Dennis Dahlen: New year, not-so-new struggles call for revamped approach

In January, 8,000 investors, innovators and market participants gathered in San Francisco for the J.P. Morgan Healthcare Conference. This gathering has become a required event for healthcare leaders to take stock of the industry.

You could feel the pulse of the conference accelerate during key moments, like when comments from an FDA regulator led to a 20% spike in shares for a gene therapy company or the buzz from deals made during the conference hit the floor. And close to my own healthcare heart: The push for responsible use of AI.

But while the pace and scale of innovation were evident, so, too, was the fact that this activity exists within an ecosystem where we aren’t moving the dial, or it’s moving in the wrong direction on spending, mortality and convenience.

For instance, increased claims denials took center stage during provider presentations.

“I know denials are up across the country, but I have never seen [a rate] like we’re experiencing,” one CFO shared. And while most large health system presenters reported an improved financial outlook, they still face major labor, reimbursement and revenue challenges.

At the same time, Blue Shield of California billed itself as “rebels with a cause.” The health plan promised to radically alter the way members pay for pharmaceuticals and expressed enthusiasm for automating care approvals. It was a hopeful sign.

Healthcare finance can take the lead in creating more forward progress by taking the following steps.

1. Renewing a spirit of collaboration with payers. Rising rates of denials require a revamped approach not just to spotting aberrations in payment, but also to bringing them to health plans’ attention — and determining, together, how to forge a new path forward. Let’s engage with payers like Blue Shield of California to finally fix the workflow that hinders both providers and payers and puts patients in the middle.
2. Working to restore trust in patient finance. Take a look at your mechanisms for educating consumers on how much they will owe after insurance and their payment options. Consider how effectively your organization determines who qualifies for financial assistance — and how your team responds.
3. Continuing to focus on cost effectiveness of health. As rising care costs influence regulatory moves around reimbursement, we must increase operational efficiency. The many mentions of AI at the conference support optimism on its application to back-office functions — including denials.

With the right moves and with focus, we can move the dials. It’s time.