1 00:00:00,000 --> 00:00:02,740 Evernorth brings the power of wonder and relentless 2 00:00:02,799 --> 00:00:05,599 innovation to create world class pharmacy, care, and 3 00:00:05,599 --> 00:00:06,580 benefit solutions. 4 00:00:07,200 --> 00:00:08,960 Barriers to care can lead to gaps in 5 00:00:08,960 --> 00:00:10,719 care, which can drive up the total cost 6 00:00:10,719 --> 00:00:13,839 of care. Our capabilities work seamlessly together to 7 00:00:13,839 --> 00:00:17,245 create innovative pharmacy care and benefit solutions for 8 00:00:17,245 --> 00:00:18,225 today and tomorrow. 9 00:00:18,765 --> 00:00:21,565 Our connected health services make the treatment, prediction, 10 00:00:21,565 --> 00:00:24,225 and prevention of health care's most complex conditions 11 00:00:24,685 --> 00:00:27,265 easier and more accessible as we drive organizations 12 00:00:27,484 --> 00:00:28,464 and people forward. 13 00:00:29,050 --> 00:00:31,210 This is Haley Recker with the Becker's Payer 14 00:00:31,210 --> 00:00:33,049 Podcast, and we are recording live at the 15 00:00:33,049 --> 00:00:35,549 Becker's third annual spring payer issues roundtable. 16 00:00:36,090 --> 00:00:37,850 I am thrilled today to be joined by 17 00:00:37,850 --> 00:00:40,809 Don Maroney, president of Alignment Health and CEO 18 00:00:40,809 --> 00:00:42,270 of Alignment Health Plan. 19 00:00:42,924 --> 00:00:44,524 Dawn, thank you so much for joining me 20 00:00:44,524 --> 00:00:46,045 today. Can you go ahead and share a 21 00:00:46,045 --> 00:00:47,804 little bit about yourself and your background before 22 00:00:47,804 --> 00:00:49,184 we get started? Absolutely. 23 00:00:49,965 --> 00:00:51,585 Well, I've been with Alignment 24 00:00:51,965 --> 00:00:52,784 for about 25 00:00:53,164 --> 00:00:55,725 eleven years. Actually, it's eleven years going on 26 00:00:55,725 --> 00:00:57,984 in May, so very excited about that. 27 00:00:58,320 --> 00:00:59,060 Thank you. 28 00:00:59,440 --> 00:00:59,920 And, 29 00:01:00,640 --> 00:01:01,460 I have been 30 00:01:01,920 --> 00:01:03,940 representing or working with Medicare 31 00:01:05,040 --> 00:01:05,540 beneficiaries, 32 00:01:06,000 --> 00:01:07,780 seniors, individuals who are typically 33 00:01:08,240 --> 00:01:09,200 65 34 00:01:09,200 --> 00:01:10,420 and or disabled 35 00:01:11,120 --> 00:01:13,655 for about a little bit over thirty plus 36 00:01:13,655 --> 00:01:14,155 years. 37 00:01:14,454 --> 00:01:16,234 I always had the, 38 00:01:17,174 --> 00:01:19,575 dream to just work with seniors as grandparents 39 00:01:19,575 --> 00:01:21,094 because I had grandparents that died at a 40 00:01:21,094 --> 00:01:23,734 very, young age, or I was young age, 41 00:01:23,734 --> 00:01:25,254 and they died at a young age as 42 00:01:25,254 --> 00:01:25,739 well. 43 00:01:26,060 --> 00:01:28,140 And, it just was an opportunity to take 44 00:01:28,140 --> 00:01:29,040 on a job, 45 00:01:29,659 --> 00:01:31,659 over thirty years ago to just work with 46 00:01:31,659 --> 00:01:34,379 seniors, and it's been that ever since. So 47 00:01:34,379 --> 00:01:36,140 it's the only space I've been in. Well, 48 00:01:36,140 --> 00:01:37,979 that's such a great story. I love to 49 00:01:37,979 --> 00:01:38,719 hear that. 50 00:01:39,075 --> 00:01:40,994 Alright. To kick things off, I wanna talk 51 00:01:40,994 --> 00:01:41,894 about affordability 52 00:01:42,435 --> 00:01:45,075 and quality of care, which is a constant 53 00:01:45,075 --> 00:01:47,234 challenge for health plans. So how is your 54 00:01:47,234 --> 00:01:49,715 organization innovating to manage the cost of care 55 00:01:49,715 --> 00:01:50,534 while maintaining 56 00:01:50,834 --> 00:01:52,215 or improving member outcomes? 