1 00:00:02,319 --> 00:00:05,059 This is where health insurance leadership comes together. 2 00:00:05,279 --> 00:00:09,039 Becker's fourth annual spring payer issues roundtable brings 3 00:00:09,039 --> 00:00:12,259 together over 400 payer and health plan executives 4 00:00:12,525 --> 00:00:16,545 and more than 100 speakers to Chicago April. 5 00:00:16,925 --> 00:00:19,804 This year's event includes keynote conversations with the 6 00:00:19,804 --> 00:00:23,164 industry's top leaders and former president George w 7 00:00:23,164 --> 00:00:25,724 Bush. For the full agenda and event details, 8 00:00:25,724 --> 00:00:27,870 visit beckershospitalreview.com 9 00:00:27,949 --> 00:00:29,310 and click on the events tab in the 10 00:00:29,310 --> 00:00:31,470 upper right. We're looking forward to hosting you 11 00:00:31,470 --> 00:00:32,609 here in Chicago. 12 00:00:35,789 --> 00:00:38,210 Hello, everyone, and welcome to Becker's Healthcare podcast. 13 00:00:38,350 --> 00:00:40,429 I'm Scott King. Thrilled today to be joined 14 00:00:40,429 --> 00:00:43,534 by a very special guest, Dawn Maroney, president, 15 00:00:43,534 --> 00:00:44,994 Alignment Health and CEO 16 00:00:45,375 --> 00:00:47,295 of Alignment Health Plan. Dawn, how are you 17 00:00:47,295 --> 00:00:48,814 doing? Thanks so much for joining us. Appreciate 18 00:00:48,814 --> 00:00:51,234 it. I'm doing wonderful. Thank you for asking. 19 00:00:51,774 --> 00:00:53,454 Of course. No. So great to have you. 20 00:00:53,454 --> 00:00:55,500 We're gonna dive into a lot of big 21 00:00:55,500 --> 00:00:57,100 payer topics that that I know we're gonna 22 00:00:57,100 --> 00:00:59,340 lean on your your expertise for. But before 23 00:00:59,340 --> 00:01:00,460 we do that, I was wondering if you 24 00:01:00,460 --> 00:01:01,899 could please just kinda share a little bit 25 00:01:01,899 --> 00:01:04,060 about your background and your journey in in 26 00:01:04,060 --> 00:01:05,359 health care with health plans. 27 00:01:05,739 --> 00:01:07,040 Well, thank you for asking. 28 00:01:07,579 --> 00:01:08,114 I actually 29 00:01:09,314 --> 00:01:12,221 have been with Alignment going on twelve years 30 00:01:12,221 --> 00:01:12,774 and, you 31 00:01:13,075 --> 00:01:13,894 know, lead the health 32 00:01:14,194 --> 00:01:16,295 plan for all of our contracts and, 33 00:01:16,754 --> 00:01:19,174 the company for other, areas. 34 00:01:20,435 --> 00:01:22,274 And, I've been in the Medicare space for 35 00:01:22,274 --> 00:01:24,659 going on thirty gosh, it'll be thirty nine 36 00:01:24,819 --> 00:01:26,500 well, thirty eight years. I'll I'll give it 37 00:01:26,500 --> 00:01:27,560 that that number. 38 00:01:28,260 --> 00:01:30,979 And I just have always loved working with 39 00:01:30,979 --> 00:01:33,379 seniors. I've worked for larger companies and a 40 00:01:33,379 --> 00:01:35,939 couple of smaller companies. In fact, the smaller 41 00:01:35,939 --> 00:01:38,594 company that when we first originally started out 42 00:01:38,594 --> 00:01:39,954 to kind of grow it was a company 43 00:01:39,954 --> 00:01:40,694 called CareMore. 44 00:01:41,314 --> 00:01:41,814 And, 45 00:01:42,355 --> 00:01:44,295 you know, so either way, 46 00:01:45,075 --> 00:01:45,734 you know, 47 00:01:46,115 --> 00:01:48,115 we've tried to do something unique here at 48 00:01:48,115 --> 00:01:49,395 Alignment, and we've just, 49 00:01:49,795 --> 00:01:52,790 have done exceptional and very excited about seeing 50 00:01:52,790 --> 00:01:54,170 how alignment is just 51 00:01:55,030 --> 00:01:55,530 blooming, 52 00:01:55,829 --> 00:01:57,670 to be able to support as many, 53 00:01:58,310 --> 00:02:00,409 seniors in the country as possible. 