John Mathewson

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After the midterm election votes were tallied, pundits and thought leaders began offering their perspectives of what the results mean for citizens, taxpayers, and businesses. In some ways, the results offer more clarity about what we can expect for America’s healthcare future. In other ways, they raise more questions.

This month we revealed the results of our annual State of The Industry Survey. They provide insight into how our peers are responding to major industry changes, and what challenges they see coming in 2019. While we all want to predict the future so we can avoid obstacles, we cannot allow our desire for clarity to become an obstacle itself. As healthcare leaders, we have tremendous control over our own destinies-and countless opportunities to improve American health and wellness.

Over the past two years in particular, healthcare has been the focus of several high-profile-and sometimes heated-policy debates. 

 (AHIP) has been at the center of many of them. In responding to the immediate, urgent policy questions on the table, we are also looking for the opportunities to drive healthcare improvements:

As we engaged in the repeal-and-replace debate, we put forth recommendations at the federal and state level for improving costs in the individual market, promoting access to affordable, comprehensive coverage for everyone.

As we responded to the 2019 annual rate notice for Medicare Advantage plans, we advocated for greater flexibility that would permit plans to offer more choices for beneficiaries.

As states consider the future of their Medicaid programs, we continue to offer studies and resources that demonstrate the benefits the managed care offers for enrollees and taxpayers.

As lawmakers debate the value of private-market health care coverage, our 

 initiative demonstrates how insurance providers protect the health and financial security of the 180 million people who receive coverage through their jobs.

As Congress developed legislation to battle the opioid epidemic, we advocated for changes that would help keep people safe from the risks of addiction. We also launched the Safe, Transparent Opioid Prescribing initiative to support the widespread adoption of clinical guidelines for pain care and opioid prescribing.

Three Ways to Better Address Social Determinants of Health

Individually, health insurance providers have been making their own bold moves to improve what’s working, and to fix what isn’t. They are improving care access by leveraging telemedicine and other on-demand technologies. A deeply held personal favorite, they are investing in social determinants of health, to help entire communities get healthier faster and stay healthier longer. Rethinking their approach to negotiating lower costs for patients, they are adopting new value-based models to bring down prices of prescription drugs and medical treatments. They are introducing new measures to better understand and drive member satisfaction; creating new collaborative relationships with doctors, nurses, and hospitals to break down barriers to care and find real solutions that will work in their communities; and launching new education initiatives to help people understand how healthcare works, and how to get the most out of their coverage and care.

It is important to take part in the policy debates. At the same time, I encourage managed care leaders to lean in to how we differentiate ourselves as a private market industry in very tangible ways. Focus your strategies relentlessly on patients and consumers. Invest in initiatives that will make sustainable improvements in health and living. Find new ways to offer more choices and value. Consider hiring executives in charge of social determinants of health. By driving innovation for more affordable choices that help people maintain their health without breaking the bank, we can truly make a difference for a better American healthcare system.

 editorial advisor, is chief operating officer of AHIP,  the national trade association representing the health insurance community. AHIP’s members provide health and supplemental benefits to millions of Americans.

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While we all want to predict the future so we can avoid obstacles, we cannot allow our desire for clarity to become an obstacle itself.

What Every Healthcare Executive Must Remember as 2019 Approaches 

	We are clearly in an intense healthcare era with risks that include major regulation uncertainties, managing population health and pressure to continue reducing costs. Healthcare leaders will need a range of skills to navigate these complex times. Flexibility is important, but one characteristic long prized in Silicon Valley is useful now-being bold. They need fearlessness. Of course, plans need compelling strategies, continued growth, strong relationships, and effective operations with good outcomes and profitability as deliverables. However, today’s pressures have created a volatility for survival for some organizations and require dramatic pivots for others. Successful plans will need to capitalize on this chaos by harnessing a convergence of clinical, behavioral, social, and environmental factors for people.

	With that, leaders must be fearless in doing at least four things:

	There has not been a recent time when leaders needed more comfort with ambiguity and complexity than now. Strategy has become a game of three-dimensional chess. Effective leaders must think, speak and act clearly while bringing the organization forward with highly engaged teams. Regardless of the exact shape of national healthcare legislation, cost pressures will continue. Leaders must also address strategic relationships, physician alignment, labor shortages, and effectively innovate. Plans must adjust their business models and steer away from only clinical thinking. Relying just on claims payment and making coverage determinations is not enough value added for long-term positioning and growth. Even care coordination as once known is passé. A broader, more inclusive view and talent portfolio is required to ensure success now and in the future.

Build more inclusion among top leadership ranks

	To add new perspectives, seize opportunities, reduce expense, and address unmet needs that can be monetized, leaders need more inclusive C-suite teams. If change moves at the speed of trust, then plans will gain from diverse senior executive teams that are creative and infuse their unique perspectives into changing markets. Leaders must leverage both empathy and insight for business solutions with more diverse customer bases. These micro-insights pay off and can get scaled for big rewards. It makes strong business sense and holds enormous potential upside for organizations.  

Use data effectively and collaborate well with traditional and non-traditional partners

	Having a command of data as intelligence is a critical leadership competency for health plans. Plans must continuously design and disrupt digital platforms as an essential component of their business model. This requires collaborating with both traditional and new partners. Many do not do this well and especially in real time. To improve results, organizations need effective partners that share a data-driven focus. Leaders must build optimal collaborations that overcome natural apprehensions and trust deserts on new partnerships, too. This is particularly true in calculating partnering with potential competitive substitutes such as ACO’s and other delivery alternatives which includes weaving in social determinants.

Intersect social determinants into clinical care delivery models

	The industry is abuzz that only 20% of health outcomes result from what plans spend on nearly 70% of their medical expense. It’s stunning to consider that for the bulk of most people’s lives, 80% of their health outcomes will not come from hospitals, physicians or drugs. The majority of outcomes come from social determinants which are usually not covered. Plans and providers will struggle to reduce expense especially for complex populations until coherent strategies that intersect care delivery and social determinants are hard-wired for prevention and cost avoidance. This model will require partner alignment and innovative payment. Here again, leaders need the vision to connect these dots across disciplines and ensure that this convergence produces meaningful results based on data, insight and execution.

John Mathewson was previously interim CEO for the 

 and has led health plan, hospital, and home care organizations. He is active on boards for multiple business and national industry organizations and his career includes roles with 

In an intense healthcare era, there’s no “one-size-fits-all" approach to managing, but here are four things a fearless leader must do.

John Mathewson

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What Every Healthcare Executive Must Remember as 2019 Approaches

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