Category: Medicaid Industry Who’s Who

Medicaid Who’s Who: Sheila Wilson, BSN, RN, CCM – Director of Care Management, Medicaid with Priority Health

---

Sheila is a Registered Nurse with over 31 years’ experience in both clinical and managed care environments. She has extensive experience in case management, and is especially knowledgeable about the challenges facing the Medicaid population. Currently Sheila serves as the Director of Care Management for Medicaid at Priority Health, a Michigan based company serving HMO, PPO, Medicare and Medicaid members across the State of Michigan. Her responsibilities include the development, implementation and administration of programs to achieve medical cost goals for the Medicaid Business Unit. She directly oversees case and disease management, as well as medical utilization operations. Sheila and her team recently received two prestigious Pinnacle Awards from the Michigan Association of Health Plans for work done to incorporate children with special health care needs into managed care, and for spearheading a pilot project with the use of a medical mobile application for children with asthma.

Sheila obtained her Bachelor of Science degree in Nursing from Alverno College, and has held her Certification in Case Management (CCM) since 1994. She has completed the first year of a 2 year Executive MBA Program with Grand Valley State University. She currently lives in Grand Rapids, Michigan with her husband Bill and daughter Ashley.

---

At the Medicaid Innovations Conference, where Clay Farris of Mostly Medicaid is the Event Chairperson, Sheila Wilson is presenting the following case study:

Taking a Multidisciplinary Approach to Care Management and Delivery: Creating Provider, Health System, and Community Partnerships
Priority Health created the Medically Complex Children’s Program to improve the member experience. A team of Pediatricians, Care Managers, Community Health Workers, Nurses and Specialists within the Academic General Pediatric Residency Clinic (part of the Spectrum Health System), coordinate care for members and aid with basic needs like food, housing, clothing, medication management and transportation. One of our most vulnerable members, a child whose family was new to the United States, arrived to the hospital with acute liver failure and needed a transplant. His parents lacked the resources that the child needed for proper care, so he was enrolled in the Medically Complex Children’s Program. After he was enrolled, a complex care plan was created with input from all team members, including the member and family. The care team assigned to his case helped plan, anticipate his needs between appointments, provide ongoing reinforcement of the care plan and minimize unnecessary Emergency Department visits. The program focuses on one patient, one family, one care plan and one care team to create a better member experience and better health outcomes!

You can learn more about this topic and the rest of the agenda at http://www.medicaidinnovations.com/

---

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

I am currently working within the Medicaid Program at Priority Health.  Priority Health is one of 11 Managed Medicaid Health Plans here in the state of Michigan. 

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

I am the Director of Care Management for the Medicaid Program here at Priority Health.

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

I have been working within the Medicaid Care Management Field since 2002. 

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

I have a passion and commitment to the underserved in the counties in which I live and work.   Understanding the barriers and challenges to obtaining the needed health and social services by segments of our population who are often overlooked and disenfranchised is a core element of my being.  I believe that we each can impact the trajectory of another person’s life through the hard work and examples that we set for each other.

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

I actually have two items that occupy the top spot.  I would love to have the ability to go to Washington, meet with our Legislators and discuss some of the current issues facing our Country and our State today.  My minor in college was Political Science, so I have a strong interest in our political system.  On a more personal note, I would love to travel the country, visiting small towns and big cities along the way.  I particularly enjoy the coastal areas and would love to spend some time sailing with my family.

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

I love spending time with my 3 grandchildren.  Time stops whenever they are around.  I love curling up with a good book in front of the fireplace during the cold winter months and tending to my garden during the summer months.

  7. Who is your favorite historical figure and why?

I would love to meet both Hillary Clinton and Michelle Obama.  I think they are both brilliant women who believe in the strength and tenacity of all women.

  8. What is your favorite junk food?

I love vanilla frosted unfilled long johns.  My father use to get them for me when I was a little girl and I’ve loved them ever since.

  9. Of what accomplishment are you most proud?

I am almost finished with my Executive MBA Program. I was able to do this while caring for my 89yr old mother, my husband and 16 yr. old daughter as well as working full time as the Clinical Lead for our Medicaid Product.  So many times, I doubted my ability to do it all and yet have somehow managed to meet the needs of my family and myself, both professionally and personally. 

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

Very early in my career, I was given the opportunity to attend an OB GYN Nurse Practioner Training Program at virtually no cost to myself.   I turned down that offer.  I often wonder how different my life would have been had I decided to take advantage of that opportunity.  

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

1. With the change of leadership in Washington, I am concerned about the future of Medicaid in general and of Medicaid Expansion more specifically.
2. Pharmacy cost trends are rising at an unsustainable rate.  There is very little that Care Management can do to impact this as it is largely a pricing/contracting issue.
3. Payment for Health Care is moving away from a Fee-For-Service Reimbursement Model to a Value Based Reimbursement Model.  I worry that our Provider Partners are not moving as quickly to meet the rapid changes that are State is requiring of its Medicaid Health Plans.

 

Medicaid Who’s Who: Michelle Miller, MS, RN, PMP – Chief Nursing Officer with the Colorado Department of Healthcare and Financing

---

Michelle received her nursing degree in 1994 from Augustana College in Sioux Falls, South Dakota. She worked until 2004 as a Pediatric and Pediatric Intensive Care Unit (PICU) Registered Nurse, specializing in respiratory disorders, children with special needs, and acute trauma services. Michelle moved to Colorado in 2003 and soon turned her focus to the outpatient clinical setting. She became a nationally certified Organ Recovery Coordinator for Colorado’s Organ Procurement Organization, Donor Alliance Inc., where she focused on increasing successful multi-organ donations in infants and children. In 2006, she accepted a position as a Liver Transplant Coordinator at the University of Colorado Hospital.

