Latest / Becker’s Payer Issues Podcast / Dawn Maroney, President of Alignment Health and CEO of Alignment Health Plan

Transcript

Dawn Maroney, President of Alignment Health and CEO of Alignment Health Plan · Becker’s Payer Issues Podcast

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  This is where health insurance leadership comes together.
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  Becker's fourth annual spring payer issues roundtable brings
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  together over 400 payer and health plan executives
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  and more than 100 speakers to Chicago April.
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  This year's event includes keynote conversations with the
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  industry's top leaders and former president George w
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  Bush. For the full agenda and event details,
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  visit beckershospitalreview.com
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  and click on the events tab in the
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  upper right. We're looking forward to hosting you
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  here in Chicago.
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  Hello, everyone, and welcome to Becker's Healthcare podcast.
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  I'm Scott King. Thrilled today to be joined
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  by a very special guest, Dawn Maroney, president,
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  Alignment Health and CEO
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  of Alignment Health Plan. Dawn, how are you
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  doing? Thanks so much for joining us. Appreciate
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  it. I'm doing wonderful. Thank you for asking.
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  Of course. No. So great to have you.
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  We're gonna dive into a lot of big
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  payer topics that that I know we're gonna
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  lean on your your expertise for. But before
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  we do that, I was wondering if you
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  could please just kinda share a little bit
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  about your background and your journey in in
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  health care with health plans.
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  Well, thank you for asking.
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  I actually
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  have been with Alignment going on twelve years
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  and, you
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  know, lead the health
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  plan for all of our contracts and,
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  the company for other, areas.
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  And, I've been in the Medicare space for
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  going on thirty gosh, it'll be thirty nine
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  well, thirty eight years. I'll I'll give it
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  that that number.
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  And I just have always loved working with
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  seniors. I've worked for larger companies and a
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  couple of smaller companies. In fact, the smaller
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  company that when we first originally started out
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  to kind of grow it was a company
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  called CareMore.
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  And,
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  you know, so either way,
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  you know,
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  we've tried to do something unique here at
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  Alignment, and we've just,
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  have done exceptional and very excited about seeing
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  how alignment is just
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  blooming,
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  to be able to support as many,
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  seniors in the country as possible.
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  That's great to hear, Don. And not just
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  about all your experience, you know, twelve years,
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  I'm sure you've seen a lot and and
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  a lot of things evolve. But, you know,
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  with seniors, it's just to follow that up,
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  it's it's really interesting that, you know, at
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  our conferences, especially, you hear about
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  I guess people are surprised
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  how
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  much seniors are able to adapt to, like,
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  technology. Have you found that too? Just kind
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  of being able to do things with with
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  their accounts and their own plans digitally?
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  Yeah. Yes. I you know, it's it's interesting.
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  Although it is improving. So I've seen a
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  big difference, in the last several years. Prior,
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  it was much more difficult. And
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  and the other piece is, you know, you
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  know, this audience, you know, they don't trust
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  the system and there's so much
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  fraud or spam or other things that are
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  going around. So
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  they're very wise in the sense of, you
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  know, what do I click on, what do
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  I use. And so there's a lot of,
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  extra effort to make sure that they know
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  if we're doing something digitally
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  as an organization or asking them to utilize
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  technology more
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  to to go through the process and educating
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  them on why they can trust us.
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  Absolutely. And, you know, one of the topics
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  I wanted to get your expertise on, Don,
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  was just that payer provider relationship and how
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  it obviously changes
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  and especially changed lately. But how are how
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  are you seeing that relationship change as both
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  sides
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  face cost pressure and and workforce shortages in
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  particular?
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  Well, what's interesting to me I mean, depending
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  on the areas,
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  you know, the payer can be a number
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  of areas. Right? So it can be the
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  provider
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  well, the health care company, the health insurance
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  company,
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  as well as you can even look at
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  original Medicare as the payer.
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  So you got Medicare Advantage, the original payer.
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  You've got,
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  you know, primarily in the insurance,
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  organizations. And then you've got the provider,
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  system, which we play literally both sides in
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  the sense of how do you support the
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  provider through our clinicians who work for us.
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  But the providers,
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  you know, are, you know, the ones that
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  are closest to the individual on providing actual
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  care. That is, primary care specialist, hospital,
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  post acute facility, SNF, home health, ancillary service,
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  a number of things.
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  So
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  the hybrid between both, there's a lot of
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  changes from a regulatory standpoint going on. And
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  it's it's it's really,
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  you know,
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  it becomes challenging,
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  you know, for both sides. But I believe
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  the payer actually gets, you know, kind of
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  more,
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  immediacy
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  tied to what's going to change or more
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  involved in the policy,
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  than you'll see even on the provider side
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  other than the providers,
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  or the hospital systems that you'll see across
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  the board.
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  Right.
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  Where do you see the biggest gap today
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  between payer strategy and operational execution?
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  Well, it's it's data. And so how do
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  you make sure
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  that you're getting data real time,
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  specifically, no matter who's, you know, who's involved
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  in caring for your members and or your
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  patients?
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  And it can't just be claims based data.
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  So, you know, the more you know about
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  a consumer or a patient, the more you
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  can be proactive in integrating care. And so
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  it's not at the level that you're getting
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  it as close as possible.
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  So we really work hard at alignment through
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  our technology platform is to try to get
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  that data sooner than later,
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  whether it's lab, pharma,
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  or a hospital,
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  you know, even the census primarily from directly
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  from CMS.
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  So,
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  you know, it's just a
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  it's, you know, it's a process. But it,
