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This is Haley Recker with the Becker's Payer
Podcast, and we are recording live at the
Becker's third annual spring payer issues roundtable.
I am thrilled today to be joined by
Don Maroney, president of Alignment Health and CEO
of Alignment Health Plan.
Dawn, thank you so much for joining me
today. Can you go ahead and share a
little bit about yourself and your background before
we get started? Absolutely.
Well, I've been with Alignment
for about
eleven years. Actually, it's eleven years going on
in May, so very excited about that.
Thank you.
And,
I have been
representing or working with Medicare
beneficiaries,
seniors, individuals who are typically
65
and or disabled
for about a little bit over thirty plus
years.
I always had the,
dream to just work with seniors as grandparents
because I had grandparents that died at a
very, young age, or I was young age,
and they died at a young age as
well.
And, it just was an opportunity to take
on a job,
over thirty years ago to just work with
seniors, and it's been that ever since. So
it's the only space I've been in. Well,
that's such a great story. I love to
hear that.
Alright. To kick things off, I wanna talk
about affordability
and quality of care, which is a constant
challenge for health plans. So how is your
organization innovating to manage the cost of care
while maintaining
or improving member outcomes?
Well, I think for affordability for all of
us, right, has been, when it comes to
health care, it just continues to rise. Medical
expenses rise as well as,
whether it's under the core
catastrophic tech coverage or preventative coverage as well
as a pharmacy cost.
And our organization for quite some time,
a lot of us started are working at
another organization where we had to do a
lot of
hands on touch. And then in this digital
age,
we started in the very beginning with working
with, our
technology platform and how do you get to
individuals
sooner,
quicker, faster, in real time from the standpoint
of when they're taking prescriptions, how do you
connect into data or into hospital systems,
doctor's offices,
and or directly with seniors? And we started,
that
actually literally
when I started eleven years ago,
and it's been growing ever since. So when
we hear about AI today, you know, everybody
talks about AI in different fashions. We're not
in the robotic phase of AI for our
company, but we do a lot of the
machine learning as well as,
many other aspects of AI,
to
prioritize
seniors when it comes to the quality as
well as the
health care that's needed sooner than later.
And we have the ability to predict things
that may happen prior to them even knowing.
Some cases, it's just quite as simple as
they're taking their prescription drugs and mixing those
drugs the wrong way or having occurrences where
they land in an ER or in a
hospital multiple times within a year.
So we put clinical programs around that, and
we've been doing that for quite some time.
And it's been quite effective,
from the standpoint of
when you look at Medicare today, the average,
admit per thousand is sitting at 220
plus,
and we're running about one fifty one for
our organization. That means we're keeping seniors out
of the hospital,
which is probably the largest one of the
largest areas of expense.
There's also the preservice, but the postservice, when
you get into a hospital,
you're talking about hospitals in many of our
markets that are 20,000
plus per day.
So how do you keep people out and
or make sure that you're proactive in that
approach? So it's what we push heavily on.
Would you say that that integration of AI
has improved member experience greatly?
It has.
We started it, and I call it AI
assist because you I believe that in health
care, it still requires a human touch, you
know, a caring
touch, especially with our audience.
But it has been
I don't think we've even seen how great
the possibilities
are in in this area,
but we've been doing this for quite some
time. And so it's helped us greatly by
not having to have thousands of physicians to
address the hundreds of thousands of popular seniors
that we serve, but it,
I think it's gonna even grow bigger. Yeah.
I kinda wanna pivot the conversation just a
little bit to health equity, which has become
a critical focus for many health plans. Can
you share an overview of a key initiative
here that you're involved in or particularly excited
about, and what are you hoping to achieve?
Absolutely.
I I think the biggest when I think
of health equity, I think of so many
different variations of health equity. But I look
at
individuals starting with income and then diversity, but
primarily when I think of people that are
less fortunate than,
many individuals out there, like people that are
the the most frail, the most I say
poor, and I'm trying to think of another
word, but low income beneficiaries or people that
are sitting with Medicare and Medicaid.