54 00:02:01,270 --> 00:02:02,870 That's great to hear, Don. And not just 55 00:02:02,870 --> 00:02:04,709 about all your experience, you know, twelve years, 56 00:02:04,709 --> 00:02:06,344 I'm sure you've seen a lot and and 57 00:02:06,344 --> 00:02:08,025 a lot of things evolve. But, you know, 58 00:02:08,025 --> 00:02:09,784 with seniors, it's just to follow that up, 59 00:02:09,784 --> 00:02:12,104 it's it's really interesting that, you know, at 60 00:02:12,104 --> 00:02:14,365 our conferences, especially, you hear about 61 00:02:14,824 --> 00:02:16,044 I guess people are surprised 62 00:02:16,344 --> 00:02:16,844 how 63 00:02:17,145 --> 00:02:19,349 much seniors are able to adapt to, like, 64 00:02:19,590 --> 00:02:21,270 technology. Have you found that too? Just kind 65 00:02:21,270 --> 00:02:23,189 of being able to do things with with 66 00:02:23,189 --> 00:02:25,050 their accounts and their own plans digitally? 67 00:02:25,670 --> 00:02:28,010 Yeah. Yes. I you know, it's it's interesting. 68 00:02:28,950 --> 00:02:30,870 Although it is improving. So I've seen a 69 00:02:30,870 --> 00:02:33,590 big difference, in the last several years. Prior, 70 00:02:33,590 --> 00:02:35,235 it was much more difficult. And 71 00:02:35,715 --> 00:02:37,634 and the other piece is, you know, you 72 00:02:37,634 --> 00:02:40,194 know, this audience, you know, they don't trust 73 00:02:40,194 --> 00:02:41,814 the system and there's so much 74 00:02:42,194 --> 00:02:44,435 fraud or spam or other things that are 75 00:02:44,435 --> 00:02:45,735 going around. So 76 00:02:46,115 --> 00:02:48,594 they're very wise in the sense of, you 77 00:02:48,594 --> 00:02:50,169 know, what do I click on, what do 78 00:02:50,169 --> 00:02:51,770 I use. And so there's a lot of, 79 00:02:52,169 --> 00:02:54,569 extra effort to make sure that they know 80 00:02:54,569 --> 00:02:56,110 if we're doing something digitally 81 00:02:56,569 --> 00:02:59,229 as an organization or asking them to utilize 82 00:02:59,290 --> 00:03:00,349 technology more 83 00:03:01,129 --> 00:03:03,210 to to go through the process and educating 84 00:03:03,210 --> 00:03:05,224 them on why they can trust us. 85 00:03:05,685 --> 00:03:07,604 Absolutely. And, you know, one of the topics 86 00:03:07,604 --> 00:03:09,444 I wanted to get your expertise on, Don, 87 00:03:09,444 --> 00:03:12,805 was just that payer provider relationship and how 88 00:03:12,805 --> 00:03:13,865 it obviously changes 89 00:03:14,884 --> 00:03:17,219 and especially changed lately. But how are how 90 00:03:17,219 --> 00:03:19,699 are you seeing that relationship change as both 91 00:03:19,699 --> 00:03:20,199 sides 92 00:03:20,740 --> 00:03:23,379 face cost pressure and and workforce shortages in 93 00:03:23,379 --> 00:03:23,879 particular? 94 00:03:24,979 --> 00:03:27,699 Well, what's interesting to me I mean, depending 95 00:03:27,699 --> 00:03:28,439 on the areas, 96 00:03:29,539 --> 00:03:32,004 you know, the payer can be a number 97 00:03:32,004 --> 00:03:33,444 of areas. Right? So it can be the 98 00:03:33,444 --> 00:03:33,925 provider 99 00:03:34,324 --> 00:03:36,824 well, the health care company, the health insurance 100 00:03:36,884 --> 00:03:37,384 company, 101 00:03:38,084 --> 00:03:39,604 as well as you can even look at 102 00:03:39,604 --> 00:03:41,224 original Medicare as the payer. 103 00:03:41,604 --> 00:03:43,764 So you got Medicare Advantage, the original payer. 