Alignment Healthcare's Maroney on Medicare Advantage, drug costs

Dawn Maroney became president of Medicare Advantage insurer Alignment Healthcare at a fraught moment.

Not only is the health insurance industry reeling from the murder of UnitedHealthcare CEO Brian Thompson in December and the backlash against the sector that followed, but the Medicare Advantage market is in a sustained period of struggle as insurers clamor to soothe investors and boost profit margins.

Related: Right place, wrong time: BCBS insurers report Medicare gains

In January, Alignment Healthcare promoted Maroney from president of markets and CEO of Alignment Health Plan to president of the parent company under founder and CEO John Kao. Alignment is one of the fastest-growing Medicare Advantage carriers: Membership rose 58% to 189,100 at the beginning of the year, far exceeding the 4% average across the sector.

The interview has been edited for length and clarity.

What are Alignment’s priorities for 2025?

The Medicare Part D prescription drug benefit is a big area of focus. It's getting more refined. How do you track that to make sure that people are getting access to drugs that are at zero copays, underneath that $35 insulin allotment and not going over the $2,000 maximum out-of-pocket? How do you make sure that there's a care plan around what they're getting access to?

There is a lot of work that goes on behind the scenes from an operational standpoint. If somebody says, "I can't afford a particular drug," and they're eligible for the new payment plan this year, how do you make sure you educate on it?

What do you think of the Medicare Advantage advance notice

Overall, it seems pretty reasonable. I want to understand more about the marketing pieces of it. I do not believe that agencies themselves should be marketing specific benefits, other than highlighting that, "I'm an agency, and I represent Medicare Advantage, and I can be an option for you."

We've got to still clean up that, so I like CMS’ position on that.

Why did Alignment sue CMS over the Medicare Advantage Star Ratings program?

We want to be better, and we want to be aligned with CMS. It's when rules or decisions come after you're already in the measurement year that there’s a problem.

Like when COVID happened, you knew people are not going to get access to care. Physician offices were closed. We're telling people to stay home, and trying to do telehealth and virtual visits. So how do you survey a senior to say, "Did you get into your doctor's office within 15 minutes?" and then you're scored on it? You're not paying attention to what's going on in the environment.

There is definitely work that CMS needs to do. When you have that many lawsuits, it's a problem. There's alignment on these lawsuits because sometimes you feel like what they do is in a black box.

How would lifting Medicare’s coverage prohibition on weight-loss drugs impact insurers?

We cover a lot of people under Ozempic and Wegovy for diagnoses other than obesity. We brought a whole team on to design a product because the cost of the [glucagon-like peptide-1 receptor agonists] are so expensive.

I'm really very much in support of it. I actually think it's powerful. But it has to have a comprehensive plan. It's not just, "Hey, let's give the drug to the person, but do nothing else to support what's going on for them and their livelihood."

We want to make sure that there is true care management, and that it’s not just a way to elevate pharmaceutical companies. It has to be comprehensive, especially if it's done with people that are over the age of 65. You have to make sure you’re maintaining your muscle mass because muscle mass goes away as you lose this weight, which can cause other problems.

How should the health insurance industry respond to the murder of UnitedHealthcare CEO Brian Thompson?

We need to get back into educating on the value of health insurance.

Sometimes you’ve got to give the reasons why there was a denial. You can't just get everything for free.

You want to be there when healthcare is really needed. In some instances where people are really disappointed, it is because some of these companies may not be there for them. You have to pay attention to what people are saying, and educate and draw change from that. How do you effectuate change as a result of people’s feedback? That feedback is powerful.

Did Alignment increase security after the UnitedHealthcare shooting?

Immediately. We’ve elevated our security for when we’re at events. It’s just so sad and disheartening. When you see that situation, I don't know if there's anything that could have been done, but we were doing that anyway as we got bigger.

We get different types of threats all the time. Some of them you wonder: Do you take it seriously or do not take it seriously?

Mental health is a problem, too. Sometimes, I'll want to personally talk to members when they're having problems or if they don't like a service person. But if they say to a customer service rep, "Well, I'm just going to show up to your door, and I don't care if I live or die," then you have to pay attention to that. That’s terrifying.

When you look at social media — no matter what position you are — if you're in this business, you start thinking, "Gosh, am I safe?"