This is where health insurance leadership comes together.
Becker's fourth annual spring payer issues roundtable brings
together over 400 payer and health plan executives
and more than 100 speakers to Chicago April.
This year's event includes keynote conversations with the
industry's top leaders and former president George w
Bush. For the full agenda and event details,
visit beckershospitalreview.com
and click on the events tab in the
upper right. We're looking forward to hosting you
here in Chicago.
Hello, everyone, and welcome to Becker's Healthcare podcast.
I'm Scott King. Thrilled today to be joined
by a very special guest, Dawn Maroney, president,
Alignment Health and CEO
of Alignment Health Plan. Dawn, how are you
doing? Thanks so much for joining us. Appreciate
it. I'm doing wonderful. Thank you for asking.
Of course. No. So great to have you.
We're gonna dive into a lot of big
payer topics that that I know we're gonna
lean on your your expertise for. But before
we do that, I was wondering if you
could please just kinda share a little bit
about your background and your journey in in
health care with health plans.
Well, thank you for asking.
I actually
have been with Alignment going on twelve years
and, you
know, lead the health
plan for all of our contracts and,
the company for other, areas.
And, I've been in the Medicare space for
going on thirty gosh, it'll be thirty nine
well, thirty eight years. I'll I'll give it
that that number.
And I just have always loved working with
seniors. I've worked for larger companies and a
couple of smaller companies. In fact, the smaller
company that when we first originally started out
to kind of grow it was a company
called CareMore.
And,
you know, so either way,
you know,
we've tried to do something unique here at
Alignment, and we've just,
have done exceptional and very excited about seeing
how alignment is just
blooming,
to be able to support as many,
seniors in the country as possible.
That's great to hear, Don. And not just
about all your experience, you know, twelve years,
I'm sure you've seen a lot and and
a lot of things evolve. But, you know,
with seniors, it's just to follow that up,
it's it's really interesting that, you know, at
our conferences, especially, you hear about
I guess people are surprised
how
much seniors are able to adapt to, like,
technology. Have you found that too? Just kind
of being able to do things with with
their accounts and their own plans digitally?
Yeah. Yes. I you know, it's it's interesting.
Although it is improving. So I've seen a
big difference, in the last several years. Prior,
it was much more difficult. And
and the other piece is, you know, you
know, this audience, you know, they don't trust
the system and there's so much
fraud or spam or other things that are
going around. So
they're very wise in the sense of, you
know, what do I click on, what do
I use. And so there's a lot of,
extra effort to make sure that they know
if we're doing something digitally
as an organization or asking them to utilize
technology more
to to go through the process and educating
them on why they can trust us.
Absolutely. And, you know, one of the topics
I wanted to get your expertise on, Don,
was just that payer provider relationship and how
it obviously changes
and especially changed lately. But how are how
are you seeing that relationship change as both
sides
face cost pressure and and workforce shortages in
particular?
Well, what's interesting to me I mean, depending
on the areas,
you know, the payer can be a number
of areas. Right? So it can be the
provider
well, the health care company, the health insurance
company,
as well as you can even look at
original Medicare as the payer.
So you got Medicare Advantage, the original payer.
You've got,
you know, primarily in the insurance,
organizations. And then you've got the provider,
system, which we play literally both sides in
the sense of how do you support the
provider through our clinicians who work for us.
But the providers,
you know, are, you know, the ones that
are closest to the individual on providing actual
care. That is, primary care specialist, hospital,
post acute facility, SNF, home health, ancillary service,
a number of things.
So
the hybrid between both, there's a lot of
changes from a regulatory standpoint going on. And
it's it's it's really,
you know,
it becomes challenging,
you know, for both sides. But I believe
the payer actually gets, you know, kind of
more,
immediacy
tied to what's going to change or more
involved in the policy,
than you'll see even on the provider side
other than the providers,
or the hospital systems that you'll see across
the board.
Right.
Where do you see the biggest gap today
between payer strategy and operational execution?
Well, it's it's data. And so how do
you make sure
that you're getting data real time,
specifically, no matter who's, you know, who's involved
in caring for your members and or your
patients?
And it can't just be claims based data.
So, you know, the more you know about
a consumer or a patient, the more you
can be proactive in integrating care. And so
it's not at the level that you're getting
it as close as possible.
So we really work hard at alignment through
our technology platform is to try to get
that data sooner than later,
whether it's lab, pharma,
or a hospital,
you know, even the census primarily from directly
from CMS.
