Category: Medicaid Industry Who’s Who

Medicaid Who’s Who: Sarah Matousek – Senior Consultant with Day Health Strategies

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

A: Day Health Strategies provides experience-based, cost-effective consulting services to private and public organizations that are focusing on strategic opportunities stemming from health reform, health sector transformation, and the emerging benefits marketplace. Right now and for the past year, I have been immersed in designing and implementing a Medicaid Accountable Care Organization in Massachusetts. As part of that project, I have assisted in the creation of a governance structure, developed the model of care, completed regulatory compliance submissions, and assisted with investment planning and project management.

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

A: I have been working in the Medicaid industry for three years.

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

A: I am passionate about finding ways to improve the way we deliver healthcare and pay for it so that people are healthier, and businesses can thrive.

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

A: I would love to hike Machu Picchu in Peru!

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

A: I enjoy traveling, hiking, exploring, and being in the mountains.

 6. Who is your favorite historical figure and why? 

A: My favorite historical figure is Marie Curie because she was a bold early look at how powerful women could be in science. She was the first woman to win a Nobel prize and was a real pioneer.

7.  What is your favorite junk food?

A: I really like Almond Joy and generally anything with coconut.

 8.  Of what accomplishment are you most proud?

A: I am most proud of launching a sustainable program to bring surgical care to rural Haiti.

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

A: I would have left basic science research sooner to move into the public health work that I am doing now because that is where my real passion lies.

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

A: 

• • The approval (or disapproval) of the pending 1115 Medicaid State Waivers is a key issue to watch in the next 6 months.
  • Mandates coming down from CMS is another area that may be important in the next 6 months.
  • There are many states that have innovative programs in process that are driving change. Over the next 6 months, it is important that these Medicaid programs continue to push forward despite any uncertainty that is coming from the federal government. Currently, we are seeing a great deal of federalism and states have a tremendous opportunity to take the reign. However, state Medicaid programs need to identify and mitigate the many risks that come with that autonomy.

 

Medicaid Who’s Who: Rosemarie Day – Founder and President of Day Health Strategies

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

A: Day Health Strategies provides experience-based, cost-effective consulting services to private and public organizations that are focusing on strategic opportunities stemming from health reform, health sector transformation, and the emerging benefits marketplace.

Currently, my firm is working on implementing one of the Medicaid Accountable Care Organizations in Massachusetts. This project has included assisting in the creation of a governance structure, developing the model of care, completing regulatory compliance submissions, and assisting with investment planning and project management. We also recently worked with Rhode Island’s Executive Office of Health and Human Services to take a look at some long-standing issues of resource scarcity and flawed organizational design and develop new approaches and modern organizational design that would better serve the needs of the Secretariat and Medicaid.

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

A: I spent most of my career working in anti-poverty and health programs. I have been working in the Medicaid and health insurance exchange space for 15 years. This includes working as the Chief Operating Officer of the Massachusetts’s Medicaid program, as the founding Deputy Director & Chief Operating Officer of the Health Connector in Massachusetts, and through my consulting work with my firm Day Health Strategies.

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

A: Two of my biggest passions are reducing inequality in the USA and making the healthcare system more patient-centered and affordable.

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

A: The top item on my bucket list is to continue to travel around the world, seeing as many countries as possible.

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

A: In my personal time, I really enjoy reading, exercising (especially if it involves music, dance is best!), and traveling.

 6. Who is your favorite historical figure and why? 

A: Elizabeth Cady Stanton is my favorite historical figure because she was a feminist way ahead of her time who managed to be both an advocate and mother to 7 children. She was able to go back and forth between advocate and family duties in a time before multi-tasking was as prevalent as it is now. I really respect someone who could juggle it all, especially in that era. I also feel that she did not get enough credit for getting women the right to vote.

7.  What is your favorite junk food?

A: I love BBQ chips and Dr. Pepper!

