This year’s HLTH conference embraced the theme of “Be Bold.” Speakers committed strongly to tackling some of the toughest challenges in healthcare, such as lack of access, clinician shortages, and frustrating prior authorization (PA) processes. As one speaker put it, paraphrasing Ralph Waldo Emerson, “What you do speaks so loudly that I cannot hear what you say.” This sentiment resonated throughout the event, highlighting the need for more action over words.

Actions That Spoke Loudly

Provider and health insurers alike shared the steps they took to tackle key challenges, from administrative burden to prior authorization, and where those actions have yielded more challenges for women’s health:

  • Building capacity using AI to tackle administrative burden. Amazon announced that One Medical providers will be able to use HealthScribe to capture details discussed in real time during patient visits. Clinicians will be able to review, update, and approve the notes before submission. The new AI-powered capabilities will also review and summarize a patient’s outside medical records to provide details to physicians on screening exams, test results, and medications. AI messaging will also help care teams respond to the influx of patient messages.
  • Offering AI avatars to support patient prep. NVIDIA’s VP of healthcare, Kimberly Powell, shared the company’s collaboration with Deloitte to develop AI-driven virtual agents, built on the NVIDIA AI Enterprise software platform, offering real-time, humanlike support. A patient-facing pilot with the Ottawa Hospital is expected to go live by the end of the year. *Note: A live interactive demo was not available at HLTH. Only prerecorded videos of the experience were shared.
  • Digitizing data to decrease the turnaround for prior authorization. In a standout video by Blue Shield of California and Salesforce, executives recreated a famous “Office Space” scene, smashing a fax machine to symbolize the outdated prior authorization process. Paul Markovich, president and CEO at Blue Shield of California, described the payor’s efforts to digitize medical data and implement a cloud infrastructure to streamline the PA process. By partnering with Salesforce to leverage the Fast Healthcare Interoperability Resources (FHIR) standard, Blue Shield went from 20 systems being used for prior authorization to one and can process transactions in near real time.
  • Promoting responsible AI with a new scorecard from CHAI. A CHAI working group unveiled its draft Model Cards at the CHAI Global Summit on Saturday (held in conjunction with HLTH). The Model Card includes the identity of the health AI’s developer, intended uses, targeted patient populations, AI model type, data types, key performance metrics, security and compliance accreditations, maintenance requirements, known risks and out-of-scope uses, known biases, ethical considerations, and third-party information. The CHAI certification process and Model Card design are expected to be available by the end of April 2025.
  • Elevating the conversation on women’s health. A panel featuring Jennifer Klein from the White House Gender Policy Council and Chelsea Clinton discussed reproductive freedom, government policy, and the impact on women’s health. The panelists discussed how restrictive laws are causing a rise in maternal and infant mortality. Making clinicians second-guess the care they offer to women delays care and worsens outcomes. The panel also highlighted that, in order to pass their medical boards, some OB-GYN residents must travel across state lines to learn about abortion care. Amid severe capacity issues, adding more barriers for medical practitioners entering the profession runs counter to the goal of improving population health.
  • Flowing government funding to women’s health. First Lady Jill Biden, PhD, announced $110 million in funding for women’s health research and product development through the Advanced Research Projects Agency for Health. Dr. Biden shared that 23 awardees will receive funding, including for projects focusing on advancing menopause treatment, creating a noninvasive blood test for endometriosis, and assessing brain disorders with a noninvasive MRI imaging biomarker. The funding announcement builds on the White House Initiative on Women’s Health Research, which launched in November 2023.

More Buzz Than Breakthrough

Conversations on combating rising medical spend took multiple forms, including a focus on GLP-1s, testing new models such as individual-coverage Health Reimbursement Arrangements (ICHRAs), the critical role of primary care, and a renewed interest in high-performance narrow networks. Notably, employers and associations representing employers were more prominent than in years past. Conversation hasn’t yet translated into meaningful action. Here are some prominent calls to action and a new vernacular for the industry to learn:

  • Employers must push for performance metrics. Dan Mendelson, CEO of Morgan Health, encouraged employers to demand key performance metrics in contracts with health insurers, including for well-controlled HbA1cs, consistent cancer screenings, and cardiovascular health. Ellen Kelsay, CEO and president of Business Group on Health, issued a call to action for health insurers to include these metrics without waiting for employers to ask for them, saying, “Should we really have to ask this? Why aren’t you doing it already?” Employers and health insurers equally need to seize the moment to ensure better outcomes for employees and members.
  • Employers and insurers consider abandoning GLP-1 rebates. The cost and peanut-butter spread prescribing trends of GLP-1 medications are unsustainable. Key stakeholders made a call for investing more in care management, advocates that can support increased shared decision-making, and care models that start not with a prescription but with more testing, as well as coaching and education on changing your diet. Speakers recommended that primary care play a more central role in managing holistic health for these individuals to better manage costs and ensure that these therapies are only given to individuals for whom meaningful improvement will be achieved.
  • ICHRA is a term few understand. Many at the conference either didn’t know or misunderstood this alternative option for employees. While speakers noted that ICHRAs can be a compelling option for small and midsized business with employees concentrated in a small number of geographies, adoption remains limited. Furthermore, ICHRAs do not address health outcomes directly. Employers continue to increasingly focus on mental health, family planning, and musculoskeletal issues, which ICHRAs do not solve. Regardless of these shortfalls, as employees grow increasingly mobile across jobs, the gig economy expands, and employees hold more influence over their benefits, adoption (and understanding) of ICHRAs will likely grow in the coming years.
  • A shift is apparent from “narrow networks” to “network curation.” The term “narrow” has carried a negative connotation for years, perceived as health insurers limiting care and choice. But speakers and attendees alike agreed the industry needs to ensure that provider networks are promoting care from high-quality providers. The industry is increasingly adopting or exploring “network curation” or tiered networks. This approach incentivizes employees and members to choose providers deemed to be high performance, thereby delivering the best care outcomes at the lowest price. Rather than eliminate the choice for members, members can pay less for care if they select a preferred provider for primary and specialty care needs. We expect to see adoption of this model grow and evolve in the coming years as the industry faces unsustainable medical spend for consumers and employers.

Where We Need More Action

Cybersecurity was notably absent from the conversation and session topics. The healthcare industry faces the highest rate of ransomware attacks. As consolidation continues, these concentrated honeypots sweeten the potential payout for bad actors. One notable announcement on this front: Microsoft released a new report on cybersecurity in conjunction with HLTH 2024 to raise awareness of the troubling connection between attacks and deterioration in patient outcomes, even patient deaths.

Furthermore, while AI will help solve many challenges, it’s only as good as the data you put into it and if the data is safe. More focus on cybersecurity and anticipated stronger regulation in the coming year will help but also require greater implementation of responsible and explainable AI.

It’s easy to talk about what’s coming at a conference. It’s harder to put ideas into motion. We’re at a critical turning point for the healthcare industry, and I walked away with the sense that attendees believe that we need to act before it’s too late.

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