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  the closer you can get to that data
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  to understand,
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  individuals
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  about that individuals,
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  you can actually be better at providing care
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  and more in a timely and accessible way
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  that this consumer really deserves.
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  What do you think some of the hang
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  ups are? And, you know, people talk about
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  clean data. What do you think some of
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  the hang ups are in getting clean data
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  and having it, you know, readily available like
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  you were saying? I mean, it's, you know,
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  2026
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  and with with all the emerging technology we've
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  seen in in health care and with health
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  plans, what what do you think the issue
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  is there?
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  You still see the same things. You know,
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  I mean, it would be great to get
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  to a point where you can actually pay
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  a claim, you know, immediately at the the
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  time of service,
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  specifically,
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  to where it's super clean. But you're you
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  need to integrate more.
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  But we're still using we're still pulling out
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  our cards when we're going into doctor's offices.
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  Right. Even though you're filling out a form
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  electronically or you're doing it through a chart,
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  you know, portal,
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  you're doing all the information, uploading, scanning, whatever
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  you need to do, but you're still showing
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  up to the practice and you're still pulling
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  out that card and your ID and, you
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  know, it and even if there's a barcode
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  or you know, it's it's
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  it's still
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  not at the level that it needs to
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  be.
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  So having
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  that
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  ingestion
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  of data where everybody's aligned,
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  to make sure that we're all working together
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  to share that information as much as possible.
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  I think what you will see,
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  Scott, with this administration is you're gonna see
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  probably more forward looking,
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  opportunities because we've got a pretty sophisticated
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  educated,
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  group. And what I mean educated through the
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  like,
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  the value of technology
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  with our current administration.
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  I'm quite impressed. And I think if there's
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  gonna be movement,
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  you know, to similar to what we're doing
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  here at alignment, we're gonna see that, at,
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  CMS trying to push and drive that with
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  this team.
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  If you could change one regulatory
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  or industry practice tomorrow to improve affordability and
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  access, what would it be and why?
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  Well,
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  immediately, I would make sure if a
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  hospital
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  system
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  accepts
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  Medicare today in a fee for service or
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  original Medicare status, Medicare
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  sub not supplemental insurance, but Medicare,
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  then I would make that hospital
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  available even at the same rates as Medicare
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  is paying, 100% of Medicare if you don't
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  have a contract,
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  have a requirement that that hospital would need
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  to be contracted
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  with a Medicare Advantage plan or frankly, any
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  participating Medicare Advantage or Medicare,
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  program.
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  And I think that policy needs to drive
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  that. This would would push more organizations to
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  be in rural areas where, you know, local,
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  state, or government officials as well as at
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  the federal level would like to see us.
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  But you can't get there without that hospital
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  saying, no. I don't wanna contract with you,
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  or I wanna charge a 150 or maybe
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  even 200% of Medicare, some crazy number where
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  it prevents organizations from contracting.
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  And then the last thing I wanna ask
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  you, Dawn.
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  What issue
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  do you think is putting the most pressure
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  on health plan margins right now, and and
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  how are you responding differently in in 2026
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  so far with it? It's a great question
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  on, margins.
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  You know, there's a lot of changes. There's
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  a lot of headwinds coming in, hitting the
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  industry as a whole provider and, insurer.
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  And,
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  you know, and it's
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  as well as, you know, the cost continue
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  to increase when it comes to health care
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  expenses, especially in the, when when you think
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  of the acute or institutional cost.
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  And it's not going away. And as well
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  as if you think of the, inflation reduction
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  act as tied to pharma,
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  you know, these costs, the
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  the liabilities hitting more on the payer side,
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  specifically.
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  So you've gotta really you gotta do it
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  right, and you gotta have discipline. And it
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  can't be just looking at it, three months
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  ago or six months back. You have to
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  have
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  discipline in this business to prepare for the
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  regulatory
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  environment
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  as well as the discipline when it comes
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  to how you manage care.
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  And for alignment,
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  you know, because we're really you know, we're
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  one of few plans,
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  that are focused primarily on seniors,
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  but let alone, we have a very rigorous
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  discipline on how we look at this business.
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  And we know we still need to improve,
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  but it's helped us when these headwinds have
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  come
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  to be able to to kind of, you
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  know, surpass the storm unlike, what we're seeing
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  of others. But I want
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  our other competitive
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  partners out there to succeed because, you know,
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  we still need competition. Competition is extremely important
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  for this consumer. I want these,
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  members or seniors who are eligible for these
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  types of products
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  to have choice. And you need to have
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  a couple of plans, more than a couple
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  plans, usually in a county, to have
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  where you're kind of pushing and forcing
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  each of those plans to perform.
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  Because if you only have one org one
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  plan, there's nothing there to force that plan
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  to perform.
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  And so it's really, really important that we
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  still have competition and we have
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  performance across these organizations.
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  But if they're gonna be in it, they're
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  gonna have to do Medicare Advantage done right.
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  Dawn, thank you so much for a great
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  conversation and for joining the podcast. We're really
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  looking forward to having you speak with us
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  at the Spring Payor Issues Roundtable as well.
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  But, thank you so much, Dawn. You're welcome.
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  Thank you.