Michelle received her Master’s degree in Leadership in Health Care Systems at Regis University prior to joining the Colorado Medicaid team in 2013 as the Pediatric Assessment Tool (PAT) Revision Project Manager. She successfully designed and implemented a PAT pilot study. Michelle transitioned into the Utilization Management (UM) Contract Manager position and made significant contributions to the modernization of the ColoradoPAR Program, the Medicaid Nurse Advice Line, and the Client Over Utilization Program over the past 3 years. Michelle was recently promoted to the Chief Nursing Officer position.

Michelle lives in Larkspur, Colorado where she enjoys gourmet cooking, all forms of exercise, and spending time on her deck with her husband, dogs, and the local wildlife.

---

At the Medicaid Innovations Conference, where Clay Farris of Mostly Medicaid is the Event Chairperson, Michelle Miller is presenting the following agenda session:

Bridging the Client Engagement and Care Coordination Gap to Improve Outcomes: The Colorado Medicaid Nurse Advice Line Model

The Colorado Medicaid Nurse Advice Line aids clients in determining the appropriate level of care, provides health education and region-specific referral information based on individual needs, and facilitates care coordination. This session will discuss this patient-centered care coordination model.

You can learn more about this topic and the rest of the agenda at http://www.medicaidinnovations.com/

---

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

State government

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

I am the Chief Nursing Officer for the Colorado Department of Health Care Policy & Financing (HCPF).  We administer Health First Colorado (Colorado’s Medicaid Program), the Child Health Plan Plus, and other health care programs.

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

I am fairly new to Medicaid; my nursing career began in 1994 and I joined the HCPF team in 2013.

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

I am passionate about empowering nurses to become leaders, not only at the bedside or in hospitals, but throughout the entire health care industry and the communities for which they serve.  Nursing is consistently rated as one of the most ethical and honest professions, however I am not confident we are utilizing nurses to their full potential. 

I am also passionate about people taking responsibility for their own health and wellness by becoming as involved in their preventative care in much the same way people are with their “sick” care.   Improving one’s health literacy, wellness, and lifestyle changes needs to be a priority for all people regardless of where they receive their medical care.  

In addition, I am very passionate about process improvement.  Innovation is the hot buzz word right now but I am a firm believer that prior to designing new programs or processes we should be certain that our current ones are fully implemented and functioning at capacity.  New does not always mean improved.

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

My bucket list includes a food and wine filled trip to Italy.   I love to cook and would also like to attend some form of professional culinary training.

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

I am an avid reader and quite literally obsessed with food.  My days off are filled with hiking followed by an afternoon of cooking or baking while simultaneously reading a book.

  7. Who is your favorite historical figure and why?

There are too many intriguing individuals to list just one but I will say that I am fascinated by historical figures who were ostracized for their beliefs only to be vindicated after their deaths. 

  8. What is your favorite junk food?

Forget sweets, I love all things salty and crunchy including nachos, buffalo wings, and french fries.

  9. Of what accomplishment are you most proud?

Graduating with my bachelor’s degree in nursing in 1994.  I worked an average of two to three jobs while attending college full time.  I used to study in my car between jobs and while waiting at stop lights.

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

I wish I had prioritized staying in touch with friends as I moved from state to state.  I grew up in North Dakota but left after high-school and then traveled across the southwest during my time as a traveling nurse.  I have met some extraordinary people who I simply lost touch with over the years.

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

There are so many challenges it is difficult to choose only three but I would have to say the future of the Affordable Care Act, improving patient access to care while incorporating strategies to address the social determinants of health, and controlling the rising cost of health care including the increasing cost of pharmaceuticals.

 

Sara Hall is a featured panelist for the upcoming Indiana State Medicaid Spotlight Webinar on November 18^th. RESERVE your seat today!

 

Medicaid Who’s Who: Sara Hall – HIP Employer Link program director at the Office of Medicaid Policy and Planning

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

A: I work at Indiana Medicaid on the policy side.

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

A: I am the HIP Employer Link program director at the Office of Medicaid Policy and Planning in Indiana’s Family and Social Services Administration (whew, that’s a mouthful!)

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

A:  I have been at Indiana Medicaid for a year and a half.  Prior to this, I worked as a Navigator assisting clients at a Behavioral Health Center which is where I first starting working with Medicaid programs and understanding their complexities from a member perspective.

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

A:  I am really focused on all Americans having access to quality, affordable healthcare.  Probably sounds like a stock answer, but after working with people as a Navigator I got a look into peoples’ lives.  This was especially true when the ACA was passed and it took Indiana an extra year to get approval for HIP 2.0.  So there was a year when a lot of low income Hoosiers simply fell into the “coverage gap.”  I had the opportunity to see people before and after our alternative Medicaid expansion.  Healthcare really changes lives and I feel privileged to be a part of that.  But, as this audience knows, it doesn’t always work perfectly or as smoothly as it should.  My passion is to continue to make improvements to existing systems and/or help create new systems so that all lives can be improved by healthcare access.

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

A: Traveling the Tran-Siberian Railway from Moscow to Beijing.

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

A:  My 14-year-old daughter is my primary focus.  We like to travel and are planning on backpacking through Belize this summer.  I also like painting, pyrography, and I am currently studying for the GRE….in between watching turn of the century British dramas on Netflix.

 7.  Who is your favorite historical figure and why?

 A: Paul Goodman, because he was a very interesting person who had very interesting ideas.