57 00:01:52,739 --> 00:01:54,579 Well, I think for affordability for all of 58 00:01:54,579 --> 00:01:56,579 us, right, has been, when it comes to 59 00:01:56,579 --> 00:01:58,739 health care, it just continues to rise. Medical 60 00:01:58,739 --> 00:02:00,340 expenses rise as well as, 61 00:02:00,899 --> 00:02:03,079 whether it's under the core 62 00:02:03,859 --> 00:02:06,899 catastrophic tech coverage or preventative coverage as well 63 00:02:06,899 --> 00:02:08,705 as a pharmacy cost. 64 00:02:09,645 --> 00:02:11,905 And our organization for quite some time, 65 00:02:12,844 --> 00:02:14,604 a lot of us started are working at 66 00:02:14,604 --> 00:02:16,365 another organization where we had to do a 67 00:02:16,365 --> 00:02:17,185 lot of 68 00:02:17,724 --> 00:02:20,604 hands on touch. And then in this digital 69 00:02:20,604 --> 00:02:21,104 age, 70 00:02:21,419 --> 00:02:23,659 we started in the very beginning with working 71 00:02:23,659 --> 00:02:24,879 with, our 72 00:02:26,060 --> 00:02:28,859 technology platform and how do you get to 73 00:02:28,859 --> 00:02:29,359 individuals 74 00:02:29,739 --> 00:02:30,239 sooner, 75 00:02:30,939 --> 00:02:34,000 quicker, faster, in real time from the standpoint 76 00:02:34,060 --> 00:02:36,435 of when they're taking prescriptions, how do you 77 00:02:36,435 --> 00:02:39,495 connect into data or into hospital systems, 78 00:02:40,194 --> 00:02:41,175 doctor's offices, 79 00:02:41,555 --> 00:02:44,275 and or directly with seniors? And we started, 80 00:02:44,514 --> 00:02:45,014 that 81 00:02:45,635 --> 00:02:46,615 actually literally 82 00:02:46,915 --> 00:02:48,694 when I started eleven years ago, 83 00:02:49,090 --> 00:02:51,810 and it's been growing ever since. So when 84 00:02:51,810 --> 00:02:54,209 we hear about AI today, you know, everybody 85 00:02:54,209 --> 00:02:56,370 talks about AI in different fashions. We're not 86 00:02:56,370 --> 00:02:58,849 in the robotic phase of AI for our 87 00:02:58,849 --> 00:03:00,530 company, but we do a lot of the 88 00:03:00,530 --> 00:03:02,289 machine learning as well as, 89 00:03:03,314 --> 00:03:05,094 many other aspects of AI, 90 00:03:05,555 --> 00:03:06,055 to 91 00:03:07,474 --> 00:03:07,974 prioritize 92 00:03:08,354 --> 00:03:10,594 seniors when it comes to the quality as 93 00:03:10,594 --> 00:03:11,414 well as the 94 00:03:12,114 --> 00:03:14,134 health care that's needed sooner than later. 95 00:03:14,995 --> 00:03:17,590 And we have the ability to predict things 96 00:03:17,590 --> 00:03:19,909 that may happen prior to them even knowing. 