HIMSS25: Transforming Healthcare in a Payer-driven World
On the morning of the last day of the HIMSS conference in Las Vegas last week, attendees gathered to listen to a panel discussing transforming healthcare in a payer-driven world.
"How do you define innovation, and what are the key metrics for success?" moderator Edward Marx, CEO of Marx Advisory, asked the panel.
"I think about big innovation as the research and development arm, where you're really on the bleeding edge of new technology," responded Heather Staples Lavoie, SVP of Enterprise Business and Technology Solutions and CIO at Horizon Blue Cross Blue Shield of New Jersey. "Sometimes we have to recognize that the small innovation is just as important," she added. Key metrics, she said, could be user engagement and adoption rates.
Khin-Kyemon Aung, senior director of Healthcare Services and Medical Director and PCP at SCAN, expressed her agreement with Lavoie. "The key metrics can very much differ based on what we are solving."
on the other side is the collision of creativity and utility that disrupts everything
"I've always had this mental model of innovation on a continuum," Aric Sharp, CEO of Clover Health, said. On one side is the quality of the process improvement, and on the other is the collision of creativity and utility that disrupts everything. You measure that more by the ripple effect of the industries that it upsets. Sharp noted that those are the types of innovations that people get mad about, as they are more revolutionary.
Everyone is toying with Artificial Intelligence (AI) in some way, Sharp gave as an example. There's also genomics, blockchain, and robotics, he said. "There's some really fascinating opportunities and potentials in there that can be very disruptive…value-based care is a tread that can work through many of those things….I see value-based care as a catalyst to spark change and get a dialog going. I don't see it as an end game."
"I think it's really important to think about innovation in the context of the members that we're serving, as well as different populations’ needs," Aung remarked. "How do we build a trusting, longitudinal relationship with them over time? Because at the end of the day, payers are reaching out to connect with the members."
About innovations in her organization, Lavoie explained: We've created systems where we're systematically creating the cases and routing them to nurses based on skill, disease state, condition, and comorbidity, so they're routing appropriately.
"I come back to what are the problems we're really trying to solve….Can we get services faster? Can we get people what they need on time?" Aung added. "Will it improve the experience of our employees?"
"Historically, we've focused on claims and clinical data because we were focused on health outcomes and quality. That's what we were driven to do: to support value-based care. But there's so much more that we can and should be doing relative to customer sentiment," Lavoie responded to a question about data analytics. She explained that all the available data can provide a much more enriched experience.