 8.  Of what accomplishment are you most proud?

A: I am most proud of establishing the Massachusetts Health Connector. It was very challenging and took a lot of work, but it was extremely rewarding to see that the Connector’s success led it to become the model for the Affordable Care Act.

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

A: Generally, I feel like I always learn something from the things in my life that went poorly. But I will say that I was raised to be exceedingly polite and I should have been a little more outspoken earlier.

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

A: 

• Waivers will be something to watch over the next 6 months. Depending on the agendas of the state, the state waivers vary greatly. Many conservative states have pending waivers that would limit eligibility or add additional requirements for eligibility. Many other states are in the process of implementing their 1115 waivers that were approved before the Trump administration. Another aspect of state waivers to track is the idea of the super-waiver that would combine 1332 with 1115 waivers.
• Medicaid Managed Care has to prove its value. With budget pressures, managed care can’t just be another layer of administrative overhead. Budget pressures will persist and there will be a continued search to do more with less. One way that MCOs can think about adding value is by partnering with provider organizations to work together and align their incentives. This partnership is being done in many states through Medicaid Accountable Care Organizations (ACOs). Because my company is based in Massachusetts, we are keeping an eye on the Massachusetts Medicaid ACO program, which just launched March 1^st, 2018, and looking at how the lessons learned can be applied to other states.
• Medicaid has always required strong leaders but now leaders need to be able to think across silos and outside of the traditional purview of Medicaid. This is because of the complexity of healthcare and the many lines that are blurring, including the merging of insurers and providers, and the changing market of subsidized care (exchanges and efforts to expand or contract Medicaid populations). Governors need a strategic health advisor, which could potentially be encompassed in the role of the Medicaid Director.

 

Medicaid Who’s Who: John Tote – Vice President of Behavioral Health Solutions with Mostly Medicaid

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

A: ‘Behavioral’ Health, which includes mental health, intellectual and developmental disabilities (IDD), substance use disorder (SUD), and integrated care

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

A:  I have been working in and around Medicaid funded services for 32 years

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

A:   I always have seen and always will see myself as an advocate…that’s where my passion lies…seeing people progress as they define, want, and need that in their own lives…

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

A: Professionally to see ‘total person’ care a true reality in the healthcare field…personally, to play golf at Augusta National…both would be heavenly!

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

A: As you might have guessed from the last answer, when I have time I love to golf…but I also love music, bicycling, working in the yard, and enjoying a great red wine with my terrific wife and friends!

 6. Who is your favorite historical figure and why? 

A:  Abraham Lincoln…despite incredible challenges-where he was from, health issues, etc.-he devoted himself passionately to causes that mattered.  He also worked-or tried to-with those that disagreed with him…in so doing, yes, he built better coalitions, but he also learned from their thinking and that made him a better listener and more able to achieve great things for those he sought to serve.

7.  What is your favorite junk food?

A: Pizza…but is that really ‘junk’ food?  Not sure about that!…

 8.  Of what accomplishment are you most proud?

A: Being part of a wonderful coalition myself that saw innovative Medicaid policies, ironically enough, passed in North Carolina for those with significant disabilities.

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

A: There have been many things that I would have liked and wanted to go differently, of course, but those ‘loses’ have been important in my growth personally and professionally…the only mulligans that I would take are those times when something I did had a negative impact on someone else…those are the things I would do over…

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

A: There will be many areas of Medicaid, both nationally and at the state level, that impact millions of people…there always are…but for me, 2 major areas of concern will be the state of ‘behavioral’ and integrated care as so many changes occur and what that means for individuals being served by Medicaid funded programs…and, secondly, also how Medicaid is and will be viewed as we go into mid-term elections.  Medicaid is often misrepresented for what it is…and what it is not…but there is also very little general understanding of how Medicaid as a health care funding source is also a major economic driver at the community level-especially in more rural areas oftentimes.  This needs to be a more substantial part of the overall Medicaid discussion and conversation.  If we can move away from the ‘politics’ of Medicaid-even a small bit-and cast a truthful eye towards it, Medicaid could take on a much more significant role throughout our healthcare system and in many of our communities. 

