John P George

John P. George

Director, Consulting Expert, Health Strategy, U.S. Operations

It was with great anticipation that health industry members gathered to listen and learn at the AHIP 2022 annual conference earlier this year. AHIP, which stands for America’s Health Insurance Plans, is an association dedicated to those who provide healthcare coverage, services and solutions to hundreds of millions of people every day.

Attendees heard much buzz about changing how we approach the entire health ecosystem. Driven by the pandemic and awakened by evolving social dynamics over the last few years, it is apparent that a focus on health equity, social determinants of health, and behavioral health are essential for a healthier population. And, while these messages were delivered to a primarily U.S. audience, we hear these themes from our clients globally as impacting health around the world.

Data analytics play a key role in addressing health equity

Building over several years, many health plans are dedicated to serving consumers equally in their care and follow-up, regardless of gender identity, income, race, ethnicity, sexual orientation, geography, and more. These organizations not only are establishing a health equity vision, but they’re also putting in place tangible goals and measures to achieve this vision.

Addressing health equity across an entire enterprise can be painstaking work. Successful health equity initiatives can be driven using data analytics tools supported by artificial intelligence and machine learning (AI/ML) and skilled data scientists. A granular analysis of health equity measures across the organization helps to pinpoint challenges to be addressed. Supported by refreshed protocols, enhanced training, and community efforts, the industry is changing its approach to health.

Social determinants lead to a “whole person” care approach

Eighty percent of a person’s health outcome is determined outside the doctor’s office, so it is no wonder that more and more health organizations are looking at the person with a 360-degree view—essentially through “whole person care.” Advances in data collection and data synthesis have sharpened our awareness. Socioeconomic factors, including affordable housing and food insecurity, show that health plans significantly impact the entire ecosystem.

Recognizing these social determinants of health is one thing, but tackling them is quite another. The 2022 AHIP conference included a significant call to action for continued policy advances, breaking apart data silos for better information flow, funding, technology, education assistance, and collaboration at all levels. A community approach is advocated, using every mechanism possible—both top-down and bottom-up—to produce public service announcements, conduct phone outreach, go door-to-door to build trust, promote health literacy and bring services to the community.

As we consider the whole person, it is not enough to share medical-to-medical data; the exchange must also include social data, and the data must be shared promptly. The philosophy and mechanics of care have changed drastically over the decades, and we’re seeing this through the millions of telehealth visits and innovative ways to engage people through mobile mechanisms.

Behavioral health is not a one-size-fits-all approach

The pandemic-driven years of uncertainty, sheltering in place, modified policies and protocols, and school and job disruptions have impacted both young and old. As a result, millions of people deferred treatments, screenings and therapy. Studies in the U.S. originating pre-COVID and continuing through 2021 show “good” mental health has declined at least 5% and that nearly 24% of Americans claim their mental health is “fair to poor.” According to the World Health Organization (WHO), the global prevalence of anxiety and depression increased by a massive 25% in the first year of the pandemic.

An interesting, underlying theme is that loneliness is reaching epidemic proportions, with the most vulnerable group being 18 to 24-year-olds as they deal with stress, anxiety and depression. These, plus addiction and other mental illnesses, strike all ages.

Experts at the AHIP 2022 conference noted that reimbursement policies, access to therapists across jurisdictions, breaking down the data barriers, and full access to social data are critical to addressing these issues. Behavioral health needs must be met where the person is, and it is not a one-size-fits-all approach. Continued innovation in care delivery and the use of predictive models (combining self-reported data, past histories and demographic and social data) are keys to addressing situations before they become more serious.

A roadmap to a healthier population

The road to a healthier population is long, yet the roadmap is becoming more apparent, and those participating in AHIP 2022 shared their vision for progress in several areas:

  • Lower costs by streamlining cumbersome processes like prior authorizations and care management operations
  • Use technology to analyze big data, monitor remotely and consult and advise where previously only face-to-face interactions were possible
  • Take a whole-person approach to treatment by sharing current, seamless information regardless of the location of their care or insurance status
  • Increase health literacy to help individuals not just receive test results, but also understand them
  • Deploy mobile technologies or use more traditional outreach to remind people about their next appointment, screening or exam
  • Prepare for evolving care and payment models as individuals focus on wellness
  • Navigate episodes of care and the events that follow—transitions in care, care management, and health at home

As participants in the health ecosystem, we all play critical roles in reaching our future state. Along that journey, we can reflect to see where we were, how far we have come, and yet how much more there is to do.

I invite you to learn more about CGI’s work in the healthcare industry.

About this author

John P George

John P. George

Director, Consulting Expert, Health Strategy, U.S. Operations

John George is an innovative business and information technology executive with over 30 years of IT and health industry experience.