 8.  What is your favorite junk food?

A:  All of them.  But I really like candy….specifically gummy peaches and Pop Rocks.

 9.  Of what accomplishment are you most proud?

A: Career wise, it would be the development and growth of the HIP Employer Link program I am currently directing.  Personally, it is my daughter and how she is growing into a responsible, smart, bold young woman.

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

A: In the second grade, I picked my nose and ate it in front of the whole classroom.  It was a poor decision that haunted me well into third grade.

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

A:  1.)  Obviously, the election.  Medicaid moves at the whim of politics and it is important that programs are funded, staffed, and properly managed when there are legislative changes so that benefits are not lost or decreased for members. 

 2.)  The results of Managed Care Organizations.  Indiana has been working with managed care for a while, but those contracts got bigger with HIP 2.0.  Over the next 6 months we will start to see the results on a number of our performance measurements.  Many other states are working for MCOs for the first time and will also start seeing more results of those relationships.  It will be important for the MCOs to prove that things are working better under their management. 

 3.)  Addiction and mental health services.  The opioid epidemic has hit Indiana hard (along with many other states).  Our Medicaid programs do not always offer ways for people to gain and maintain sobriety through their current health care plans.  Indiana also has a huge gap in mental health providers in and outside of Medicaid.  If we don’t have enough doctors/counselors/case workers to help people who are suffering it will be difficult to see this epidemic decrease.

Sara Hall is a featured panelist for the upcoming Indiana State Medicaid Spotlight Webinar on November 18^th. RESERVE your seat today!

Calder Lynch is a featured panelist for the upcoming Nebraska State Medicaid Spotlight Webinar on October 21^st.

RESERVE your seat today!

 

Medicaid Who’s Who: Calder Lynch – Nebraska Medicaid Director

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

A: I’m a state health policy nerd, but I like to think I work at the intersection of policy and politics – where we really can make things happen. However, my real passion and focus comes after the policy-making—at the executing and operationalizing of reforms and programs. That’s the fun stuff!

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

A: I am the Director of the Division of Medicaid and Long-term Care within the Department of Health and Human Services for the State of Nebraska. Put more simply, I’m the Nebraska Medicaid Director.

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

A: I’ve been in my role here in Nebraska for a little over 18 months. Before this, I worked in the health care and Medicaid arena for the State of Louisiana for about six and a half years.

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

A: We’ll always have the debates about what government should and shouldn’t do, can or can’t provide–but the fact is that we are going to do something, we should do it well. Good government is non-partisan, and a well-run government is something every citizen and taxpayer deserves. And in my experience some of the most dedicated and passionate people work in the health and human services programs of the public sector. In Nebraska, we are totally rethinking and restructuring how our Medicaid program is administered – from our eligibility and MMIS systems, to our managed care programs, our policies & regulations, our staffing structure, and our contract oversight. With the right tools, planning and leadership, we can accomplish amazing things. My passion is to help create that structure and empower our team to show how effective we can be at making programs, processes, and outcomes better for the people we serve and the citizens who fund out programs.

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

A: I am excited about our vision for modernizing the systems that support our Medicaid program and how we view our role and structure in the future. We like to talk about how we are implementing a “No MMIS” approach – where the state will no longer own or operate a claims processing system. I would love to see us completely decommission or legacy self-administered system and move to a services based architecture.

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

A: I like to cook, especially for others. I really enjoy sharing a good meal that I’ve prepared, and I’ve enjoyed bringing my Cajun flavors to Nebraska. I also enjoy traveling, especially when it leads to spending time with friends and family in places that lend themselves to photography and being outdoors.

 7.  Who is your favorite historical figure and why?

 A: While not my favorite in terms of his beliefs or politics, I have always been deeply fascinated by Huey Long. As a child, I actually appeared as an extra in a TV movie about him called ‘The Kingfish.’ He is an incredible figure in American politics, and particularly for me in Louisiana history. His story is both a cautionary tale against government corruption and an interesting lesson in the roots of populism that I think continue to have influences on today’s politics.

 8.  What is your favorite junk food?

A: I’m a Louisiana native, and it’s not all that often I can get my hands on some Zapp’s Cajun Crawtator potato chips. And that’s probably a good thing!

 9.  Of what accomplishment are you most proud?

A: I think one of the most important functions of a leader and manager is the recognition and cultivation of talent. I am most proud of the team of folks we’ve assembled here in Nebraska, where we have our complete leadership team in place for the first time in a number of years. Seeing their daily successes, growth, and future potential is the most rewarding part of my job.

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

A: One of the very first projects I was given to manage was the carve-in of pharmacy to managed care in Louisiana, coupled with the implementation of a new reimbursement methodology. We did it, and in many ways it was successful. But it was a lot of change very quickly. Looking back, I would have recommended some different policy prescriptions as it related to how the benefit would be managed in a carve-in environment (like retention of a common PDL). Sometimes the trick to implementing lasting reform is to work incrementally. I learned some important lessons that have influenced our decision-making here in Nebraska.

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

 A: In the short term, the most impactful thing will be the federal leadership transition and the selection of new leadership at CMS. This will ultimately have tremendous impact on how the recent flurry of federal regulations will be implemented, like the managed care regulation and guidance around specific provisions like the IMD rule.

 Other timely things to watch will be how CMS applies the Access Rule to ongoing state plan amendments, the impact of Part B premium increases on state budgets and the expiration of the Money Follows the Person program.

