Episode 96

Affordability & Innovation in Healthcare

with Ceci Connolly

January 19, 2023

Share Episode
Share on email
Share on twitter
Share on linkedin
Share on facebook




Ceci Connolly
President & CEO, Alliance of Community Health Plans

Ceci is a recovering journalist who now is in passionate pursuit of a better, more equitable, more affordable health system. She is President and CEO of the Alliance of Community Health Plans, a national organization of leading nonprofit, provider-aligned plans. Ceci is also the host of the Healthy Dialogue podcast. After 25 years in the news business – at outlets such as the Washington Post, the Associated Press and Congressional Quarterly – she worked at both McKinsey and PwC in health care thought leadership and consulting. She is a founding member of Women of Impact for Healthcare, co-author of Landmark: The Inside Story of America’s New Health-Care Law and What It Means for Us All, and serves on the advisory board of Fannie Mae’s Sustainable Communities Initiative.


We don't advance or propose or support policies just because we like them. It's because ultimately, it's going to help our companies be better.



Dr. Gary Bisbee: Well, good morning, Ceci, and welcome.

Ceci Conolly: Thank you, Gary. It’s great to be with you.

Dr. Gary Bisbee: We’re pleased to have you at this microphone and we’d like to dig into the Alliance for Community Health Plans and your role as the president and CEO could we start off Ceci with you’re describing the Alliance for Community Health Plans for us please.

Ceci Conolly: Yeah, I’d be happy too. So the Alliance we also refer to it as a C H P cuz we love initials here in Washington, DC is a national trade association based in Washington. All of our member. Are not-for-profit provider aligned regional health plans. And I know that’s a bit of a mouthful, but it’s important that I hit each of those criteria because it not only describes our unique membership, but the particular model in healthcare, the payer provider partnership. Grounded in local communities that we believe very strongly in. So it’s also our North Star in terms of the work that we do here in Washington with our members. We think it’s a model that more often leads to better health outcomes for individuals and the communities, and over the long term better.

Dr. Gary Bisbee: So Ceci, after. 20 years as a distinguished journalist and a leader of research slash publishing organizations you chose to agree to join the Alliance. What was your thinking behind that? Why did you do that?

Ceci Conolly: Well, a couple things and at heart I still tell people that I’m an Instaed Re which is indeed fundamentally my d n a. I have reporter d n a 25 years in the daily news business, including at the Washington Post. After that, I went to McKinsey and helped a good friend. Set up the Center for Health Reform there. So I was still in the kind of thought leadership world, if you will, and pwc a very similar role. But what attracted me to the Alliance of Community Health Plans is that I had. Seen enough of healthcare across the entire sector that I really did come to believe in that model. And so when this opportunity presented itself, I thought to myself, this is a chance to have a job that aligns with my own beliefs. And my own values, and so to get paid every morning to get up and try to contribute to something that I really believe in and want to succeed in our country was just an amazing opportunity.

Dr. Gary Bisbee: We all know now that the federal government is the largest payer and regulator of healthcare. How do you spread the gospel about the value of the payer provider model in Washington?

Ceci Conolly: Well, and I’m really glad that you mentioned that payer piece, Gary, because it’s interesting. Everybody thinks about the government as a regulator, and in fact, healthcare is, as one of the most highly regulated industries that we have in the country. But as a payer, the federal government has the opportunity to use that purchasing power to achieve other goals. And so we are often in dialog. I’m very constructive with H S, the Centers for Medicare and Medicaid Services, other federal departments and agencies, often speaking to them about how they might use that purchasing power. The big example right now would be Medicare. Medicare Advantage. In particular, in Medicaid. Those are the two. Behemoths, if you will, and they’re getting bigger as more and more baby boomers are retiring. So much of our work is research and then writing and talking about we hope, creative, innovative solutions for those programs to make sure that they stay modern and relevant and serving this next generation of beneficiary. Of course, we’re also spending a lot of time on Capitol Hill. Having similar conversations with lawmakers and their staffs, and I will just credit our team in 2022. We had a couple of very significant wins, not us alone. Certainly organizations like mine we’re all about partnership and coalitions, but we really did score some important healthcare victories in 2022. So it can actually work sometimes.

Dr. Gary Bisbee: Yeah. So can you share with us what were the victories that you’re referring to?

