Medicare Advantage, AI, MFN, China, and Consensus Building: Powerful Insights from HLC

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Welcome to Value-Based Voices, a podcast from the Association for Value-Based Cancer Care.
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Each episode dives into the shifting terrain of cancer care in the United States, exploring what value means in today's clinical, policy, and patient-centered environments.
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Our mission is to spark informed dialogue, promote transparency, and equip every stakeholder from providers to payers to patients with the insight they need to navigate cancer care with clarity, confidence, and purpose.
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My name is Jayson Slotnik.
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I'm a partner at Health Policy Strategies and an AVBCC board member, and I'll be your host for this episode.
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I am so happy to be joined by Maria Ghazal, president and CEO of the Healthcare Leadership Council.
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We are going to discuss a wide range of topics, starting with Medicare Advantage and its future, transitioning into the power that artificial intelligence can have on healthcare, and finishing up with some words of wisdom from Maria on how to build consensus in a much more diverse organization than ABBCC.
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Before I turn it over to you, Maria, I just have to say I've been a swamp creature for almost 30 years now, and HLC has always been a valued resource for us policymakers, right?
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Because of the kind of members that you have, the work product that you put out, and I'm really excited about this conversation.
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We are going to cover a wide range of topics: Medicare Advantage, Consensus Building, Artificial Intelligence, China.
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So the audience, get ready for a wild ride here.
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We're going to cover a lot of issues here.
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And on behalf of Value Based Voices, we're a collaborative organization.
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So I look forward to learning from one of the best in the Swamp here on how one builds policy.
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But before we get into that, Maria, why don't you give us a few words about yourself, uh, how you came to run HLC, your background, and of course what HLC's mission is and who your members are.
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Great.
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Well, thank you very much, Jason.
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It's a real honor to be here and to be your guest today.
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So my name is Maria Ghazal I'm the president and CEO of the Healthcare Leadership Council.
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You're calling it HLC.
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Not everyone knows our acronym, but they certainly will by the end of the podcast.
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And you're right.
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It was established almost 40 years ago.
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It's hard to believe because you and I both remember when it was put together.
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And it's an honor for me to be leading it.
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I've joined, I'm in my third year as the president CEO.
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And this is an organization of CEOs, C-suite leaders, who are they represent organizations across the healthcare ecosystem.
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So we have payers, we have providers, we have manufacturers, pharma, and device, we have technology, we have we have new entrants into healthcare.
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And we are uh we are a public policy organization.
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We're based here in Washington, and we are we are a highly respected and a real uh organization that is is looked to for where we can come up with consensus-driven solutions to uh to help patients and improve outcomes.
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Yeah, and I know you're a bipartisan organization.
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Um about how many members do you have now?
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We have about almost 60 members, which is uh which is a high for for the Healthcare Relational Council.
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It's a high for HLC.
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We hover between 50 and 60, and that's one of the one of our goals there is to have an organization where everyone knows each other and there's a real trust, because as you and I know, that's an important part of building consensus.
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Exactly right.
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I was about to say the same thing.
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Uh and so we're gonna dive right into it.
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Um and because you have a diverse membership, there isn't an issue in healthcare, as everybody heard in the intro, that doesn't touch HLC.
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So we're gonna start on the payer side.
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We're gonna start with Medicare Advantage.
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And you and I have been around long enough.
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We saw Medicare plus Medicare plus choice, right?
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The Flint administration, it goes up and down the payment rates.
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And but Medicare Advantage has been pretty stable over the last couple of years.
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It's growing.
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It's we hear it's the government's overpaying for Medicare Advantage.
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But HLC has done a lot of work, and by the way, for those of you who are watching this, um, you should certainly go to the HLC website.
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You can see all of Maria's organization's position papers.
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You can probably follow along.
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So, Maria, tell us what you guys are doing on Medicare Advantage and how you guys are building a consensus to work around preserving Medicare Advantage, keeping the market focused, right, a market-based solution competition as opposed to perhaps a single payer, which some have called for.
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Tell us what some of the work HLC has been doing on MA.
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You're right.
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I mean, over 50% of seniors are now in Medicare Advantage.
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And when we hit that watermark, I think things changed a little bit.
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And we we found ourselves really looking at a lot of attacks almost on Medicare Advantage, whether it's on the cost side and particularly what the MedPAC estimates.
