Medicare Advantage, pharma costs among AHIP's top five focus areas

Marilyn Tavenner has had her hands full since taking the helm of America's Health Insurance Plans last summer. Two of the country's largest health insurers have left the group, mega-mergers are set to change the for-profit payer landscape and health reform continues to challenge the industry's long-held habits.  

But because of all these challenges, Tavenner, who previously served as Centers for Medicare & Medicaid Services administrator, has set lofty goals for the trade group.

She described these goals--as well as AHIP's role in helping standardize care quality measures--in her keynote speech Wednesday at the National Quality Forum's annual conference in the District of Columbia. The two subjects are closely related, she said, because "quality basically weaves through all of our objectives."

Going forward, Tavenner said AHIP's five primary focus areas will be:

  • Delivery system reform. "You will see us talk about delivery system reform, not just for Medicare Advantage, but across all payers," Tavenner said, including commercial insurance and Medicaid. Health plans are uniquely positioned to lead the transition to value-based care, she said, because they have the "critical mass" of patients and the technology to allow for rapid evaluation of patients' response to therapy.
  • Medicaid managed care. Medicaid enrollment growth nationwide has now surpassed Medicare, Tavenner noted, and "regardless of happens with the election in November, I think Medicaid growth with continue." State Medicaid programs managed by private insurers also are ideally suited for alternative payment models.
  • Medicare Advantage. "You don't have to market Medicare Advantage," Tavenner noted, as its popularity continues to grow and it is leading the way in terms of delivery system reform--a key rationale for the Aetna-Humana merger.
  • Pharmaceutical costs. AHIP will focus its efforts on driving transparency and predictability in pricing; working with the FDA to get more medications to market as well as promote generic and biosimilar drugs; and building pharmaceutical pricing and delivery into alternative payment models.
  • Consumer relations. "That's is a new field for health plans--in terms of the consumers have always been important, but the relationship has been at a distance," Tavenner said. That relationship will continue to get much closer, however, as consumers care increasingly about their primary care and pharmaceutical benefits, causing AHIP to sharpen its focus on consumer education.

Tavenner has also said recently that another of her major goals is to win back UnitedHealth and Aetna, both of which have parted ways with AHIP since she took the reins from longtime CEO Karen Ignagni.

Related Articles:
Marilyn Tavenner, Karen DeSalvo: Why healthcare needs standard care quality measures
Marilyn Tavenner sets aggressive goals for AHIP
Aetna's AHIP exit may be turning point for industry advocacy
AHIP's Marilyn Tavenner hopes to win back Aetna, UnitedHealth
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