104 00:03:43,764 --> 00:03:44,504 You've got, 105 00:03:44,909 --> 00:03:47,090 you know, primarily in the insurance, 106 00:03:47,469 --> 00:03:49,330 organizations. And then you've got the provider, 107 00:03:50,590 --> 00:03:53,150 system, which we play literally both sides in 108 00:03:53,150 --> 00:03:55,310 the sense of how do you support the 109 00:03:55,310 --> 00:03:58,370 provider through our clinicians who work for us. 110 00:03:58,830 --> 00:03:59,650 But the providers, 111 00:04:00,395 --> 00:04:02,395 you know, are, you know, the ones that 112 00:04:02,395 --> 00:04:05,275 are closest to the individual on providing actual 113 00:04:05,275 --> 00:04:08,735 care. That is, primary care specialist, hospital, 114 00:04:09,115 --> 00:04:11,995 post acute facility, SNF, home health, ancillary service, 115 00:04:11,995 --> 00:04:12,974 a number of things. 116 00:04:13,835 --> 00:04:14,335 So 117 00:04:14,770 --> 00:04:17,170 the hybrid between both, there's a lot of 118 00:04:17,170 --> 00:04:20,129 changes from a regulatory standpoint going on. And 119 00:04:20,129 --> 00:04:21,750 it's it's it's really, 120 00:04:22,209 --> 00:04:22,870 you know, 121 00:04:23,250 --> 00:04:24,389 it becomes challenging, 122 00:04:24,930 --> 00:04:27,269 you know, for both sides. But I believe 123 00:04:27,970 --> 00:04:30,524 the payer actually gets, you know, kind of 124 00:04:30,764 --> 00:04:31,204 more, 125 00:04:31,644 --> 00:04:32,144 immediacy 126 00:04:32,444 --> 00:04:34,444 tied to what's going to change or more 127 00:04:34,444 --> 00:04:35,504 involved in the policy, 128 00:04:36,204 --> 00:04:37,964 than you'll see even on the provider side 129 00:04:37,964 --> 00:04:39,024 other than the providers, 130 00:04:39,564 --> 00:04:41,964 or the hospital systems that you'll see across 131 00:04:41,964 --> 00:04:42,544 the board. 132 00:04:42,845 --> 00:04:43,345 Right. 133 00:04:44,740 --> 00:04:46,660 Where do you see the biggest gap today 134 00:04:46,660 --> 00:04:49,560 between payer strategy and operational execution? 135 00:04:52,500 --> 00:04:55,459 Well, it's it's data. And so how do 136 00:04:55,459 --> 00:04:56,360 you make sure 137 00:04:57,254 --> 00:04:59,915 that you're getting data real time, 138 00:05:00,855 --> 00:05:03,335 specifically, no matter who's, you know, who's involved 139 00:05:03,335 --> 00:05:05,495 in caring for your members and or your 140 00:05:05,495 --> 00:05:05,995 patients? 141 00:05:06,775 --> 00:05:08,775 And it can't just be claims based data. 142 00:05:08,775 --> 00:05:11,569 So, you know, the more you know about 143 00:05:11,569 --> 00:05:13,649 a consumer or a patient, the more you 144 00:05:13,649 --> 00:05:16,550 can be proactive in integrating care. And so 145 00:05:16,930 --> 00:05:19,250 it's not at the level that you're getting 146 00:05:19,250 --> 00:05:20,870 it as close as possible. 147 00:05:21,969 --> 00:05:24,474 So we really work hard at alignment through 148 00:05:24,474 --> 00:05:26,474 our technology platform is to try to get 149 00:05:26,474 --> 00:05:27,854 that data sooner than later, 150 00:05:28,154 --> 00:05:29,615 whether it's lab, pharma, 151 00:05:30,074 --> 00:05:31,294 or a hospital, 152 00:05:32,235 --> 00:05:35,595 you know, even the census primarily from directly 153 00:05:35,595 --> 00:05:36,334 from CMS. 154 00:05:36,954 --> 00:05:37,115 So, 155 00:05:38,029 --> 00:05:39,150 you know, it's just a 156 00:05:39,870 --> 00:05:42,650 it's, you know, it's a process. But it, 157 00:05:42,910 --> 00:05:44,509 the closer you can get to that data 158 00:05:44,509 --> 00:05:45,250 to understand, 159 00:05:45,790 --> 00:05:46,290 individuals 160 00:05:46,590 --> 00:05:47,650 about that individuals, 161 00:05:48,350 --> 00:05:50,805 you can actually be better at providing care 162 00:05:51,285 --> 00:05:54,164 and more in a timely and accessible way 163 00:05:54,164 --> 00:05:56,104 that this consumer really deserves. 