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I think your your listeners all know uh what MedPAC is.
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So we've we spent a lot of time last year putting together a very thoughtful report, taking a going through line by line what the cost estimates are and really pushing back on that.
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And again, that that's all available on our website, but that's one aspect of it about the the um the cost.
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We also want to make sure that people understand the quality because Medicare Advantage, we think, is a great place to be implementing value-based care.
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This is care coordination that that is very important.
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We want to see more of that in healthcare, not less.
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And we also think that that is an area where uh the players are are really trying to address some of the tension points, such as prior authorization.
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And so we're we are working on that uh that uh that issue as well.
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I I don't know what I think we all know, uh or maybe your listeners know or or don't know, that a bill is just passed uh unanimously, which is how rare is that in the House Ways and Means Committee.
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It's called the Improving Seniors Timely Access to Care Act, and we supported it, and uh and this and we're pushing to have Congress move it forward.
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And that's uh a very important bill because it it really focuses a lot on on the it it says uh it I think that it really shows that there's broad recognition that that there's still an appetite to work on prior authorization uh and that it needs modernization.
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We um you know, we're supportive of the bill.
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We also think at the same time that uh that that patients need to understand that why we have prior authorization.
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I mean, it can do things like it can address you know adverse drug reactions, it can address overutilization or misutilization, it can, you know, it can be a good guardrail, but there's clearly an appetite for for speed and for uh and for for addressing you know the tension points.
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As you mentioned, we we do have a right, same broad representation you do.
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We have payers, we have providers, we have patient groups, and it's a prior auth is a great example of how we've got that that of an issue that really touches all aspects of the membership, like it does for you.
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And depending on what point of view you have, right, it drives on what you how you feel about prior auth.
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And I I think agree with you, which is prior auth as most healthcare policies is rooted in a good policy to some extent, and then sometimes it drifts one way or the other and it gets abused or it's used in the wrong way.
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And I agree, prior auth probably has moved too far to sort of as a barrier, as a as an unnecessary tool in some places, but some places it is.
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It is a necessary tool to sort of, as you said, manage and do the gateway, and then it it could be approved.
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And so I think I agree with you.
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I know the legislation it should be modified, the prior auth should be modified and um used and have some greater oversight.
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Is that where HLC is as well?
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Is that what we're trying to do?
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I mean, we're supportive of the of the bill that just passed the House of Waste and Means Committee, but you know, let's not forget that there's already been some regulations that that we have.
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There's already some new uh you know prior auth reforms, and then there's these voluntary pledges.
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And we um we look to those voluntary pledges.
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A number of our members and probably our mutual members have signed these pledges.
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Uh, we think there should be a little more time for them to work for so we can get data out of them uh instead of jumping too far ahead to you know to knee-jerk reaction.
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We also think that that uh that AI is starting to help.
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I mean, you hear these commitments that AI is being used to say yes, not to say no.
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It's helping with the paperwork, it's helping with speed, it's helping with you know getting some of these frustrations are that there's the lack of communication, the lack of of of intersection of you know the data that is needed to make a decision.
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So hopefully AI will help with with that as well, and we'll we'll talk, I'm sure, more about that.
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But you know, we think that that it's uh it's definitely a tension point.
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It seems to be particularly focused on MA, but there's there's parts of this that, you know, let's see what some of the reforms are going to do, and then let's also see this bill, and then some of the voluntary commitments.
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We we spent a lot of time, frankly, on this issue.
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When I first came to HLC, it it came up at the first membership meeting.
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And we we really spent a lot of time.
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We went back out to some of the other organizations who represent the payers.
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How can we be helpful?
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They were starting to think through all of these commitments that they eventually announced and that they got pledges for, and we socialized it a lot, the concepts here at at the Healthcare Leadership Council, and we try to, you know, have a better understanding.
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Uh we'll talk about consensus throughout today, but one of the the good th things that we can do is we can have a panel discussion of just our members, closed door, they're hearing each other, they're able to ask questions that are harder to ask at a in a bigger venue that you know maybe you want to ask in a somewhat of a larger room.
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And I think that that's increased some of the understanding and the frustrations.
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Because for every I mean, you know, we've heard this our whole lives.
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There's always two sides a little bit to every story.
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So it's I think it's increased - yeah, if not more, so it's increased some of the understanding.
