2024 AHIP Annual Meeting: Key Takeaways

The 2024 AHIP Annual Meeting in Las Vegas was the usual bubbling cauldron of payer-centric solutions to the main challenges in the US healthcare system. Many broader societal issues, including the role of artificial intelligence (AI) and social determinants of health, were on the agenda. Multiple speakers talked about GLP1 medications like Ozempic and, more specifically, how to pay for them. Other key topics included:

Increasing Collaboration between Payers and Providers

An ongoing theme at AHIP this year was the need for increased collaboration with providers. There were multiple discussions about how payers could improve interactions with providers ranging from oft discussed incentives and disincentives written into network contracts to more real-time monitoring, actual case management, and more focused outreach to target what are referred to as “gaps in care.”   

Improving Prior Authorization Processes 

While these discussions are often designed to be win-win payer-provider discussions,  AHIP also had sessions and many exhibitors addressing the more contentious prior authorization processes. Many AHIP attendees were no doubt aware of the increasing chances of Congressional passage of a prior authorization bill that would increase the ability of CMS to regulate prior authorization performance and reporting. These discussions underpin the increasing demand from CMS and employers for payers to prospectively manage clinical care and not just pay for it after the fact.  

What was Missed: Massive Information and Data Needs

As with the sessions on AI, what was arguably not fully addressed were the massive information and data needs required for modern computing approaches to managing clinical care. Inferring a patient’s clinical status from ICD-10 and CPT-4 codes is increasingly inadequate. AHIP highlighted many workarounds for the limited amount of clinical data payers have today. No doubt future AHIP conferences will pivot to modern clinical data gathering approaches.   

The modern Internet economy’s magic is in large part due to the ubiquitous real-time interfaces that power every app on our smartphone linking vast networked data stores to the services provided on our phones. This same technology is making its way to healthcare. 

Payers and providers have in place today – or in the very near future – the same kinds of clinical data sharing JSON (FHIR) APIs we use in the rest of our lives. One can just imagine next year’s conversations at AHIP as payers start to emulate the rest of the economy in integrating much richer information streams to gain competitive advantage. 

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