164 00:05:56,964 --> 00:05:58,004 What do you think some of the hang 165 00:05:58,004 --> 00:05:59,685 ups are? And, you know, people talk about 166 00:05:59,685 --> 00:06:01,204 clean data. What do you think some of 167 00:06:01,204 --> 00:06:02,805 the hang ups are in getting clean data 168 00:06:02,805 --> 00:06:04,805 and having it, you know, readily available like 169 00:06:04,805 --> 00:06:06,060 you were saying? I mean, it's, you know, 170 00:06:06,139 --> 00:06:06,939 2026 171 00:06:06,939 --> 00:06:08,860 and with with all the emerging technology we've 172 00:06:08,860 --> 00:06:10,220 seen in in health care and with health 173 00:06:10,220 --> 00:06:11,579 plans, what what do you think the issue 174 00:06:11,579 --> 00:06:12,240 is there? 175 00:06:12,540 --> 00:06:14,699 You still see the same things. You know, 176 00:06:14,699 --> 00:06:16,060 I mean, it would be great to get 177 00:06:16,060 --> 00:06:17,740 to a point where you can actually pay 178 00:06:17,740 --> 00:06:19,985 a claim, you know, immediately at the the 179 00:06:19,985 --> 00:06:20,884 time of service, 180 00:06:21,345 --> 00:06:21,845 specifically, 181 00:06:22,705 --> 00:06:24,625 to where it's super clean. But you're you 182 00:06:24,625 --> 00:06:25,925 need to integrate more. 183 00:06:26,944 --> 00:06:28,865 But we're still using we're still pulling out 184 00:06:28,865 --> 00:06:31,045 our cards when we're going into doctor's offices. 185 00:06:31,185 --> 00:06:33,264 Right. Even though you're filling out a form 186 00:06:33,264 --> 00:06:35,610 electronically or you're doing it through a chart, 187 00:06:35,769 --> 00:06:36,669 you know, portal, 188 00:06:36,970 --> 00:06:39,769 you're doing all the information, uploading, scanning, whatever 189 00:06:39,769 --> 00:06:41,129 you need to do, but you're still showing 190 00:06:41,129 --> 00:06:42,649 up to the practice and you're still pulling 191 00:06:42,649 --> 00:06:44,490 out that card and your ID and, you 192 00:06:44,490 --> 00:06:46,910 know, it and even if there's a barcode 193 00:06:47,050 --> 00:06:48,509 or you know, it's it's 194 00:06:48,810 --> 00:06:49,550 it's still 195 00:06:49,995 --> 00:06:51,514 not at the level that it needs to 196 00:06:51,514 --> 00:06:52,014 be. 197 00:06:52,795 --> 00:06:53,615 So having 198 00:06:54,115 --> 00:06:54,615 that 199 00:06:55,115 --> 00:06:55,615 ingestion 200 00:06:55,915 --> 00:06:58,095 of data where everybody's aligned, 201 00:06:58,875 --> 00:07:01,535 to make sure that we're all working together 202 00:07:01,595 --> 00:07:04,495 to share that information as much as possible. 203 00:07:04,909 --> 00:07:06,430 I think what you will see, 204 00:07:06,829 --> 00:07:09,329 Scott, with this administration is you're gonna see 205 00:07:09,949 --> 00:07:11,569 probably more forward looking, 206 00:07:12,589 --> 00:07:15,810 opportunities because we've got a pretty sophisticated 207 00:07:17,149 --> 00:07:17,649 educated, 208 00:07:18,189 --> 00:07:19,949 group. And what I mean educated through the 209 00:07:20,349 --> 00:07:20,805 like, 210 00:07:21,204 --> 00:07:22,745 the value of technology 211 00:07:23,604 --> 00:07:25,144 with our current administration. 