Author: Sarai McDowell

Johhny Wilkinson is CEO of Five Star Home Health Care.  Check out his LinkedIn profile HERE.

1. Which segment of the industry are you currently involved?

We are a full service home health agency, providing both personal care and skilled care to the Washington DC suburbs of Northern Virginia. We try to be the easiest for hospitals and Skilled Nursing Facilities to work with by being a one-stop-shop and being an in-network provider for every payer in the markets we serve.

2. How many years have you been in the Medicaid industry?

I started as a private duty personal care agency in 2006. We were very successful in private duty and our referral partners kept asking us to expand into Medicaid Waiver personal care services, which we completed in 2009. In 2012 we completed our vision of becoming a full service agency by providing Medicaid personal care and Medicaid/Medicare skilled services with a “whole-person” approach to care.

3. What is your focus/passion? (Industry related or not)

My personal passion and business focus are intertwined and optimistically big in scope…I believe we can have a world without Skilled Nursing Facilities or Assisted Living facilities. Seniors want to age in place – near family, friends and their pets. I firmly believe that it’s possible, even with memory care, but it requires a reimagined approach to senior care execution from providers, payment models that support a new approach to facility-less care delivery and technology/data standards the connects everything together. We have a LONG way to achieve my vision, but I’m in this for the long haul. 

4. What is the top item on your “bucket list?”

Traveling outside of North America has always been at the top. I would love to see Europe, Australia and South America. 

5. What do you enjoy doing most with your personal time?

I truly enjoy working on building my business and using time away from work to network with other business leaders and have quiet time to just think. I’m an entrepreneur at heart and for people like me that are lucky enough to do exactly what you want to do, there is no distinction between personal time and work time. It’s all living life to the fullest doing what you enjoy.

6. Who is your favorite historical figure and why?

Ted Turner inspired me to be an entrepreneur. He completely reimagined how news could be delivered by creating CNN. He was laughed at because of the monumental challenges in front of him to build CNN. It’s hard at the beginning of such a massive change in how people have done certain things for decades, and it’s always hard being first at anything big, but true entrepreneurs never give up. The vision pulls them and they cannot let go. I feel the same way about reimagining senior care without facilities.

7. What is your favorite junk food?

The strawberry shortcake at Cheesecake Factory is the best thing on the planet. There is no comparison. 

8. Of what accomplishment are you most proud?

I’m immensely proud of following in my father’s footsteps of building my own business like he did. Although we are in different industries, there is no comparison to seeing your success (and failures along the way) that go into building something from scratch. The accomplishments enabled by running my own business are the ability to hire, empower and develop great leaders. This business is comprised of the hundreds of people who work within it and share my vision. Nothing is more gratifying to me than seeing my team grow and succeed in building their own careers.

9. For what one thing do you wish you could get a mulligan?

In an industry undergoing as much change as healthcare and Medicaid programs, it’s hard to pick just one do-over. But I would have to say the leading do-over would be investing in HR earlier on in the rapid growth of the business. I underestimated the value of employee relations, defining long term career paths for people, training/development and the value HR talent brings in helping you hire for your weaknesses.

10. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months?

Medicaid has fully transitioned to managed care in Virginia. I firmly believe this is the right move for patients, providers and gives the best value to taxpayers. The per-month, per-member capitated payment model of how the managed care companies are paid, coupled with performance benchmarking required by the state, forces these companies to think creatively about how to deliver better care outcomes, with good patient satisfaction and at a lower cost. Although managed care doesn’t yet fully understand the potential of home care and home health to achieve those goals, I’m bullish on the potential to help them navigate it, realize mutual success and grow my business to new heights in the process. I also see significant potential to infuse physician house calls into my one-stop-shop business model and have a triple win for integrated senior care delivery: Preventative care, primary care and post-acute care.

—————————–

Know someone in the space who’s doing great work and is an all around interesting person?

Send a note to clay@mostlymedicaid.com to nominate them for the next round of Medicaid Industry Who’s Who Interviews.

