Brian Fitzpatrick: 'There Is Nothing More Important' Than Ensuring Seniors Have Good Healthcare

5 months ago

During a House Ways and Means Committee hearing before the Congressional recess, Rep. Brian Fitzpatrick (R-PA) asked CEO of Alignment Health Plan and President of Alignment Health Dawn Maroney about how high-quality care is delivered to seniors.

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00:00Fitzpatrick, you're recognized. Thank you, Mr. Chairman. Thank you to our witnesses for being

00:04here today. In my home state of Pennsylvania, year after year, more seniors are choosing to

00:11enroll in Medicare Advantage plans with approximately 54 percent of seniors on Medicare

00:17now enrolled in Medicaid Advantage plans. These plans have been proven to be significant cost

00:25savings for our seniors. Just in my home state of Pennsylvania, MA beneficiaries spend approximately

00:3237 percent less than Medicare fee-for-service annually, with an average of over $3,000 in

00:39savings on out-of-pocket costs and premiums. There's also health outcomes that should be

00:45highlighted. 70 percent fewer hospital readmissions for MA beneficiaries relative to the traditional

00:52population and lower rates of unnecessary medication usage. There is nothing more important than

00:59ensuring our seniors have access to affordable and high-quality care. First question for Ms.

01:06Maroney. Can you speak to how Alignment Health coordinates with physicians and care teams to

01:14ensure the highest quality of care is provided to your beneficiaries? And can you address how

01:20offering special needs plans, including benefits such as meal plans, has impacted patient care?

01:26Thank you for that question. The whole team has to be involved. The physician, we actually have

01:35critical intervention teams specifically for your higher risk patients as well as people that are

01:39just aging into Medicare or into the program specifically as they're starting out. So depending on the age and

01:48stage of or the diagnosis of that individual is a development of a care plan that is specific to that

01:55individual consumer or beneficiary, as well as making sure that the physicians, starting with the primary

02:03care and or if there's an interdisciplinary team as a whole, is integrated in that plan. So it's putting a very

02:12proactive integrated approach to care no matter where they are in their age or stage specifically or diagnosis

02:21to address that. Our ADK, our admits per thousand are sitting at 149 ADK in comparison to over 200 plus

02:30when you look at the basic fee-for-service program. Our readmission is in, you know, in the low numbers

02:36specifically in comparison about four to five percent better than Medicare fee-for-service.

02:41And so we look at that and then you can offer additional benefits above and beyond traditional

02:47Medicare that are very rich directly to that Medicare beneficiary. So whether utilizing getting food

02:53or getting special vitamins or getting fitness or dental hearing among a vast variety of packages that

03:01are customized specifically for that constituent. Thank you. And I want to note, Medicare Advantage can be

03:07strengthened, must be strengthened, specifically through modernizing approaches to administrative

03:13challenges. Mr. Chairman, I'm very glad to see prior authorization being addressed by the industry in an

03:19effort to streamline and improve patient experiences. The potential for administrative burdens delaying access to

03:26care, we've all seen it, we've all heard about it, especially medically necessary care, must be taking seriously as more seniors choose MA plans.

03:36At a time when too many providers are already stretched in, therapy requirements place an additional administrative burden,

03:43particularly on independent and community-based practices. Many providers report experiencing high

03:49administrative challenges when navigating varying MA plan step therapy policies for physician-administered drugs.

03:59This often requires hiring additional staff and adds hours of administrative work each and every week.

04:06Dr. Miller, a final question for you. How might this administrative process be improved

04:12so providers' time and resources are more focused on delivery of care rather than step therapy

04:18requirements on prior authorization to lease? So, input for drugs in particular, putting the

04:26formulary tiering into the electronic health record, showing where the beneficiary is in their deductible,

04:32showing what's not formulary, showing what requires a prior auth, automating that data submission.

04:38And I think that the managed care industry has the funds to do that. Hopefully now they have the

04:44political willpower to do that, given that we've now had probably 20 conversations about prior authorization

04:50amongst all my colleagues and I over the past couple hours. And I would say, you know, Medicare Advantage plans,

04:57they spend around 72 percent of their rebate dollars on reducing beneficiary cost sharing or premiums for

05:04routine medical services. So that means, and that's A, B, and D benefits, so that means that there are other

05:09dollars in there that they can use to promote and improve IT administrative process. Thank you. Thank you all

05:17for your time. Mr. Chairman, I yield back.

Brian Fitzpatrick: 'There Is Nothing More Important' Than Ensuring Seniors Have Good Healthcare

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