 

Medicaid Who’s Who: Joe Reblando – Media Relations Consultant for Medicaid Health Plans of America (MHPA)

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

A: Medicaid Managed Care

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

A: Eight years

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

A: Helping tell the story of America’s under served and the industry that serves them. Also motorcycles, dogs, and bourbon.

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

A: To remove the term “bucket list” from the American lexicon ?

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

A: Spending time with family

 6. Who is your favorite historical figure and why? 

A: Winston Churchill for his charismatic leadership qualities, his courage and resolve in the face of tyranny, and his daily whiskeys.

7.  What is your favorite junk food?

A: Pizza, but not just any pizza – I’m talking about real NY pizza where you fold slices in half before taking a bite

 8.  Of what accomplishment are you most proud?

A: Being quoted in the New York Times in a story by Robert Pear on Medicaid payments to physicians

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

A: Not discovering health care public relations as a profession earlier. However, I think all my varied roles in health care up until now led me to where I am today (and I am a better health care public relations professional for it), so it’s all good.

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

A:

• States seeking waivers for their Medicaid programs, especially those instituting work requirements
• Bringing high drug prices down via a total revamp of the Medicaid Drug Rebate Program

 

Medicaid Who’s Who: Audrey Taylor – CEO and Founder of netlogx LLC

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

A: netlogx has a wide breadth and depth of experience in the Medicaid Industry with several specializations spanning both State governments and private sector healthcare entities. Our expertise includes: 

• Medicaid Management Information System (MMIS) replacement and modularity projects supporting 
  • Vision and planning 
  • Public procurements 
• Integration Verification & Validation (IV&V)
• Centers for Medicare & Medicaid Services (CMS) Certification 
• Medicaid Information Technology Architecture Self-Assessment (MITA SSA)
  • Medicaid Policy regulatory Traceability at the state and federal levels
  • Support to Managed Care Entities

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

A: Since the inception of the company in 1998, netlogx has been operating in the health and human services practice area and has actively supported State Medicaid programs for all 20 years. 

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

A: I am passionate about lifting up women to help them follow their dreams and meet their goals; especially those who own, or seek to own, their own businesses. 

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

A: At the netlogx corporate office we have a “Before I Die Wall” and I’ve added that I’d like travel to a destination of my choice with no prior planning.

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

A: Reading is my favorite past time; I find it provides the opportunity to visit other cities, counties and periods of history all with the turn of a page. 

 6. Who is your favorite historical figure and why? 

A: I find the lives of iconic women of history to be illuminating – as I read about Elizabeth I and her choice not to marry, I marvel at how she learned to navigate in a man’s world.

7.  What is your favorite junk food?

A: As a former Brit turned American, I have two:  Here in the U.S. it is a hamburger, ideally with blue cheese, lettuce, tomato and onion. Back in the U.K., it is fish and chips with a side of curry sauce!

 8.  Of what accomplishment are you most proud?

A: My family – my husband is my greatest champion and partner in both life and work and our sons are both a joy and a challenge.  Since our sons are both adults now, it will be all joy from here on in!

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

A:  I feel that I learn more from my mistakes than from my successes, so I guess I’m going to skip the mulligan.

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

A:

• The funding of new Medicaid Welfare-To-Work programs to determine who bears the direct financial burden for the programs – state budgets or managed care health plans.
• The impact to State budgets as they begin to plan covering the increased state share of costs for the Medicaid expansion populations when federal program funding at 100% ends by 2020.

 

Lisa Holden is a featured speaker for the upcoming Medicaid Innovations Conference in Orlando, FL on January, 31st – February 2nd. Use code MM200 for $200 off your registration HERE!

