Ex­change strat­egy fo­cuses on get­ting ‘the right steps in place to en­sure long-term sta­bil­ity’

Modern Healthcare - - Q & A -

Mar­i­lyn Taven­ner was hired last year to take over lead­er­ship of America’s Health In­sur­ance Plans, the in­dus­try’s lead­ing ad­vo­cacy group. Its mem­bers were strug­gling to get their bear­ings in the fledg­ling in­sur­ance mar­ket­places erected through the Af­ford­able Care Act while Medi­care Ad­van­tage and Med­i­caid man­aged-care pro­grams were surg­ing as busi­ness lines.

Taven­ner had re­cently left her post as ad­min­is­tra­tor of the CMS, an agency in­ti­mately in­volved in those are­nas. Now, Taven­ner is faced with the task of coax­ing two of the largest U.S. health in­sur­ers back to the fold. Unit­edHealth Group, the largest health in­surer in the na­tion, dropped out of AHIP just be­fore she was hired, and Aetna quit this month. Taven­ner ad­dressed the chal­lenges ahead of AHIP and its mem­bers dur­ing an in­ter­view last week with Mod­ern Health­care in­sur­ance re­porter Bob Herman. This is an edited tran­script.

Mod­ern Health­care: Why did you make the de­ci­sion to go to AHIP?

Mar­i­lyn Taven­ner: There was ac­tu­ally a bit of a time-off pe­riod for me, where I en­tered re­tire­ment and pub­lic speak­ing. Then I was ap­proached by the AHIP board chair­man to come in for an in­ter­view. So there was, by the time I started, an eight- or nine-month pe­riod be­tween jobs. But I cer­tainly have had the plea­sure of work­ing with health plans, not just dur­ing the Af­ford­able Care roll­out, but on Medi­care Ad­van­tage and Med­i­caid man­aged care. There were many op­por­tu­ni­ties for me to get to know health plans and how they func­tioned, both in the pri­vate and the govern­ment mar­ket.

MH: Do you per­ceive any con­flicts of in­ter­est with the quick move, given the CMS’ au­thor­ity over health in­sur­ers?

Taven­ner: There are cer­tain re­stric­tions that I have in terms of ap­proach­ing this ad­min­is­tra­tion and HHS, which I will honor un­til the end of this ad­min­is­tra­tion, but I don’t see it as a con­flict of in­ter­est. I see it as an op­por­tu­nity to con­tinue to work with health plans and to try to pro­vide ac­cess to the unin­sured and qual­ity health­care.

MH: How would you de­scribe your re­la­tion­ship with the Obama ad­min­is­tra­tion?

Taven­ner: I haven’t had any con­tact with the Obama ad­min­is­tra­tion since I left the job. I joined the ad­min­is­tra­tion as the chief op­er­at­ing of­fi­cer for a chance to work on all things Medi­care and Med­i­caid, and I’m sure the re­la­tion­ship is fine. I’ve been very proud of my bi­par­ti­san out­reach. When I was con­firmed, Eric Can­tor spoke on my be­half, and I think that’s an ex­am­ple of the bi­par­ti­san ap­proach I took through­out my time at the CMS.

MH: What are the rea­sons be­hind the de­par­tures of Unit­edHealth and Aetna from AHIP?

Taven­ner: I think that is a great ques­tion, and one that I think you’d prob­a­bly be bet­ter off ask­ing ei­ther Aetna or United. I will tell you I have great work­ing re­la­tion­ships with both. They’re both great com­pa­nies, and it cer­tainly is my in­ten­tion to work closely with them as we go for­ward with our ad­vo­cacy agenda.

MH: Do you think they will re­join AHIP dur­ing your ten­ure, and are you do­ing any­thing to try to en­tice them back?

Taven­ner: Cer­tainly that door is open, and I have worked closely with both CEOs in the past and hope to do so in the fu­ture. We are look­ing at ev­ery­thing, from dues to gov­er­nance to how we move for­ward with our ad­vo­cacy agenda, which I think matches their ad­vo­cacy agenda.

MH: What is AHIP’s strat­egy for 2016 and be­yond?

Taven­ner: When I ar­rived here at the end of Au­gust, we sat down with the board and talked about the four or five key points that are im­por­tant to mem­bers, im­por­tant to con­sumers and im­por­tant to, I’d say, this coun­try.

You will not be sur­prised to hear that one is Medi­care Ad­van­tage. Medi­care Ad­van­tage mem­bers are now prob­a­bly over 30% of the over­all Medi­care pop­u­la­tion, and con­sumers like that plan. So we’ll con­tinue to work on qual­ity and cost and grow­ing the Medi­care Ad­van­tage

“We’ll con­tinue to work on qual­ity and cost and grow­ing the Medi­care Ad­van­tage mem­ber­ship.”


The sec­ond area is Med­i­caid man­aged care. Over 60% of all Med­i­caid in this coun­try is now de­liv­ered through man­aged-care plans, so it is a big op­por­tu­nity and a big chal­lenge for us to make sure that we are de­liv­er­ing high-qual­ity, af­ford­able prod­ucts to each state.

The third area is pharma pric­ing, and how do we work to help pro­mote and pro­duce so­lu­tions in that area. The fourth area has to do with de­liv­ery-sys­tem re­form, and that’s ev­ery­thing from nar­row net­works to provider direc­to­ries. And the fifth, and hope­fully a theme that we keep through­out, is how the con­sumer fits into this model.

MH: What dif­fer­en­ti­ates AHIP from other groups ad­vo­cat­ing for the same things, such as the new Bet­ter Medi­care Al­liance on Ad­van­tage?

