Latest / Becker’s Payer Issues Podcast / Margaret Anderson on Growth, Integration and Affordability at Health Alliance Plan

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Margaret Anderson on Growth, Integration and Affordability at Health Alliance Plan · Becker’s Payer Issues Podcast

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  - Hi, everyone. This is Elizabeth Caslow with the
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  - Becker's Payer Issues podcast.
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  - I'm really excited today to be joined by
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  - Margaret Anderson, president of Health Alliance Plan by
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  - Henry Ford Health. Margaret, thank you so much
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  - for taking the time. Thank you. Thank you
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  - for having me. Of course. So before we
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  - jump in, I would love to hear a
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  - bit more about your career background in health
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  - care and also your current role.
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  - Sure. So I've been in health care for
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  - the majority of my career,
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  - both on the provider side and then in
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  - this in the payer space most recently.
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  - And, I would say very excited to be
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  - here right now leading the health alliance plan.
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  - We are a regional plan
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  - owned by Henry Ford Health. We serve about
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  - 510,000
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  - members in Southeast Michigan, actually throughout the entire
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  - Lower Peninsula.
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  - Prior to joining here, I had roles at
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  - Blue Cross Blue Shield of Western New York,
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  - Blue Shield of California, and WellCare Health Plans.
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  - All all different plans that I had the
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  - opportunity
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  - to lead, teams primarily in the sales and
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  - account management area as well as marketing and
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  - business planning and strategy.
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  - So I know one motivator for this conversation
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  - is some relatively recent news coming from the
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  - plan,
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  - the rebrand to Health Alliance Plan by Henry
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  - Ford Health, making sure that Henry Ford Health
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  - piece is right on there. So can you
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  - walk me through what motivated that change, and,
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  - why now? Why now do you think it's
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  - important?
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  - Yeah. We're at a really interesting time in
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  - the health care sector. And when we looked
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  - at HAP Health Alliance Plan, we were called
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  - HAPT before, which which was what the acronym
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  - that we used.
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  - We really looked at about eighteen months worth
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  - of data and research
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  - to think through, like, we really wanna get
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  - our constituents and our key stakeholders input. You
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  - know, what really resonates
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  - with people about our brand and how important
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  - the brand is because it's not just the
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  - name, it's really what we stand for and
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  - how we think about being part of a
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  - larger enterprise.
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  - And so
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  - Henry Ford Health has owned Health Alliance Plan
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  - for forty years. We're celebrating our fortieth anniversary
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  - of being one family in July.
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  - And it's just been something that we've kinda
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  - danced around and said, we really wanna say
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  - put a stake in the ground and be
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  - a part of Henry Ford Health. We wanna
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  - be all thanks to everybody. We wanna think
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  - about other providers that we do business within
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  - Michigan that aren't part of the Henry Ford
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  - Health family. Well, we really tested and asked
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  - the question.
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  - There was so much more alignment
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  - and affinity where people really resonated with the
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  - fact that we were part of something big.
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  - And so it's that was part of the
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  - motivation. The second piece is we really are
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  - on a journey to affordability,
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  - thinking through how we can make health care
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  - more affordable together
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  - when we provide care and coverage to our
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  - members and patients.
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  - So this journey,
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  - the path to affordability really also looked at
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  - how can we take waste out of the
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  - system, what can we do to reduce costs,
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  - and we thought to ourselves, you know what?
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  - We can put a stake in the ground
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  - and say we are part of something bigger.
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  - And it also has helped us from a
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  - national perspective just in terms of name recognition,
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  - things along those lines. And Health Alliance plan
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  - was in the top 10 for Medicare Advantage
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  - growth in 2026.
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  - And that's pretty big for a regional plan.
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  - So we really thought that this was the
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  - time was right for us to say let's
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  - be part of a bigger system and be
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  - part of Henry Ford Health.
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  - So I I know, you know, regional plans,
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  - a lot of them happen, seeing some growth.
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  - So I just kind of wanna ask as
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  - a follow-up, what are you excited for,
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  - as a regional plan operating in this market
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  - over the next few years?
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  - We have so much positive momentum. I'm so
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  - excited about, our leadership team and our ability
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  - to be intentional about being in the community.
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  - So being a regional plan, we really do
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  - commit to making sure that we are focused
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  - on the health and well-being of the communities
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  - that we serve.
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  - So this year in particular, every single 800
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  - team members that we have here at the
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  - plan,
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  - have a goal to do two community events
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  - that we are represented in here in Michigan.