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It's I don't I'm not saying it's cured everything, but um but it's well right.
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I mean, you're not gonna cure everything when you got everybody on the all all these opposite sides, right?
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Like you said, we get to consensus.
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But that is good news for the membership of VBCC to hear that there is a recognition that perhaps the prior authorization as it currently is constructed has gone a little too far by those that are using it, and they are working right with their voluntary pledge and that they are committed to do that and they hope to reduce the friction in prior auth.
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That is good news for our physicians and our and our patients to hear, but they also need to hear, it sounds like, right, that prior auth is never going to go away, right?
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It is still gonna be there, it is still gonna be a value uh a tool that payers use to do what it's supposed to do, is just to make sure it's an extra gateway, a safety net, if you will, that the patient gets another opinion on the right, the appropriate care at the appropriate time.
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Yeah, I think that's that's that's that's absolutely right.
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Um so what else has occurred, if you can, right, regarding Medicare Advantage in those rooms?
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How does what does HLC see as the the future for of MA, right?
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In addition to following the prior off issue within MA, right?
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Has HLC been involved with perhaps some of the star ratings issues?
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You mentioned the cost issues, there's been a lot of consolidation of payers leaving certain markets, right?
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Centin, I've just announced.
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How does HLC's vision the what is the vision in HLC's mind of the future of MA?
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Is it sustainable as it is, or will we reach the boiling point of consolidation?
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What should patients think about as we head towards open enrollment of what the MA market's going to look like?
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How is HLC talking about the bigger picture of MA and its future?
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It's still going to be a challenging market.
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I mean, I I think that that's that's something that that we are hearing.
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But there's there's a commitment to to continuing MA.
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We do think, as I mentioned before, that it is it is a great place for value-based care to to be to succeed and to be pushed.
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And we think that it is really a solid option for those who are not, I mean, if you're if you we have we have a number of members, by the way, who who um who also are uh help with as brokers to help seniors better understand this.
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And if you really understand what you're what you're enrolling in, I think that it can be a great product for people to have like a complete coverage.
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And that's something that we've we've been talking about at HLC, that you know it's it's more affordable if you understand, if you're care, if you're clear about what what you're enrolling into.
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And we um we are looking at a a number of reforms.
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We have we're not there yet.
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We're having some discussions about some of the the items that you just mentioned, and and how can we make it more sustainable?
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We think it's a very important part of Medicare sustainability.
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And and we think that um we just had a briefing on Capitol Hill.
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We had uh Michael Chernov, the former MedPAC chair, we had John Brooks, one of the um directors at CMS, and we had I I mean, I was so impressed, I mean, uh filled with with Hill staffers, and they're trying to better understand Medicare Advantage because I think most people do think that it is the it is it needs to succeed, it needs to continue, and it is overall a very successful public-private partnership.
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So we are looking at these specific issues, but it's a it's a work in progress at this point.
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Yeah, I mean thankfully it'll always be a work of progress, right?
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It's a little job security for us, but um, I um yes, I I hope we can continue to iterate and it that it continues to be a viable program, right?
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Because there are others.
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Uh personally I'm not a big believer in a single-payer Medicare for all.
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I think we need the market in here, and we need to continue to work on MA, and MA with a PDP plan for patients, can really do what you just said, right?
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Is coordinating care, allowing for value-based care, right?
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Coordination of that.
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And what I big I'm really maybe naively hanging my hat on is that a concept you mentioned a few minutes ago, which is artificial intelligence and the availability of all this information at the fingertips, literally, of physicians to be better informed on making decisions.
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And like you said, coordinating care and all that claims data being analyzed can really help transition into lower, right, more efficient, better outcomes.
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And recently, right, you guys built a whole collaboration around AI and what the policy should be for HLC.
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So tell us tell our listeners what is HLC doing on AI and what you think the future is of AI for for healthcare.
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We spent um about six months, and one of our members, ZS, helped us coordinate all of the viewpoints within the membership.
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We you know, we did surveys, we did one-on-one interviews, and in this case, many of our executive members said, I want to designate our AI expert, whether it's at one of the hot leading hospital systems or one of these manufacturers, farmer, or in or the insurer.
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So we we had the benefit of true expertise and uh and we put together these nine uh policy recommendations because we and starting with that we need to make sure, I mean, the the number one issue that that came up was that we need some type of national federal framework.