Jim McInnis is Experienced Chief Executive, CAO, CFO, VP, and Builder of Mission Driven Companies & Relationships. Check out his LinkedIn profile HERE.

1.     Which segment of the industry are you currently involved?

I work with states and MCOs to manage long term care and support services and a variety of waiver programs.

2.     How many years have you been in the Medicaid industry?

Over 20 years, including my consulting and operations leadership roles.  Given how fast things move, the time feels a lot shorter.  It’s terrific!

3.     What is your focus/passion? (Industry related or not)

Having influence and impact in the community.  I often dabble in town politics.  I also like to see people I’ve recruited get promoted and make an impact.

4.     What is the top item on your “bucket list?”

Playing for the Boston Bruins, but that time has well past.  I’d like to do a tour of baseball stadiums with my sons and convince my wife and daughter to attend a couple games too.

5.     What do you enjoy doing most with your personal time?

I’m a gardener.  I could spend hours at a landscape nursery.

6.     Who is your favorite historical figure and why?

The Wright Brothers because despite the competition and failures they remained enthusiastic and committed to achieving.  They put their money and reputations on the line and subjected their work to hundreds of public trials.  Their character outlasted their business ventures.

7.     What is your favorite junk food?

Brownie edges.  Moist, cake-like brownies are over-rated – chewy and crunchy are the best.

8.     Of what accomplishment are you most proud?

After we had triplets, the support from our family that permitted us some sleep and allowed me to wrap-up my MBA.

9.     For what one thing do you wish you could get a mulligan?

My first month driving a car.  Not good when the insurance agent asks, ’you again?’

10.  What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months?

Watching how states will move managed long-term care services to MCOs and how the MCOs will adapt their capabilities to serve consumer direction programs.  Until recently, these programs were untouched by managed care.  States grew the programs and established rules to encourage recruitment and retention of direct care workers.  Under new contracts, MCOs will need to sort out data integrity, provider network and fraud prevention challenges in a politically charged and disruptive environment.  Wage increases and union efforts to organize direct care workers will influence quality.  If you can’t find and keep a good direct care worker, then overall costs go up.  MCOs also will need to test and deploy new electronic visit verification (EVV) fraud tools that states delayed doing this year.

Mark Rakowski is the Vice President at Children’s Community Health Plan.

Check out his LinkedIn profile HERE.

1. Which segment of the industry are you currently involved?

Children’s Community Health Plan (CCHP) has participated in the Medicaid program in Wisconsin since our inception in 2006, and currently covers 125,000 members, including 3,200 children in a foster care medical home pilot.  We entered the Marketplace in Wisconsin in 2017, and covered 27,500 individuals in 2018.

2. How many years have you been in the Medicaid industry?

Beyond the 12+ years that CCHP has been in existence, I have been involved in Medicaid from a provider side over the 20 years that I have been with CCHP’s parent, Children’s Hospital of Wisconsin.

3. What is your focus/passion? (Industry related or not)

Being a parent of two boys myself, I am passionate about improving the health and well-being of children and their families, and advocating for low income populations to ensure that they are not left behind.

4. What is the top item on your “bucket list?”

Something sports-related, for sure.  I have already seen the Packers win a Super Bowl in person (sorry, Pittsburgh fans), so it would probably be taking my sons to an NBA Finals game.

5. What do you enjoy doing most with your personal time?

Traveling with my family.  We gravitate to beaches (St. John is our favorite), and also have enjoyed New York City as well as Europe.

6. Who is your favorite historical figure and why?

President Lyndon Johnson – I think his domestic accomplishments are often overshadowed by the Vietnam War, however under LBJ sweeping civil rights legislation was passed, including the outlawing of segregation, improved school funding for poor districts, the National Endowment for the Arts that funds public television was established, and LBJ also initiated Medicare, Medicaid and Head Start.  Before he was a politician, he taught disadvantaged Mexican-American kids in Texas where he witnessed firsthand the effects of poverty and discrimination, and made sure that education was a priority of his administration.

