Top Takeaways from Becker’s Healthcare Payers Roundtable

by Akshay Sharma, Chief AI Officer, Lyric

I recently had the privilege of attending Becker’s Payer Issues Roundtable, a significant gathering of health insurance leaders across the United States. Over two days, attendees engaged in dynamic discussions exploring a myriad of topics.

Day one included discussions on Prior Authorization Reform, Medicare Advantage strategies, the role of Chief Medical Officers in coverage, emerging trends in Health Plans, and innovative solutions for ED encounters and hospital readmissions. The event also delved into the impact of AI and digital technology in healthcare, strategies for Medicaid Redeterminations, evolving payer partnerships, and the transformation of Social Determinants of Health.

That’s enough right? Not so fast—day two brought just as much. Attendees took in engaging discussions and insights from panelists on healthcare regulatory issues, chronic care coverage, the future of aging and in-home care, telehealth advancements, and the significant role of Chief Equity Officers.

Overall, this event was a profound exploration of healthcare's evolving landscape, underlining the importance of value-based care, AI integration, and health equity initiatives. And here’s a few takeaways from some notable panels:

Panel 1: Health Plan Disruption and Innovation—What to Expect by 2030

The talk featured Mac Davis, Vice President of Digital Product and Data at Belong Health, and Megan Reid, senior vice president for Medicare Growth and Strategy at Humana, focused on the future of health plans and the importance of addressing health equity. The riveting discussion revolved around organizations' strategies to engage in and better utilize social determinants of health over the next seven years—emphasizing measurable goals. The panel also delved into the trend of co-branding between Medicare Advantage plans and grocery companies. Finally, they shared thoughts on Mark Cuban’s Drug Company partnering with some top insurers, and what that means per future slowdowns for PBMs.

Panel 2: Big Trends for Health Plans and Where to Expect Growth

In a dynamic session, industry leaders Gregg Kimmer (ATRIO Health Plans), Michael Todaro (Magnolia Health), Allison Hofmann (Cigna), and Krista Hoglund (Security Health Plan) dissected key trends shaping health plans for 2024 and beyond. They zeroed in on growth areas, balancing accelerated business lines segments against more tempered ones, while navigating economic and political headwinds. The dialogue also centered around planning for future challenges, which could impact hospitals and healthcare provider relationships. The panelists also noted what “success” in 2024 member and revenue goals would look like. 

Panel 3: Artificial Intelligence, Digital Tech, and Analytics: Bold Strategies for Health Plans

In a dynamic third panel, Jack Shoemaker of Medical Home Network and Matthew McGinnis from Evernorth, a branch of Cigna, delved into AI's transformative role in healthcare. With a nod to speeding up prior authorizations and fraud detection, they highlighted how their organizations are utilizing AI—and its biggest potential for insurers moving forward. Highlighting the urgency for industry leaders to adapt to AI, the panelists also discussed navigating the emerging federal regulations and guidelines shaping AI's future use in insurance.

Neel pointed the way to help industry leaders learn more about AI and effectively “speak the language.” Matthews shared a bit more about Evernorth and its plans to purchase telehealth platform Bright.MD to enhance existing virtual care. Finally, Arta from Alignment Health shared a bit more about the company’s strategy with new partners, Walgreens and Instacart—plus the impact on insights and data that will be gathered.  

At the event, I was privileged to present at Lyric’s executive roundtable entitled, “AI and Healthcare.” The room was busy, and the questions came flying in throughout the hour-long talk. A lot of great energy and many attendees were leaders of some of the top payers in America.

Here are five key takeaways from my executive roundtable talk:

 The Evolving Role of AI in Healthcare

AI's journey in healthcare is not new, but its evolution is noteworthy. We have seen AI make significant impacts across various domains, from enhancing patient experiences in clinical trials to accelerating drug discovery processes. For health insurers, this evolution signals a shift towards more sophisticated applications in administrative areas such as claims processing and benefit payments.

 Emergence of Generative AI and Large Language Models

The latest advancement in AI – generative AI and large language models like GPT-4 and other open-source models – are a game-changer. These technologies are making inroads into healthcare, bringing about efficiencies and capabilities previously unattainable. They allow for natural language processing, making AI more accessible and user-friendly, a critical factor in enhancing stakeholder engagement across healthcare ecosystems.

AI as a Catalyst for Advanced Payment Integrity

Focusing on the future of payment integrity, I shared insights into how AI, particularly generative AI, is set to revolutionize this domain. AI's ability to sift through massive amounts of data and identify patterns can significantly enhance the accuracy of claims processing and fraud detection. At Lyric, we use AI to review and maintain payment integrity content, promoting transparency. This approach will allow for more efficient healthcare delivery, reducing costs and improving the overall quality of care.

Enhancing Stakeholder Engagement with AI Tools

AI-driven tools, such as co-pilot programs, are revolutionizing stakeholder interactions. These tools act as advanced assistants, providing real-time aid in understanding complex healthcare data and decisions. For instance, they can help explain claim adjudications for providers and customer service personnel, offering contextual information and reducing administrative burdens. This is not just an operational improvement but a stride towards better provider relations.

Championing Trust, Fairness, and Data Privacy

The healthcare industry is at a pivotal juncture where prioritizing trust, fairness, safety, and data privacy in AI is not just an option but a necessity. At Lyric, we're aligning with this industry imperative by actively addressing bias and fairness in our AI-based solutions—reflecting the industry’s movement towards more diverse and inclusive datasets; and ensuring our solutions are equitable and representative of all patients.

Transparency in AI decision-making is crucial for fostering trust within the healthcare community. It is imperative that AI systems be transparent, so that stakeholders can understand and trust the insights and guidance. This commitment to clarity and accountability must be the industry standard.

Similar to the advancements discussed today, the integration of blockchain technology through a decentralized exchange platform offers a unique avenue for enhancing transparency, security, and efficiency in healthcare transactions and data management.

Finally, more than ever, protecting patient data is paramount. In our development of our AI-based platform and powerful tools, we uphold stringent data security measures, safeguarding the confidentiality and integrity of patient information.

Final Reflections from Becker's Payer Issues Roundtable

The Becker's Payer Issues Roundtable was a hub of progressive discussions, highlighting key trends and innovations shaping the future of healthcare. From exploring Medicare Advantage strategies to discussing the impact of AI in accelerating healthcare processes, the event encapsulated the rapid evolution of today’s payers and, more broadly, the healthcare sector.

In a series of engaging panels, industry leaders delved into the future of health plans, the role of AI in enhancing healthcare services, and the critical need for adaptive AI strategies amidst evolving federal regulations. My presentation at Lyric’s roundtable, "AI and Healthcare," focused on AI's transformative potential in healthcare, especially in payment integrity and stakeholder engagement. We emphasized the importance of ethical AI use, underscoring our commitment to fairness, transparency, and retaining the “human component” for Lyric’s growth and in serving our valued customers as a true ally.

The event was a testament to the healthcare industry's journey towards more efficient, equitable, and technologically advanced care delivery.