Marilyn Tavenner discusses AHIP’s strategy

In this Q&A with Managed Healthcare Executive (MHE), Marilyn Tavenner, president and CEO of America’s Health Insurance Plans (AHIP), discusses AHIP’s top priorities, challenges, and opportunities. Tavenner served as CMS administrator from 2010 to 2015, and as HHS secretary from 2006-2010.

MHE: Last year, you took over leadership of AHIP. What were some of your biggest fears moving into the position, and what were you most excited about?

TavennerTavenner: I’ve worked in many facets of the healthcare system during the course of my career and in the last five years have learned how health insurance works, both in the private sector and in the government. Coming to AHIP was an opportunity to work directly with plans during this period of transition to innovative healthcare delivery and to ensure consumers are provided the highest quality, most affordable care possible. It was also an opportunity to work on issues that will affect the long-term future of the U.S. healthcare system and the role of health plans to help make our system more sustainable.

MHE: What is one of the biggest lessons you learned at CMS that you will use/are using in your role at AHIP?

Tavenner: During my time at CMS, I watched the private sector take a lead in delivery system and payment reform efforts that were transforming the way we pay for care. Medicare Advantage and Medicaid Managed Care are two key examples of the type of innovation that can deliver better value and improved quality of care for beneficiaries in public programs. Strengthening and protecting those programs are fundamental to the work that we do at AHIP, and those remain key priorities of mine moving forward.

MHE: Recently, a few insurers have voiced concerns over their participation in the health insurance exchanges and the financial implications of participating. What is AHIP's response to these concerns and what actions is it taking as a result?

The exchange market is still in the midst of a major transition. We will continue to offer solutions to ensure long-term stability and success of the market so that consumers have access to high-quality, affordable care

MHE: There were a few recent exits from AHIP, such as UnitedHealth Group and Aetna. What efforts is AHIP taking as a result of these exits?

Tavenner: I have close relationships with both companies and will continue to have regular dialogue with their leadership, leaving the door open to working together on advocacy initiatives that are beneficial to the industry as a whole going forward. In addition, this week our board of directors approved new changes to modernize the structure of our dues and governance, the first major restructuring since 2003. These changes will allow us to build on AHIP’s strong track record of advocating on behalf of its members and the consumers they serve.

Next: What is AHIP doing to help address the rising cost of specialty pharmaceuticals?

MHE: The rising cost of specialty pharmaceutical medications is a key challenge facing the industry. What are some things AHIP is doing to help address this issue?

Tavenner: There are several ways we can begin to address the unsustainable cost of prescription drug. We believe there should be greater transparency around what goes into the pricing of a drug. Research and development is the argument many pharmaceutical companies use to defend high prices for certain medications, and in cases where those medications are proving to be effective for patients, innovation and development should not be stifled. But many drugs that have been on the market for years are undergoing arbitrary price increases, making them unaffordable and inaccessible for many patients who depend on them. We need to focus on value-based pricing where improvement to a patient’s quality of life factors into the true value of a drug.

MHE: AHIP recently announced it is launching a pilot program to ensure that physician directories are more up to date. Can you tell us a bit more about the program, and your overall objectives?

Tavenner: This project aligns with our focus on improving the healthcare experience for consumers. It’s important for patients to have easily accessible, accurate information about their doctors, but that requires providers and health plans to work together to keep directories up to date. We launched the pilot in March, with 12 of our member plans and the support of two vendors, BetterDoctor and Availity, which will proactively contact doctors for information. At the conclusion of the pilot in September, an independent evaluation will be conducted based on feedback from providers, health plans and consumers. Our hope is that the results will help shape a long-term strategy to streamline maintenance of provider directories at the national level. 

MHE: Looking ahead to 2017, what do you think some of AHIP's biggest priorities will be?

Tavenner: We will be working with our board to identify priorities that are important to our members and will contribute to improvement of the healthcare system as a whole. In June, we announced the appointment of Joseph Swedish, chairman, president and CEO of Anthem, as our board chair for 2017, and Bernard Tyson, chairman and CEO of Kaiser Permanente, as board chair for 2018. Their leadership over the next two years will build on our commitment to transform the industry to one that is more consumer focused. As part of that, we will continue to support the protection of programs like Medicare Advantage that are providing high-quality, coordinated care to beneficiaries. We will also be working with many of our Medicaid members to educate and advocate for Medicaid managed care, which was a new priority for us this year. There are so many areas where we can actively engage with other stakeholders to ensure a healthy, stable market. Finally, their leadership will be instrumental as AHIP and our members look out beyond the 2016 elections to envision the future U.S. healthcare system and develop long-term strategies to improve affordability, access, quality and the overall sustainability of our system. 

Aubrey Westgate is executive editor of Managed Healthcare Executive.