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That there's definitely a worry that if we have this state-by-state regulation, if we have, you know, even jurisdictions regulating, we're going to be, you know, we can't have this growing patchwork of of requirements.
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We're going to create more uncertainty, we're going to slow adoption.
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And I think everyone most people do agree on this, but but not because they still see states stepping in because they think there's a vacuum.
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So I mean our our consensus position is that it's not that AI, whether AI should be governed, the challenge is just really that the governance and the and the framework will certainly protect the patients, but not stifle uh innovation.
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So we can we identified some barriers, then we identified what we think should be some of the solutions.
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Um this is a preliminary report, in all honesty.
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I mean, we don't have the answer for liability, like how it should how it should be addressed.
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But we do identify it as an issue that absolutely needs to be taken into consideration.
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So as a step one in this report, we said regulatory complexity is the most significant barrier, and it will stifle AI adoption at scale.
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And so we that's why we are saying we need a national risk-tiered federal framework.
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Not not like it, and so that's I mean, we left ourselves some, you know, some room for, but we're really just trying to say here's the direction you should go in.
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And you know, and we also came up with identifying that trust will be a very important aspect, not only trust for patients and and you know, everyone in all aspects of AI, but also those who will be expected to use it and to use it well.
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They need to make sure that they're comfortable, that we have the right workforce, that they're trained on this.
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And we need to make sure that um, again, on the liability front, that that's something that is addressed.
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But the biggest issue that you can go back to is the risk-tiered, so that not all AI is the same.
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It's different if you're taking notes versus if you're you know giving a recommendation or hopefully helping to develop a cure.
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So Yeah, so um it what's interesting, I I don't know if you saw this week, right?
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Uh Zeke Manual came out with a with an op-ed, right?
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Yeah.
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Where an article, I think he wrote it in JAMA, where he believes he should you should have the AI.
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Like you said, not all AI is created equal.
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You run it through the medical school exams, and then you had like this national framework that then adopts and licenses, as you said, the AI for it to be used.
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Uh and now the AMA is inviting him in to come and speak.
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So it sounds like some of your ideas are already being proffered and out there and being adopted.
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You mentioned this report is preliminary.
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I'm assuming it's available on on the website of the.
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I guess preliminary.
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I don't want to undersell it.
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I mean some you know, my colleagues worked really hard on this, not to mention our members.
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I just mean that we're not claiming to have all of these specific ideas at this point.
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Have you advanced this?
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Are you put have you talked to Hill uh you know policymakers on the Hill or at the A.
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So tell us what the board what have you been doing to advance it?
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Yes, so we have been advancing it, and we also held a a another very much standing room-only briefing on the Hill back in May.
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And we had some of our members come in and talk about their viewpoints.
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So we had Seema Verma, former CMS administrator, she's our member representing Oracle, we had Sword, we had J and J.
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We had uh we had a number of folks come in, and then we had demonstrations.
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But we talked about the report.
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We had Z there, as the author along with us of the report, uh talking about what the recommendations were.
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And we had great attendance uh, you know, on Capitol Hill.
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We had policymakers and staff.
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And then after, both before and after the briefing, you could see the demonstrations, which there was a ride wide variety of how it's being used, whether it's being used to develop you know actual systems and better manufacturing, or in the case of SWORD, how they're doing physical therapy remotely and how it they're able to figure out what you know through the computer what you're doing and it whether you're doing it correctly and how the results will be affected.
00:19:47.200 --> 00:20:02.160
So it was um we're we are we are continuously pushing this this and and we're and we're really um being looked at as a resource, I mean, between the experts here at the organization and then the experts that we can pull in for them.
00:20:02.960 --> 00:20:03.200
Right.
00:20:03.200 --> 00:20:04.880
I wouldn't expect anything less, right?
00:20:04.880 --> 00:20:17.200
But so where do you think the next what's what for our listeners, where where should they be looking to see, oh wow, we're actually making progress on an adoption of a national framework or whatever.
00:20:17.200 --> 00:20:18.880
What dominoes will start?
00:20:18.880 --> 00:20:28.720
What's the first domino to fall where they should be like, oh good, we're getting some progress on having AI more universally adopted and and regulated, whatever it may be.
00:20:28.960 --> 00:20:29.200
Yeah.