Medicaid Industry Who’s Who: SreyRam Kuy, MD, MHS – Chief Medical Officer, Louisiana Medicaid

 

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

My work in healthcare has been fluid, moving between the patient bedside, the surgical suite and the board room.  However, at the heart of it, I’m a surgeon with a passion for healthcare quality and vulnerable populations.  As a surgeon I took care of veterans.  It was such a privilege to care for veterans; the men and women who fought for the freedoms that we enjoy.  Many of my patients struggled with PTSD, depression, substance abuse and poverty.  However, they are such an extraordinary group; one of the favorite parts of my work as a surgeon was listening to the incredible stories my patients shared about courage, camaraderie and the concept of never leaving behind your fallen “battle buddy”. 

I’ve since transitioned from the operating room to the health policy arena, but these lessons that my patients taught remain with me.  As we face the challenges of how to improve healthcare for our communities, our state and our country, it is only by having the courage to change the way we think that we can impact the direction of our future.  It is courage that gives us clear eyes to embrace innovation and imagine beyond the reality of today. 

Working in complex state level health policy, I see daily that camaraderie is collaboration crucial for accomplishing goals.  Only by collaborating can we move the needle in health outcomes.  Ultimately, we all have the same goal; to improve the health of people of our state.  And bringing together all stakeholders’ perspectives, from providers to plans, from medical centers to the individual patient, is critical to making a real change in the health of the whole state. 

Last of all, my veterans taught me that in the heat of the battle, you never leave behind your fallen battle buddy.  For me, never forgetting your fallen battle buddy means never leaving behind the most vulnerable populations of our community.  In Louisiana, we’ve been ranked 50^th in the country for women’s health, childhood poverty, and overall health of our people.  We have one of the highest incidences of cancer, highest rates of incarceration and highest rates of sexually transmitted infections.  Being one of poorest states in the country, these are extraordinary challenges to face.  However, as we work to improve healthcare quality, we have to realize that to truly move the needle on health, the most vulnerable populations can’t be left behind. 

I truly do believe that with courage, collaboration, and the conviction to never forget our vulnerable populations, we can move towards a healthy community. 

2. What is your current position and with what organization? How many years have you been in the Medicaid industry?

I currently serve as Chief Medical Officer for Louisiana Medicaid.  This is my first year in Medicaid.  I was appointed by Secretary Gee with the charge to improve the quality of healthcare for the state of Louisiana, develop a statewide HIT strategy that would help us achieve the vision of quality, transparency and accountability, and address the health needs of the new expansion population.  As you know, Louisiana is the first state to expand Medicaid in the Deep South.  Previously, Louisiana Medicaid served only pregnant women, children, disabled and the extreme poor (at 12% of the federal poverty level (FLP).  When we expanded Medicaid on July 1, for the first time adults aged 19-64 living at 138% of the federal poverty level, had access to healthcare coverage.  In just two months, under the pioneering leadership of Secretary Gee, we’ve enrolled more than 300,000 new adults, who didn’t have healthcare coverage before.  I don’t believe any other state has been able to expand Medicaid this rapidly, in such a short time span.  This is a population that we hadn’t really cared for in the past.  Now, our thinking had to expand beyond pregnancy and childhood health, to adult chronic diseases, cancer prevention, adult behavioral health, and the prison population.  And we had to do it rapidly.  All while also proactively addressing the Zika threat sweeping the southern gulf states and respond to the devastating flooding in Louisiana.  So it’s been a fast learning curve.  But I’ve been blessed with an incredibly talented team.  They are truly the ones who’ve enabled us to nimbly tackle the challenges and proactively advance innovation during this first year.  I am so grateful to get to serve the people of this great state, and work towards achieving a Healthy Louisiana!

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

My focus is healthcare quality.  All my work, designing a health information exchange, developing health quality performance metrics, implementing health initiatives; they all are aimed ultimately towards the end goal of improving quality to healthcare.  In Louisiana, we’ve made tremendous strides in improving access to healthcare through Medicaid Expansion.  Having access to healthcare is the first step.  However, the next step is to ensure that people don’t just have access, but have access to quality healthcare.  Ultimately, moving the needle on health quality is the end goal.

And we are seeing progress in moving towards a healthier Louisiana.  In just the first two months since we expanded Medicaid, among the expansion population more than 1,000 women have gotten breast cancer screening or diagnostic imaging, among which 24 are being treated for breast cancer.  Among this new expansion population, there have been nearly 700 colon cancer screening or diagnostic scopes, with 112 patients undergoing polyp removals.  That’s 112 colon cancers averted. We’ve had nearly 12,000 patients receive preventive healthcare or new patient services. These are just among the newly enrolled patients.  We’re also working on designing a comprehensive Health Information Technology strategy that promotes widespread adoption of EHR, enables connectivity and sharing of data, and promotes transparency in this data.  These are just first steps, but a journey begins with those first steps.

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

I would love to one day go on an extended medical mission trip.  I’ve never actually done a real, full time medical mission trip.  During the recent flooding in Louisiana, I spent much of my time at the various shelters helping to coordinate medical relief efforts at the shelters.  It was the amazing volunteer medical professionals from our community, as well as through the Red Cross and the National Public Health Service who provided direct patient care.  But on occasion, I’d get to actually sit down with a few shelterees and hear their stories.  They told about literally losing everything; from family photos to their whole home being gutted by the flood waters.  But what I kept seeing throughout all these stories was a thread of resilience and compassion.  One woman in a wheelchair talked about how another person in the shelter helped her get needed supplies, as she had difficulty navigating her way on her own in the shelter.  Another person told me how they had lived through both Katrina, Gustav and now the “Great Flood”, and simply said, “I’m starting over again.”  These stories of resilience, courage and compassion are what nourish the soul and define our humanity.  They also keep me grounded and remind me of where I come from. 