 

Medicaid Who’s Who: Lisa Holden – Vice President Accountable Care for Independent Care Health Plan (iCare)

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

A: We are a Managed Care Organization offering services to Wisconsin Medicaid members and Medicare Advantage Dual Eligible Special Needs Population members.

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

A: 35 years

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

A: My passion has always been service to people living in poverty including those with disabilities. For the first eighteen years of my career I was deeply involved in Women’s Health; particularly Access to Prenatal Care and addressing the impact of Racism on Infant Mortality. I chaired our state’s Perinatal Association and March of Dimes Public Affair committee for many years. My passion was to educate policy makers on system barriers that prevented poor women from accessing early prenatal care. My attention was always focused on the need for additional supports to address social determinants of health. My passion for the past sixteen years has been on Domestic Violence, Nonprofit consulting and education; and now Care Management for people living in poverty who suffer from chronic conditions at young ages and need assistance with social determinants of health.   

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

A: Designing a Care Management model of care that addresses social determinants in such a way that the positive outcomes last generations (for eternity). On a private note, riding my horse every weekend.  

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

A: Spending time with my husband and our kids, outside in nature with my horse and dogs.

 6. Who is your favorite historical figure and why? 

A: Don’t have one.

7.  What is your favorite junk food?

A:  Sorry, but I had to give up junk food quite some time ago. I am now a Gluten Free, Dairy Free, Pescatarian, and… I do love my New Zealand Sauvignon Blanc.

 8.  Of what accomplishment are you most proud?

A: Raising our children to be outstanding human beings, having a circle of friends who meet quarterly for twenty years to share how we are refining ourselves into our true essences, standing in the truth of who and what I am.   

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

A: I’ve had bad horse luck for the past four years including a significant injury last year. I need 2018 to be my best horse year ever.  I just bought a horse last weekend and my fingers are crossed.

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

A:

• Strengthening the impact that managed care has to improve health outcomes, especially in preventing unnecessary readmissions.
• Advocating for coverage for all people instead of taking a Neanderthal approach that leaves people uninsured.
• Expanding the opportunity to provide nontraditional care management services that focus on self-management, community inclusion and safe living conditions.

Lisa Holden is a featured speaker for the upcoming Medicaid Innovations Conference in Orlando, FL on January, 31st – February 2nd. Use code MM200 for $200 off your registration HERE! 

Randy Ricker is a featured speaker for the upcoming Medicaid Innovations Conference in Orlando, FL on January, 31st – February 2nd. Use code MM200 for $200 off your registration HERE!

 

Medicaid Who’s Who: Randy Ricker – Vice President for MLTSS at Optima Health

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

A: Implementing a statewide MLTSS program under a new contract with the Commonwealth of Virginia.

2. What is your current position and with what organization?

A: Currently serving as Vice President for MLTSS at Optima Health in Virginia Beach, VA.

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

A: Eighteen years in the Medicaid business, with some Medicare Advantage thrown in for seasoning!  Thirty six years in the healthcare industry.

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

A: Creating effective teamwork that produces results.

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

A: Participating in John Newcombe’s “Legends” tennis camp.

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

A: Playing or coaching tennis.

 7. Who is your favorite historical figure and why? 

A: President Eisenhower – a truly bi-partisan leader with an incredible history of service to our country in a variety of critical roles.

8.  What is your favorite junk food?

A:  IPAs – while not truly junk food, all those wonderful carbs should make it count!

 9.  Of what accomplishment are you most proud?

A: 38 years of a really fantastic marriage

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

A: My first two years of college!

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

A:

1. 1. • CHIP funding
      • Congressional attempts at Medicaid Reform
      • dealing with the opioid crisis and behavioral health issues.

Randy Ricker is a featured speaker for the upcoming Medicaid Innovations Conference in Orlando, FL on January, 31st – February 2nd. Use code MM200 for $200 off your registration HERE! 

