to be less than what I would have expected for the audience. I truly believe that, IF we can get disease/population management, evidence-base performance metrics and ancillary service provision perfected to have demons ratable ROI for the investment here in the US, we can offer the world tremendous opportunities when public/private collaboratives are sought. Until then? I’d prefer to fix what we have and perhaps learn from some of the EU’s initiatives. It should be noted however that few countries, regardless of their primary source of funding, have failed to recognize opportunities for the private sector to bring value. Opportunities today can be enhanced down the road if we give proper attention to analysis here in the States.

Afterwards, I found myself hearing more about consumer engagement tools leveraged by WellPoint and Kaiser. I am 110% supportive of these initiatives and only hope that we as a healthcare community embrace them not just for immediate returns but for the potential to drive a behavioral change amongst both the member, patient or consumer and the provider. On occasion I do cringe when I hear of Zagatt patient satisfaction of physician/provider surveys similar to what WellPoint presented. Is it totally unreasonable to think it to be only natural for patients to generally say they have confidence in their physician, trust their relationship, like their methods of communications and the patient setting? What patient wants to say they have made the wrong physician selection? The bigger question is what the survey would reflect if a provider’s compliance with evidence-based protocols were made public to the patient before the survey and perhaps 6 months later. Nevertheless, these two leading-edge organizations are to be commended for their portal information sharing efforts, incentives to align modes of interventions with patient characteristics and recognition that the patient should drive the methods of communication. If it’s about mass outreach, “there ain’t no killer app” it was said. I would argue that these advancements make it clear that we are finally recognizing the importance to factor all data points & sources into the matrix for analysis, prediction and optimizing patient engagement. Value drives performance and member/patient outreach, though in its infancy, is beginning to leverage learning from other industries.

A new breed of marketing automation and campaigns directed both at members/patients and providers can take us to the next stage.

Taking a walk thru the Exhibit Hall tonight, there are many participants not here last year and even more not in existence 2 years ago. A good thing if they are each engaged in the past, present and future demands & challenges for the healthcare industry. But a warning flag perhaps if one believes new “Fixes” should outweigh intelligent discovery and exploration of data while being positioned to respond to new business intelligence expectations down the road.

The sun is setting over the Pacific, its past midnight back East, and yet a new dawn in health plan intelligence is within reach. The next few days might just reflect that. Stay tuned.

Onto to Day 2, Keynotes & Concurrent Tracks.
Rick

AHIP’s 2008 Institute is getting cranked up and the streets of San Fran are filling with bag-carrying registrants scurrying back and forth between their “conference hotels” (1 block to 15 blocks away) while the early session workshops are underway.

This morning’s AHIP Evidence Policy “update” was a good supplement session to AHIP’s May-June 2008 article “Better Evidence; Better Health Care Decisions” but I couldn’t help shaking my head on a few points.

The session included a briefing on the Federal Comparative Effectiveness Initiative (also known as “The Entity”). To date, what seems to be agreed upon is that the initiative is based to foster substantial comparative effectiveness research, be a public/private entity and also support evidence development while evaluating existing evidence. Still undetermined is the method of funding the entity (no surprise), the degree to which cost-effectiveness will be brought into study and who will have access for use (Medicare and private insurance?). Anyone familiar with the public hearings last fall around AHIC 2.0 must have experienced the “Groundhog Day – Haven’t we already done this” reaction that I did. With AHRQ’s work to-date along with the direction of AHIC 2.0, I am not convinced that another entity is necessary and fear that it will only foster the provider community questioning the entity’s findings versus AHRQ or other work AHIC may support.

Some things are clear though:

 Clinical Effectiveness will not likely ignore cost & value considerations
 Evidence grading will require the ability to integrate into performance management capacities
 Registry data, in itself, doesn’t support prediction as much as outline past behavior
 Observational data & surrogate outcome data must be included into any grading structure

Between multiple evidence evaluation efforts, randomized clinical trials, and coverage/no coverage decisions, the time it takes to get mutually agreed evidence out to the provider community is lengthy. Of even great length is the subsequent time it takes to change physician decision-making and practices.

I take all of this as a further sign that the greatest data gathering efforts in healthcare will ultimately only prove of value if analytics can support new discovery and validation. Furthermore, performance management efforts within hospitals should be evidence-focused and that means they must be robust enough to handle the data complexities inherent in comparison metrics.
I don’t believe AHIP’s policy session in itself will deliver change but it did drive home the importance of including providers and payers into a single collaborative (again, AHIC’s intent). Finally, the best quote of the session was shared third-party during the informative panel portion of the policy update: “If you don’t treat me like an idiot, I won’t treat you like a crook!” Words to live by…….anyone care to guess who the idiot was and who was the crook?

It’s a beautiful cloudless day in San Fran and it’s time to walk back the 12 blocks for afternoon sessions shortly. Ah conference life.

As we head into the week before America’s Health Insurance Plan’s annual Institute, just a few thoughts……..

How healthy is our healthcare system? It depends of course on your definition of healthy. Imagine spending 24/7 tirelessly working to improve “the system” and always being painted as the “bad guy.” What core values must exist within individuals who work tirelessly to collaborate with many players throughout the healthcare spectrum, all the while knowing that too often journalists and politicians love to lay blame on your industry? Such is the work in the health insurance industry.

Depending upon your viewpoint, there are multiple reasons why AHIP’s Institute 2008 is a valuable event personally and professionally. AHIP provides direct access to those “in the know” politically with timely discussion and predictions around where healthcare is headed. AHIP provides a single forum to join colleagues in discussing and exploring new approaches to balance costs with evidence-based medical practice and quality of outcomes. AHIP allows for new issues to be examined as to fads, trends or calls-for-substantive change. Finally AHIP allows all players engaged in the Health Plan business to come together and recharge. The energy and excitement after three days at AHIP is undeniable.

I am excited about engaging in discussions around next-generation consumerism in healthcare. I look forward to examining what must take place to bring about a new breed of analytics to support improvement in healthcare. I feel we are just beginning to recognize what it will take to bring value to health information exchanges and want to bounce some ideas off others. After hearing Clayton Christensen discuss “disruptive remedy for healthcare” in Washington this past April, I want to hear him again. Finally, I wonder what the “moment of insight” for me will be this year. Last year it was author Malcolm Gladwell (Blink: The Power of Thinking Without Thinking) discussing change in healthcare in terms of the latest hot band to spring on the scene versus Fleetwood Mac’s music - nurtured and developed over the years (conceptual innovation versus experimental innovation).

Perhaps most of all, I look forward to again being reminded how pervasive the dedication is within health plans to really trying to be a part of a solution for a healthier healthcare system.

So I look forward to sharing thoughts after attending AHIP sessions and look forward to your thoughts and feedback!
Cheers-
Rick