I myself lived in shelters when I was a young child, after we escaped from Cambodia and the Killing Fields.  It was during this time in the Cambodian border refugee shelters that my family was injured by errant RPG explosives.  A volunteer Red Cross Surgeon operated on my mother and me, saving our lives. I never learned his name, but that volunteer surgeon inspired both my sister and me to go into medicine.  For me, it truly does hit home to see how medical mission volunteers can make such a tremendous impact in people’s lives.  So one day, from my bucket list, I’d love to join a medical mission trip and work, not as a health official or administrator, but as a surgeon. 

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

I enjoy writing.  I’m very much an amateur, but practice makes better.  As my sister and I were growing up, my mom would retell us incredible stories about our family’s life in the Cambodian Killing Fields.  She shared stories about extraordinary acts of compassion, about having courage in the face of evil, and unrelenting faith that enables hope during the darkness of a bloody genocide.  My mom, a small, humble woman, taught me so much about courage and hope. She truly has the heart of a tiger.  Later, while I was studying at Yale, I visited the Yale Genocide Project, which made me realize how important it was to write down these stories, so they don’t get lost.  So in my spare time, I write down the stories my mother shared, and weave into them my own experiences as a refugee, a patient, and a surgeon.  My goal is that through sharing these stories I can inspire hope.  The message I would share is that no matter how challenging your circumstances are; never, ever give up.        

6. Who is your favorite historical figure and why?

John Lewis.  I heard John Lewis speak when I was working as a Kaiser Family Foundation health policy intern for Senator Tom Harkin.  I still remember his vivid stories about his boyhood growing up on a sharecropper’s farm in rural Alabama, where he honed his oratorical skills preaching to his pet chickens, and first practiced nonviolence protesting his parents cooking those same chickens!  It was amazing to hear the humble origin stories of this giant in the Civil Rights movement. 

7. What is your favorite junk food?

Peanut M&M’s and chocolate chip mint ice cream.  Actually, any kind of ice cream is great!

8. Of what accomplishment are you most proud?

I’m always very happy, and a little bit proud, whenever I convince my patient to quit smoking.  I know it’s challenging, and people often think why would a surgeon care about smoking?  That seems like a primary care issue.  However, smoking is one of the main reasons why some of my patients need surgery, and it affects the ability of my patients to recover after surgery.  Whenever I have to perform an amputation for a gangrenous diabetic leg, or for complications of severe peripheral vascular disease, it always feels like a failure.  I always wish I could have prevented my patient’s disease from progressing to that point.  And preventive care, such as smoking cessation counseling, diabetes treatment and prevention, and hypertension management, all contributed to that amputated leg.  So even though it seems like a small win, every time I get a patient to quit smoking, I feel so happy and, yes, proud.  I still have a photo of the package of Winstons that one patient handed over as he agreed to quit. The fact is, we have to think about health on both the individual level, as well as the population level.  That is why, since we expand Medicaid in Louisiana, and now have the opportunity to care for this 19-64 year old adult population for the first time, preventive care is so critical as we work to move the needle on healthcare. 

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

If I could do things over, get a mulligan in life, I think I’d be braver about taking chances.  When two roads diverge, don’t be afraid to take the one less traveled.  When I decided to become a surgeon, I had no idea how I would fit healthcare policy, into a surgical career.  Since I was young, I’d always known that I wanted to work in some form of public service, and after working in Washington DC, I had a passion for healthcare policy, but I didn’t see how those would fit with surgery.  However, during my medical school clerkships, I fell in love with wielding the scalpel.  There was no place I loved more than being in the operating room.  I had no idea how I would integrate these different passions, but I took a leap of blind faith and decided to do what I loved, and went into a surgical residency.  However, there was a great deal of doubt and worry as to how it would all work out.  I would tell my younger self, don’t be afraid.  Just do what you love, and be brave.   

10. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months? 
    1. Access to Quality Healthcare
    2. Meaningful HIT which helps us achieve quality healthcare
    3. The opioid epidemic and how we proactively and thoughtfully address it

 

Dr. Gee is the featured panelist in the Louisiana State Medicaid Spotlight on Friday, Sept.16th. For more info or to register to attend, visit this page.

Medicaid Industry Who’s Who Series: Rebekah Gee, MD

Secretary, Louisiana Department of Health

 

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

I lead the Department of Health in Louisiana, a state which recently implemented Medicaid Expansion. In addition to Medicaid, my agency also includes Public Health: Behavioral Health; Adults and Aging Services; and Services for Citizens with Developmental Disabilities.

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

Secretary, Louisiana Department of Health

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

I began working as a physician in 2002. I was recently appointed Secretary of the Louisiana Department of Health in January of 2016. Before that I served as the Medicaid Medical Director for Louisiana for three years and I work as an Associate Professor of Health Policy and Management and Obstetrics and Gynecology at Louisiana State University (LSU).

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

Professionally, I’m passionate about preventative health care for women; about healthy birth outcomes and preventing elective deliveries before 39 weeks; healthcare disparities; and for ensuring health care access and health care coverage to thousands of men, women and children who could not afford it without Medicaid Expansion.

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

I’ve always wanted to be happy and make other people happy.

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

I’m the mother of five energetic children, twins Elizabeth and Eva (3), Nathan (9), Eloisa (12) and Ben (12). Whether I’m out watching their tennis match or dance class, at home, or even taking short weekend trips, I enjoy spending time with my husband and family.