Ceci Conolly: Sure. Couple. One is an extension of the telehealth flexibilities that were put into place during the pandemic, and I think now everybody can see the marvels of telehealth. It’s not perfect. It doesn’t apply to every patient in every situation, certainly, but the things that can now be done with telehealth and potentially at a reduced cost are so important. So the federal government, extending those flexibilities, gives all of us in the industry the opportunity to keep improving, keep refining. Collecting that important data that we can demonstrate the outcomes and the impacts. So that area is super exciting. The other, frankly, and I know this won’t thrill all of your listeners, but from our perspective, starting to get a little bit of control on some drug pricing issues, Gary. For our small plans that typically run on one in 2% margins, the rising cost of pharmaceuticals can be crippling. So we had some major success working with C m s and really urging that experimental Alzheimer’s drug Agile hem not have broad coverage at this point. And so in fact, the the department did agree. A will be prescribed in a clinical trial, and that makes the most sense because we can keep studying and learning and see if it’s really worth that price point. The other provisions came in the Inflation reduction Act, and they include things such as a little bit more transparency on drug pricing and also the h s Secretary now having the ability. To negotiate prices on a small set of those very high cost drugs. So they’re baby steps in our perspective, but they’re so important to patients, being able to get the right drug at the right time, at the right price.

Dr. Gary Bisbee: Well, you’re talking. About the role of a C H P, as a leader in change and the evolution of our healthcare system which you mentioned just due to the the incredible growth of Medicare eligible as Medicaid. Right now I think we have almost half the people in the country on either Medicare or Medicaid. So this has been a major evolution.Ceci, one of the main issues that we all talk about is value. and I think the payer provider model that your members exemplify our key to that. How do your members think about value and what steps are they taking to promote value?

Ceci Conolly: I think that the simple way to maybe think about it is how you spend that premium dollar and you want more of that dollar to be going to care. Care coordination, patient service, patient access in an equitable fashion. You’ve probably heard me say this before, Gary, but I think that at the root of our problems in the US health system is fee for service medicine. And I’ll give my usual example, which is if I were still working at the Washington Post and the editor walked up to my desk one day and said, from now. You’re gonna get paid per word. stories would get longer, not better. And so why we think that for healthcare, doctors, nurses, hospitals, you name it. That they only get paid a good healthy wage if they do more stuff to you is just wrong, frankly. And we’ve seen the result of those perverse incentives. So I’d like to think that value is the opposite of that. If we can really get there and we’re on a journey, it’s a slow, long, painful, torturous journey at that. But I do think of it as a journey and it’s really applying that dollar. To what’s gonna keep people healthy. And a lot of times that means not going to the hospital, not having a surgery, not having one more scan, not taking one more pill. And that’s a very counterintuitive thing for people who, for generations were brought up in an economic environment that said no, you earn a living by doing.

Dr. Gary Bisbee: You spent a lot of. I’m sure with congressional members and staff, how does the message about fee for service versus value, how does that message carry with them? Are they do they understand it? Are they willing to begin to lead a campaign to try to, to soften, be for service and move more to some kind of value like your members are providing?

Ceci Conolly: I think that with so many new players in Washington and to some extent the very polarized nature it’s difficult to get to the sophisticated solutions that need to follow. I would say in a typical conversation, when I share these thoughts with lawmakers, they understand it from a basic, logical perspective and they can agree, but then translating that into legislative policy that’s gonna upend the industry and they’re gonna hear from people that would lose under change. That becomes a very powerful counter force in the.

Dr. Gary Bisbee: We always talk about aligned incentives and how the fact that fee for service, I mean you make the point, really stands in the way of aligning incentives. Your members and the. model that they use clearly moves down this pike toward much more aligned incentives. Is that a model that you can use when you talk to the congressional staff and members as examples of aligned incentives?

Ceci Conolly: Absolutely. And those are really the ones that are most terrific. And frankly, it’s not just coming from me, but it’s coming from our member company CEOs and CMOs and pharmacy directors who come into town and we go and we do meetings together. And I’m able to say, why don’t you hear this directly from. This person who’s on the ground doing this work, and we do have wonderful case studies instances from all of our members, and they’re up on our website too. But really shows how when you have those groups coming together on behalf of the patient, you can have terrific outcomes. So, Medicare Advantage is the best example of that because a plan gets a set amount of money for each Ben. And the plan then determines what are the things that are going to keep this person healthy and well and thriving. So it enables them to do things like food and nutrition, if that’s what’s needed, or transportation to a doctor or to rehabilitation therapy, these sorts of things. If you’re back in that fee for service, factory, machine model those become additional. And very hard to include those.