97 00:03:20,389 --> 00:03:22,569 Some cases, it's just quite as simple as 98 00:03:22,870 --> 00:03:25,830 they're taking their prescription drugs and mixing those 99 00:03:25,830 --> 00:03:28,069 drugs the wrong way or having occurrences where 100 00:03:28,069 --> 00:03:30,629 they land in an ER or in a 101 00:03:30,629 --> 00:03:32,889 hospital multiple times within a year. 102 00:03:33,405 --> 00:03:36,044 So we put clinical programs around that, and 103 00:03:36,044 --> 00:03:37,885 we've been doing that for quite some time. 104 00:03:37,885 --> 00:03:39,585 And it's been quite effective, 105 00:03:40,044 --> 00:03:41,425 from the standpoint of 106 00:03:41,965 --> 00:03:45,264 when you look at Medicare today, the average, 107 00:03:46,169 --> 00:03:49,129 admit per thousand is sitting at 220 108 00:03:49,129 --> 00:03:49,629 plus, 109 00:03:49,930 --> 00:03:52,729 and we're running about one fifty one for 110 00:03:52,729 --> 00:03:55,049 our organization. That means we're keeping seniors out 111 00:03:55,049 --> 00:03:55,709 of the hospital, 112 00:03:56,250 --> 00:03:58,409 which is probably the largest one of the 113 00:03:58,409 --> 00:03:59,849 largest areas of expense. 114 00:04:00,169 --> 00:04:02,865 There's also the preservice, but the postservice, when 115 00:04:02,865 --> 00:04:04,084 you get into a hospital, 116 00:04:04,384 --> 00:04:05,985 you're talking about hospitals in many of our 117 00:04:05,985 --> 00:04:07,664 markets that are 20,000 118 00:04:07,664 --> 00:04:08,645 plus per day. 119 00:04:09,025 --> 00:04:11,185 So how do you keep people out and 120 00:04:11,185 --> 00:04:13,104 or make sure that you're proactive in that 121 00:04:13,104 --> 00:04:15,930 approach? So it's what we push heavily on. 122 00:04:16,009 --> 00:04:18,250 Would you say that that integration of AI 123 00:04:18,250 --> 00:04:20,669 has improved member experience greatly? 124 00:04:21,370 --> 00:04:22,009 It has. 125 00:04:22,410 --> 00:04:24,410 We started it, and I call it AI 126 00:04:24,410 --> 00:04:27,209 assist because you I believe that in health 127 00:04:27,209 --> 00:04:30,335 care, it still requires a human touch, you 128 00:04:30,335 --> 00:04:30,915 know, a caring 129 00:04:31,215 --> 00:04:33,395 touch, especially with our audience. 130 00:04:34,014 --> 00:04:35,314 But it has been 131 00:04:36,095 --> 00:04:38,435 I don't think we've even seen how great 132 00:04:38,655 --> 00:04:39,475 the possibilities 133 00:04:39,775 --> 00:04:41,475 are in in this area, 134 00:04:42,220 --> 00:04:43,819 but we've been doing this for quite some 135 00:04:43,819 --> 00:04:45,500 time. And so it's helped us greatly by 136 00:04:45,500 --> 00:04:47,660 not having to have thousands of physicians to 137 00:04:47,660 --> 00:04:50,379 address the hundreds of thousands of popular seniors 138 00:04:50,379 --> 00:04:52,139 that we serve, but it, 139 00:04:52,699 --> 00:04:55,199 I think it's gonna even grow bigger. Yeah. 140 00:04:55,354 --> 00:04:57,514 I kinda wanna pivot the conversation just a 141 00:04:57,514 --> 00:04:59,675 little bit to health equity, which has become 142 00:04:59,675 --> 00:05:02,074 a critical focus for many health plans. Can 143 00:05:02,074 --> 00:05:03,914 you share an overview of a key initiative 144 00:05:03,914 --> 00:05:05,995 here that you're involved in or particularly excited 145 00:05:05,995 --> 00:05:07,774 about, and what are you hoping to achieve? 146 00:05:08,310 --> 00:05:08,810 Absolutely. 