A trending topic for payers we’ve often covered is the importance of clean, evidence-based data strategies to address team challenges and strengthen industry alignment.
Data inspired many of the discussions dominating the AHIP 2025 conference in Las Vegas, which convened health insurance leadership and thought leaders to make connections and discover new ideas for reaching their business and care management goals.
A huge theme and phrase that was repeated a lot at the event was “data-rich, insight-poor,” setting the tone for the proactive approach health plans are taking to, not only their data, but their mission at-large.
Payers aren’t waiting for the greater healthcare industry to solve issues surrounding interoperability and information exchange anymore. Many are using their own data – the real-world data that they already have – and creating digital twins or virtual models of member personas that they can run through rigorous testing scenarios to better understand risk. And some are getting very sophisticated. Payers are no longer willing to wait to get the insights out of the data. They’re ready to use their data to find their own practical applications. (And some already have, moving beyond pilot phase with data projects of this kind.)
That spirit of proactivity and redefinition permeated AHIP, where the discussions seemed to swirl around how to find a balance between helping provide the best healthcare possible, but also shifting away from the social services aspect toward which the industry has been pushed in the past few years.
Here are four of the top trends payer leaders were talking about at AHIP that are likely to steer health plan data decisions for the year to come:
1. An appetite for solutions with a purpose (and no fear of AI)
Payers at AHIP weren’t necessarily looking for the next big thing. When it comes to data and technology solutions, payers want solutions – even if they are relatively simple point solutions – that fill a specific need and do exactly what they are supposed to do really well. It just needs to be clear in its purpose, and it needs to have proven outcomes. Easy, right?
Payers are risk-averse in general and have been using advanced analytics for decades. When it comes to AI, they're just doing what they normally do and using solutions that serve a distinct business purpose. AI is getting crisper in how it deploys and how it is used. Because of their long history with advanced technology, payers are confident using it as targeted tool solutioning. There’s simply a higher bar to what they're looking for.
2. Guarding against ‘unintended consequences’
The phrase “unintended consequences” was everywhere this year as health plan leaders stressed the importance of rigor and vigilance to attempt to mitigate unfortunate outcomes before they occur.
In some cases, it seemed to refer to acts of violence against healthcare workers and health insurance professionals.
But the phrase took on a broader life, with so many initiatives carrying the caveat: We need to make sure that whatever we put in place doesn't have unintended consequences to our members or to other stakeholders.
Payers have to function as both a financial services company and a healthcare provider. Ideally, a good payer will strike a balance serving these two functions through greater transparency and communication. The better the balance, it usually means the better the organization will be at identifying unintended consequences early or preemptively so that they can work through and mitigate those risks. However, a better balance can also often mean it takes longer to process approvals. It’s the trade-off to avoid unintended consequences.
3. Increasing focus on ‘care navigation’
A popular term floating around is “care navigation.” This care management-driven trend is about focusing on the customer journey beyond just reminders and scheduling. It’s a concept that’s been around the industry for a while but is starting to gain more traction with a wider swath of plans and care management programs – enabling people to be consumers of healthcare, have greater expectations that align with their customer experiences in industries outside of healthcare, and be better educated about their own care and choices.
The key for care management and their data strategies is to make sure this journey is “navigated” – that members will still be guided to evidence-based information they need, rather than just dropping them in the deep end of the information pool and letting them fend for themselves.
4. Pivoting away from ‘health equity’ without giving up on personalized care
While payers can never fully walk away from a commitment to heath equity – it is an incentivized metric from the Centers for Medicare & Medicaid Services (CMS) – the conversations surrounding health equity were noticeably diminished this year.
In its place, care management language is getting stronger. (See the above topic on care navigation.) Different members need different things, and in those discussions, the spirit of health equity was still there. It's just the language around it changed a bit.
To help payers hone their targeted member outreach and engagement, metadata tagging is getting crisper to help identify which health education content could impact member populations. These metadata tags are meant more to help personalize a member’s specific stage in their care journey (e.g., have they just been diagnosed with hypertension, or have they been struggling with it for a while) or to tailor care management to a population-related factor (e.g., adults are affected by this medication differently than children, or more biologically female patients face this issue than male). So, it becomes an effort to meet the member where you know for certain that they are and get them the content that will resonate with them, so they take action.
Data next steps: Navigating complexity with certainty
High-quality data can help payers drive efficiency, improve outcomes, and foster alignment to navigate the complexities of today’s healthcare landscape. As payers search for those precise, purposeful solutions to fill their gaps, the right resources will use data meaningfully to help personalize member outreach while safeguarding against unintended consequences and promoting consistency and evidence-based practice. Learn more in our eBook, Navigating complexity with certainty