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  - And you really can see the Brandon Act
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  - and seeing people connect with folks in the
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  - communities, you know, volunteering at key events, volunteering
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  - where police people really need our help.
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  - So really that being out there and being
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  - visible has been incredibly important for us. What's
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  - exciting is that we actually are launching products
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  - and programs that are impacting the cost of
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  - health care, which is such a big topic
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  - of discussion these days. And so we are
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  - really committed to thinking through how can we
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  - do things differently.
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  - So one of the things that's super exciting
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  - for me
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  - is we launched a product last year called
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  - Henry Ford Health Select.
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  - And it's a high performing network that people
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  - have access to. That's just the Henry Ford
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  - Health Network.
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  - It includes 13 hospitals, five fifty sites of
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  - care, and throughout Southeast Michigan. And we really
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  - saw a significant
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  - uptick where people were excited about learning more
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  - about this product. We've got over
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  - 18,000
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  - members
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  - that are in a Henry Ford Health Select
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  - product across Medicare,
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  - small business. A lot of small business owners
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  - are using that product as well as our
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  - large group business. So it's exciting to introduce
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  - new products and new services
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  - to the community and to see how much
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  - they're embracing it and looking for an alternative
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  - and something that's different.
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  - One thing that I've been noticing just in
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  - the space more broadly,
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  - with payviders and health systems that have health
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  - plans is there's been some pullback, and then
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  - there's also been some parties that are just
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  - totally leaning into it right now. So,
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  - could you walk me through what you're seeing
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  - in that space,
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  - and what's next for your level of integration?
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  - I know you just touched on that network,
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  - but what's next, when it comes to that
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  - integration with Henry Ford Health more broadly?
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  - Yeah. I think what's exciting is,
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  - you know, it's been a journey. I've been
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  - here for just over seven years, and we
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  - certainly weren't always, as integrated and connected as
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  - we are today. But it's something that we
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  - committed to from our CEO, our CFO, and
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  - and everyone here at the plan. And we
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  - really you know what? If we are gonna
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  - be relevant, if we're going to make an
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  - impact, we need to lean into integration. So
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  - our strategic plan actually has our number one
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  - priority as we think enterprise first. So if
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  - things are going to benefit the health care
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  - ecosystem
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  - and Henry Ford Health, we're gonna lean into
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  - those priorities first. And we're really seeing that,
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  - show up in many different ways, and it's
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  - exciting to really see it in action.
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  - The one thing I'll say is what's happening
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  - across the industry,
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  - A lot of, my colleagues that do run
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  - provider sponsored plans, they might not have the
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  - same sense of integration, and they don't have
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  - the same alignment at the leadership level on
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  - the executive teams. And you really need that
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  - alignment and that shared vision. And once we
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  - have that shared vision, it's much easier to
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  - start articulating what we want our goals to
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  - be. And so we've we've, really grown a
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  - tremendous amount, and it's fun. Growth is exciting.
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  - We just had a two day off, like,
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  - leadership meeting,
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  - and it's fun to talk about growth. It's
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  - great to think about how we can do
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  - things differently. And so,
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  - really, really looking forward to leading the plan
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  - as we continue to grow. We're marking toward,
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  - 07/50000
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  - members as our goal. And so having that
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  - aligned goal with Henry Ford Health and with,
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  - you know, them by our side, it's really
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  - been exciting.
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  - So with growth in this space, I know
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  - one concern that some plans have is discipline
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  - and making sure they're being able to meet
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  - all of those different needs
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  - as, the population gets bigger. So could you
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  - talk about what's on your mind with regard
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  - to that?
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  - Yes. We are very committed to looking at
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  - our administrative spend, and so I'm proud to
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  - say that our administrative loss ratio was is
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  - less than 10.5%,
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  - the lowest it's been since 2013.
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  - So I think it's really important as we
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  - grow, we need to hold the tension around
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  - capacity
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  - and adding too much capacity to the plan.
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  - And so we really are focused on
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  - optimizing
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  - technology where we can, on thinking through, you
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  - know, what makes the most sense for our
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  - members. One thing we did, and this might
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  - sound counter, counter to what I just shared
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  - on the admin side, is we've moved our
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  - customer service centers back onshore.
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  - And the reason for that was it was
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  - actually costing us more money when you looked
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  - at the complaints we were getting in, you
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  - know, some potential compliance concerns,
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  - and that's created a differentiator for us where
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  - people can talk to,
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  - somebody that actually lives in the state of
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  - Michigan, can actually understand what their needs are
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  - and and how they might be unique and
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  - different. And so that's something that's important.