So,
you know, it's just a
it's, you know, it's a process. But it,
the closer you can get to that data
to understand,
individuals
about that individuals,
you can actually be better at providing care
and more in a timely and accessible way
that this consumer really deserves.
What do you think some of the hang
ups are? And, you know, people talk about
clean data. What do you think some of
the hang ups are in getting clean data
and having it, you know, readily available like
you were saying? I mean, it's, you know,
2026
and with with all the emerging technology we've
seen in in health care and with health
plans, what what do you think the issue
is there?
You still see the same things. You know,
I mean, it would be great to get
to a point where you can actually pay
a claim, you know, immediately at the the
time of service,
specifically,
to where it's super clean. But you're you
need to integrate more.
But we're still using we're still pulling out
our cards when we're going into doctor's offices.
Right. Even though you're filling out a form
electronically or you're doing it through a chart,
you know, portal,
you're doing all the information, uploading, scanning, whatever
you need to do, but you're still showing
up to the practice and you're still pulling
out that card and your ID and, you
know, it and even if there's a barcode
or you know, it's it's
it's still
not at the level that it needs to
be.
So having
that
ingestion
of data where everybody's aligned,
to make sure that we're all working together
to share that information as much as possible.
I think what you will see,
Scott, with this administration is you're gonna see
probably more forward looking,
opportunities because we've got a pretty sophisticated
educated,
group. And what I mean educated through the
like,
the value of technology
with our current administration.
I'm quite impressed. And I think if there's
gonna be movement,
you know, to similar to what we're doing
here at alignment, we're gonna see that, at,
CMS trying to push and drive that with
this team.
If you could change one regulatory
or industry practice tomorrow to improve affordability and
access, what would it be and why?
Well,
immediately, I would make sure if a
hospital
system
accepts
Medicare today in a fee for service or
original Medicare status, Medicare
sub not supplemental insurance, but Medicare,
then I would make that hospital
available even at the same rates as Medicare
is paying, 100% of Medicare if you don't
have a contract,
have a requirement that that hospital would need
to be contracted
with a Medicare Advantage plan or frankly, any
participating Medicare Advantage or Medicare,
program.
And I think that policy needs to drive
that. This would would push more organizations to
be in rural areas where, you know, local,
state, or government officials as well as at
the federal level would like to see us.
But you can't get there without that hospital
saying, no. I don't wanna contract with you,
or I wanna charge a 150 or maybe
even 200% of Medicare, some crazy number where
it prevents organizations from contracting.
And then the last thing I wanna ask
you, Dawn.
What issue
do you think is putting the most pressure
on health plan margins right now, and and
how are you responding differently in in 2026
so far with it? It's a great question
on, margins.
You know, there's a lot of changes. There's
a lot of headwinds coming in, hitting the
industry as a whole provider and, insurer.
And,
you know, and it's
as well as, you know, the cost continue
to increase when it comes to health care
expenses, especially in the, when when you think
of the acute or institutional cost.
And it's not going away. And as well
as if you think of the, inflation reduction
act as tied to pharma,
you know, these costs, the
the liabilities hitting more on the payer side,
specifically.
So you've gotta really you gotta do it
right, and you gotta have discipline. And it
can't be just looking at it, three months
ago or six months back. You have to
have
discipline in this business to prepare for the
regulatory
environment
as well as the discipline when it comes
to how you manage care.
And for alignment,
you know, because we're really you know, we're
one of few plans,
that are focused primarily on seniors,
but let alone, we have a very rigorous
discipline on how we look at this business.
And we know we still need to improve,
but it's helped us when these headwinds have
come
to be able to to kind of, you
know, surpass the storm unlike, what we're seeing
of others. But I want
our other competitive
partners out there to succeed because, you know,
we still need competition. Competition is extremely important
for this consumer. I want these,
members or seniors who are eligible for these
types of products
to have choice. And you need to have
a couple of plans, more than a couple
plans, usually in a county, to have
where you're kind of pushing and forcing
each of those plans to perform.
Because if you only have one org one
plan, there's nothing there to force that plan
to perform.
And so it's really, really important that we
still have competition and we have
performance across these organizations.
But if they're gonna be in it, they're
gonna have to do Medicare Advantage done right.
Dawn, thank you so much for a great
conversation and for joining the podcast. We're really
looking forward to having you speak with us
at the Spring Payor Issues Roundtable as well.
But, thank you so much, Dawn. You're welcome.
Thank you.