7. Who is your favorite historical figure and why?

Ben Franklin and Albert Einstein – Both were innovative and trailblazers.

8. What is your favorite junk food?

Cupcakes – BUT only in moderation.

9. Of what accomplishment are you most proud?

I’m proud to be part of the Medicaid Expansion team in Louisiana. With very little resources, this team worked to find innovative solutions to implement expansion. To-date, nearly 300,000 patients have enrolled and now have access to healthcare and preventative medicine they previously were not able to afford.

Personally, I’m proud to be the mother of five wonderful children.

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

My dad taught me to learn from my mistakes and keep moving forward. I’ve learned many life lessons through my education and career. No need to look back. Onward and upward.

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

Access – continued enrollment to Medicaid Expansion for Louisiana residents; and network adequacy so patients have access to primary care and specialty care as appropriate.

Transparency and quality – encouraging providers to be transparent and rewarding them for positive health outcomes and positive patient satisfaction.

Dr. Gee is the featured panelist in the Louisiana State Medicaid Spotlight on Friday, Sept.16th. For more info or to register to attend, visit this page. 

Medicaid Who’s Who: David Evans – VP of State Government Programs with Geisinger Health Plan in PA

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

A:  I currently am responsible for the 175,000 plus Medicaid members in the MCO where I work.  I am also responsible for approximately        10,000 CHIP members. 

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

 A: I am the VP of State Government Programs for the Geisinger Health Plan in Pennsylvania.

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

 A: Although I have been in the healthcare industry for over 30 years (half of which have been in managed care), I have only been involved in the Medicaid portion for the last 4 years.

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

A: For most of my healthcare career I have been involved in quality and process improvement in one form or fashion.  That is why I jumped at the opportunity 4 years ago to move into the Medicaid industry, to take my quality experience into a new line-of-business for Geisinger Health Plan at the time.

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

A: To spend time in Alaska.  I love the outdoors and that would be the ultimate for me.

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

 A: Fly fishing. Nothing beats the quiet and solitude of standing in a trout stream fly fishing. 

7. Who is your favorite historical figure and why?

 A: Abraham Lincoln.  Certainly regarded as possibly the best US President, Lincoln’s humane personality and democratic eloquence are what makes him stand out among all political figures. 

8. What is your favorite junk food?

A: Pizza, although I don’t consider it a junk food.

9. Of what accomplishment are you most proud?

A:  Starting to work with the Geisinger Health Plan at the infancy of NCQA Accreditation and HEDIS reporting and helping to build that program into one of the top 10 Commercial programs in US is an accomplishment I am very proud of.

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

A: In reality nothing.  I have certainly made some mistakes over my life and career, but I would rather learn from them and move on than attempt a do-over.

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

 A: Although there are a number of issues that are impacting Medicaid currently, for me personally, building a service oriented program for Managed Long Term Services and Supports will be the most important.  Pennsylvania is moving MLTSS into managed care and Geisinger Health Plan will be ready. 

 

To ensure that you’re in the loop on all things Mostly Medicaid, be sure to sign up to receive our free newsletter, join the discussion on LinkedIn and check out tons of great content at www.mostlymedicaid.com.

Thomas Novak is a featured panelist for the upcoming “New Medicaid Health IT Funding and CMS Guide” Webinar on August 15^th. RESERVE your seat today!

 

Medicaid Who’s Who: Thomas Novak – Medicaid Interoperability Lead with the Office of the National Coordinator for Health IT

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

A: I help build Health Information Exchanges at the state level. The state Medicaid agencies have a lot of carrots and a lot of sticks they can use to drive statewide interoperability in efforts to improve outcomes and control costs and it can be difficult to think through strategy of funding streams, sustainability, standards, architecture, and which use cases actually move the needle on outcomes and cost. I provide a lot of direct support to states to help where needed.

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

A: I am the Medicaid Interoperability Lead with the Office of the National Coordinator for Health IT. I am also detailed 50% to the Medicaid Data and Systems Group at the Centers for Medicare and Medicaid Services. Sitting (virtually) in both places allows me to really manage state level interoperability efforts.

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

A: 16 years. I have had the opportunity to be on all sides of Medicaid. My wife practices pediatric emergency medicine so I’ve moved around a lot as she’s gone from medical school, to residency and fellowship, and now attending. I started at the state level working with Massachusetts’ Uncompensated Care Pool and then rolling out their HIPAA transactions. I spent several years at Health Partners of Philadelphia, the largest urban MCO in Philadelphia. There I worked in Complaints and Grievances as well as helping coordinate plan-wide NCQA accreditation and ran some of our leased networks; all roles that really exposed me to all aspects of Medicaid’s processes. Finally, my provider experience was as the Director of Quality for the AIDS Resource Center of Wisconsin, the largest HIV agency in the state. There I had great support from the CEO and Medical Director who set me loose to see if I couldn’t get us to be the first HIV clinic recognized as a patient-centered medical home in the country by NCQA and we did it, and received enhanced Medicaid support as a result. And finally, I have been with the federal government for over 5 years now. I helped launch the Medicaid Meaningful Use program and supported most of the east coast states, as well as did a lot of work on the regulations and I have now settled into Health Information Exchange as my primary policy focus.

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

A: I truly believe we can save lives by putting the right information in front of the right provider at the right time. The complexity involved in doing as such thoughtfully is attractive, and will be a career well-spent, I believe.

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

A: Aside from building a health information exchange in every state and territory that serves the needs of Medicaid patients,  I do think it would be nice to get back to running. I’ve ran two marathons but my wife and I now have four daughters aged five and under, which is clearly a joy, but carving out time for training is essentially impossible.