00:20:29.519 --> 00:20:31.359
What what what what should they be looking for?
00:20:31.839 --> 00:20:35.440
Well, in the short term, I don't think they're gonna see it.
00:20:35.440 --> 00:20:48.480
I think that you know they're going to have to start like looking at their own compliance programs, they're gonna potentially have to satisfy multiple state requirements, and that's not good necessarily because it adds cost, it adds complexity.
00:20:48.480 --> 00:20:58.720
I think that it's going to take a little while, um, and there's going to have to be more clarity in Washington, both with Congress and probably administration, of what how they want to proceed.
00:20:58.720 --> 00:21:06.480
Um you know, there's there's different bills that have come up, and it seems like a lot of politics have gotten in the way with the midterms coming.
00:21:06.480 --> 00:21:12.799
So it seems that that's put somewhat of a you know a damper on moving things forward.
00:21:12.799 --> 00:21:31.039
Um I think, you know, more conversations and and more demonstrations of the the potential of AI can only help policymakers better understand, and more more players saying that we need a federal, some type of federal framework because AI isn't bound by state law, state boundaries.
00:21:32.160 --> 00:21:32.400
Right.
00:21:32.400 --> 00:21:44.960
I mean, uh the clients I work with to have to comply with 40 or 50 different kinds of regulatory infrastructures is just is just cost prohibitive and it's just gonna stifle, like you said, the innovation.
00:21:44.960 --> 00:21:54.559
And one of the main areas where AI uh has been very helpful is sort of on drug discovery and and drug understanding and the interactions.
00:21:54.559 --> 00:21:59.680
And so you can't throw a stick in this town, as my segue is trying to get at, w without finding.
00:22:00.400 --> 00:23:05.119
somebody with about you know what's talk about most favored nation and importing a foreign price where is hlc in this debate um and where do you what do you see happening going forward on uh most favored nation yeah so obviously many of our our members are um you know having their own conversations and negotiations with the administration that's their business decision and that's that's you know that's that's that's not really the the purview of HLC that we're a policy organization what we're worried about though is that this let's see how this you know this works different deals have been adopted what we don't want to see is for this to be signed into law we don't want Congress to adopt this and so we're spending a good amount of time to talk about that innovation and affordability should not be looked at as as competing goals so constantly reminding people you know policymakers and staff and and other stakeholders of this because we need to make sure that the we don't forget about the importance of innovation.
00:23:05.119 --> 00:23:40.160
I mean we're you know we're talking about we're here talking about cancer oncology we need cures and the potential of AI should not be run smack into MFN really making a different policy because MFN can appear straightforward but it really is at odds at the end of the day with you know with research development long-term investments and we're concerned about that we we we are playing a role in trying to make sure that there's more data out there to better so that everyone can un better understand here in Washington what the implications are.
00:23:40.160 --> 00:23:49.680
Again it's different agreements or are agreements but what our concern is is that we don't necessarily want this to be assigned you know adopted into law.
00:23:49.680 --> 00:23:53.680
So we're we're spending a good deal of time to make sure that people understand this.
00:23:53.680 --> 00:24:15.599
I mean many of of you know the the potentials have taken how I mean you would know this better than me how many years decades to to come to fruition and if we start to put in these these price controls basically you know there has to be a better way and I think there's there are better ideas on how to address affordability without jeopardizing our innovation ecosystem.
00:24:16.240 --> 00:24:36.559
Twenty-five years ago when I started uh as I affectionately call myself as being a drug dealer one of the the the message I've had started with then and continue to say now and I advocate regardless of the audience is that what makes America so great even outside of drugs is that we believe in competition.
00:24:36.559 --> 00:25:04.319
And that competition is the only force whether it's in iPhones or cars or of course in drug pricing that does the what we want it to do which is stimulate innovation more drugs competition and also therefore bringing down price right when you have competition that's what drives down price importing a foreign price control will have like you said the short term effect of reducing the price but will kill the innovation going forward.
00:25:04.319 --> 00:25:07.359
And that's now what we want as a healthcare system.
00:25:07.359 --> 00:25:24.880
And so we are already seeing some of that right we've seen what most favored nation is doing a little bit we have don't have as many launches XUS and so what has stepped in is of course the China Chinese right that China is now launching in Europe.