Taven­ner: Whether you’re a Demo­crat or a Re­pub­li­can, folks look at AHIP as the source of in­for­ma­tion. I cer­tainly think that my back­ground in Medi­care Ad­van­tage and my back­ground in Med­i­caid help, and I worked for four years in state govern­ment, run­ning Med­i­caid pro­grams, then had five years at the CMS. A great deal of that time was spent not deal­ing with the Af­ford­able Care Act; it was deal­ing with Medi­care fee-for-ser­vice and Medi­care Ad­van­tage, and how to im­prove those pro­grams.

MH: Drug pric­ing has been a con­tentious is­sue. How can AHIP change the con­ver­sa­tion?

Taven­ner: Some of the so­lu­tions that we have been pro­mot­ing have been, how do we tie pharma and pharma pric­ing more closely to de­liv­ery-sys­tem re­form, to value-based pur­chas­ing? How do we make sure that in­di­vid­u­als are get­ting the right med­i­ca­tion, that they’re ad­her­ing to that pre­scribed med­i­ca­tion, and that there are ac­tu­ally sav­ings—not only sav­ings in terms of cost, but sav­ings in terms of qual­ity of life? We have not been in fa­vor of price con­trols, although we have pro­moted more trans­parency around what goes into pric­ing.

MH: You didn’t men­tion the ACA in­sur­ance ex­changes as a fo­cal point, but many health in­sur­ers have said the ex­changes are not work­ing for them right now.

Taven­ner: Ev­ery­thing that we would do with the ex­change mar­ket (fo­cuses on) how we get the right steps in place to en­sure long-term sta­bil­ity. This is a brand new pro­gram.

MH: Some have crit­i­cized spe­cial-en­roll­ment pe­ri­ods and pro­pos­als to stan­dard­ize health plans op­tions.

Taven­ner: We re­cently re­sponded to reg­u­la­tory pro­pos­als for 2017, and you’ll cer­tainly see that theme in there about con­trol of spe­cial-en­roll­ment pe­ri­ods, and not adding ad­di­tional con­straints around ben­e­fit pack­ages. One of the things we’re in­ter­ested in is, how do you have peo­ple look at this as long-term in­sur­ance, and how do you deal with pre­mi­ums? And that was why the de­lay of the health in­sur­ance tax was so im­por­tant to us.

MH: Will the sus­pen­sion of the tax in 2017 help con­sumer pre­mi­ums?

Taven­ner: I cer­tainly think it does equate to some low­er­ing of pre­mi­ums, but prob­a­bly more im­por­tantly, there is a study by Oliver Wy­man that points to about a 3% re­duc­tion.

MH: How do you view the push to­ward high-de­ductible plans and nar­row net­works?

Taven­ner: I think nar­row net­works are here to stay, and I think that what goes along with that is the abil­ity, whether it’s an em­ployer or an in­di­vid­ual, to un­der­stand who is in their net­work, and what that means for them in terms of qual­ity and med­i­cal-cost changes. That’s the type of work with con­sumers that we’re pro­mot­ing.

As far as co­pays and de­ductibles, I think they are prob­a­bly here to stay in some fash­ion, and the ques­tion is, how do con­sumers learn how to work with co­pays and de­ductibles? How do they plan ahead? How do they know how to select, so that whether they’re pick­ing a plan in an em­ployer mar­ket or in an in­di­vid­ual mar­ket, they un­der­stand what their co­pay and de­ductible re­spon­si­bil­i­ties are, and have a way to fund it? I think it’s just part of the evo­lu­tion of in­sur­ance, pe­riod.

MH: Have there been con­ver­sa­tions with other plans about chang­ing how AHIP is or­ga­nized to align dif­fer­ent mem­ber in­ter­ests?

Taven­ner: That’s the con­ver­sa­tion that’s go­ing on at the board level and will con­tinue into the spring. We have both small­group and large-group meet­ings on dif­fer­ent top­ics to make sure that our mem­bers—re­gard­less of whether they’re com­ing from a ma­jor med­i­cal group, or a Medi­gap, or a health sav­ings ac­count, or a den­tal plan—that we’re meet­ing them where they need to be.

MH: Are there other plans that won’t be re­new­ing their mem­ber­ship?

Taven­ner: Not that I’m aware of, but that’s not some­thing peo­ple al­ways tell me. But right now, in talk­ing with our mem­bers, they ap­pear to be very sat­is­fied with what we’re able to do.

MH: It’s a pres­i­den­tial elec­tion year. How do you view the health­care po­lit­i­cal cli­mate right now?

Taven­ner: I wish I could be a lit­tle more spe­cific. We’re all kind of wait­ing to see what hap­pens in the pri­maries, and how things shake out over the next sev­eral months. Re­gard­less of who ends up be­ing the can­di­date on ei­ther side, health­care will still be on the agenda.

MH: If a Re­pub­li­can is elected, do you fore­see any pos­si­bil­ity that the Af­ford­able Care Act will be re­pealed?

Taven­ner: I think we have to wait un­til Novem­ber and see what plays out.

MH: As a former ex­ec­u­tive with hos­pi­tal chain HCA, how do you view the spate of hos­pi­tal merg­ers?

Taven­ner: You’re talk­ing about my back­ground, which goes back to start­ing as a nurse, spend­ing 20 years in a hos­pi­tal sys­tem and 25 years with HCA. I don’t have a set pol­icy on hos­pi­tal con­sol­i­da­tion. I think it very much de­pends on what’s go­ing on in the mar­ket.

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