Will the arrival of artificial intelligence (AI), coupled with the long-awaited emergence of pharmaco-genomics, be the technology that finally breaks managed care’s 40-year business model? As cost-of-production breakthroughs in genomic science finally come to the market, along comes AI, a far cheaper data science with the potential to analyze massive amounts of real-world information on patients.

In the next few years and for vastly less computing cost, AI will democratize the same concept behind genomic science: an individual patient is exquisitely clinically unique, and not just genetically – something pricey pharmaco genomics now reveals – but demographically, custodially, behaviorally. What medical care may work best for an individual patient may have little to do with what an insurer finds may in that patient’s claims history, and everything to do with education, income, racial complexity, neighborhood, domestic stability, food insecurity.

Will employer and government purchasers of health care, along with health plans, PBMs, and others operating under the old managed care model, awaken to this new reality, and the opportunity it represents for truly better health care? Or will patients and their well-organized advocates and proxies in Washington and statehouses around the country, have to resort to new legislation to fix what the market cannot?

For decades, health policy and legislation in the US followed a predictable script: one party wanted more regulation of health care providers and payers, more public funding for vulnerable populations, and price controls. The other party preferred to let markets, competition and consumer choice drive the system toward efficiency.

The result was a classic political hybrid like the Affordable Care Act, which attempted to split the difference, and a drug industry free to charge what it wanted for its biggest breakthroughs. All of that changed in the last eight years. Now, both parties are calling for price controls on drugs, anti-trust enforcement of health care mergers, and aggressive regulation of billions in private equity acquisitions that were given free reign to roil nearly every kind of health care labor market.

While the new partisan math in health policy has turned the once politically unassailable pharmaceutical industry into a political orphan, what other health policy impacts are just around the corner? Might this sudden populist majority, forged across old party lines, drive legislation previously unimaginable? Might it actually be good news for patients, nurses and doctors, difficult news for health insurers, and terrible news for the drug industry?

Health insurers have been reacting to the inflationary spiral and cost compression of the past few years the same way they did to the last assault on their profit margins - managed care in the 1990s - with lockstep acquisitions of each other, of providers, and of businesses with often tenuous relevance to their core competencies. Payers and providers are scrambling to re-align around what many believe will be major changes in reimbursement, health insurance markets, and consumer and patient economic behavior. This session attempts to explain why!

We will examine the impact of inflation and intense cost compression on health insurance market upheavals, the collateral impacts on hospitals and physician groups; the emergence of new payment models for astronomically expensive new drugs; and the potential reshuffling of different patient populations in and out of coverage. This speech is not for the faint of heart!

Over the past two decades, the locus of medical decision making – via the rise and fall of “managed care” – has shifted from physician, to health plan, to patient. High-deductible health insurance, complex co-payment systems, and the emergence of hundreds of new digital tools for patients are conspiring to change everything we thought we knew about the economic behaviors of health care consumers.

Payers and providers are scrambling to re-align around these changes, resulting in a series of unusual mergers, acquisitions, and a few wildly new business initiatives and models over the past few years. This session attempts to explain why. We will examine the impact of the ACA on health insurance market upheavals; the collateral impacts on hospitals and physician groups; the emergence of new payment models for astronomically expensive new drugs; and the potential reshuffling of different patient populations in and out of coverage. This speech is not for the faint of heart!

First, the good news: after 30 years of hype, hope, and disappointment, telehealth has finally broken through – and all it took was a global pandemic. But thanks to the pandemic, one-third of the medical workforce now wants to quit.

How will your organization cope with the coming systemic shock? Will the ongoing migration of medical care to less invasive settings ease some of the burden, by re-aligning where patients get their care with where and how your employees would rather work?

The question is especially pressing as the demand for all health care services is about to spike, thanks to the “collateral epidemiology” of the pandemic: the medical consequences of patients putting off primary care, cancer screenings, surgeries and other treatments for two years. Challenges yes, but are they also mean opportunities for organizational transformation in what may be the most significant structural re-alignment of health care in the US since the rise of managed care in the 1990s.

This session will outline what both telehealth and traditional medical care will look like in the very near future – and organizational strategies for adapting, surviving and thriving in the American health care system after the pandemic.

After $17.2 billion in Federal funding, the health care provider industry is finally computerized. Sort of. And while everyone has been busy implementing Electronic Medical Records (EMRs), there has been explosive growth in all kinds of digital tools for patients to share exquisite details about their medical conditions and experiences – with their current providers, with new providers, and with each other.

New reimbursement  methods and models – including insurer-paid e-visits and annual “connectivity” fees from patients – are emerging in parallel with these technologies. And the one element central to the business strategies of almost all health plans and provider systems is information technology. EMRs and other information technologies are now mission-critical, as they are required to support (among others things): new payment models for hospitals and physicians for acute cases; the transfer of financial risk from insurers and the governmen to providers for the aggregate cost of chronically ill patients; the cost-driven re-engineering of antiquated clinical workflows; and connectivity with patients and potential patients.

This session will outline how your organization can avoid the pitfalls and seize the opportunities associated with this long overdue computerization of American medicine.

Do payers really mean it this time...or are we just partying like it’s 1999? Value-based payment, global package pricing, MACRA, ACOs, medical homes – these are only a few of the latest attempts to correct the health system’s economic, behavioral and organizational disorders a century in the making.

The cost and quality problems that gave rise to the national managed care companies in the 1990s have not gone away, inspiring both the government and large health plans to simultaneously revisit many of those same managed care strategies. Will this second round - and double dose - of harsh economic medicine prove worse than the disease? Or are certain aspects of health care’s cost and quality problems simply incurable? How can provider organizations cope with a system that, as the government and payers attempt to re-engineer it around reimbursement, seems to yield only more chaos?

This session will outline how your organization can navigate the latest attempt to use reimbursement and other payment reforms to re-engineer the U.S. health care system.

The majority of medical research compels the utilization of ever newer and ever more expensive drugs and other medical technologies. At the same time, the majority of actions by private and public health plans seek to constrain their use – or outright shift the bulk of payment for them to patients and their families.

The result is an emerging collision course - between the march of medical science and the countermarch of medical policy - arising from often bitterly divided views about the optimal use of expensive medical resources.

The turmoil in the private health care system's approach to managing health benefits and costs can be remedied through adoption of a value-based (rather than price-based) approach to pharmaceutical and other medical technology spending - and all stakeholders in the system have the opportunity to enable, rather than resist, the hard economic news associated with all of our good clinical luck.