00:25:24.880 --> 00:26:31.839
They have first in human trial right there's a lot going on in the drug space and of course in other spaces in HLC you have a huge diverse membership and I probably China's one of the few issues similar to AI where everybody's like yes we need to do something about this right this is an issue so what is HLC doing right you're well positioned to talk about China policy what what are you uh how have you guys been thinking about this the last couple of uh months in the administration we have been thinking about it you know it's uh we we're talking to the administration we're having we're going to see them they're coming to to to our gatherings to our meetings and I think it was most eye-opening in January we had you know at our member only meeting we had a panel of our pharma leaders and they brought this up and I can't tell you how many leaders from the other sectors it's not that they hadn't been thinking about this but hearing that it comes straight from their colleagues who are from pharma it was so compelling and it became very much this you know this realization that this is an economic and national competitive issue that everyone should be concerned about.
00:26:32.000 --> 00:26:35.440
That we cannot you know let China get ahead.
00:26:35.440 --> 00:26:44.160
We we have been leading the world in biopharmaceutical innovation and and medical technology and and more than in pharma, right?
00:26:44.160 --> 00:26:47.039
And increasingly AI enabled healthcare.
00:26:47.039 --> 00:27:03.519
So we have really um we've really taken this on and we I can't point to any report that we've necessarily done yet but I mean you know hopefully more to come but this is an issue of increasing awareness within our membership and what can we do?
00:27:03.519 --> 00:27:09.039
I mean a lot of this is now just making sure that we are talking about it that we are bringing it up in all of these meetings.
00:27:09.039 --> 00:27:28.480
It's it's not it's not like the last issue and we're trying to make it more toward the top of the of the list and making sure that you know the the point being we need to make sure that here what can we do here to maintain our leadership strong intellectual property protections we need to have the most supportive ecosystem for innovation.
00:27:28.480 --> 00:27:40.559
We need to make sure we can get the skilled talent here I mean I think that's one of the issues that's that is this is is exacerbating the situation and just clear innovation friendly policies.
00:27:40.559 --> 00:27:55.920
I I think I don't think anyone wakes up in Washington to say we want China to lead or we want to come in second or third but looking at it from a broader perspective is really important and that's something that an organization like ours can can do and do well.
00:27:56.400 --> 00:28:43.599
I completely agree I was about to say I I'll tell the story right the administration passed this something called the Coins Act which as you as you may know right a couple of months years ago whatever it really limited technology companies' ability to invest in China and the administration came to the drug industries and sort of said well we're watching you guys do this and we want to extend this to the either extend coins or pass the bins whatever it may be and the first thing the industry said is stop this most favored nation business right I mean you can't have it both ways right we have this great entrepreneurial spirit this right and you you are you are totally missing the message here and you need to do the big picture and HLC is in the best position to sort of give that because of your diverse membership.
00:28:43.599 --> 00:28:56.000
So I'm hoping right I'm getting the sense that when you guys give the message you're getting some good reception on it right we are we are I mean especially issues where they appear to be a little more one sector.
00:28:56.160 --> 00:29:24.480
I mean like so MFN going back to MFN for a minute when we when we raise something that appears to be well why is everybody worried about you know we see things from a broad lens and and we push that you know I mean the the members push themselves to say well and and it's also sort of the just the culture at HLC that you know this may be your your issue pharma maybe maybe you're the most you know at risk at the moment but do we want that for the for any other part of the of the ecosystem?
00:29:24.480 --> 00:29:35.599
And so there's a little bit of a of a consensus collaboration and um and so when it's an issue like that we we do get a little more of a of a raised eyebrow of of interest almost which is nice.
00:29:36.240 --> 00:29:36.799
Which is great.
00:29:36.799 --> 00:30:39.440
I mean that's that's why people are part of HLC right I mean because when you come to them they know that it's been well vetted and as we get towards the the end of our discussion here today we get into you know consensus building and and and uh some other issues that that we sort of want to talk about here at the end is it was around value-based care and it it was great to hear you say at the opening right that this is something that the health that the MA plans and of course you have it on the commercial side too right your members at 200 million commercial lives and it's great to hear that they are still dedicated right still right I believe they are having to sort of providing good outcomes value based care what have you heard around the table what is the what is what is the consensus around the HLC around how do we get to better value-based care initiatives and implementation and outcomes is it because of AI is it because of other innovation what is how is what have you seen around the table you have the best view in in the swamp here about how this could possibly happen.
