The 3,500 attendees of this year's big confab for health insurers—America's Health Insurance Plans Institute 2011—were met in San Francisco with mild Pacific Ocean breezes, sunny skies and a general spirit of reconciliation.

There was a lot of talk of building bridges with providers, cooperating with states and generally getting on board with the many changes mandated in the federal healthcare reform law.

Over the three days of events, from June 15 to June 17, many of the seminars focused on embracing the inevitable. Even the protesters outside seemed mild-mannered compared to years past; they were few in number, stuck around for just a couple of hours and held homemade signs supporting single-payer healthcare and Medicare.

Protesters who did manage to get past security and into the conference didn't interrupt speeches with loud shouting, like the last time AHIP came to San Francisco, in 2008. Instead, they threw pink confetti and glitter on Tim Pawlenty, a Republican presidential candidate and former governor of Minnesota, during a book signing. Eyewitnesses reported that he took the interruption in stride.

Likewise, AHIP leadership urged members to soldier on. “You need to stay at the table and stay engaged,” Candy Gallagher, vice president of state policy for AHIP, said about the exchanges. She added that if the exchanges fail, insurers will catch some of the blame.

Dr. Sam Nussbaum, executive vice president and chief medical officer for WellPoint, agreed.

“As we look at the next election cycle, I believe our industry will again be targeted,” he said during a panel discussion. He urged plans to work toward improving population health and to collaborate more closely with providers to improve quality.

Talk of the legal efforts to block or repeal the Patient Protection and Affordable Care Act continued. But many saw inevitable reforms even if this particular law isn't fully implemented.

“Whatever happens to the Affordable Care Act, healthcare is a changing landscape,” said Dr. Andrea Gelzer, senior vice president and chief medical officer of AmeriHealth Mercy, a Medicaid managed-care plan.

Gelzer and others stressed the importance of changing relationships with providers. “Plans need to collaborate with providers and reduce barriers to actionable information,” she said. “Innovative partnerships with providers will be important moving forward.”

Dr. Michael Sherman, senior vice president and chief medical officer of Harvard Pilgrim Health Care, said plans should work toward shared accountability. But they must also be mindful that not all providers are prepared for new payment systems and collaborations. “If we force provider organizations to take risks and they are not ready, they will fail,” Sherman said.

With this in mind, Harvard Pilgrim and other insurers are providing funding and resources to provider groups to meet new challenges.

Cigna, for one, is integrating its clinical support programs with some physician practices, and creating new financial reward structures for providers, said Dr. Robert McLaughlin, senior medical director of Cigna HealthCare.

Dr. Nancy Nielsen, former president of the American Medical Association and now a senior adviser for the Center for Innovation at the CMS, said the federal government, too, wants to be more collaborative.

The proposed rule on Medicare's Shared Savings Program, for instance, is likely to undergo major revisions based on feedback from payers and providers, she said. “Don't get your britches in a bunch,” Nielsen said. “The whole idea of the proposed rule is we will listen—and they are listening.”

Some of the most contentious issues in the proposed rule, such as the high number of quality measures and retrospective patient assignment, will be resolved, she predicted.

Moving forward, Nielsen urged health plans to stay engaged.

“We have a short window to do this before it is done to us,” she said.

In this vein, the Innovation Center met with health plans in recent weeks to explore areas of agreement on what is needed to effectively develop medical homes. Nielsen quickly added that insurers that weren't invited to the session shouldn't be offended as other opportunities will become available to participate.

“We need to work together,” she told the health insurance representatives. “We sincerely need your ideas.”