147 00:05:09,110 --> 00:05:11,189 I I think the biggest when I think 148 00:05:11,189 --> 00:05:12,790 of health equity, I think of so many 149 00:05:12,790 --> 00:05:15,750 different variations of health equity. But I look 150 00:05:15,750 --> 00:05:16,250 at 151 00:05:16,790 --> 00:05:19,910 individuals starting with income and then diversity, but 152 00:05:19,910 --> 00:05:21,930 primarily when I think of people that are 153 00:05:22,444 --> 00:05:23,644 less fortunate than, 154 00:05:24,125 --> 00:05:26,685 many individuals out there, like people that are 155 00:05:26,685 --> 00:05:29,084 the the most frail, the most I say 156 00:05:29,084 --> 00:05:30,685 poor, and I'm trying to think of another 157 00:05:30,685 --> 00:05:33,165 word, but low income beneficiaries or people that 158 00:05:33,165 --> 00:05:34,865 are sitting with Medicare and Medicaid. 159 00:05:35,629 --> 00:05:37,649 We've put that task force, 160 00:05:38,189 --> 00:05:40,029 many years ago, and it's one of the 161 00:05:40,029 --> 00:05:43,470 fastest growing populations for us. The other tie 162 00:05:43,470 --> 00:05:45,310 to that is health equity when it comes 163 00:05:45,310 --> 00:05:47,709 to people that have chronic conditions or multiple 164 00:05:47,709 --> 00:05:50,370 chronic conditions that are also frail and that 165 00:05:50,704 --> 00:05:52,884 have, need income assistance. 166 00:05:53,584 --> 00:05:56,305 And, we were probably one of the first 167 00:05:56,305 --> 00:05:59,524 with creating collaboration with different companies like Instacart 168 00:05:59,584 --> 00:06:01,365 and others, when it comes to 169 00:06:01,665 --> 00:06:02,644 giving food 170 00:06:02,944 --> 00:06:04,979 to people that, you know, instead of picking 171 00:06:04,979 --> 00:06:05,479 medications 172 00:06:05,860 --> 00:06:08,019 over food or vice versa, how do you 173 00:06:08,019 --> 00:06:09,479 get that? How do 174 00:06:10,099 --> 00:06:12,899 you give them unique benefits that help them 175 00:06:12,899 --> 00:06:14,519 with loneliness and other things 176 00:06:14,899 --> 00:06:16,279 or access to 177 00:06:16,625 --> 00:06:18,384 getting a ride, something as basic as getting 178 00:06:18,384 --> 00:06:20,245 a ride to your doctor or your pharmacy 179 00:06:20,305 --> 00:06:22,805 or even picking up, certain supplies 180 00:06:23,504 --> 00:06:24,324 and having, 181 00:06:25,504 --> 00:06:28,064 programs to outreach to individuals because they are 182 00:06:28,064 --> 00:06:30,360 living alone. And so there are things or 183 00:06:30,360 --> 00:06:32,920 questions that we do or sending clinicians to 184 00:06:32,920 --> 00:06:33,580 the home, 185 00:06:34,439 --> 00:06:37,000 to to address that. And they don't wanna 186 00:06:37,000 --> 00:06:37,980 feel like 187 00:06:38,680 --> 00:06:41,560 they're needy or being dependent on a child 188 00:06:41,560 --> 00:06:44,004 or a loved one. They're, you know so 189 00:06:44,004 --> 00:06:46,245 they will go without. And so it's like, 190 00:06:46,245 --> 00:06:47,704 how do you break that barrier? 191 00:06:48,084 --> 00:06:50,165 And it's been quite successful for us by 192 00:06:50,165 --> 00:06:52,485 addressing that in its entirety with from a 193 00:06:52,485 --> 00:06:52,985 clinical 194 00:06:53,285 --> 00:06:55,285 care as well as a service and then 195 00:06:55,285 --> 00:06:57,785 a benefit package that's designed around that, 196 00:06:58,449 --> 00:07:00,449 where we are sitting today with that audience 197 00:07:00,449 --> 00:07:02,870 with a net promoter score of 75 plus, 198 00:07:03,089 --> 00:07:04,790 which is very hard to do, 199 00:07:05,169 --> 00:07:07,009 and it's continuing to grow at a very 200 00:07:07,009 --> 00:07:09,169 fast pace for alignment. So we're super excited 201 00:07:09,169 --> 00:07:10,069 that it's working, 202 00:07:10,449 --> 00:07:12,629 but it starts with that senior, that consumer 203 00:07:12,769 --> 00:07:13,269 directly 204 00:07:13,675 --> 00:07:15,435 talking to them, finding out what are their 205 00:07:15,435 --> 00:07:17,455 needs and what are their fears about, 206 00:07:17,995 --> 00:07:20,155 you know, whether it's the government or it's 207 00:07:20,155 --> 00:07:21,134 the state or 208 00:07:21,514 --> 00:07:23,615 asking for help. It's critical. 