Healthcare consolidation 'warrants being looked at,' AHIP CEO says


Matt Eyles is president and CEO of AHIP, a national trade association representing health insurance providers. He spoke with Becker's July 20 about the rebranding of AHIP, President Joe Biden's recent executive order targeting healthcare consolidation, and the biggest challenges facing health insurers.

Editor's note: Interview was lightly edited for clarity.

Question: AHIP recently underwent a brand overhaul. Can you talk about what the inspiration was behind that?

Matt Eyles: So AHIP has always had a very strong brand, and its origins go back to the early 2000s. And when you think about the evolution of healthcare and the role of health insurance providers, we just felt like it was time to really update our brand and reflect the vision of the organization and our members, which is really around guiding greater health. The industry has changed so dramatically from the way it was prior to the Affordable Care Act in terms of really trying to help guide care for patients and consumers, and given the 360-degree perspective that health insurers have, really harnessing their data analytics, collective experience and insights to represent who we are as an industry, and really being much more about health, not just about health insurance — although that's still a critical component of who we are — but really about that entire experience, about how we can help enable patients and consumers to really achieve their best possible health at the lowest possible cost, and really focusing on a quality experience for consumers.

Q: What are your top three goals for AHIP this year? 

ME: I think our first goal was really around helping to accelerate and improve health equity, especially focusing on vaccine equity. We launched an initiative earlier this year along with the Blue Cross Blue Shield Association and also ACAP, another health insurance provider-focused association that joined us later, that was intended to do everything that we could to advance and accelerate equitable vaccine uptake, especially in socially vulnerable communities. We started with the 65-and-over population with the goal of vaccinating 2 million additional 65-and-over individuals. We achieved that goal in less than a hundred days, and we've expanded it to other populations like the Medicaid population. And I think that's really been an important effort and one that continues today. Even though we reached the goal that we stated, we know how important it is to continue to get as many people vaccinated as possible, certainly as we've seen what's happening with the variants.

The second one is really about continuing to expand coverage, and focusing on delivery through our member companies and private sector health plans. [We're] extremely supportive of what happened in the American Rescue Plan Act improving the subsidies for the ACA marketplace, and wanting to make sure that people who fall in the Medicaid coverage gap get covered. We know that there's more work to do there, making sure that we continue to keep Medicare Advantage strong for almost 40 percent of seniors that that program now serves. 

I'd say our final area of focus is prescription drugs and prescription drug prices and costs. And we know how urgent an issue it is for the country to address. We want to see positive Part D reforms to make sure that seniors are protected from out-of-pocket costs, but also don't increase their premiums along the way, and make sure that we're doing everything that we can to effectively manage prescription drug prices and costs.

Q: Where do you stand on President Biden's executive order targeting healthcare consolidation?

ME: We think that there are important challenges that need to be addressed within the healthcare marketplace and what we can do to promote additional competition to keep healthcare affordable, we think is really important. We've seen, especially on the health system and hospital side, the impacts of consolidation and greater physician practice acquisition. And we do think that that's an area that warrants being looked at. It's an area where there really hasn't been much, if any, oversight historically, except for when you're talking about one very large health system acquiring another. And I think we're seeing the impacts of that and what it means with respect to cost, prices and affordability.

Q: What do you think are the top three biggest challenges facing payers at this time?

ME: I'd say continuing to navigate the COVID and post-COVID environment, what the impact is going to be with respect to patients who have deferred care as a result of the pandemic — what will the new normal look like? 

I think another area is how do we make sure that we have lasting impacts from the shift to telehealth, and that we continue to move forward with respect to making sure that that becomes a really important part of the permanent landscape post-COVID, but that also is designed in a way so that it doesn't just become another cost increase because more people are just accessing it through different channels and we're not actually acting more efficiently.

So I'd say those are probably two of the bigger challenges. And then I think third is how we continue to evolve the system toward a more value-based system and an interoperable one that ensures patients have access to the consumer tools and prices they need to make informed healthcare decisions. It's an incredibly complex effort. It's one that we absolutely need to move forward with in the right way. But I think some of the timetables that we're looking for with respect to implementation are very challenging right now in terms of getting to a truly interoperable healthcare system that shares information seamlessly between providers, payers and consumers.

Q: Some healthcare executives think a value-based care model is going to be impossible to uphold for the next couple of years. Any thoughts on that? 

ME: I'll be a bit more optimistic. I think yes, there will certainly be challenges, but I think what became clear through the pandemic, especially during the heights of it last year when utilization of care was down so low — those healthcare practitioners that were in value-based arrangements did better because they weren't still living on a fee-for-service model. And when utilization dries up in a fee-for-service model, we know what the outcome is there. So I'll be a little bit more optimistic to say that we'll have learned a number of things that worked coming out of COVID at least in terms of accelerating value-based models. They are complicated. We need to expand them to greater parts of the system, including pharmaceuticals, where they're really still in their infancy compared to other areas. But I'm optimistic that they will continue to grow over time. And I think this administration will do what it can to focus on advancing it as well.

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