3 Takeaways From #AHIPMMD

by Alicia Caramenico

September 29, 2017

From payment rates and value-based payment models to new innovations and new regulations, AHIP held four days of informative sessions on the Medicare and Medicaid programs in Washington, D.C. We’ve collected some of the key themes and takeaways from the National Conferences on Medicare, Medicaid, & Duals.


Bernard J. Tyson, Chairman and CEO of Kaiser Permanente delivered a strong message about the importance of ensuring that everyone in this country has access to high-quality, affordable health care. Looking at the big picture, Tyson said that people need to be in good health to live out the American dream of life, liberty, and the pursuit of happiness. He reflected on the creation of Medicaid and Medicare in 1965, and the fact that today Medicaid provides access to the front door of the U.S. health care system for 75 million Americans.

Accessibility also goes beyond the boundaries of health care to nonmedical social determinants, such as access to healthy food, housing, employment, and education. For instance, Young Joo, vice president of Clinical Operations for CareMore Health System, discussed his company’s commitment to meet the health and social needs of members through mobile comprehensive care, extended appointments, and greater integration of behavioral health.

And Sara Rosenbaum, professor at George Washington University, emphasized how Medicaid is the building block for other social safety-net programs and is central to the support we provide for adults with disabilities. Rosenbaum also noted the important role that Medicaid managed care plays in serving beneficiaries, especially in ensuring continuity of care.


Humana President and CEO Bruce Broussard discussed the importance of health plans evolving together from an industry focused on institutionalized, episodic treatment to an industry that enables integrated care. He pointed to opportunities to integrate health care and lifestyle, improve interoperability to remove friction points in the current system, and advance innovation and technology through analytics. Broussard suggested growing cost pressures, advances in technology, and changing consumer preferences will drive structural changes over time as health care organizations respond to these issues.

John Baackes, CEO of L.A. Care Health Plan, shared his passion for “out of the box” thinking to integrate Medicare and Medicaid and better serve patients eligible for both Medicare and Medicaid. While noting that simplicity is a key objective, Baackes highlighted the need for a benefit that is both comprehensive and comprehensible for beneficiaries, families, and caregivers.

Opioid Crisis

The opioid crisis is the most vexing problem facing our nation today, according to Virginia Gov. Terry McAuliffe. While he thanked health insurance providers for the role we play in helping to reduce how much and how often opioids are prescribed, Gov. McAuliffe also emphasized that more help is needed from the federal government, including a stronger partnership with states.

Dr. Nicholas DeGregorio, Senior Medical Director at UPMC For You, discussed how UPMC Health Plan is focused on several goals to combat the opioid crisis in its community. They include increasing evidence-based, safe prescribing; reducing opioid overdoses and deaths; increasing screenings, referrals, and treatment; increasing medication-assisted treatment and quality standards; reducing avoidable utilization related to opioid use disorders; and reducing the misuse and diversion of prescription opioids.

AmeriHealth Caritas also is taking multi-faceted approach to address the opioid crisis. Corporate Chief Medical Officer Dr. Andrea Gelzer highlighted itsr focus on monitoring and calling out overprescribing, integrating behavioral health and primary care, providing non-pharmacological benefits and support, and ensuring access to naloxone and multi-disciplinary pain centers. Gelzer also noted the role yoga and physical therapy can play in helping some patients who are struggling with addiction.