209 00:07:24,155 --> 00:07:26,095 So it's big. Yeah. That's fascinating. 210 00:07:26,810 --> 00:07:29,449 We've, been talking about the imperative to reduce 211 00:07:29,449 --> 00:07:32,009 costs, improve quality, and advance health equity, and 212 00:07:32,009 --> 00:07:33,770 I'd like to keep going with that. So 213 00:07:33,770 --> 00:07:35,930 how do you approach aligning these priorities in 214 00:07:35,930 --> 00:07:37,710 your organization's strategic vision? 215 00:07:39,535 --> 00:07:42,254 Well, seniors in general, it's interesting because when 216 00:07:42,254 --> 00:07:43,154 you think about 217 00:07:44,175 --> 00:07:46,095 when I talk to people, and I actually 218 00:07:46,095 --> 00:07:47,935 have experienced this now that I'm say I'm 219 00:07:47,935 --> 00:07:50,495 50. Well, I'm going through my full age, 220 00:07:50,495 --> 00:07:50,995 but, 221 00:07:51,454 --> 00:07:52,355 just ageism 222 00:07:53,300 --> 00:07:56,019 and how people view seniors today and where 223 00:07:56,019 --> 00:07:58,339 they were twenty years ago. And I say 224 00:07:58,339 --> 00:08:00,120 that at every stage of life. 225 00:08:00,899 --> 00:08:03,379 When you're 30, and if you're not married 226 00:08:03,379 --> 00:08:05,379 or you don't have a child, why are 227 00:08:05,379 --> 00:08:06,899 you not married, and why don't you have 228 00:08:06,899 --> 00:08:09,125 children? It's like, well, why should I have 229 00:08:09,125 --> 00:08:10,564 to be married? Or if you're Exactly. There's 230 00:08:10,564 --> 00:08:12,564 no time left. Plus, or why don't you 231 00:08:12,564 --> 00:08:15,044 have grandchildren? Or, you know, there's just so 232 00:08:15,044 --> 00:08:16,805 many things. Or when you talk to people 233 00:08:16,805 --> 00:08:18,664 and interview them and survey them, 234 00:08:19,125 --> 00:08:21,444 their view of what somebody is at 60, 235 00:08:21,444 --> 00:08:22,504 60 five, 70 236 00:08:23,279 --> 00:08:24,580 is really interesting, 237 00:08:24,960 --> 00:08:27,220 so from that perspective. And so it's 238 00:08:27,759 --> 00:08:29,620 when you think about equity, 239 00:08:29,920 --> 00:08:32,240 even as it applies and where we kind 240 00:08:32,240 --> 00:08:34,720 of have judgment with that audience, and so 241 00:08:34,720 --> 00:08:37,299 then then tap on somebody who's got Medicare 242 00:08:37,440 --> 00:08:38,179 and Medicaid, 243 00:08:39,245 --> 00:08:41,245 why should they be treated any different? Because 244 00:08:41,245 --> 00:08:43,644 of their income level? Or if you start 245 00:08:43,644 --> 00:08:45,245 to put because of the color of my 246 00:08:45,245 --> 00:08:45,745 skin 247 00:08:46,365 --> 00:08:49,084 or because you there's so many different things. 248 00:08:49,084 --> 00:08:52,125 And so from the company perspective, we do 249 00:08:52,125 --> 00:08:53,985 senior sensitivity trainings. 