Tavenner: Berwick Part 2 for payers?

Jim O'Neil
Since the Obama administration announced Marilyn Tavenner as its pick to run the Centers for Medicare & Medicaid Services (CMS), questions about her leadership style and goals for the agency have been running rampant throughout the healthcare industry.

Tavenner is a nurse, former executive at Hospital Corporation of America (HCA), and past Virginia health secretary. She joined CMS as principal deputy administrator in 2010, where she has helped oversee Medicare, Medicaid, and the Children's Health Insurance Program.

For payers, it seems Tavenner will be on their side, or at least recognize and understand their perspectives based on her past experience working in the private sector. Rep. Eric Cantor (R-Va.), who isn't exactly known for supporting anything President Obama does, spoke highly of Tavenner, highlighting her private sector work. Tavenner "is somebody who understands the private sector and business concerns" Cantor said. "I always found her to be extremely professional and understanding of the value of the private sector in health care," he added.

Unlike former CMS Administrator Dr. Donald Berwick, Tavenner isn't associated with a grand vision for health reform and hasn't made comments in the past about the benefits of a government-run healthcare system. That's likely why so many healthcare groups, including America's Health Insurance Plans, almost immediately offered their support for Tavenner.

However, payers shouldn't get overly excited about a Tavenner-led CMS reversing course on healthcare reform. She has said that, if chosen to become CMS administrator, she would follow Berwick's lead in implementing reform provisions. She told a group of Nashville healthcare execs that CMS has a very clear strategic five-year plan under the reform law. "Whether I'm nominated or not, we would not have a different approach," she said, adding that "the agency's priorities would not change." So, payers might not see a return to the days of unfettered premium hikes and little transparency.

Further aligning herself with Berwick's policies, Tavenner explained her ideas on how to control healthcare costs to the National Association of Medicaid Directors. "The only way to stabilize costs without cutting benefits or provider fees is to improve care to those with the highest healthcare costs," she said. That's an approach Berwick frequently advocated while leading CMS.

Tavenner also opposes turning Medicaid into a block grant that would limit the amount of federal funding states can receive for the program. "That approach would simply dump the problem on states and force them to dump patients, benefits or make provider cuts or all the above," she said.

Only a few days after her nomination, criticism and resulting doubt began surrounding Tavenner. The Association of American Physicians and Surgeons declared that the "new CMS pick [is] no better than Berwick." It also highlighted the fact that HCA allegedly defrauded Medicare and Medicaid, resulting in $840 million in fines in 2000 and another $640 million in 2003, while Tavenner was an exec at the company.

So while it's difficult at this early juncture to definitively discern where Tavenner would take CMS and its oversight of payers' compliance with health reform, one thing is certain: We haven't heard the last of her. The White House already sent her nomination to the Senate and we are sure to learn a lot more about Tavenner as the nomination process unfolds and Congress thoroughly vets and scrutinizes her experience and ability to lead the largest U.S. health plan. Maybe we should withhold judgment until then. - Dina (@HealthPayer)