A payer trend topic that we have often covered is the importance of a clean, evidence-based data strategy to address team challenges and enhance industry alignment.
The data influenced many debates that dominated the AHIP 2025 conference in Las Vegas. This has convened health insurance leadership and thought leaders to discover new ideas for achieving business and care management goals.
Many recurring and enormous themes and phrases at the event were “data-rich and insightful,” and not only their data, but their mission set the tone of an incredible, aggressive approach.
Payers aren't waiting for the larger healthcare industry to resolve the issues surrounding interoperability and information exchange. Many people use their own data (the real world data they already have) and create digital twins or virtual models of member personas that can perform rigorous test scenarios to better understand risk. And some are very refined. Payers are no longer willing to wait for insights from their data. They are ready to use their data to find their own practical applications. (And some people are moving beyond the pilot phase with this type of data project.)
Its positivity and spirit of redefinition permeated AHIP. There, the discussion seemed to swirl around ways to find a balance with helping to provide the best possible healthcare, but has shifted away from the social services aspects that have been promoted over the past few years.
here it is Top 4 trends Payer leaders were talking about AHIP, who is likely to pilot data decisions for this year's health plan.
1. Appetite for a purposeful solution (and no fear of AI)
Ahip payers weren't necessarily looking for the next big thing. When it comes to data and technology solutions, payers want solutions that meet their specific needs and do exactly what they need to do. It needs to clarify its purpose and achieve proven results. It's easy isn't it?
Payers are generally risk aversion and have used advanced analytics for decades. When it comes to AI, they are just doing the usual thing and using solutions that serve clear business purposes. AI is more clear about how it is unfolded and used. Due to its long history of advanced technology, we believe that payers will use it as a targeted tool solution. What they are looking for is simply a high standard.
2. Protecting “unintended consequences”
The phrase “unintended consequences” has been everywhere this year as health planning leaders emphasized the importance of severity and vigilance in trying to alleviate unfortunate outcomes before they occur.
In some cases, it seemed to refer to violence against healthcare professionals and health insurance professionals.
However, this phrase led a wider life, as so many initiatives have warned.
Payers must act as both a financial services company and a healthcare provider. Ideally, a good payer will balance these two functions with greater transparency and communication. The better the balance, it usually means that the organization is better identifying unintended outcomes early or preemptively, allowing them to pass and mitigate those risks. However, a good balance means that it often takes time to process approvals. Avoiding unintended consequences is a trade-off.
3. Focus on “Care Navigation”
A popular term that surrounds us is “care navigation.” This care management-driven trend is to focus on the customer journey beyond mere reminders and scheduling. This is a concept that has been around the industry for a while but is beginning to gain more traction within the wider range of planning and care management programs, allowing people to become healthcare consumers, with greater expectations consistent with customer experiences in non-healthcare industries, and better educated about their care and choices.
The key to care management and its data strategy is to ensure that this journey is “navigated.” Its members are guided to information based on the necessary evidence rather than dropping into the deep edge of the information pool and covering themselves.
4. Pivot away from “health equity” without giving up on personalized care
Payers cannot completely separate themselves from Heath's commitment to equity, but that's an incentive metric from the Centers for Medicare and Medicaid Services (CMS) – which has dropped significantly this year.
Instead, the care management language is becoming stronger. (See the above topics on care navigation.) Different members needed a variety, and in these discussions, health equity was still there. It's just a little weird about the language around it.
Metadata tagging is becoming more vivid to help payers hone targeted member outreach and engagement, and helps identify which health education content could impact member populations. These metadata tags are intended to help personalize a particular stage of a member on a care journey (e.g., have you just been diagnosed with hypertension or have been struggling for a while), or to coordinate care management to population-related factors (e.g., adults differ in the effects of this medication from children, so they become an effort to meet members, and take action to get content that resonates with them.
Next Step in Data: Reliably Navigate Complexity
High-quality data helps payers navigate the complexities of today's healthcare environment by driving efficiency, improving outcomes, promoting alignment. When payers search for accurate and intentional solutions to fill gaps, appropriate resources will use data meaningfully to personalize member outreach while preventing unintended consequences and promoting consistency and evidence-based practice. Find out more in our eBook
