Ceci Connolly 00:08
So we probably lost a little bit of momentum for a few years there. But I think that it’s coming back strong, partially because of the pandemic and the experience of providers that really saw their utilization plummet. But as you experience a downturn, more people and more businesses are really sensitized to that. And you’re starting to hear that conversation pick up where people are saying, what are we getting for our health care dollar.
Gregg Masters 00:39
PopHealth Week is brought to you by Health Innovation Media. Health Innovation Media brings your brand narrative alive via original or value-added digitally curated content for omnichannel distribution and engagement. Connect with us at www.popupstudio.productions and welcome everyone. I’m Gregg masters, Managing Director of Health Innovation Media, and the producer and co-host of PopHealth Week. Joining me in the virtual studio is my partner, colleague, and lead co-host of PopHealth Week Fred Goldstein, President of Accountable Health, LLC. On today’s show, our guest is Ceci Connolly President and CEO of the Alliance of Community Health Plans ACHP notes, they are the voice of America’s top-quality nonprofit, community-based health plans ACHP advocates for policies and industry reforms that enhance the health of communities across the nation. And with that introduction, Fred over to you help us catch up with Ceci’s work at ACHP
Fred Goldstein 01:42
Thanks so much, Gregg, and Ceci welcome to PopHealth Week.
Ceci Connolly 01:45
It is great to be back with you, Fred.
Fred Goldstein 01:48
It’s a pleasure. It’s been a while Ceci but it’s fantastically fun to get you on the show. You’ve obviously accomplished a whole bunch since the last time we spoke. So why don’t you give our audience a little sense of your background,
Ceci Connolly 01:58
Oh, goodness, okay, well, so really, my DNA is ink-stained wretch. As you know, Fred 25 years in the news business had a blast did a little time at a couple of consulting firms. And then five and a half, almost six years ago took over the Alliance of Community Health Plans. We are a national association based here in Washington DC. So yes, I’m also a swamp dweller. And our organization, our members, and our focus are really one in the same, which is that we believe very much in a model in healthcare that our health plans and the providers working very closely together. So our members of a nonprofit provider aligned community health plans. We believe in that model, we think that it is good for consumers and patients. And that’s what we focus our advocacy on which these days means really spending time getting folks back focused on value.
Fred Goldstein 02:58
Fantastic. And in terms of membership, who are some of your typical members in the group?
Ceci Connolly 03:03
Well, we have a number of the very large, prominent integrated systems around the country, the biggest, of course, being Kaiser Permanente, but also UPMC, and Geisinger and HealthPartners, and Presbyterian, and Scott and White in Texas. But then we also have groups of members, as I say, provider aligned, so their community health plans that may not own hospitals, but are very close to the physician and delivery systems in their regions. So that could be an AvMed in Florida, Group Health Cooperative in Wisconsin, Martin’s Point up in Maine, just to give you a few of them.
Fred Goldstein 03:44
And so when you talk about you’ve got two models, in essence, I guess, the ones that are more like a Kaiser with the owned or their own physician, provider groups and the others, and so they’re an integrated delivery system, in a sense, and so they work closer, is that sort of the belief with the providers then, say a typical insurer,
Ceci Connolly 04:02
yes, we see that every day. And those are the roots of our members. So a couple that I mentioned Group Health Cooperative and Martin’s Point, they don’t own hospitals, for instance, but they have primary care and physician group practices within their entity. AvMed not owning any of those delivery system assets if you will, but they have these really tight connections, and they just approach the business of healthcare very different. You know, the the comparison I like to use is that typically in healthcare, you have the payers sitting on one side of the table, the providers sitting on the other side of the table, and they’re, you know, constantly butting heads and fighting over who’s gonna get paid what, but ours, they have their financial incentives aligned and they’re all aligned around the patient and health outcomes. So instead of fighting over those dollars, they’re trying to figure out how to be most efficient with the dollars.
