Latest / Becker’s Payer Issues Podcast / Advocating for Medicare Advantage with Dawn Maroney of Alignment Health Plan

Transcript

Advocating for Medicare Advantage with Dawn Maroney of Alignment Health Plan · Becker’s Payer Issues Podcast

• 0:00
  Everyone. This is Jacob Emerson with the Becker's
• 0:02
  Payer Issues podcast.
• 0:04
  Thrilled today to be joined by Don Maroney,
• 0:06
  who is the president of Alignment Health and
• 0:08
  CEO of Alignment Health Plan. Don, thank you
• 0:11
  so much for taking the time to be
• 0:12
  with me on the podcast today. You're welcome.
• 0:15
  And and Dawn, before we dive into everything
• 0:17
  we wanna talk with you about, a pretty
• 0:18
  big issue and something really impactful that you
• 0:21
  did last week,
• 0:22
  can you tell us a little bit more
• 0:23
  about yourself and for our listeners who might
• 0:26
  not be familiar, what Alignment Health does and
• 0:28
  who you serve?
• 0:30
  Absolutely.
• 0:32
  Well, I actually,
• 0:34
  have been in the health care
• 0:37
  space primarily,
• 0:38
  working with Medicare beneficiaries for about thirty six
• 0:42
  plus years
• 0:43
  and with alignment for approximately eleven of those
• 0:46
  years.
• 0:47
  I've had the privilege of leading the organization
• 0:50
  that is, redefining how we serve seniors. And
• 0:53
  in alignment, we are a Medicare Advantage prescription
• 0:55
  drug plan primarily,
• 0:57
  serving in five states in Arizona, California, Nevada,
• 1:01
  Texas,
• 1:03
  North Carolina.
• 1:04
  Super excited about that. We're continuing to grow.
• 1:07
  We serve about
• 1:09
  200,000,
• 1:11
  Medicare Advantage lives,
• 1:13
  And it really is about transforming lives and
• 1:16
  being there when they need us most.
• 1:18
  And, so super excited about that.
• 1:21
  Well, appreciate you taking the time to sit
• 1:23
  down with us, Don. And, like you mentioned,
• 1:25
  you've been in the Medicare space for a
• 1:27
  long time, and you had to share your
• 1:29
  expertise,
• 1:31
  last week, July 22, as a witness in
• 1:34
  front of the House Committee on on Ways
• 1:36
  and Means and the Health and Oversight Subcommittees,
• 1:39
  in a joint hearing about the past lessons,
• 1:41
  current insights,
• 1:42
  and future opportunities
• 1:44
  within the Medicare Advantage program.
• 1:47
  Alongside you, we heard from academics and and
• 1:50
  from other Medicare Advantage insurers as well.
• 1:53
  So talk to us about what this experience
• 1:55
  was like for you. How how did it
• 1:56
  feel to testify before congress on on such
• 1:58
  a high stakes issue
• 2:00
  like Medicare Advantage, and and what motivated you
• 2:02
  both personally and professionally to take something like
• 2:05
  this on?
• 2:06
  Well, I love this program. I love, working
• 2:09
  with seniors and Medicare Advantage,
• 2:11
  you know, since the the very beginning, as
• 2:14
  many years as I can go back. I
• 2:15
  think it's 1989,
• 2:17
  specifically.
• 2:18
  And it was such an honor,
• 2:20
  to represent Alignment Health before congress, specifically, as
• 2:24
  you stated, the house, ways and means and
• 2:26
  oversight subcommittees,
• 2:28
  with, you know, chairman Buchanan,
• 2:31
  oversight subcommittee chairman, Schweikert,
• 2:34
  and then, of course, the ranking members,
• 2:36
  who as well as the full committee, which
• 2:38
  was exciting. It was a full house,
• 2:41
  including the overall chair,
• 2:43
  mister Smith. So
• 2:45
  very, very exciting on that. It was I
• 2:47
  mean, I was a little bit nervous because
• 2:49
  I wanted to make sure when,
• 2:51
  we talk about Medicare
• 2:53
  Advantage and the program
• 2:54
  when done right, how it saves lives, saves
• 2:57
  money.