212 00:07:25,444 --> 00:07:27,365 I'm quite impressed. And I think if there's 213 00:07:27,365 --> 00:07:28,264 gonna be movement, 214 00:07:29,365 --> 00:07:31,204 you know, to similar to what we're doing 215 00:07:31,204 --> 00:07:33,685 here at alignment, we're gonna see that, at, 216 00:07:33,925 --> 00:07:35,845 CMS trying to push and drive that with 217 00:07:35,845 --> 00:07:36,540 this team. 218 00:07:37,899 --> 00:07:39,839 If you could change one regulatory 219 00:07:40,220 --> 00:07:43,339 or industry practice tomorrow to improve affordability and 220 00:07:43,339 --> 00:07:45,199 access, what would it be and why? 221 00:07:45,660 --> 00:07:46,160 Well, 222 00:07:46,540 --> 00:07:48,960 immediately, I would make sure if a 223 00:07:49,660 --> 00:07:50,160 hospital 224 00:07:50,540 --> 00:07:51,040 system 225 00:07:51,764 --> 00:07:52,264 accepts 226 00:07:52,884 --> 00:07:54,964 Medicare today in a fee for service or 227 00:07:54,964 --> 00:07:57,305 original Medicare status, Medicare 228 00:07:58,245 --> 00:08:01,144 sub not supplemental insurance, but Medicare, 229 00:08:01,925 --> 00:08:03,944 then I would make that hospital 230 00:08:04,580 --> 00:08:06,500 available even at the same rates as Medicare 231 00:08:06,500 --> 00:08:08,500 is paying, 100% of Medicare if you don't 232 00:08:08,500 --> 00:08:09,400 have a contract, 233 00:08:09,860 --> 00:08:12,259 have a requirement that that hospital would need 234 00:08:12,259 --> 00:08:13,080 to be contracted 235 00:08:13,540 --> 00:08:16,339 with a Medicare Advantage plan or frankly, any 236 00:08:16,339 --> 00:08:18,600 participating Medicare Advantage or Medicare, 237 00:08:19,514 --> 00:08:20,014 program. 238 00:08:20,555 --> 00:08:22,555 And I think that policy needs to drive 239 00:08:22,555 --> 00:08:25,754 that. This would would push more organizations to 240 00:08:25,754 --> 00:08:28,574 be in rural areas where, you know, local, 241 00:08:28,714 --> 00:08:30,714 state, or government officials as well as at 242 00:08:30,714 --> 00:08:32,575 the federal level would like to see us. 243 00:08:34,409 --> 00:08:36,409 But you can't get there without that hospital 244 00:08:36,409 --> 00:08:38,250 saying, no. I don't wanna contract with you, 245 00:08:38,250 --> 00:08:40,490 or I wanna charge a 150 or maybe 246 00:08:40,490 --> 00:08:43,289 even 200% of Medicare, some crazy number where 247 00:08:43,289 --> 00:08:45,309 it prevents organizations from contracting. 248 00:08:46,970 --> 00:08:48,264 And then the last thing I wanna ask 249 00:08:48,264 --> 00:08:48,925 you, Dawn. 250 00:08:49,384 --> 00:08:50,365 What issue 251 00:08:50,745 --> 00:08:52,425 do you think is putting the most pressure 252 00:08:52,425 --> 00:08:54,904 on health plan margins right now, and and 253 00:08:54,904 --> 00:08:57,465 how are you responding differently in in 2026 254 00:08:57,465 --> 00:08:59,945 so far with it? It's a great question 255 00:08:59,945 --> 00:09:01,085 on, margins. 256 00:09:02,480 --> 00:09:04,000 You know, there's a lot of changes. There's 257 00:09:04,000 --> 00:09:06,160 a lot of headwinds coming in, hitting the 258 00:09:06,160 --> 00:09:09,059 industry as a whole provider and, insurer. 259 00:09:09,519 --> 00:09:10,019 And, 260 00:09:10,720 --> 00:09:11,700 you know, and it's 261 00:09:12,240 --> 00:09:14,320 as well as, you know, the cost continue 262 00:09:14,320 --> 00:09:15,920 to increase when it comes to health care 263 00:09:15,920 --> 00:09:18,535 expenses, especially in the, when when you think 264 00:09:18,535 --> 00:09:20,475 of the acute or institutional cost. 265 00:09:21,335 --> 00:09:23,495 And it's not going away. And as well 266 00:09:23,495 --> 00:09:26,215 as if you think of the, inflation reduction 267 00:09:26,215 --> 00:09:27,835 act as tied to pharma, 268 00:09:28,215 --> 00:09:29,995 you know, these costs, the 269 00:09:30,389 --> 00:09:33,430 the liabilities hitting more on the payer side, 270 00:09:33,750 --> 00:09:34,250 specifically. 