Fred Goldstein 05:03
And in terms of that, does that mean that more of these plans are working on value-based agreements with their providers? Or are they still for majority under a fee-for-service type model?
Ceci Connolly 05:13
You know, Fred, that number has been steadily rising. And the pandemic probably accelerated a little bit of that movement, especially in those early months. We are a bit concerned, though, that especially Washington and policymakers over the last several years, they lost sight of the importance of moving from volume to value. And so we probably lost a little bit of momentum for a few years there. But I think that it’s coming back strong, partially because of the pandemic and the experience of providers that really saw their utilization plummet. And as a result, their revenue plummet, which is our whole problem with fee for service medicine. But also, I think that as the pandemic subsides, policymakers are getting back to some of those core health reform issues.
Fred Goldstein 06:14
That’s interesting, because I had seen, you know, some of the changes coming out of DC, and they were pushes to more risk to providers and things like that, particularly through some of the ACO models. But you’re saying that, in essence, there’s actually a greater move to value now than there was during the prior administration.
Ceci Connolly 06:29
I think that there is a renewed interest and appreciation in Washington on affordability and value. And as you know, we’ve been at this for a long while now. Interestingly, when the economy is good, and you have low unemployment, people have jobs, they have health insurance with their jobs, I don’t think there’s that same focus on health care costs and the burden of wasteful, inefficient health care. But as you experience a downturn, more people and more businesses are really sensitized to that. And you’re starting to hear that conversation pick up where people are saying, what are we getting for our health care dollar?
Fred Goldstein 07:23
Yeah. And it’s interesting, you know, you made it made a great point, it’s about how do we focus on the costs and things? So do you have examples? I mean, everybody talks about, we’re going to save money, we’re cutting costs, we’re putting these services in place, this new plan is going to do XYZ, yet we continue to see it this upward trend. Are you seeing examples in any of your members have of actually bending that or reducing that cost?
Ceci Connolly 07:48
Yes, the word is telehealth. And I want to come back to that, Fred, because I’m super bullish on that. But let me first say that in all of my years writing about or being involved in healthcare, this is the first time I have been able to answer yes to that question. And as you know, nobody ever expected healthcare costs to go down. Right? Our big hope was just to kind of control the rate of growth.
Fred Goldstein 08:18
Right bend the trend?
Ceci Connolly 08:20
That’s right. That is right. And and that was hard enough, believe me. But I mean, I sort of am pinching myself that I can tell you that. We now have a handful of member companies that have rolled out this year, these telehealth first products, and the premiums for those products are running 5 to I think 11%, below comparative premiums for more of the traditional insurance products. I mean, I just had a conversation with Michael Carson, the President at Harvard Pilgrim, they rolled out the first of these in New England, and the premium is 8% below their standard HMO product. That’s incredible.
Fred Goldstein 09:07
Yeah, it really is. And can you explain to our audience what you mean by telehealth first,
Ceci Connolly 09:12
yes, and each one has gotten a little bit of a variation. But the concept is that if you decide to purchase or sign up for one of these insurance plans, lots of your first interactions with the healthcare system would be virtual by phone, video, email consult, those sorts of things. Naturally, if you need to be in person, if you and your doctor communicate and say, Oh my gosh, yeah, we need to get an X-ray of this or we need lab work, then you go in person. But what I think the pandemic really illustrated for so many people is that a lot of your engagement with your clinical team can be done in the same way that you and I are communicating right now. So much more convenient. Don’t have to leave your house. Think about if you’ve just got a question, you know, is this serious? Do I need to go running to the emergency department. So some of it might be some triage, a lot of it can be managing chronic conditions, check-in, maybe you’ve downloaded some information off of a device. And the other one, of course, that is just incredible, is the usage of virtual care for mental health. And through this crisis, I am not exaggerating when I say lifesaver.