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  - I would also say the one thing that's
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  - that, certainly is concerning is the increase in
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  - rise in gene therapies.
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  - Concerning from a cost standpoint, it's wonderful, and
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  - these are definitely therapies that we need our
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  - patients and members to have access to, but
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  - there isn't a mechanism
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  - to fund these gene therapies.
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  - And so you're talking anywhere from 3 to
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  - $4,000,000
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  - just for one person to be treated with
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  - these therapies. And so thinking through
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  - as we look at things nationally, should there
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  - be risk pools to help offset those those
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  - costs? What could we be doing differently as
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  - an industry as we lean into the that
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  - work? It's very important, critical,
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  - but we also need to think about how
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  - we fund it.
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  - Would you mind going into a little bit
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  - more detail? I'm just curious with the risk
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  - pool idea there. I mean, I'm imagining it's
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  - a pretty small population of people that would
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  - need these therapies, but I'm, you know, I
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  - don't write about this all every day, so
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  - I'm I'm curious to hear what you think.
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  - Yeah. Well, it's small until, I think there
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  - are close to over there's over a thousand,
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  - new gene therapies that are in the pipeline.
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  - One of them is for diabetes. So So
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  - when you think about how prevalent diabetes is
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  - in this country,
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  - and you think about the cost of that,
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  - it's just going to be exorbitant. And so,
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  - essentially, what happens is right now, we could
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  - have a someone who's at an employer group,
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  - and they need a gene therapy for muscular
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  - dystrophy, for example.
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  - So they might, you know, they come in,
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  - they present, they meet all the criteria, we
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  - go ahead, we approve it, we pay for
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  - it, and then that employer could choose to
• 10:23
  - go to another health plan the following year.
• 10:25
  - So you're kind of sitting there, you know,
• 10:27
  - you've just paid for all this, but yet,
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  - you know, there's there's no way we can
• 10:30
  - follow that patient. There's nothing that we can
• 10:32
  - do to really impact their care going forward.
• 10:34
  - So the thought process is that,
• 10:36
  - health plans would be
• 10:38
  - essentially,
• 10:39
  - responsible for I'll make up a number. The
• 10:41
  - first million dollars of care, and then there
• 10:43
  - would be a risk pool that would have
• 10:44
  - some type of reinsurance on top of it
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  - that would that would fund the remaining cost
• 10:49
  - for that.
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  - Got it. And then going back to bigger
• 10:52
  - picture here, I know you talked a little
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  - bit about peers, with the health system on
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  - plans before. What advice do you have for
• 10:59
  - players in that space right now?
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  - Yeah. I I think you really need to
• 11:02
  - focus on making sure that you've got aligned
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  - goals. There's a natural misalignment when you think
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  - about providers and plans, And so you have
• 11:09
  - to think about what are some shared goals
• 11:11
  - that you can rally around. Things like Medicare
• 11:13
  - Advantage star rating. You know, that's something that
• 11:15
  - we can all lean in on together. People
• 11:17
  - get better outcomes, better access to quality care.
• 11:20
  - It helps the provider side. It helps the
• 11:22
  - plan side. So thinking about having shared goals,
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  - I think is critical.
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  - I also think it's really important to develop
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  - relationships
• 11:29
  - with the provider between the provider and the
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  - plan across the enterprise. It's so important, it's
• 11:34
  - so critical
• 11:35
  - to have those conversations,
• 11:36
  - to be able to solve problems together.
• 11:39
  - But you really think about innovation in a
• 11:40
  - different way.
• 11:42
  - I I just think it's critical. I mean,
• 11:43
  - you have to have that alignment in goals
• 11:45
  - and in strategy.
• 11:47
  - Anything else that you wanna share while I
• 11:48
  - have you here?
• 11:50
  - No. I think this has been fabulous. I
• 11:51
  - really appreciate you taking the time to talk
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  - with me. I would just say that, you
• 11:54
  - know, we
• 11:55
  - are excited about the year coming up ahead,
• 11:58
  - and we look forward to, you know, continuing
• 12:00
  - to grow in Michigan and excited to be
• 12:03
  - part of the Henry Ford Health family as
• 12:04
  - we celebrate our fortieth year anniversary.
• 12:07
  - Well, thank you so much, Margaret. I really
• 12:09
  - appreciate you taking the time. Thank you. Have
• 12:11
  - a great afternoon. Yeah. You too. And to
• 12:13
  - our listeners, if you'd like to hear more
• 12:14
  - podcasts from Becker's Health Care, you can visit
• 12:16
  - beckershospitalreview.com.
• 12:18
  - Thank you. Thank you.