A chal­leng­ing year ahead for the new AHIP czar

Modern Healthcare - - POLITICS - —Shan­non Much­more

“Run­ning AHIP is one of the tough­est jobs in D.C., pe­riod.”

– For­mer CMS of­fi­cial John Gor­man

It’s es­pe­cially tough when you’re new to the job, your most pow­er­ful mem­bers are de­fect­ing and you’re a for­mer Obama ad­min­is­tra­tion of­fi­cial. Mar­i­lyn Taven­ner, the for­mer head of the CMS, faces all those chal­lenges and more in 2016, a year when the big­gest play­ers in Amer­ica’s Health In­sur­ance Plans will be in the an­titrust au­thor­i­ties’ crosshairs.

Her con­fir­ma­tion to head the CMS in 2013 by a Repub­li­can Congress showed she had al­lies on both sides of the aisle on Capi­tol Hill. But those ties will be se­verely tested in the com­ing year.

Crit­ics now say AHIP’s hir­ing Taven­ner so soon af­ter she quit the CMS rep­re­sented a con­flict of in­ter­est. At the CMS, she was one of the ACA’s big­gest back­ers.

Now, as AHIP’s chief ex­ec­u­tive, she has to spend her days talk­ing to Repub­li­cans ea­ger to re­place a law that brought her mem­bers 10 mil­lion new cus­tomers. She will also have to de­fend the in­di­vid­ual man­date—key to mak­ing the new ex­changes work—while staving off de­mands for fur­ther cuts to Medi­care Ad­van­tage.

She will also be un­der pres­sure to show re­sults in rein­ing in pre­scrip­tion drug price in­creases. While the topic has sparked con­gres­sional hear­ings and gained the at­ten­tion of 2016 pres­i­den­tial can­di­dates, Taven­ner faces a drug in­dus­try lobby that’s demon­strated its abil­ity to wield in­flu­ence on the Hill.

In a blog post to­ward the end of 2015, Taven­ner said she wants to fo­cus on con­sumer em­pow­er­ment through pric­ing trans­parency and qual­ity com­par­i­son tools. She also ad­vo­cated for more co­or­di­nated care.

But her tasks won’t be made easy by fis­sures emerg­ing in AHIP’s mem­ber­ship. United Health­Group, the na­tion’s largest in­surer, quit the group weeks be­fore she got her job. And Aetna, an­other top player, con­firmed last week it would drop out.

Taven­ner spent 25 years in var­i­ous lead­er­ship po­si­tions at Nashville-based HCA be­fore go­ing to the CMS, which is usu­ally con­sid­ered one of the tough­est jobs in health­care. With trust­busters scru­ti­niz­ing in­sur­ance merg­ers and a long list of leg­isla­tive is­sues on her plate, 2016 may be her big­gest chal­lenge yet.

“This is no pic­nic,” said for­mer CMS of­fi­cial John Gor­man, who worked in the Clin­ton ad­min­is­tra­tion. “I think run­ning AHIP is one of the tough­est jobs in D.C., pe­riod.”

Mar­i­lyn Taven­ner Po­si­tion Pres­i­dent and CEO

Or­ga­ni­za­tion Amer­ica’s Health In­sur­ance Plans

Ten­ure in job

Five months

Pre­vi­ous po­si­tions CMS ad­min­is­tra­tor; LifePoint Health board of di­rec­tors

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