Fred Goldstein 10:43
Yeah, it’s been unbelievable. One the growth of issues associated with mental health, depression, anxiety from the pandemic itself, and being stuck in your homes and the kids. And then the ability of the telehealth system to deliver an effective service, obviously, in that arena has been really fantastic to see and to watch that grow. When you think about that, and I think about the global healthcare system, I think, okay, we took eight to 11% out, where did it come from? In other words, somebody’s revenue was lowered unless somebody has become more efficient and doesn’t have an office space in the overhead. So are these provider groups changing their practice patterns and behaviors?
Ceci Connolly 11:22
Well, I hope so. I think that some of the smart ones are, but you know, unfortunately, this is where I do tend to worry a little bit that lots of the provider community are going to quickly revert back to in-person fee for service. Once you’re in the building, you can go down the hall for some blood work, and you can go up to the fifth floor for a full body scan and someplace else for a few other add ons. You know, Fred, I’m, I’m not doing the academic work. But I hope that that academic analysts are really scrutinizing this past year to dig into what was, what was lost, what wasn’t delivered, I have a theory that a certain amount of it, not all of it absolutely positively, but a certain amount of it were some of those extras, the duplication, the unnecessary, inappropriate low-value kind of things. Now, of course, we also want to really study what happened to people who maybe had underlying conditions that were not detected or managed through the pandemic. And that’s really, really hard to tease out. And I don’t mean to make light of it, because clearly there were there were those instances.
Fred Goldstein 12:56
Yeah, I think there’s some real issues regarding particularly screenings for various cancers that might not have occurred, and now you’re identifying individuals at a much later state, which obviously, is a terrible outcome for what we’ve seen. And you talked about telehealth some, and I know you’re really supporting the Connect for Health Act of 2021. And there’s a letter up on your website about it. Tell us about that and why you’re supporting it.
Ceci Connolly 13:18
Well, first of all, I’ve got to give a shout-out to my ACHP policy team, because they have been working really close with members on Capitol Hill and continuing to sort of refine that. And so I’m not going to be as detailed as some of them. But I’m glad folks can see all of this on our website. What I would tell you is that from an ACHP policy and advocacy perspective, we’ve kind of taken this conversation to the Hill and the Biden administration on a couple of levels. First preference is let’s just maintain the terrific flexibilities that we’ve had through this public health emergency, we have essentially had a 14-month experience, and it seems to have gone pretty darn well. So why would we want to go backward? Why would we start like theorizing about problems that have not been reported during this period? You know, however, we are realists when it comes to Washington, and we understand that might be asking a lot of policymakers. So there are a couple of immediate things that really need to happen. One is and I’m going to get slightly wonky here, but within Medicare Advantage, we need to include in risk adjustment, audio-only visits. So that’s when Nana is just talking on the telephone to her doctor because she doesn’t have internet or a video screen. And we’ve got to make certain that all of those visits are captured.
Gregg Masters 14:58
And if you’re just tuning in to PopHealth Week our guest is Ceci Connolly , president, and CEO at the Alliance of Community Health Plans, the voice of America’s top-quality, nonprofit, community-based health plans.
Ceci Connolly 15:12
I’m thrilled to tell you, everyone we talked to in Congress gets this. Now they just have to sort of move on to the fix. But we’re very optimistic about that. A lot of these other provisions, we could see it play out, Fred, that health companies are given one to two years beyond the public health emergency to continue this experiment, if you will, not perfect, but we’d we’d be happy because it would be good progress.
Fred Goldstein 15:46
One of the concerns and Gregg and I talk about this quite a bit is each time we look at a new service, like, okay, we want to allow voice which by the way, I think is great. I actually just did a voice visit with my physician. And it was incredible. I wrote back I scored him five stars and everything, it was great. So I really do think it works. And it works in certain situations is this idea that we need the federal government to give us another CPT code to bill another service, which then just kind of adds on another layer to the onion. Whereas if we could switch that reimbursement to value base and let the provider say, I’m going to do this by a voice call, and I’m going to do this telehealth, we probably wouldn’t create that ever-increasing spiral. Do you see it that same way?
