Will AHIP survive major payer departures?
Aetna's recent decision to leave AHIP, months after UnitedHealth left, no doubtedly leaves the industry trade group on less secure ground, experts say. However, opinions are mixed on what it will ultimately mean for the lobby and for the payer industry at large.
Questions are circulating over whether AHIP should expect its membership to dwindle even further due to more attrition or insurer consolidation--most notably with the pending mergers of member Humana with the departed Aetna, and member Cigna with member Anthem. The ultimate question is whether AHIP will lose significant influence or even dissolve.
Much of the issue comes down to the increase in industry diversity that may make it difficult for AHIP to continue to represent the interests of insurers that now range more than ever before in size, model, and mission, experts say.
Eric Helman, chief strategy officer at Hodges-Mace, suggests Aetna’s recent decision to leave AHIP may be an indicator of the insurer’s view of the changing face of the health insurance industry.
“The Affordable Care Act has accelerated a trend toward the commoditization of health insurance in the U.S. and increased the importance of a more diversified product portfolio for the top managed care companies,” Helman tells Healthcare Dive.
He describes AHIP as very health insurance centric, and says to support the needs of its smaller regional members, it often tends to advocate positions that may not be aligned with those of the big insurers like Aetna and UHC that have much broader interests as a result of their diverse product lines and presence in multiple market segments.
“AHIP will survive,” Helman predicts. “There are some very smart folks there and with Marilyn Tavenner at the helm, they will always have a voice with CMS.”
At the same time, however, AHIP’s 2015 changeover in leadership to Tavenner, former CMS administrator, may itself be a factor in the departures among some who see her status as an administration insider as a liability rather than an asset to the organization.
Another factor, as Modern Healthcare notes, is the industry’s largest players have become increasingly willing to lobby for themselves, and leaving AHIP gives them not only more freedom but more money to do that. While membership dues have not been publicly disclosed, industry insiders estimate them at $1M+ for the largest members.
In addition, leaving AHIP does not necessarily mean insurers will have to go it alone.
"We should not be surprised if we see splintering and the rise of new organizations that better represent the goals and objectives of the sponsoring entities who, too, are seeking value," suggested Joel Brill, CMO at Predictive Health, to Managed Healthcare Executive.
Indeed, Aetna, Humana, and UnitedHealth prove the point, having already founded the Better Medicare Alliance, a health insurance lobbying group that focuses on Medicare Advantage, Modern Healthcare points out.
What remains to be seen is what path AHIP will take in the midst of these events.
“Undoubtedly they must respond to the loss in these anchor members, if for no other reason than the 2+ million dollars in budget they just lost,” Helman says. “Some programs will have to be prioritized. It will be telling to see where they choose to focus.”