00:30:39.680 --> 00:31:09.519
So give us some insight about where we could possibly go on value-based care so I mean I think that there's always a a wish that would move faster it would be you know better I particularly you know I mean just to raise an an issue uh you know in the oncology space I I think that there is you know uh we should be honest I mean just to start from the disappointing side is that there is probably no single oncology value-based care model that is nationally scaled yet, right?
00:31:09.519 --> 00:31:11.519
And that's that's disappointing.
00:31:11.519 --> 00:31:40.720
The arrangements still continue to be highly customized in local markets but but at the same time we are still we are seeing growth we're seeing a strong determination among our members um we're seeing you know increased outcomes based arrangements between manufacturers and payers which is good and in the oncology space in in some cases and and that's um you know and and other new approaches that are based on how patients are responding to treatment so that's good.
00:31:40.720 --> 00:32:12.720
So we're seeing this innovation but it continues to be to be challenging um you know value-based care is built on two foundations how do you balance the risk and you know and that's that continues to be a challenge based on the provider's size and resources their ability to to manage the risk and then you have to have the right ability to maintain data and interoperability so you really need that the the struct the infrastructure to take on all of this and and have the the right uh care coordination.
00:32:12.720 --> 00:32:18.960
So those are things that um that continue to be challenges for for some to get into this.
00:32:18.960 --> 00:33:10.319
But but we do see our members are taking on the full risk and uh and they are uh and and some of that is about they want to invest in they're also investing in the data infrastructure and um and I think that the more predictability that we can have and and that we're that we're trying to keep pushing for better benchmarks uh you know standardized quality measures stable rules that that will help to keep the capital um flowing into these arrangements but it continues to be I think somewhat of a challenging space one of the things that you know I I mean this isn't just a little bit jumping to another issue but you know there's a lot of um angst sometimes about you know are organizations getting too large or you know how are they and and looking at the organization rather than what what are the what's the potential from it.
00:33:10.319 --> 00:33:22.559
So if we you know how do we get away from fragmentation it I don't know I mean just like as a person trying to manage you know relatives care, it's daunting when you see how fragmented it still is right.
00:33:22.559 --> 00:33:32.480
I mean just when you think we have these great conversations you hear from the like cream of the crop members and then you go into your you know into your own space and you're like how can this be?
00:33:32.480 --> 00:33:33.680
And it is.
00:33:33.680 --> 00:33:42.319
So I think that's one of the other messages that we want to make sure that we're we're not inhibiting any kind of ways that we can be promoting this.
00:33:44.000 --> 00:34:15.599
I mean as you said right change is hard and it these are large organizations that it makes it even harder to change but you know I I find optimism in what you have said because um the i I'm hearing that there's still a appetite right there's still a desire absolutely absolutely right from the payer side and we know from the physician side the manufacturer side because it what I what I still want to believe after 30 years of doing this is that what drives us all is the same thing is a better outcome for the patient, right?
00:34:15.599 --> 00:34:24.960
The patient is sick and we all want the same outcome which is a better feeling patient a better patient experience right for the whole family right in that regard.
00:34:24.960 --> 00:34:28.960
And we will none of us will stop until we get there.
00:34:28.960 --> 00:34:54.960
We all maybe had disagree on how we get there but we're all going to continue to try to get there which speaks to consensus building so right your HLC you've been consensus building all along right VBCC we're not as old as you guys are so you know as we as we head towards the end of our conversation like I mentioned give us some ideas some some words of wisdom some guidance if you will on so how do you guys do it?
00:34:54.960 --> 00:35:06.480
What's the secret sauce here about developing consensus and driving policy give us some like two or three tips on how you've been doing it what what to avoid some examples would be great.
00:35:06.480 --> 00:35:07.039
Go ahead.
00:35:07.360 --> 00:35:15.360
Yeah yeah you know um I didn't mention this at the beginning you asked me about my bio I forgot to mention that I came from a consensus organization.
00:35:15.360 --> 00:35:28.639
I came from I spent almost 20 years at the business roundtable which is the CEOs of you know all of the leading companies in America all across the the economy not solely based on healthcare although we had quite a few healthcare CEOs.
00:35:28.639 --> 00:35:36.320
And so I've spent most of my career how like how do you build consensus and I mean there's so there's there's a lot of different ways.
