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Quality & Governance News

After CMS Tenure, Tavenner Takes Over Payer Relations at AHIP

By Jennifer Bresnick

- Months after stepping down as Administrator of the Centers for Medicare and Medicaid Services (CMS), Marilyn B. Tavenner will become President and CEO of America’s Health Insurance Plans (AHIP), a powerful trade group for payers that includes most of the biggest insurance companies in the nation.  Tavenner will take the reins from Karen Ignagni on August 24, the New York Times reports

Former CMS Administrator Marilyn Tavenner

“This is a great opportunity,” said Tavenner in an interview with the NYT. “AHIP has a longstanding reputation as focused on consumers and consumer advocacy, and being a leader in the transformation of health care.”

The healthcare industry underwent massive changes during Tavenner’s time at CMS, including the genesis of the EHR Incentive Programs and the implementation of the Affordable Care Act.  While Tavenner, along with former HHS Secretary Kathleen Sebelius, quickly became mired down in political morass following the unsuccessful launch of Healthcare.gov in 2013, both leaders are also credited with nurturing accountable care and value-based reimbursement during its initial challenges.

“As an agency, we rose to the challenge to control costs and increase value,” said Tavenner in her farewell email to CMS staff when she announced her resignation in February.  “We are moving the needle by accelerating the development and expansion of innovative new healthcare payment and delivery models.”

“In the past five years, we have seen historically low growth in overall healthcare spending, which is projected to continue into 2015,” she added. “Medicare Part B premiums have been stable, beneficiaries are saving money on prescription drugs and preventive care, and the solvency of the Medicare Trust Funds was recently extended to 2030.”

Tavenner plans to continue the industry’s momentum in these areas, albeit from the perspective of private payers who must keep a sharp eye on their profit margins.   She acknowledged that federal rules limiting lobbying efforts due to potential conflicts of interest would keep her away from urging HHS or CMS into favorable courses of action, but she added that she is not prohibited from lobbying Congress.

She may not have to push too hard on certain issues, however, as AHIP members have been largely supportive of working with federal groups to increase value-based purchasing, expand population health management, and significantly cut unnecessary utilization of expensive services.  Some payer groups, like the Health Care Transformation Task Force, have even pledged to exceed federal goals for accountable care in a rare instance of alignment between federal and private industry interests.

Departing President and CEO Karen M. Ignagni, who will become President of EmblemHealth after 22 years at the helm of AHIP, recently praised private payers for driving accountable care forward through the use of advanced big data analytics, health information exchange, and care coordination strategies.

“Today, health plans are employing a multi-faceted approach to care coordination and disease management,” she wrote in an op-ed published by the American Journal of Managed Care in March. “With detailed data analysis, health plans are working with clinicians to identify gaps in care and to provide personalized support for patients managing chronic conditions.”

“Our unique ability to help individuals across the care continuum—from the time patients make that first doctor’s appointment to when they visit a specialist to help them to manage a chronic disease—is what enables health plans to ensure that patients receive the best value for their care.”

Tavenner’s experience with accountable care at CMS, as well as lessons learned during her former employment with the Hospital Corporation of America, may serve her well as she transitions back into the private sector once again.  Acting CMS Adminsitrator Andy Slavitt has been nominated to take her place as head of Medicare and Medicaid.

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