• 2:58
  I was there to, you know, of course,
• 3:00
  spotlight what works and why it matters.
• 3:02
  This was a powerful opportunity to, you know,
• 3:05
  share our vision and how we can become
• 3:07
  more proactive, more personal, and purpose driven.
• 3:10
  It did give alignment the national platform to
• 3:13
  push policies that we believe,
• 3:16
  that were will reward the right kind of
• 3:18
  care, care that delivers better outcomes and real
• 3:21
  value.
• 3:22
  You know, being in health care for the
• 3:24
  past several decades,
• 3:26
  I wanted, you know, why you joined alignment.
• 3:28
  I wanted to become something, you know, just
• 3:31
  more than just providing just insurance, but really
• 3:34
  advocating for seniors with more compassion,
• 3:37
  accountable health system.
• 3:39
  And it's not just, you know, it's isn't
• 3:41
  just a privilege. It's a responsibility that, I
• 3:44
  take seriously, and it was such an honor
• 3:47
  to be there.
• 3:48
  Absolutely. That's that's really great to hear,
• 3:51
  and how you advocated on behalf of your
• 3:53
  members and and, of course, the wider program.
• 3:56
  Don, it's it's certainly no secret that the
• 3:58
  that the MA program has faced a lot
• 3:59
  of challenges these these last few years. And
• 4:02
  so I wonder, you know, what were some
• 4:04
  of the most urgent changes that alignment was
• 4:07
  advocating for and that you wanna see from
• 4:09
  lawmakers when it comes to the future
• 4:11
  of Medicare Advantage, especially in light of some
• 4:14
  of the more recent regulatory and, reimbursement trends
• 4:17
  we we've seen?
• 4:18
  Yeah. It it is, it has been. I
• 4:21
  think it's been probably the most challenging in
• 4:23
  the last,
• 4:25
  you know, eighteen to twenty four months, I
• 4:27
  would say more and more with, some of
• 4:29
  the regulatory policies as well as some of
• 4:31
  the changes that, you know, everybody wants.
• 4:34
  And, for us, you know, our positioning, there's
• 4:36
  you know, we believe that there's a couple
• 4:38
  of priorities,
• 4:40
  that can address some of the concerns of
• 4:42
  the congressional leadership that, you know, they talked
• 4:44
  about prior authorization.
• 4:46
  They talked about rural care,
• 4:48
  and making sure that, you know, as this
• 4:50
  plan has more than 50% beneficiaries that are
• 4:53
  in the environment that are and people are
• 4:55
  electing to choose that. How do you get
• 4:57
  plans like this even in more rural counties?
• 5:01
  And so one, I would put out,
• 5:03
  really,
• 5:04
  hospital parity. Too many large hospital systems,
• 5:07
  or even smaller community hospitals,
• 5:10
  systems
• 5:11
  in, rural counties or in counties,
• 5:14
  declined to contract with higher performing smaller MA
• 5:17
  plans such as ours.
• 5:19
  This undermines access and competition, especially in those
• 5:22
  markets.
• 5:23
  We believe,
• 5:24
  that
• 5:25
  if a policy were generated
• 5:28
  to push
• 5:29
  where
• 5:31
  every hospital, if they're accepting Medicare fee for
• 5:34
  service,
• 5:35
  that they should automatically accept Medicare Advantage contracts.
• 5:39
  Now there can be a baseline of, those
• 5:41
  contracts. For example,
• 5:43
  at minimum, if there's not a value pay
• 5:45
  value based care
• 5:47
  agreement, then we would default to a Medicare
• 5:50
  fee for service contract, meaning we'd pay a
• 5:52
  100% what Medicare does, and this would give
• 5:55
  some flexibility
• 5:56
  and some competition in those markets,
• 5:58
  but it should be hospital parity across the
• 6:01
  board.
