Tell us about your role at America’s Health Insurance Plans (AHIP).
I joined AHIP as a managing director. The former CEO of AHIP liked what we were doing with our consumer shared decision-making start-up, where I was one of the founding employees. Soon after, I had a speaking session at an AHIP conference, and I was asked if I wanted to act as resource for our membership. It was a new function and in a new area for us: innovation. We began to build out an innovation practice into what is now a formal function within the association.
Describe the type of work AHIP is doing to fuel innovation across health insurance plans.
We work with our members to infuse innovative concepts into the ecosystem. Our goal is to understand C-suite priorities—what’s keeping them up at night—and, in a non-commercial setting, help them to figure out how to solve for those challenges by defining and agreeing upon the business value first and foremost.
Payer/provider collaboration has not been prevalent in the past few decades, but now it’s top of mind. We bring together both sides to create a framework for solving challenges, such as how to get better patient engagement and how to blend high-tech with high-touch to improve the cost to serve. It’s not about developing a new shiny object. It’s about focusing on innovation to solve a problem that will drive strategic objectives.
Tell us about the AHIP Innovation Lab (IL).
When we set up the AHIP IL, we knew it had to be more than just a "payer" solutions hub; we envisioned it to be a healthcare ecosystem solutions hub. In a confidential, non-commercial setting, we welcome payers, providers and care management, employers and life sciences companies to collectively solve for self-reported challenges. The AHIP IL acts as a catalyst for senior executive decision makers to sit with people they wouldn’t normally sit with. No single entity can solve the complex challenges facing healthcare, and we believe the only silver bullet is true collaborative innovation.
It’s an invaluable member resource because if we don’t action these good ideas and clearly share the economic impact they will have, they will vaporize. One of our membership's CEOs said, "the AHIP IL is not a think tank—it’s a do tank.”
You’ve been with AHIP since 2013. What are some of the most significant transformations you’ve seen among health plans during that time?
I’d say the first and foremost transformation is the willingness for collaborative innovation among payers, providers and other essential stakeholders.
I also see a shift toward willingness to embrace new avenues to improve access to care. It’s not just about putting a widget on a website or procuring a portal for care coordination. It’s establishing outcomes-based risk sharing agreements, making sure every stakeholder has skin in the game and clearly defined responsibility. It’s refreshing to see that we are all striving for the same thing. Each essential healthcare stakeholder has been going about it alone for too long.
Why are payers and providers now more open to collaboration?
It has always been—you’re in charge of patients and/or you’re in charge of coverage and reimbursements. Now, we realize the number one stakeholder is the consumer. If we can aggregate and share actionable information, that will lead to a lot of value and benefit our goal for the improved health status of our populations.
What game-changing innovations do you expect to see for health insurance plans in the next three to five years?
There will be increased access to behavioral health as we explore virtual care and increase access for the underserved.
Payers will be better positioned to aggregate data, with volume, variety and velocity, for a comprehensive longitudinal view, and to share that information with providers and other nontraditional stakeholders. Whether it’s around diabetes or other illnesses, once you get the infrastructure down, you can plug and play, regardless of the disease state.
We need to continue to address inefficiency and administrative burdens that are inhibiting outcomes. We have successful fraud, waste and abuse proof of concepts underway. The savings we have revealed are being used as a funding source to transform care delivery and enable new initiatives and product offerings to generate growth.
What do you like most about your job?
There are so many great rewards I have received since opening the AHIP IL, but I’d say what is most rewarding is bringing together people who wouldn’t normally sit together at the table to create meaningful and actionable innovative frameworks. In the first hour, people hold their cards close to their chest. The atmosphere changes to become more comfortable and trusting when people realize that they want to achieve the same outcome. It’s beautiful to witness the light bulbs turn on, simultaneously, across the entire room.
Do you have any special hobbies or interests?
I enjoy volunteer tourism and service. I just got married a week and a half ago. We had a destination wedding in Baja, Mexico. We collected food and household goods with our wedding guests and distributed these items to local families in need. It made our special occasion a bit more meaningful to give back and it is a continuous practice of gratitude.
I’m also an avid tennis player. I get teased because in the winter I often travel with my rackets if I’m going to business meetings in warm climates. It’s not unusual for me to have a 4:45 am to 6 am court time before meetings. It breaks up the routine of jumping on a plane.