Marilyn Tavenner was hired last year to take over leadership of America's Health Insurance Plans, the industry's leading advocacy group. Its members were struggling to get their bearings in the fledgling insurance marketplaces erected through the Affordable Care Act while Medicare Advantage and Medicaid managed-care programs were surging as business lines. Tavenner had recently left her post as administrator of the CMS, an agency intimately involved in those arenas. Now, Tavenner is faced with the task of coaxing two of the largest U.S. health insurers back to the fold. UnitedHealth Group, the largest health insurer in the nation, dropped out of AHIP just before she was hired, and Aetna quit this month. Tavenner addressed the challenges ahead of AHIP and its members during an interview last week with Modern Healthcare insurance reporter Bob Herman. This is an edited transcript.
Modern Healthcare: Why did you make the decision to go to AHIP?
Marilyn Tavenner: There was actually a bit of a time-off period for me, where I endured, if you will, retirement and public speaking. Then I was approached by the AHIP board chairman to come in for an interview. So there was, by the time I started, an eight- or nine-month period between jobs. But I certainly have had the pleasure of working with health plans, not just during the Affordable Care rollout, but on Medicare Advantage and Medicaid managed care. There were many opportunities for me to get to know health plans and how they functioned, both in the private and the government market.
MH: Do you perceive any conflicts of interest with the quick move, given the CMS' authority over health insurers?
Tavenner: There are certain restrictions that I have in terms of approaching this administration and HHS, which I will honor until the end of this administration, but I don't see it as a conflict of interest. I see it as an opportunity to continue to work with health plans and to try to provide access to the uninsured and quality healthcare.
MH: How would you describe your relationship with the Obama administration?
Tavenner: I haven't had any contact with the Obama administration since I left the job. I joined the administration as the chief operating officer for a chance to work on all things Medicare and Medicaid, and I'm sure the relationship is fine. I've been very proud of my bipartisan outreach. When I was confirmed, Eric Cantor spoke on my behalf, and I think that's an example of the bipartisan approach I took throughout my time at the CMS.
MH: What are the reasons behind the departures of UnitedHealth and Aetna from AHIP?
Tavenner: I think that is a great question, and one that I think you'd probably be better off asking either Aetna or United. I will tell you I have great working relationships with both. They're both great companies, and it certainly is my intention to work closely with them as we go forward with our advocacy agenda.
MH: Do you think they will rejoin AHIP during your tenure, and are you doing anything to try to entice them back?
Tavenner: Certainly that door is open, and I have worked closely with both CEOs in the past and hope to do so in the future. We are looking at everything, from dues to governance to how we move forward with our advocacy agenda, which I think matches their advocacy agenda.
MH: What is AHIP's strategy for 2016 and beyond?
Tavenner: When I arrived here at the end of August, we sat down with the board and talked about the four or five key points that are important to members, important to consumers and important to, I'd say, this country.
You will not be surprised to hear that one is Medicare Advantage. Medicare Advantage members are now probably over 30% of the overall Medicare population, and consumers like that plan. So we'll continue to work on quality and cost and growing the Medicare Advantage membership.
The second area is Medicaid managed care. Over 60% of all Medicaid in this country is now delivered through managed-care plans, so it is a big opportunity and a big challenge for us to make sure that we are delivering high-quality, affordable products to each state.
The third area is pharma pricing, and how do we work to help promote and produce solutions in that area. The fourth area has to do with delivery-system reform, and that's everything from narrow networks to provider directories. And the fifth, and hopefully a theme that we keep throughout, is how the consumer fits into this model.