• 6:02
  The other area which we're seeing and as
• 6:04
  you're you know, we're seeing some other changes
• 6:07
  in other sectors,
• 6:08
  specifically
• 6:09
  on Medicaid,
• 6:11
  we're seeing, you know, that the force and
• 6:13
  the push in the last several years is
• 6:15
  to push
• 6:17
  Medicare
• 6:18
  Advantage members that have dual eligible status
• 6:22
  to be enrolled in an exclusively
• 6:25
  aligned
• 6:26
  plan.
• 6:27
  And this is not just California, but there
• 6:29
  are multiple states that are pushing this agenda
• 6:32
  where they automatically default to those plans.
• 6:36
  I think, you know,
• 6:38
  those programs
• 6:39
  absolutely should be there, but they should also
• 6:41
  stand alone, and they should still have competition.
• 6:44
  The Medicare Advantage
• 6:46
  that seniors should not be limited on their
• 6:49
  choice and selection of what they're choosing,
• 6:52
  Especially when you look at an organization like
• 6:54
  ours, a 100% of our members across all
• 6:57
  of our states are in a four star
• 6:59
  or greater.
• 7:00
  And I talked about this last week as
• 7:01
  well
• 7:02
  that we are one of, you know, as
• 7:04
  I said nine, but we're actually one of
• 7:06
  seven Medicare Advantage Plans across the country that
• 7:09
  qualify for a five star plan.
• 7:11
  And we believe continuing on, we should hope
• 7:14
  to see that that we'll be consistent in
• 7:16
  that category as we look at this fall
• 7:18
  and open enrollment.
• 7:20
  But
• 7:21
  dual eligible beneficiaries, which are commonly have multiple
• 7:25
  chronic conditions,
• 7:26
  have lower incomes,
• 7:28
  they have, you know,
• 7:30
  less flexibility of what to choose if they're
• 7:32
  defaulted into a plan. I don't think that's
• 7:35
  right. I think these seniors deserve a choice
• 7:37
  and that they should,
• 7:38
  they should absolutely still have a plan like
• 7:41
  an alignment
• 7:42
  that will be available to them and have
• 7:44
  the continuous open enrollment that they do today.
• 7:48
  Absolutely. And I'm really glad you you pointed
• 7:50
  out that tidbit about your your star rating
• 7:52
  success because it's true. You really alignment is
• 7:55
  one of the most highest rated,
• 7:57
  Medicare Advantage Plans consistently year after year, and
• 7:59
  you're one of just a handful of plans
• 8:01
  around the country that has achieved that. So
• 8:03
  it's so great to hear, you know, about
• 8:05
  how you're advocating for for more choice and
• 8:07
  and supporting rural health care access moving forward,
• 8:10
  for your members and and for the wider
• 8:12
  population.
• 8:14
  I also wanna ask you, you know, we
• 8:15
  we we've heard so much from both sides
• 8:17
  of the aisle these last few years,
• 8:19
  about about Medicare Advantage changes that should be
• 8:22
  made.
• 8:23
  So what was your sense of of what's
• 8:25
  going on in Washington right now?
• 8:27
  How do you think lawmakers are currently thinking
• 8:30
  about the Medicare Advantage Program? Certainly, now that
• 8:32
  we're under a new administration,
• 8:34
  are are you feeling that they're leaning more
• 8:36
  toward reform, more restriction,
• 8:39
  support for what you're talking about? What what
• 8:41
  do you what's your sense of what's happening
• 8:43
  right now, Dawn? Well, first and foremost, I
• 8:45
  have respect for both sides, and I actually
• 8:47
  do believe both sides really care, when I
• 8:50
  think about Chairman Buchanan and Schweikart and, Doggett
• 8:53
  and Sewell.
• 8:54
  They
• 8:55
  understand the value of Medicare Advance, what it
• 8:58
  brings, and they really do care about,
• 9:01
  the Medicare beneficiaries.