250 00:08:54,750 --> 00:08:57,309 We you know, when we're interviewing, we want 251 00:08:57,309 --> 00:08:58,370 a heart of caring. 252 00:08:58,750 --> 00:09:00,350 So they have to have that passion to 253 00:09:00,350 --> 00:09:03,070 wanna work with this audience and not want 254 00:09:03,070 --> 00:09:03,730 to just 255 00:09:04,830 --> 00:09:06,669 do this because of a job. And it 256 00:09:06,669 --> 00:09:08,750 is hard to find talent that's out there, 257 00:09:08,750 --> 00:09:09,490 and so, 258 00:09:10,205 --> 00:09:13,245 we have a a phenomenal culture of caring 259 00:09:13,245 --> 00:09:15,644 within our organization. And as we're growing, because 260 00:09:15,644 --> 00:09:17,745 we are getting bigger and we're growing fast, 261 00:09:18,524 --> 00:09:20,524 we work really hard. How do you keep 262 00:09:20,524 --> 00:09:23,004 that culture of caring as we're growing? And 263 00:09:23,004 --> 00:09:25,259 that is something that we need to continue 264 00:09:25,259 --> 00:09:26,080 to pay attention, 265 00:09:26,460 --> 00:09:28,000 because at the end of the day, 266 00:09:28,460 --> 00:09:31,180 the number one person in our company is 267 00:09:31,180 --> 00:09:33,019 that senior, and how do we make sure 268 00:09:33,019 --> 00:09:33,840 that we're doing 269 00:09:34,220 --> 00:09:36,504 doing right by doing good. Yeah. Thank you 270 00:09:36,504 --> 00:09:39,084 so much for for, providing that perspective. 271 00:09:39,945 --> 00:09:41,464 Before we wrap up here, do you have 272 00:09:41,464 --> 00:09:43,065 any final thoughts you'd like to share with 273 00:09:43,065 --> 00:09:44,125 our listeners today? 274 00:09:44,584 --> 00:09:45,084 Well, 275 00:09:45,384 --> 00:09:47,004 first of all, thank you for listening. 276 00:09:47,544 --> 00:09:48,044 Secondly, 277 00:09:48,985 --> 00:09:51,245 you know, just when you see that 278 00:09:51,899 --> 00:09:54,539 individual that is older out there or if 279 00:09:54,539 --> 00:09:57,100 they they're walking in the door and they're 280 00:09:57,259 --> 00:09:58,079 whether they're 281 00:09:58,620 --> 00:10:01,339 frail or not frail, just have think about, 282 00:10:01,339 --> 00:10:03,600 like, their life and how far they've become 283 00:10:03,659 --> 00:10:04,159 and 284 00:10:04,464 --> 00:10:06,464 just make that extra step and helping them 285 00:10:06,464 --> 00:10:08,384 out. Open the door, something as simple, or 286 00:10:08,384 --> 00:10:10,304 help them out on lifting something for them. 287 00:10:10,304 --> 00:10:11,345 Just be there, 288 00:10:12,144 --> 00:10:14,544 as an audience to take care of this 289 00:10:14,544 --> 00:10:17,345 consumer, and, you know, they've been leading the 290 00:10:17,345 --> 00:10:19,169 pack, and now we've gotta follow with the 291 00:10:19,169 --> 00:10:21,409 next generation of just doing, you know, doing 292 00:10:21,409 --> 00:10:23,089 right by doing good. Yeah. I love that. 293 00:10:23,089 --> 00:10:24,529 I think we can all take that home 294 00:10:24,529 --> 00:10:26,449 with us today. Well, thank you so much 295 00:10:26,449 --> 00:10:28,610 for joining me today. Again, this is Haley 296 00:10:28,610 --> 00:10:30,470 Rucker with the Becker's Payer Podcast 297 00:10:30,938 --> 00:10:33,178 recorded live at the Becker's third annual spring 298 00:10:33,178 --> 00:10:34,238 pair issues roundtable. 299 00:10:34,538 --> 00:10:36,078 Dawn, thank you so much. You're welcome.