Everyone. This is Jacob Emerson with the Becker's
Payer Issues podcast.
Thrilled today to be joined by Don Maroney,
who is the president of Alignment Health and
CEO of Alignment Health Plan. Don, thank you
so much for taking the time to be
with me on the podcast today. You're welcome.
And and Dawn, before we dive into everything
we wanna talk with you about, a pretty
big issue and something really impactful that you
did last week,
can you tell us a little bit more
about yourself and for our listeners who might
not be familiar, what Alignment Health does and
who you serve?
Absolutely.
Well, I actually,
have been in the health care
space primarily,
working with Medicare beneficiaries for about thirty six
plus years
and with alignment for approximately eleven of those
years.
I've had the privilege of leading the organization
that is, redefining how we serve seniors. And
in alignment, we are a Medicare Advantage prescription
drug plan primarily,
serving in five states in Arizona, California, Nevada,
Texas,
North Carolina.
Super excited about that. We're continuing to grow.
We serve about
200,000,
Medicare Advantage lives,
And it really is about transforming lives and
being there when they need us most.
And, so super excited about that.
Well, appreciate you taking the time to sit
down with us, Don. And, like you mentioned,
you've been in the Medicare space for a
long time, and you had to share your
expertise,
last week, July 22, as a witness in
front of the House Committee on on Ways
and Means and the Health and Oversight Subcommittees,
in a joint hearing about the past lessons,
current insights,
and future opportunities
within the Medicare Advantage program.
Alongside you, we heard from academics and and
from other Medicare Advantage insurers as well.
So talk to us about what this experience
was like for you. How how did it
feel to testify before congress on on such
a high stakes issue
like Medicare Advantage, and and what motivated you
both personally and professionally to take something like
this on?
Well, I love this program. I love, working
with seniors and Medicare Advantage,
you know, since the the very beginning, as
many years as I can go back. I
think it's 1989,
specifically.
And it was such an honor,
to represent Alignment Health before congress, specifically, as
you stated, the house, ways and means and
oversight subcommittees,
with, you know, chairman Buchanan,
oversight subcommittee chairman, Schweikert,
and then, of course, the ranking members,
who as well as the full committee, which
was exciting. It was a full house,
including the overall chair,
mister Smith. So
very, very exciting on that. It was I
mean, I was a little bit nervous because
I wanted to make sure when,
we talk about Medicare
Advantage and the program
when done right, how it saves lives, saves
money.
I was there to, you know, of course,
spotlight what works and why it matters.
This was a powerful opportunity to, you know,
share our vision and how we can become
more proactive, more personal, and purpose driven.
It did give alignment the national platform to
push policies that we believe,
that were will reward the right kind of
care, care that delivers better outcomes and real
value.
You know, being in health care for the
past several decades,
I wanted, you know, why you joined alignment.
I wanted to become something, you know, just
more than just providing just insurance, but really
advocating for seniors with more compassion,
accountable health system.
And it's not just, you know, it's isn't
just a privilege. It's a responsibility that, I
take seriously, and it was such an honor
to be there.
Absolutely. That's that's really great to hear,
and how you advocated on behalf of your
members and and, of course, the wider program.
Don, it's it's certainly no secret that the
that the MA program has faced a lot
of challenges these these last few years. And
so I wonder, you know, what were some
of the most urgent changes that alignment was
advocating for and that you wanna see from
lawmakers when it comes to the future
of Medicare Advantage, especially in light of some
of the more recent regulatory and, reimbursement trends
we we've seen?
Yeah. It it is, it has been. I
think it's been probably the most challenging in
the last,
you know, eighteen to twenty four months, I
would say more and more with, some of
the regulatory policies as well as some of
the changes that, you know, everybody wants.
And, for us, you know, our positioning, there's
you know, we believe that there's a couple
of priorities,
that can address some of the concerns of
the congressional leadership that, you know, they talked
about prior authorization.
They talked about rural care,
and making sure that, you know, as this
plan has more than 50% beneficiaries that are
in the environment that are and people are
electing to choose that. How do you get
plans like this even in more rural counties?
And so one, I would put out,
really,
hospital parity. Too many large hospital systems,
or even smaller community hospitals,
systems
in, rural counties or in counties,
declined to contract with higher performing smaller MA
plans such as ours.
This undermines access and competition, especially in those
markets.
We believe,
that
if a policy were generated
to push
where
every hospital, if they're accepting Medicare fee for
service,
that they should automatically accept Medicare Advantage contracts.
Now there can be a baseline of, those
contracts. For example,
at minimum, if there's not a value pay
value based care
agreement, then we would default to a Medicare
fee for service contract, meaning we'd pay a
100% what Medicare does, and this would give
some flexibility
and some competition in those markets,
but it should be hospital parity across the
board.