271 00:09:34,950 --> 00:09:37,750 So you've gotta really you gotta do it 272 00:09:37,750 --> 00:09:39,750 right, and you gotta have discipline. And it 273 00:09:39,750 --> 00:09:42,149 can't be just looking at it, three months 274 00:09:42,149 --> 00:09:44,389 ago or six months back. You have to 275 00:09:44,389 --> 00:09:44,889 have 276 00:09:45,715 --> 00:09:47,715 discipline in this business to prepare for the 277 00:09:47,715 --> 00:09:48,215 regulatory 278 00:09:48,674 --> 00:09:49,174 environment 279 00:09:49,554 --> 00:09:51,475 as well as the discipline when it comes 280 00:09:51,475 --> 00:09:53,815 to how you manage care. 281 00:09:54,674 --> 00:09:55,735 And for alignment, 282 00:09:56,434 --> 00:09:58,434 you know, because we're really you know, we're 283 00:09:58,434 --> 00:09:59,495 one of few plans, 284 00:10:00,009 --> 00:10:02,269 that are focused primarily on seniors, 285 00:10:02,970 --> 00:10:05,789 but let alone, we have a very rigorous 286 00:10:06,009 --> 00:10:08,350 discipline on how we look at this business. 287 00:10:08,570 --> 00:10:10,350 And we know we still need to improve, 288 00:10:10,970 --> 00:10:13,769 but it's helped us when these headwinds have 289 00:10:13,769 --> 00:10:14,269 come 290 00:10:14,705 --> 00:10:17,345 to be able to to kind of, you 291 00:10:17,345 --> 00:10:20,625 know, surpass the storm unlike, what we're seeing 292 00:10:20,625 --> 00:10:22,004 of others. But I want 293 00:10:22,384 --> 00:10:23,764 our other competitive 294 00:10:25,024 --> 00:10:27,985 partners out there to succeed because, you know, 295 00:10:27,985 --> 00:10:31,079 we still need competition. Competition is extremely important 296 00:10:31,079 --> 00:10:33,000 for this consumer. I want these, 297 00:10:33,480 --> 00:10:35,959 members or seniors who are eligible for these 298 00:10:35,959 --> 00:10:36,860 types of products 299 00:10:37,240 --> 00:10:39,159 to have choice. And you need to have 300 00:10:39,159 --> 00:10:40,919 a couple of plans, more than a couple 301 00:10:40,919 --> 00:10:43,339 plans, usually in a county, to have 302 00:10:43,720 --> 00:10:46,365 where you're kind of pushing and forcing 303 00:10:46,745 --> 00:10:48,445 each of those plans to perform. 304 00:10:49,065 --> 00:10:50,825 Because if you only have one org one 305 00:10:50,825 --> 00:10:53,865 plan, there's nothing there to force that plan 306 00:10:53,865 --> 00:10:54,605 to perform. 307 00:10:54,985 --> 00:10:56,904 And so it's really, really important that we 308 00:10:56,904 --> 00:10:58,764 still have competition and we have 309 00:10:59,190 --> 00:11:00,730 performance across these organizations. 310 00:11:01,190 --> 00:11:02,950 But if they're gonna be in it, they're 311 00:11:02,950 --> 00:11:05,210 gonna have to do Medicare Advantage done right. 312 00:11:06,309 --> 00:11:07,830 Dawn, thank you so much for a great 313 00:11:07,830 --> 00:11:09,750 conversation and for joining the podcast. We're really 314 00:11:09,750 --> 00:11:11,110 looking forward to having you speak with us 315 00:11:11,110 --> 00:11:13,350 at the Spring Payor Issues Roundtable as well. 316 00:11:13,350 --> 00:11:15,675 But, thank you so much, Dawn. You're welcome. 317 00:11:18,295 --> 00:11:18,797 Thank you.