AI models are the golden moment, innovative care models are the golden moment

This month's HLTH 2024 conference brought more than 12,000 healthcare industry leaders to Las Vegas to discuss and debate bold directions for the future of healthcare. For those in attendance, one of the inevitable elements of this future was undoubtedly artificial intelligence (AI). Abhinav Shashank, CEO of Innovaccer, said, “200 out of 250 startups incorporated 'AI' into their marketing.”

To be fair, AI continues to drive significant enthusiasm and investment, with AI startups accounting for nearly a third of all venture funding and a quarter of digital health investments in Q3 2024. are gaining. Needless to say, the biggest digital health IPO of the year was Tempus AI (an “AI” suffix was added to Tempus’ core name in 2023).

The AI ​​hype is not new, but the risks are significant. As Shashank points out, in real-world care settings, healthcare providers are dealing with real-world problems and don't have time to experiment with exciting but unproven technologies.

While it may not have generated as much pomp and atmosphere as AI, HLTH featured several presentations, sessions, and discussions about new and innovative models of care. In many cases, these new approaches are uprooting decades of healthcare oligopolies, payment structures, and healthcare disparities.

Here are three of the most disruptive and impactful new (and reinvested) care models highlighted at this year's HLTH.

1. Blue Shield of California is rethinking its pharmacy benefits model.

Blue Shield of California announced a new partnership with Salesforce to transform its slow-moving pre-approval process. Through this partnership, Blue Shield will leverage Salesforce's Health Cloud to automate authorization approvals for medical services, providing near-instant response for physicians and patients.

As Paul Markovich, president and CEO of Blue Shield of California, said on stage at HLTH, “[Prior authorization]is, if not the most painful process in healthcare. It’s pretty close to that.”

The system is expected to significantly increase efficiency and reduce delays that prevent patients from receiving timely treatment. “What used to take hours or days now takes seconds,” Markovic said.

The initiative is based on an overhaul of Blue Shield's pharmacy benefits program that bypasses traditional pharmacy benefits managers (PBMs) and reinvents a patient-centered benefits model. Recent pharmacy model changes are designed to negotiate lower drug prices directly for members, eliminating PBM intermediaries and enabling Blue Shield to develop cost-effective, member-focused pharmaceutical services. I did. Early success means Blue Shield will purchase Humira's biosimilar at a transparent net price of $525 per monthly dose, which is 25% of Humira's net price, and will make the new version available to plan members for $0. This has already been achieved by contract. Shared burden.

PBMs dominate the pharmacy benefits market with unwavering authority, with the three largest PBMs controlling more than 80% of prescription drugs dispensed in the U.S., but seismic shifts in the market are exposing cracks in the traditional PBM model. I'm starting to. Shifting public sentiment and regulatory scrutiny, persistent economic instability and unaffordability, and increased consumer use of mobile health apps are driving new models of care to reform the pharmacy benefits landscape ( and supporting technology) are ready.

2. Changing roles and priorities for employer-driven healthcare

The main topic of discussion at HLTH is employer-paid health insurance, with topics ranging from mental and women's health, AI-designed benefits, GLP-1 coverage, and consumer coverage. Main throughline? Our nearly 100-year-old employer-directed insurance model is needed and in the midst of modernization.

The U.S. employer-paid health insurance model began in the 1940s and was shaped primarily by World War II policies and labor market changes. Currently, more than 60% of the population under the age of 65 has employer-sponsored insurance.

With the changing realities of the modern economy, traditional employer-driven insurance models are no longer able to meet the needs of a growing proportion of the nation's workforce.

Speaking on stage at HLTH, Oscar Health CEO Mark Bertolini said: Everyone has different types of care needs. In our gig economy, people can't even afford employer-provided health insurance. It also gives you workforce mobility without having to stay with your employer long enough to actually take advantage of the benefits it offers. Now we need to make (benefits) more relative to individuals and groups. ”

This is why a fairly new consumer-driven benefits model, the Individual Insurance Health Reimbursement Arrangement (ICHRA), is gaining traction. Introduced in 2020, this type of employee-paid health insurance gives consumers more control and flexibility in choosing the plan that best suits their health needs, even if they change jobs. It gives you the portability of maintaining your insurance. For small and medium-sized employers, ICHRA is a new way to provide affordable health benefits to employees.

3. New funding and innovation to support the entire women's health lifecycle

First Lady Dr. Jill Biden, in her closing remarks at HLTH, announced $110 million in funding for the Advanced Research Projects Agency for Health (ARPA-H) aimed at supporting groundbreaking research in women's health. announced the offer.

“The United States loses $1.8 billion in work time each year due to the life-altering symptoms of menopause for women,” Dr. Biden said. “Women's health is understudied and underfunded.”

This initiative emphasizes a holistic approach to women's health across the entire woman's lifecycle, rather than limiting it to reproductive medicine. This is an important change to address a disease that disproportionately affects women. By prioritizing and funding research and technology for women's health, the health care industry is beginning to address long-standing disparities and improve outcomes for women across the country.

In parallel, Maven Clinic's recent $125 million Series F funding round marks a milestone in private investment in women's health, valuing the company at $1.7 billion and making it a unicorn. . Will Porteous, Chief Growth Officer at Maven Clinic, discusses the company's unique approach to supporting women throughout their reproductive lives, from fertility and family building to menopause and midlife health. Ta.

Academy Award-winning actress and founder Halle Berry also recognizes that women's health requires a fundamental redesign. She spoke on HLTH about her company, Respin, which provides women with a community that supports connection and well-being during menopause and beyond.

What is clear at HLTH is that there is growing awareness, discourse, and funding for improving women's health. And new approaches and models of care center on inclusive, stigma-free health care for women throughout their lives.

Advances in AI and technology may have taken center stage at HLTH, but those that developed new and innovative ways to deliver care stole the show. Although health care continues to become increasingly inaccessible and unaffordable for many, new health care models are repairing and inheriting the very foundations of our health care system and creating a bold new future for Americans' health. are in a position to support.