![]() ![]() Our number-one priority is to identify the 10 to 20 percent of the population that need the most care, and then provide it virtually as an extension of primary-care providers. John Kao: At Alignment, we often refer to the virtuous cycle, by which we mean our ability to leverage data to identify high-risk patients and intervene earlier as needed to provide care. ![]() Monisha Machado-Pereira: How do your companies differentiate themselves in the market? Those experiences, combined with some personal experience with my mom, led me to start Alignment Healthcare, with the goal of making Medicare Advantage even better, including with increased consumer advocacy. Ultimately I learned about chronic-disease management, bending the cost curve, and how to identify the 20 percent of the chronically ill, frail population that accounts for 80 percent of the spend. That’s where I met Alan Hoops, who became one of my mentors. Then, in 1996, PacifiCare Health Systems acquired FHP to expand its own Medicare operations, which it marketed to seniors under the name Secure Horizons. John Kao: I started serving seniors in 1995 when I worked as vice president of M&A for FHP International, a managed-care provider and one of the first Medicare contractors. Back then, Medicare did not significantly contribute to the overall business, so in a sense I got the opportunity to work for a small company inside a large company, which allowed us to move quickly and grow. Our Medicare group has grown from 350,000 members in 2004 to over 4.5 million today. ![]() ![]() That legislation changed the game not only for Medicare beneficiaries, by providing them with drug benefits for the first time through Part D, but also for Medicare Advantage companies because it increased funding for the program. In 2004, I moved into the Medicare group, shortly after the Medicare Modernization Act was passed, in December 2003, and I’ve been there ever since. I managed sales, ran actuarial, ran product development, managed finance, created value-based strategies, and ran the consulting group. I’m a finance and accounting guy by training, but I’ve held many roles at Humana. Then, in 1992, Humana spun off its hospital operations, and I stayed with the remaining insurance operations. At the time, Humana was the nation’s largest hospital system. Monisha Machado-Pereira: Describe your career journey and how you arrived at your current role.Īlan Wheatley: I joined Humana nearly 30 years ago, on September 3, 1991. An edited excerpt of their conversation follows. In this episode of the McKinsey on Healthcare podcast, recorded on July 21, 2021, Monisha Machado-Pereira, a senior partner who leads the Medicare work in McKinsey’s Healthcare Systems & Services Practice, discusses the changing Medicare landscape with Alan Wheatley, retail segment president at Humana, a market-leading Medicare payer that serves more than 4.5 million MA members, and John Kao, CEO at Alignment Healthcare, a fast-growing MA innovator that recently launched an IPO. We have previously discussed how new Stars ratings in MA prioritize the customer experience, and how MA plans have increased their supplemental benefit options. MA has 26 million enrollees, representing 42 percent of the total Medicare population. Medicare Advantage (MA), which lets seniors choose benefits through private insurance companies, reflects the fastest-growing Medicare segment nationally. ![]()
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