Dr. Gary Bisbee: Yep. Do your members have Medicare Advantage plans or do they work with Medicare Advantage plans? Ceci.

Ceci Conolly: absolutely. And I’m also proud to say that we have a disproportionate number of the five star plants. Those highest rated, as well as up there on the four and four and a half, and. Unfortunately, not a lot of consumers are paying attention to those stars. I’d love to encourage everybody. If you’re helping somebody shop for Medicare Advantage, take a look at those.

Dr. Gary Bisbee: Ceci as as well as are better than most. The healthcare system has been criticized for not being consumer oriented pretty much forever it seems like. What are your members doing to be more consumer centric?

Ceci Conolly: Well, several things, and it is a good question. And I would start with, I remember very early in this role, one of our CEOs said to me, that frankly he gets a little bit frustrated by that criticism because when you stop and think about it, Who is negotiating on your behalf with hospitals and drug companies and your occupational therapy and your physical therapy, and all of these other components of the healthcare system. It’s your health plan that sits across the table and negotiates to make certain you can go to this hospital and what is it gonna cost? And you can get these prescription medications and that is hard work. , very hard work. Not perfect by any means, but that is the role of your health plan to help negotiate for all of those services that you and your family might have. Now, that doesn’t necessarily translate into a great consumer experience because consumers are still left to navigate the system. So many of the things that our members are doing now, and they can do this because they are there in the local community, is that they. Many different entry points for people so that you are meeting the patient and you’re meeting the beneficiary where they are.

Dr. Gary Bisbee: Yeah, I think it’s clear that consumers aren’t always attuned to affordability and how they can. Find more affordable care Inherent in what you’re saying, I think, is that your members actually are thinking about how they can work with the consumer to make sure that they understand what the issues of affordability are. Is that fair to say Ceci?

Ceci Conolly: Yes, absolutely. And I’ll be more specific, Gary. Long before the federal government headed down the path, Requiring pricing transparency. Many of our member companies had already invested in or developed themselves. These tools typically right there on that homepage of the website where you can type in a little bit of your personal information and then you can do a search, Hip replacement surgery or x-ray or broken arm, and it will show you some choices and it will show you where you can go. So which one is close or could I do it with a televisit? And then prices. But it will tell more specifically, not just some big negotiated price, but it’ll tell you your specifics. So have you reached your deductible? What would be the co-payment, that kind of information, and even many of them are tying in quality metrics. And so that’s really in throughout this entire conversation here in Washington about price transparency. We’ve said, listen, just throwing out massive databases of negotiated prices is not gonna help a consumer. It might be fun for companies that want to look up their competitors, and we know that’s going on, but it’s not a consumer oriented provision.

Dr. Gary Bisbee: So home care is one of those areas that seems intuitively to be a good idea, but we know that there’s regulatory issues, there’s payment issues. What are your members doing about home care and trying to expand home care in in their among their members?

Ceci Conolly: Well, in many respects it’s back to the future, right? There used to be the doctor, the family doctor that did house calls, and I think that a lot of us probably now miss that . And some of our members are actually bringing that back in one form or another. But the difference nowadays is that it is usually technology enabled home care. The great example with several of our member plans is hospital at home. And it’s typically a choice that’s given to a patient and family, these 100, 200 different conditions. It could be pneumonia, it could be C O P D recovery from surgery, any number of things, and you give the patient and the family the choice. not surprisingly, most of them, when they hear they can stay in their own bed. And maybe even eat their, loved ones. Home cooking , that’s what they choose over that hospital, . And then there are gonna probably be some remote monitoring devices, whether it’s a blood pressure cuff or if they’re a diabetic, maybe a glucose monitor, Whatever the technology may be, that’s gonna be feeding constant information back to your healthcare hub, if you will. And then probably a nurse or a physician will be coming and doing periodic checks. And I can tell you at a place such as security, one of our members affiliated with Marshfield or Select Health part of Intermountain the con, the consumer satisfaction, Gary is. . It’s up in the nineties and that is just remarkable. And in most instances, they are saving money because, and again, somebody will say, well, that’s expensive to send somebody out to the home.