00:35:36.320 --> 00:35:48.400
First of all, you want to get the right people in the room you want to get the the leaders in the room and their teams uh and you know working with them as well but you want to get the leaders in your room in the room who want to do this.
00:35:48.400 --> 00:35:51.199
Like you really have to see the the value.
00:35:51.199 --> 00:35:56.320
I you know we're not and we're not a a the sector trade association.
00:35:56.320 --> 00:36:02.719
We you know we have great relations with all of them we make a point to have great relationships with them but that's not our role.
00:36:02.719 --> 00:36:05.039
Our role is to find where can we agree.
00:36:05.039 --> 00:36:16.079
So it always surprises people just that oh that what do you work on one issue how can you find anything to agree on actually the whole access to care and access to high quality affordable care.
00:36:16.079 --> 00:36:52.239
I mean those are words that we you and I have been saying our whole careers but if you start with that you start to look at value-based care you start to look at MA because it's affordable it's more affordable you start to look at these things that and and then you and so we look at access we look at the uh technology that's another big big uh bucket of of issues for us and then we look at competition and innovation so when you start to look at those you start to then drill down and a lot of what we do is we we try to see the issues around the corner try to identify them we we pulse our members all the time it's not it's not that hard because there's about 60.
00:36:52.239 --> 00:36:53.039
So we know them.
00:36:53.039 --> 00:37:05.760
We know them well they know each other well and if you're invited to become a member of of the of HLC you pretty much have bought into that I want to be part of an organization that's looking for consensus driven solutions.
00:37:05.760 --> 00:37:09.920
I can oppose things all day long at my other organization.
00:37:09.920 --> 00:37:39.280
I can protect our own interests and not that people you know you don't forget that you're leading a hospital or you're you're or you're from a pharma company or a medical device company but you come in with a different attitude and and that's um that's really that's one of the the ways but I think it's the trust we Jason we never have to say we're you know uh Chatham House rules because it just goes without saying that you wouldn't take the conversation you wouldn't say you know who I heard say this at the meeting.
00:37:39.280 --> 00:37:55.440
And yet when I first came here and I interviewed you know I I asked for calls and meetings with all the members that I had not been you know privileged to meet during the interview process the number one reason that they like being a member the biggest value they get yes you do great policy work.
00:37:55.440 --> 00:38:33.760
Yes we care about all the reports and the comment letters but I always learn something from my interaction with a leader from another sector because I spend all my time in this sector and when I come to HLC I just I come away with an insight that I'm so surprised about it could be something subtle it could be something small but it helps me become a better leader understanding you know the like how things are affecting right I mean it's the two it it boils down to leadership and diversity and open mindedness right it's uh and that's what makes it great and what I try to explain to my children who are young adults right get your heads out of the phone and go talk to people.
00:38:34.000 --> 00:38:55.360
Go talk to people go talk to people right go join groups go socialize talk to people right I mean that's right right how about suggesting that you watch the national news it's like you've you've lost your mind right it's like we used to do that and just hear it yeah right exactly go and talk to people well well speaking of which I really appreciate your time uh today.
00:38:55.679 --> 00:39:02.639
Oh this was a delight it was great to to see you it was great to have this conversation and we look forward to continuing to work together.
00:39:03.039 --> 00:39:18.719
Thank you very much and so listeners right hlc.org right for more information about the group and all the papers you're putting together so uh once again Maria thank you very much uh could we look forward to working with you in the future and um we'll see you in October.
00:39:18.719 --> 00:39:19.440
Thank you all.
00:39:19.440 --> 00:39:20.800
Right thank you.
00:39:20.800 --> 00:39:28.079
That wraps up another fabulous episode of Value Based Voices brought to you by the Association for Value Based Cancer Care.
00:39:28.079 --> 00:39:59.039
Thank you so much Maria for sharing your insights on leadership, consensus building and the future of Medicare advantage and artificial intelligence and how to promote competition and try to manage what's going on between the United States and China and most favored nation we really appreciate your time and more importantly to our listeners for joining in on the conversation if you found today's discussion thought provoking be sure to subscribe to Value Based Voices wherever you get your podcast.
00:39:59.039 --> 00:40:04.000
Stay tuned for more episodes that spotlight the voices that are shaping the future of oncology