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

A: I really enjoy cooking. I have a smoker and a sous vide and various other devices. Whenever I have free time I tend to come up with a fun recipe to try out. Spending an afternoon listening to music, with a glass or two of wine and cooking is probably my favorite leisure activity.

7.   Who is your favorite historical figure and why?

A: Marquis de Lafayette. Sure, he was somewhat just an impulsive post-adolescent, but he abandoned his nobility and sailed across the ocean to support this great experiment of democracy and we arguably owe our freedom to his passion.

8.   What is your favorite junk food?

A: I tend towards savory rather than sweet. As I am half Mexican I have to say chips and salsa. Specifically, chips and salsa from Jacobo’s in Omaha, Nebraska, my hometown.

9.   Of what accomplishment are you most proud?

A: Being a good father to my daughters, of course. But the work behind our State Medicaid Director’s letter (16-003) supporting interoperability for more Medicaid providers (long term care providers, behavioral health providers, substance abuse treatment providers, etc.) was such a satisfying achievement. My youngest twin daughters were born 3 days before it was published, and though I thought, “It’s like we both gave birth!” was a solid joke, my wife never quite agreed.

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

A: I think we could have spent more time facilitating the workflow conversations around Health IT. The Regional Extension Program was demonstrably successful in helping with providers adopting Electronic Health Records, but providers who were not fortunate enough to be connected with a regional extension center may have never received that hands-on support. A sizable number of complaints about EHRs are really complaints about workflow. There might not be someone who took the time to sit down and talk with the provider before implementation, ask about his or her workflow, and then implement the EHR in a way that meaningfully improved efficiency and quality of care.

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

I’ll answer in terms of health information exchange as I can’t help myself:

A.  Public Health Architecture, specifically how Medicaid can respond to Zika, lead exposure or other state priorities. The SMD 16-003 supports states in the architecture and on-boarding to specialty registries, which are part of Meaningful Use. These sorts of systems are integral to whatever case management we need to develop  to address these conditions and those systems can now be supported. States are also thinking of specialty registries in ways that really bring innovation into the Medicaid enterprise. We have states looking at building homelessness registries, registries for school based clinics, advanced directive registries, all great ideas.

B.  On-boarding sounds vague but really is that missing piece hindering semantic interoperability in many cases. A state bringing in a someone to work with a provider on integrating the health information exchange data into his or her workflow and making sure that they are not simply connected to the HIE, but there has been testing and production data exchanged. There’s also the crucial administrative work that on-boarding involves. Looking at contracts. Looking at consent models. Looking at Business Associate Agreements. Looking at encryption standards. Coordinating these things truly gets data moving.

C.  I’ll group encounter alerting and care plan exchange together and they’re the best tools for the really aggressive case management you need in Medicaid to support those with multiple chronic conditions, the super-utilizers, if you will. Knowing where your patients are and are not, and coordinating their care is so critical and not only improves outcomes, but truly moves the needle on costs.

 

To ensure that you’re in the loop on all things Mostly Medicaid, be sure to sign up to receive our free newsletter, join the discussion on LinkedIn and check out tons of great content at www.mostlymedicaid.com.

Ray Hanley is a featured panelist for the upcoming Medicaid News Roundtable Webinar on May 27^th. RESERVE your seat today at bit.ly/1S4sns9!

 

Medicaid Who’s Who: Ray Hanley – CEO of Arkansas Foundation for Medical Care

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

A: The CEO of Arkansas Foundation for Medical Care, a 240-employee organization that sprang from the old PROs of the 1970s, but which today does a wide variety of work for Medicaid, Medicare and others.

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

A: I began as an Medicaid eligibility caseworker in 1974, went on to managed Medicaid UR, and then Medicaid Director for Arkansas for 16 years, then to EDS/HP as client executive working with Medicaid agencies.

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

A: Improving access to health care and improving the quality of that care which is one of the reasons I led the 35 organization “AR Health, AR Jobs Coalition” that worked to pass expanded Medicaid coverage in Arkansas.

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

A: Help move Arkansas substantially up in health rankings among states.

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

A: Biking around the world since I had to give up running marathons 4 years ago with bad knees, so far I have biked on four continents.  Otherwise spending time with my family at a log cabin near the Buffalo National River in the rugged Arkansas Mountains.

I’ve also put into print 20 Arkansas history books.

6. Who is your favorite historical figure and why?

A: Teddy Roosevelt who created the conservation movement from his “bully pulpit”

7. What is your favorite junk food?

A: Pizza

8. Of what accomplishment are you most proud?

A: Two daughters who, while raising 4 young children between them, turned out to be outstanding people and health care professionals in their own right.

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

A: Since I’ve never played golf, I have no idea how to answer that.

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

1. Access … too many states have not expanded coverage, especially in the South.
2. Access … in that too many providers won’t see Medicaid patients in part because the rates are too low … coverage without access is self-defeating.
3. Quality improvement … driven by wider use of outcome-based payment metrics and refinement of the patient-centered medical home concept.

Warren Hebert is a featured panelist for the upcoming Medicaid and Long Term Care Webinar on May 2^nd.

RESERVE your seat today at http://mostlymedicaid.com/medicaid-ltc-webinar/

 

Medicaid Who’s Who: Warren Hebert – CEO of HomeCare Association of Louisiana

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

A: I am involved with skilled home health care, primarily Medicare patients, as the executive for the state association. In that role I find myself engaged in conversations about long term care for seniors and those with physical and cognitive challenges. We are also Medicaid consumers, as our 25 year old daughter has Down Syndrome and has a waiver that provides her with assistance. She has direct service workers who have been godsends in keeping her engaged in the community and allowing my wife and I to continue to work.