Ceci Connolly 16:27
Oh, completely. It is as if you and I scripted this right? No, of course. I mean, we started this conversation on value. And we believe in it. And we think this is absolutely the perfect example where you want that clinical team. And by the way, it’s not just MD but it’s all those other important players in your on your care team, talking to you, the patient, and your family members about what’s going to fit right today, tomorrow, what do we need for which kinds of things? Sometimes I just email with my doctor? It’s a quick question bing boom, bam, we’re done. So the clinicians have got to have that flexibility. And we actually did you know, speaking of wonky, we have got a white paper that says we understand payment parity right now for telehealth, we’re still in this transition period, however, we lay out two paths that you get to value you get to telehealth within a value-based arrangement in three to five years. And we think that’s pretty reasonable.
Fred Goldstein 17:35
That’s fantastic. One of the other areas I know that you focus on because your members are involved in is both Medicare and an area I really love, which is Medicaid. So how do we ensure equity for these telehealth and technology approaches for those within Medicaid or these rural or communities or those that are less fortunate?
Ceci Connolly 17:54
Well, as you know, a lot of Medicaid comes down to state policy. So interestingly, even before the pandemic, there were some states that were pretty progressive when it came to permitting telehealth within the Medicaid program. And so that’s terrific because we already have some foundational work that’s happened. And the other really nice thing and we’ve got to give props to Congress and the administration for the big sum of money that’s going to broadband can’t happen fast enough, because many of those populations, rural underserved, but also, frankly, in a number of urban settings where they haven’t got that. So that’s going to be a big piece of the puzzle. But then we’d like to see it go one step further. And that is starting in whether it’s Medicare, but also Medicaid quality ratings have got to start to incorporate access for underserved populations and health equity. And when you start looking at the overall quality of a health company, based on everybody in the community, not just the white affluent folks, frankly, then we’re gonna get serious.
Fred Goldstein 19:14
So you just raised a fascinating point, I was involved in a Medicare stars rating bias and discrimination working group. And is it your belief that we need to begin to allow plans to recognize the types of individuals within their plan that may be biasing their ability to get higher star ratings?
Ceci Connolly 19:34
It is my hypothesis that any company is going to first go for low-hanging fruit. And so in health care, if you want high quality scores, you’re going to start with those compliant patients that are tuned in, who are connected, who have the Insurance, who can handle co-pays, all of that stuff. And everything that we’ve seen and heard so far is that that then builds in a bias against people of color, in particular, in this country. And so I think it’s high time that we start looking for the right incentives that are going to say to all of the players in health care, how are you reaching out to these folks and ensuring that they are getting appropriate care culturally appropriate when and where they need it, and we’re gonna measure it,
Fred Goldstein 20:41
right. So in essence, what those what I was getting it those health plans that say, target various minority communities, or more in Medicaid or something, or have a higher ratio in a certain socio-economic group or regional area, might have a tougher time achieving a higher star rating, because they’ve started with a lower number to begin with, is that something that you as your group may be working on?
Ceci Connolly 21:06
Not that specific approach, although now I got to quickly send a note to our policy team, because that’s a really interesting idea. You know, I think that this starts getting into some levels of complexity that really deserve, you know, some serious, serious research here. But what I would say is that ACHP philosophically does think that we need to start looking at data differently, we need to look at performance and health outcomes differently. And we need to recognize where some historical biases have contributed to these awful, awful gaps
Fred Goldstein 21:48
One of the other areas I applaud you on is the effort you’re doing to try to push legislation regarding Medicaid and post-maternity coverage. Can you talk some about that issue?