Dr. Gary Bisbee: So we’ve seen the advent of the large cap companies of c v s, Walgreens, Walmart, Optum now Amazon elbowing their way into primary care. How is that affecting your members or how do you expect it will affect your members? Ceci.

Ceci Conolly: It’s probably still a little bit early days for us to really know how this is gonna play out, and we’ve certainly seen non-healthcare companies try to get into the business in the past and it’s been a tough road to hoe in part because healthcare is complicated and it’s highly regulated. . That said I think that there is the potential for partnerships with our plans if this is another way to improve access, especially equitable access, maybe for populations that are not getting to a doctor or an academic medical center. That could be positive. I think though, we’ve really got to press on the notion of. Coordinated care or integrated care models, because if you go to a C V S for one thing and then you’re at Walmart getting something else checked, and then you get to a doctor and then you’re at somebody else’s hospital, nobody’s gonna be quarterbacking that care for you except maybe you, and that’s a full-time job. Keeping it all straight. And that’s really where you end up with these gaps in care and you miss things and you probably repeat things. So if it’s a disintermediation of the business, it will be problematic for legacy companies from a financial perspective. But I more importantly, I don’t think it’s gonna lead to better health unless we start seeing that coordination.

Dr. Gary Bisbee: So, Publishing the report on affordability in healthcare, an annual report, which seems like just a terrific idea. What led to that? Why are you doing that now? Ceci?

Ceci Conolly: Well, it was interesting, shortly before the pandemic, we had a board meeting and we spent a lot of time talking about, first of all, our roadmap for the next decade. So we had published Roadmap 2030. , and that really lays out some of the big important pillars from the perspective of our members that we’re focused on. But as an element of that, I really credit our board members and the CEOs who said, we need to lead by example. And so the two pledges that our board members established, one was on publishing that annual report on affordability. And it’s just our attempt to say, here’s what our members have done in the past. To try to improve the cost of care and coverage and make things affordable for individuals, for purchasers, for the government, you name it. The other pledge that our board took was over this 10 year period to really, in their communities, move the needle on two chronic diseases, diabetes and heart disease. Not surprisingly, those are the ones we landed on since they really are. Spreading across the population are terrible impacts on our health and also cost. And we’re very excited that really that came from our CEOs.

Dr. Gary Bisbee: Ceci, let’s dig into your role as president and c e o of the Alliance and you’ve been C e o now for more than seven years, which I think in Washington DC an eternity actually. But what have you found to be the most rewarding about leading a membership group?

Ceci Conolly: Well, it’s first and foremost about our terrific team and we just have such a strong. Passionate, committed group of individuals. We like to say that we’re small but mighty and that is really just a testament to everybody on our staff. The other thing that just gets me so energized, and this was difficult during the pandemic for me, but being able to go and visit our member companies all over the country. and see firsthand, maybe it’s the reporter in me, but I don’t wanna be sitting in the office. I wanna be out seeing and doing and understanding, and on the ground and every single trip that I make, even if I say, gosh, I’ve been on an airplane so much, I’m tired and the hassles this and that. As soon as I get there and that I have that opportunity, I just am completely re-energized and recommitted to the.

Dr. Gary Bisbee: Ceci, one thing about a, an organization like this where you have a representative board of your members, it’s a large board. How do you handle coordinating the board and educating the board?

Ceci Conolly: Our board is our group of CEOs and they are busy people and they have major challenges these days. And so it can’t just be one email that’s gone out and assume that everybody had time to sit and carefully read it and think about it. I do one-on-one calls with every single one of our board members multiple times throughout the year. there are four board meetings typically in person, some virtual and then I go and do the visits. So, and it really is important that I am able to listen and hear what’s on their mind, what are their priorities, what are their pain points, so that I can bring that back to the team and we can then make certain that we are really tracking. What they’re looking for. On the other hand, there are times, especially as it relates to Washington and policy, where they’re gonna be looking to us to be a little bit ahead of them and be saying, Hey, this is on the horizon. This is probably coming up. We wanna prepare for this. So it’s a very much a two-way relat.

Dr. Gary Bisbee: Ceci, thanks so much for your time. This has just. As expected, by the way just a very interesting and informative interview. Thanks again.

Ceci Conolly: My pleasure.

Subscribe for Updates​

For exclusive access to Think Medium content and program updates, subscribe here.