• 9:03
  This isn't really about restricting the program. It's
• 9:06
  refining it and strengthening it. And how do
• 9:08
  you have
• 9:10
  organizations that may be smaller than the larger
• 9:12
  organizations that are out there in the environment
• 9:14
  have
• 9:15
  be a part of that competition without having
• 9:17
  restrictions around it? And it's giving
• 9:20
  seniors choice, driving quality through that competition and
• 9:23
  value and, you know, and how you stretch
• 9:23
  every
• 9:26
  you know, and how you stretch every health
• 9:28
  care dollar.
• 9:29
  And that's what we do. We look at,
• 9:31
  a proactive integrate integrated approach to care.
• 9:35
  We have a high touch care model,
• 9:37
  which is, different. We believe that sometimes you
• 9:40
  may invest, higher dollars in the first year
• 9:42
  of that enrollment where you're actually losing money.
• 9:45
  But in in the years to come, if
• 9:47
  you really do put your patients before profit,
• 9:50
  then you shall profit.
• 9:52
  So it but it does take time, and
• 9:53
  it takes an investment. And,
• 9:56
  I felt
• 9:58
  the listening of what we were trying to
• 10:00
  do, but how do you reform, you know,
• 10:03
  reform the program without restricting it?
• 10:05
  And, there was a lot of dialogue and
• 10:08
  a lot of discussion,
• 10:09
  and our goal is just to make sure
• 10:10
  that we have a seat at the table
• 10:12
  to help them refine those policies.
• 10:14
  Sure. Yeah. That make that makes a lot
• 10:16
  of sense.
• 10:17
  Before we go, Don, what else are we
• 10:19
  missing? Are there any final thoughts or final
• 10:22
  tidbits of advice that you wanna offer,
• 10:24
  the other Medicare leaders listening in?
• 10:28
  I think they're first of all, you have
• 10:30
  to really care about this consumer and make
• 10:32
  sure that they are the absolute
• 10:35
  priority.
• 10:35
  We look at it as, you know, you
• 10:37
  put the senior first,
• 10:39
  but how do you support the doctor that
• 10:41
  is taking care of that senior? And that
• 10:42
  doctor doesn't always have to work for you.
• 10:44
  We have 25%
• 10:46
  of our employees that are clinicians, but they
• 10:48
  don't always have to work with us and
• 10:50
  work for us. I mean, they have to
• 10:51
  work with us, I should say. They should
• 10:52
  be aligned.
• 10:53
  And, you know, enable technology. There's a lot
• 10:55
  of discussion about AI.
• 10:57
  We look at AI as how do you
• 10:59
  use AI, from an assistant standpoint,
• 11:02
  And then how do you have a serving
• 11:04
  heart? But this consumer
• 11:06
  really wants to make sure that they are
• 11:09
  independent,
• 11:10
  mobile,
• 11:11
  and,
• 11:13
  and have peace of mind, in in that
• 11:15
  process. And if you think about those pieces,
• 11:18
  no matter if you're somebody that's starting up
• 11:21
  or if you're somebody that's been in business
• 11:23
  for quite some time, if you put them
• 11:24
  at the center of your focus,
• 11:27
  then you should be able to do Medicare
• 11:29
  Advantage right
• 11:31
  and win in in this business
• 11:33
  for years to come.
• 11:35
  Fantastic. Well, Don, I I really appreciate you
• 11:38
  taking the time to sit down with us
• 11:39
  and for sharing your insights about how you
• 11:42
  and Alignment are really advocating and and pushing
• 11:44
  for the continued evolution, refinement, and, improvements
• 11:48
  of such an important program. We really appreciate
• 11:51
  it. Thank you so much.
• 11:52
  And to our listeners, if you'd like to
• 11:54
  listen to more podcasts from Becker's Healthcare, you
• 11:56
  can visit beckers hospital review dot com.