Ceci Connolly 22:01
Well, I can a little bit because we’re supportive of that. Again, I think that anyone who’s been a mom, knows a mom, has a mom, right? I mean, we all understand that’s not just a discrete nine months, and you’re done, situation. And that postpartum health in particular, is so critical, and has often been overlooked. I mean, even people started getting excited about maternity bundles. But most of those were just nine months, now you’re starting to see a different kind of thinking about moms, as well as the newborn babies. But here, I want to really give credit to our friends at ACAP, who I would say are even leaving on this, but we’re very supportive,
Fred Goldstein 22:50
fantastic. Yes, having done a high risk maternity program in Mississippi Delta, I can tell you, the two months post was not enough time, you know. And so it’s really important, I think, to be able to expand those benefits, really a great effort to do that. And hopefully, we’ll see Congress begin to push out. And I know, they have and begin to get states to say we’re going to make those changes in our Medicaid benefits to cover those mothers. So that’s really a fantastic area. What are some of the other things you’re working on? As you look on going forward with the group?
Ceci Connolly 23:19
Well, we got to get back to drug pricing. You know, thank you pharmaceutical companies for these revolutionary vaccines, God bless, really, and truly, at the same time, that cannot be justification for the many, many decades of blackbox, you know, a blackbox pricing system, a failed market. Truly, there’s not competition there. In fact, when you have a second drug come on to a market, you would think that the competition would drive prices down, it just gives everybody permission to just start creeping them up higher and higher. So I’m really pleased that our board of directors gave us the go-ahead to lobby for an entire package of reforms having to do with drug pricing. And we’ve been engaged in conversations on the Hill about this. And we do think, sadly, that it is time to give the HHS Secretary power to negotiate on those highest price drugs. And the reason I say sadly is that we and our members are believers in the free market and capitalism and competition, but you don’t have that in the drug sector nowadays. So we’re kind of this is almost like the desperation move to tell you the truth when you’ve got to call in government to to rescue a failed market. There are other provisions around Part D reforms around capping co-payments, also transparency, bringing more biosimilars onto the market. We see all of these kind of coming together, you know, different pieces of the puzzle to start to get at what is now, you know, just a really severe crunch.
Fred Goldstein 25:11
I know we’re getting sort of close to the end. One question is, do you see there’s been this move now with direct contracting by CMS to providers, self-insured employers are direct contracting? Does that mean over time that the days of a health insurer may be numbered?
Ceci Connolly 25:28
Well, so first of all, let me say, I completely understand the reasoning to head in the direction of direct contracting, it’s pure and simple frustration with the current system, and I get it, I’m right there, I find it super frustrating, especially the duplication, the unnecessary care, the low-value care, everything fee for service, perverse, misaligned incentives. I do think, however, that, you know, to use the cliche, let’s not throw the baby out with the bathwater. Because again, if you look at, for instance, our community health plans, they tend to operate on margins, 1, 2%, you know, most of them will say to me, and that’s a good year. But because of those relationships in the community, they play a vital role. They have it not just claims data Fred, but they have such a better complete understanding of an individual patient or a community, and they can bring that population health strategy in if we kind of address some of these other systemic problems.
Fred Goldstein 26:39
I really think you know, at the end of the day, it’s gonna be interesting to watch how this transitions through as people move this direction, and some providers are buying practices and etc. So a fascinating time coming up. I really want to thank you for coming on Ceci, it’s been great to catch up with you, there are a ton more areas we can go into. I would really applaud the work you’re doing. It’s really fantastic to see it and hope to get you back on again.
Ceci Connolly 27:01
We’d love it anytime. Thanks to all of you for what you do.
Fred Goldstein 27:05
It’s our pleasure.
Gregg Masters 27:06
Back to you, Greg. And thank you, Fred. That is the last word for today’s broadcast. I want to thank Ceci Connolly, president and CEO at the Alliance of Community Health Plans the voice of America’s top-quality, nonprofit, community-based health plans for her time and insights today. For more information on Ceci and ACHP’s. Work, go to www.ACHP.org or follow them on Twitter via @ CeciConnolly. That’s C E C I C O N N O L L Y and @_ACHP respectively. And finally, if you’re enjoying our work at PopHealth Week, please subscribe to our channel on the podcast platform of your choice. And do follow us on twitter via @PopHealth Week. Bye now.