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

A: I have served as CEO of the HomeCare Association of Louisiana for 18 years, handling advocacy in the regulatory, legislative, and reimbursement arenas. Our organization also hosts workshops and educational conferences here in Louisiana and across eight states. This role has included Congressional advocacy, engagement with an IOM study on the future of home health, as a grant reviewer for the Centers for Medicare and Medicaid Innovation, and on a CMS technical expert panel.

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

A: I have provided care as a home health nurse to all patients, including Medicaid, as far back as 1974 when I was a student X-Ray Tech, and later a nurse at Charity Hospital in New Orleans. My home health career involved work in rural impoverished areas, where Medicaid was the primary payer. And now the association executive role involves advocating for fair reimbursement for Medicaid beneficiaries. One might argue that we have access to care issues in many states due to poor reimbursement for services provided to Medicaid beneficiaries.

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

A: My focus is family caregivers. There are over 45 million family caregivers across the country. My wife and I are caregivers to our daughter. Though very high functioning and fiercely independent (she is a university student and in a college sorority), we are still her primary caregivers. My family cared for my father over his seven year challenge with Alzheimer’s and Parkinsonism. He was not hospitalized once over those years, even when he was bed & chair bound in his last 12 months. Family caregivers provide over 80% of all long term care, at no cost to taxpayers, insurance companies, or government. The Rand Corporation estimates that has an economic impact of $522 Billion a year. One study showed that heart failure patients, going home from the hospital to a family caregiver, is less than half as likely to be readmitted to a hospital than a person going home alone.

I have hosted a weekly radio program, Family Caregiving, for seven years on a station that broadcasts on the web, and across seven states. Three of those stations reach into Houston, Chicago, and New York City. I focused my Doctoral project on family caregivers. They deserve our support.

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

A: I would like to see as many of our National Parks as I can. I’ve been to Rocky Mountain, Glacier, Hot Springs, Hawaii Volcanoes, Mammoth Care, and Jean Lafitte here in Louisiana. I would like to visit Acadia in Maine, Bryce, Zion, and Arches in Utah, Grand Canyon & Petrified Forest in Arizona, and Yellowstone.

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

A: Our ten grandchildren are the greatest enjoyment for my wife and me. The oldest is 8 and the youngest is due to arrive in June, but we’re counting him already. Eight live within ten minutes and the other two are just 90 minutes away. This past weekend we rode bikes, planted Marigold and Sunflower seeds, and had an early morning around our backyard fire pit. We have taken Saturday morning hikes and visited local cultural sites here in Cajun country over the past few months. We also love spending weekends at our local state park cabins.

7. Who is your favorite historical figure and why?

A: I’d like to name two, Mahatma Gandhi, because of what he accomplished via nonviolence in leading India to independence.

The second is our most recent historical figure, Pope Francis, born Jorge Mario Bergolio. He is the first Pope from the Americas, and the first Jesuit Pope. He selected the name of Francis of Assisi, who loved the poor. The Pope’s compassionate approach to leadership is shaking things up in the name of love and concern for those on the fringes and margins of life. He seems to have a strong bias for the marginalized in society.

8. What is your favorite junk food?

A: Do I have to have just one?? OK, an ice cream made in Brenham, Texas, sold in many southern states, Blue Bell, and Homemade Vanilla is my favorite flavor. 

9. Of what accomplishment are you most proud?

A: Our children. Two daughters followed Dad into nursing, one is a Neonatal ICU nurse, the other a Family Nurse Practitioner with an oncology group. Our eldest son is a Chiropractor, and our younger son an Assistant District Attorney. And our Daughter with Down Syndrome indicates she wants to “work in a hospital helping little children so they don’t cry.” They are all compassionate people, who married compassionate people. So our grandchildren should all turn out to be very loving human beings.

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

A: Sorry, no mulligans!! One of my favorite books is entitled Everything Belongs. It was written by a Franciscan priest, and the premise is that everything that has happened in our lives belonged there. Our mistakes, failures, omissions, faux pas, etc., have all impact the person we become. So I’m good not taking a mulligan, thanks for offering. (On the golf course I would definitely take that offer though!!)

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

1. Recognize the family caregiver’srole and be creative in supporting them. Whether it’s tax breaks, pay for those who need it, extra time away from work to give care, training, counseling, or more, we should support family caregivers to a far greater extent than we do now.
2. Remove constraints to practice from Advanced Practice Nurses. As a nurse myself I have a bias. Nurse Practitioners are educated and trained to provide primary patient care. Research has quantified NP’s effectiveness as at least equal to the outcomes of physicians. Nurse Practitioners have had a positive impact on access to care, especially in impoverished urban areas and rural areas that cannot recruit physicians.
3. Advance health policy that promotes equityin care for those on Medicaid. The poor, among them those on Medicaid, have a right to fair, just treatment. If all things were equal, then we would be OK with equal treatment of all. But all things are not equal. We often have different starting points, different resources. That’s why we need health policy that promotes equity.    Equity goes beyond equality. It  involves trying to understand each individual’s situation, and giving people what they need to enjoy full, healthy lives.

 

A quote that best illustrates equity is one from former Vice President Hubert H. Humphrey. “It was once said that the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped.” 

 

To ensure that you’re in the loop on all things Mostly Medicaid, be sure to sign up to receive our free newsletter and join the discussion on LinkedIn.