Medicaid Who’s Who: Steve Konsin, Sr. – President, Syrtis Solutions

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

 A: Currently in Third Party Liability..but more specifically in “Medical and Pharmacy Claim “Cost Avoidance” vs. Pay and Chase which is     what we try to help our customers either minimize or move away from entirely. 

 2. What is your current position and with what organization?

 A: President, Syrtis Solutions.  My business partner and I started the company almost 10 years ago.

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

 A: 12 years directly involved in Medicaid programs

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

 A: Savings and Innovation which has been a constant throughout my career.

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

 A: Go to an F1 race in Monaco.

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

 A: Racing Vintage sports cars…a life-long hobby…

 7. Who is your favorite historical figure and why? 

 A: Benjamin Franklin because he was so diverse in his interests and accomplishments. He demonstrated that you can do just about anything if you put your mind to it…

8.  What is your favorite junk food?

A:  Pimento cheese (its a southern thing I picked up.)

9.  Of what accomplishment are you most proud?

A:   Working thru and succeeding with some very difficult life challenges 

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

A: When I missed a shift for the lead on the last lap going on to the front straight of Watkins Glen in the 50th running of the Collier cup race. The race I won 25 years earlier…man I wish I had won that trophy to put next to the earlier one…

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

 A: 

• The status of the economy as a whole.
• The future or demise of the ACA.
• The current administrations actions.

 

 

Jeff Myers is the President and CEO for the upcoming Medicaid Health Plans of America (MHPA) Conference in Washington, DC on October 29th -31st. Use code MHPA17-MM200 for $200 off your registration HERE!

 

Medicaid Who’s Who: Jeff Myers – President and CEO, Medicaid Health Plans of America (MHPA)

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

A: Four (dog) years

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

A: Leaving the world a better place than I found it – if that includes motorcycles, sailing, or Medicaid reform, then all the better

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

A: Hearing one of my children say “you know, Dad, you’re right.”

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

A: With three kids, there is no such thing.

5. Who is your favorite historical figure and why? 

A: And this is risky (it is what I said to the Board): Joan of Arc – she did what she thought she was called to do, and was willing to burn at the stake for her beliefs.

6.  What is your favorite junk food?

A:  whiskey

 7.  Of what accomplishment are you most proud?

A: Hiking the Andes over an old Jesuit trail with my now-wife and not scaring her off.

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

A: Every mistake is a learning opportunity and chance for growth, and every mulligan I have ever taken on the golf course has ended the exact same way as the first shot.

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

A:

1. 1. • CMS decision(s) on all of the pending waivers;
      • Congressional decisions on  the future of the funding structure for Medicaid;
      • CHIP extension of current and future reauthorization
      • (since this is only 6 months)

 

Jeff Myers is the President and CEO for the upcoming Medicaid Health Plans of America (MHPA) Conference in Washington, DC on October 29th -31st. Use code MHPA17-MM200 for $200 off your registration HERE!

Richard Topping is on the Board of Directors for the upcoming Medicaid Health Plans of America (MHPA) Conference in Washington, DC on October 29th -31st. Use code MHPA17-MM200 for $200 off your registration HERE!

 

Medicaid Who’s Who: Richard Topping – CEO, Cardinal Innovations Healthcare

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

A: Nine Years

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

A: Finding ways to provide all Americans with access to health, education and economic opportunities.

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

A: To visit St. Petersburg, Russia.

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

A: Cycling

5. Who is your favorite historical figure and why? 

A: Winston Churchill, because he persevered and succeeded against difficult odds.

6.  What is your favorite junk food?

A:  Pizza

 7.  Of what accomplishment are you most proud?

A: Leading Cardinal Innovations through Medicaid transformation and driving policy reform.

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

A: All of my golf games.

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

A: Federal Financing; State System Design; Industry Consolidation

 

Richard Topping is on the Board of Directors for the upcoming Medicaid Health Plans of America (MHPA) Conference in Washington, DC on October 29th -31st. Use code MHPA17-MM200 for $200 off your registration HERE!