We've put that task force,
many years ago, and it's one of the
fastest growing populations for us. The other tie
to that is health equity when it comes
to people that have chronic conditions or multiple
chronic conditions that are also frail and that
have, need income assistance.
And, we were probably one of the first
with creating collaboration with different companies like Instacart
and others, when it comes to
giving food
to people that, you know, instead of picking
medications
over food or vice versa, how do you
get that? How do
you give them unique benefits that help them
with loneliness and other things
or access to
getting a ride, something as basic as getting
a ride to your doctor or your pharmacy
or even picking up, certain supplies
and having,
programs to outreach to individuals because they are
living alone. And so there are things or
questions that we do or sending clinicians to
the home,
to to address that. And they don't wanna
feel like
they're needy or being dependent on a child
or a loved one. They're, you know so
they will go without. And so it's like,
how do you break that barrier?
And it's been quite successful for us by
addressing that in its entirety with from a
clinical
care as well as a service and then
a benefit package that's designed around that,
where we are sitting today with that audience
with a net promoter score of 75 plus,
which is very hard to do,
and it's continuing to grow at a very
fast pace for alignment. So we're super excited
that it's working,
but it starts with that senior, that consumer
directly
talking to them, finding out what are their
needs and what are their fears about,
you know, whether it's the government or it's
the state or
asking for help. It's critical.
So it's big. Yeah. That's fascinating.
We've, been talking about the imperative to reduce
costs, improve quality, and advance health equity, and
I'd like to keep going with that. So
how do you approach aligning these priorities in
your organization's strategic vision?
Well, seniors in general, it's interesting because when
you think about
when I talk to people, and I actually
have experienced this now that I'm say I'm
50. Well, I'm going through my full age,
but,
just ageism
and how people view seniors today and where
they were twenty years ago. And I say
that at every stage of life.
When you're 30, and if you're not married
or you don't have a child, why are
you not married, and why don't you have
children? It's like, well, why should I have
to be married? Or if you're Exactly. There's
no time left. Plus, or why don't you
have grandchildren? Or, you know, there's just so
many things. Or when you talk to people
and interview them and survey them,
their view of what somebody is at 60,
60 five, 70
is really interesting,
so from that perspective. And so it's
when you think about equity,
even as it applies and where we kind
of have judgment with that audience, and so
then then tap on somebody who's got Medicare
and Medicaid,
why should they be treated any different? Because
of their income level? Or if you start
to put because of the color of my
skin
or because you there's so many different things.
And so from the company perspective, we do
senior sensitivity trainings.
We you know, when we're interviewing, we want
a heart of caring.
So they have to have that passion to
wanna work with this audience and not want
to just
do this because of a job. And it
is hard to find talent that's out there,
and so,
we have a a phenomenal culture of caring
within our organization. And as we're growing, because
we are getting bigger and we're growing fast,
we work really hard. How do you keep
that culture of caring as we're growing? And
that is something that we need to continue
to pay attention,
because at the end of the day,
the number one person in our company is
that senior, and how do we make sure
that we're doing
doing right by doing good. Yeah. Thank you
so much for for, providing that perspective.
Before we wrap up here, do you have
any final thoughts you'd like to share with
our listeners today?
Well,
first of all, thank you for listening.
Secondly,
you know, just when you see that
individual that is older out there or if
they they're walking in the door and they're
whether they're
frail or not frail, just have think about,
like, their life and how far they've become
and
just make that extra step and helping them
out. Open the door, something as simple, or
help them out on lifting something for them.
Just be there,
as an audience to take care of this
consumer, and, you know, they've been leading the
pack, and now we've gotta follow with the
next generation of just doing, you know, doing
right by doing good. Yeah. I love that.
I think we can all take that home
with us today. Well, thank you so much
for joining me today. Again, this is Haley
Rucker with the Becker's Payer Podcast
recorded live at the Becker's third annual spring
pair issues roundtable.
Dawn, thank you so much. You're welcome.