The other area which we're seeing and as
you're you know, we're seeing some other changes
in other sectors,
specifically
on Medicaid,
we're seeing, you know, that the force and
the push in the last several years is
to push
Medicare
Advantage members that have dual eligible status
to be enrolled in an exclusively
aligned
plan.
And this is not just California, but there
are multiple states that are pushing this agenda
where they automatically default to those plans.
I think, you know,
those programs
absolutely should be there, but they should also
stand alone, and they should still have competition.
The Medicare Advantage
that seniors should not be limited on their
choice and selection of what they're choosing,
Especially when you look at an organization like
ours, a 100% of our members across all
of our states are in a four star
or greater.
And I talked about this last week as
well
that we are one of, you know, as
I said nine, but we're actually one of
seven Medicare Advantage Plans across the country that
qualify for a five star plan.
And we believe continuing on, we should hope
to see that that we'll be consistent in
that category as we look at this fall
and open enrollment.
But
dual eligible beneficiaries, which are commonly have multiple
chronic conditions,
have lower incomes,
they have, you know,
less flexibility of what to choose if they're
defaulted into a plan. I don't think that's
right. I think these seniors deserve a choice
and that they should,
they should absolutely still have a plan like
an alignment
that will be available to them and have
the continuous open enrollment that they do today.
Absolutely. And I'm really glad you you pointed
out that tidbit about your your star rating
success because it's true. You really alignment is
one of the most highest rated,
Medicare Advantage Plans consistently year after year, and
you're one of just a handful of plans
around the country that has achieved that. So
it's so great to hear, you know, about
how you're advocating for for more choice and
and supporting rural health care access moving forward,
for your members and and for the wider
population.
I also wanna ask you, you know, we
we we've heard so much from both sides
of the aisle these last few years,
about about Medicare Advantage changes that should be
made.
So what was your sense of of what's
going on in Washington right now?
How do you think lawmakers are currently thinking
about the Medicare Advantage Program? Certainly, now that
we're under a new administration,
are are you feeling that they're leaning more
toward reform, more restriction,
support for what you're talking about? What what
do you what's your sense of what's happening
right now, Dawn? Well, first and foremost, I
have respect for both sides, and I actually
do believe both sides really care, when I
think about Chairman Buchanan and Schweikart and, Doggett
and Sewell.
They
understand the value of Medicare Advance, what it
brings, and they really do care about,
the Medicare beneficiaries.
This isn't really about restricting the program. It's
refining it and strengthening it. And how do
you have
organizations that may be smaller than the larger
organizations that are out there in the environment
have
be a part of that competition without having
restrictions around it? And it's giving
seniors choice, driving quality through that competition and
value and, you know, and how you stretch
every
you know, and how you stretch every health
care dollar.
And that's what we do. We look at,
a proactive integrate integrated approach to care.
We have a high touch care model,
which is, different. We believe that sometimes you
may invest, higher dollars in the first year
of that enrollment where you're actually losing money.
But in in the years to come, if
you really do put your patients before profit,
then you shall profit.
So it but it does take time, and
it takes an investment. And,
I felt
the listening of what we were trying to
do, but how do you reform, you know,
reform the program without restricting it?
And, there was a lot of dialogue and
a lot of discussion,
and our goal is just to make sure
that we have a seat at the table
to help them refine those policies.
Sure. Yeah. That make that makes a lot
of sense.
Before we go, Don, what else are we
missing? Are there any final thoughts or final
tidbits of advice that you wanna offer,
the other Medicare leaders listening in?
I think they're first of all, you have
to really care about this consumer and make
sure that they are the absolute
priority.
We look at it as, you know, you
put the senior first,
but how do you support the doctor that
is taking care of that senior? And that
doctor doesn't always have to work for you.
We have 25%
of our employees that are clinicians, but they
don't always have to work with us and
work for us. I mean, they have to
work with us, I should say. They should
be aligned.
And, you know, enable technology. There's a lot
of discussion about AI.
We look at AI as how do you
use AI, from an assistant standpoint,
And then how do you have a serving
heart? But this consumer
really wants to make sure that they are
independent,
mobile,
and,
and have peace of mind, in in that
process. And if you think about those pieces,
no matter if you're somebody that's starting up
or if you're somebody that's been in business
for quite some time, if you put them
at the center of your focus,
then you should be able to do Medicare
Advantage right
and win in in this business
for years to come.
Fantastic. Well, Don, I I really appreciate you
taking the time to sit down with us
and for sharing your insights about how you
and Alignment are really advocating and and pushing
for the continued evolution, refinement, and, improvements
of such an important program. We really appreciate
it. Thank you so much.
And to our listeners, if you'd like to
listen to more podcasts from Becker's Healthcare, you
can visit beckers hospital review dot com.