7. What is your favorite junk food?

Frozen mint Oreos

8. Of what accomplishment are you most proud?

We built CCHP from scratch and have grown from 26 members our first month to the largest Medicaid plan in our service area, covering almost 20% of all Medicaid members in our state, and are now one of the largest Marketplace plans in the state.

9. For what one thing do you wish you could get a mulligan?

I don’t really have any regrets that would need a mulligan.  Mistakes are just opportunities to learn.

10. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months?

Addressing how health plans can sustain their investments in housing and other social determinants of health

Figuring out how to better engage providers and align incentives so that value-based arrangements are not just pieces of paper.

Wanda Seiler is the Senior Director at Alvarez and Marsal, LLC. Check out her LinkedIn profile HERE.

1.Which segment of the industry are you currently involved?

I work primarily in Long Term Services and Supports (LTSS).  My areas of emphasis are Medicaid eligibility and Home and Community Based Services.  I’ve assisted states with waiver transformation, quality improvement, critical incident reporting, payment transformation, provider billing documentation, shared living, and the development and implementation of software to support human service administration.

2. How many years have you been in the Medicaid industry?

I’ve worked in the industry for over 30 years, including as a policy analyst for a state Medicaid agency, and in leading state behavioral health and developmental disabilities agencies.  I’ve been consulting with states for the past 10 years.

3. What is your focus/passion? (Industry related or not)

My passion is developmental disability services and I’m particularly interested in transformative efforts that improve both the efficiency and quality of long term services and supports.

4. What is the top item on your “bucket list?”

I’d like to spend some time in Italy, touring and perhaps taking some cooking lessons to learn the tricks and secrets for preparing great Italian meals.

5. What do you enjoy doing most with your personal time?

Hiking an boating with my two best friends – my husband and my dog, and doing just about anything with my granddaughters.

6. Who is your favorite historical figure and why?

Abraham Lincoln.  I think his second inaugural address best illustrates his ability as a leader – to know what to say to unite a nation during a critical juncture in our history.  Leadership in never easy, but truly great leaders are distinguished by leading others through difficult times.

7. What is your favorite junk food?

Gabbert’s popcorn – cheese and caramel mix.  Is it obvious that I spend a fair amount of time at Chicago O’Hare?

8. Of what accomplishment are you most proud?

Bringing financial stability to a state developmental disability agency that had a significant structural deficit.  In a single budget cycle, I was able to correct the deficit and over my eight-year tenure as Director of this agency, eliminate all waiting lists for services.  During this time – all service providers achieved and maintained national accreditation demonstrating that efficiency doesn’t have to compromise quality.

9. For what one thing do you wish you could get a mulligan?

When working in state government, I didn’t maximize the use of information technology (IT) solutions.  We did a small IT project that yielded significant returns for people and families receiving services.  Frankly – I wish I would have done much more of this during my time in state government.  Information systems are foundational to the effective administration and delivery of human services.

10. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months?

1. I think states will likely be challenged by Federal audits focused on long term services and supports.  State systems struggle to perform LTSS rate setting, billing and claiming creating a significant financial risk to home and community-based services.
2.  Intellectual/developmental disability services are at a critical juncture. Many state I/DD agencies will begin a slow and difficult transition to managed care.  Many will explore value-based purchasing but must first crack the code to determine the outcomes that should be purchased and then how they can be measured.
3. With control of the US House of Representatives switching following the mid-term elections, Medicaid should be safe from block grants.  It will be interesting to watch the remaining non-expansion states consider their options.  Perhaps the most interesting focus will be on the concept of “personal responsibility” in transitioning non-working Medicaid participants to work.  It will be an interesting, “chicken or egg” discussion in understanding if people need health insurance to maintain employment or if Medicaid will be the carrot, they need to seek and retain employment.  As LTSS tries to navigate through a devastating workforce crisis – every worker will become increasingly important.