Category: Amazing Free Content

René González, MBA, Ph.D.

Affiliate Faculty at University of Colorado Boulder

Community & External Relations Strategy at Colorado Access

Check out his LinkedIn profile HERE.

Which segment of the industry are you currently involved?

Healthcare, Medicaid Industry.

How many years have you been in the Medicaid industry?

7 years.

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

Social determinants of health, K-12, and higher education equity.

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

After traveling to 6 of the 7 continents, my top bucket item is to visit Antarctica.  

What do you enjoy doing most with your personal time?

Traveling, exercising, and Fútbol (Soccer).

Who is your favorite historical figure and why?

Cesar Chavez, advocate for farm workers. My family also worked the fields in rural Colorado.

What is your favorite junk food?

Any and all desserts.  

Of what accomplishment are you most proud?

Completing my Ph.D.

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

Spending more time with my grandparents in Mexico.

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

a.     Behavioral Health Integration

b.     Social Determinants of Health

c.     Medicare for all  

René is also speaking at Insight Exchange Network’s 2nd annual Social Determinants of Health Action Forum in Miami, FL November 14-15, 2019.

For more information about the conference, click HERE.

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

Pamela Mokler, MSG is Post-Acute, LTSS & SDOH Innovation Consultant at Pamela Mokler & Associates, Inc.

Check out her LinkedIn profile HERE.

Which segment of the industry are you currently involved?

I am currently working in the “medical and social integration” space as a consultant to build bridges and integrate our silos. My focus is connecting health plans, health systems and providers (medical, LTSS and SDOH, as well as affordable housing), to create person-centered care that focuses on the holistic needs of Medicare and Medicaid beneficiaries. This involves the creation of innovative and common-sense solutions and interventions that improve the quality of care and lives of older adults, people with disabilities, the institutionalized and people experiencing homelessness.  This sometimes also involves writing funding proposals to launch innovative models and expand Medicaid and existing programs into new markets.

How many years have you been in the Medicaid industry?

My focus has been on Medicaid-eligible individuals for over 20 years, although I began working with older adults as a nurse aide at the age of 14 at a Medicaid-financed nursing/rest home in upstate New York. I segued into law and became a paralegal for several years, which gave me a strong foundation for creating partnerships. After a 97-year old extended family member, who I was caring for in my home, passed away, I was drawn back into working with older adults, and volunteered as an LTC Ombudsman while I was getting my Master of Science degree in Gerontology.

SCAN Health Plan engaged me immediately after graduation, and I realized that I could impact older adults and people with disabilities in a greater way by helping develop Medicare Special Needs Plans (SNPs) and building community outreach teams to enroll economically disadvantaged beneficiaries.  I ended up founding a senior housing company in the late 1990s to provide contract service coordination so low-income affordable housing residents could receive services and continue to age-in-place (primarily Medicaid and duals). After serving as Executive Director of an Area Agency on Aging (which are federally mandated to assist older adults with the greatest needs, with an emphasis on low-income ethnic minorities), I realized how fragmented and duplicative our systems are and began focusing on integration.

For the past 16 years, I have served as an Executive Advisor, Vice President of LTSS and Consultant, to health plans and other providers, focusing on integrating Medicare Advantage, SNPs and Managed Medicaid plans with social services providers by building networks, negotiating contracts and launching innovative pilots and community partnerships.

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

I was fortunate to discover my passion for older adults as a teenager, and to spend most of my life working to improve their quality of care and lives. Helping organizations serving people experiencing homelessness is a more recent passion, especially since the number of older adults experiencing homelessness is continuing to rise at an alarming rate. I miss working with older adults directly; however, I am grateful that I can impact their lives by focusing on improving access to care and much needed social supports.

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

Continuing to travel to countries not only to see tourist sites, but to also learn how they are caring for their most vulnerable populations. We can learn a lot from what others are doing in the space.

What do you enjoy doing most with your personal time?

I love to travel, and it’s a special treat when I can combine travel and my passion for older adults and see how they are living and being cared for in other countries. Some of my favorite places have been Peru, Thailand, Argentina, and Italy. I also enjoy spending time outdoors with my partner, family and/or friends – hiking – especially in Sedona, the Eastern Sierras and Utah Parks, walking on the beach or in the woods, biking, kayaking, skiing and dancing. I went sky diving once and would love to do so again. I also enjoy quiet evenings, going out to dinner and to concerts, and reading historical novels and autobiographies.

Who is your favorite historical figure and why?

There are so many famous and not-so-famous historical figures that I admire, especially those who took great risks to improve the lives of those less fortunate than themselves. A current individual whom I greatly admire is Supreme Court Justice Ruth Bader Ginsberg. I have a tremendous amount of respect for those who speak on behalf of and do for those who cannot do for themselves.

What is your favorite junk food?

Chocolate!

Of what accomplishment are you most proud?

On a personal level, I am most proud of my two daughters, who have evolved into amazingly strong and talented young women. Professionally, I am proud and grateful to be able to work with leaders running health plans and systems, social services organizations and affordable housing companies who have and continue to give me opportunities to serve our vulnerable populations. I view our siloed systems from 30,000 feet, and see people, companies, and programs that could and should be connected. Some of those projects include integrating a health plan with an Area Agency on Aging (AAA), an Independent Living Center (ILC), a Long-Term Care Ombudsman program (LTCOP) and a Recuperative Care facility for people experiencing homelessness who need a place to heal following hospitalizations.

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

If I was given the opportunity to run another government agency, I would take a more measured and incremental approach to changing systems. I would spend more time listening to the individuals who have worked in that space for many years and ensure key stakeholders are on board with the changes before agreeing to such a large restructuring. Too many strategic plans and innovative programs are created that are not sustainable because of politics and resistance to change.

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

We are living in exciting times – the health care industry has awoken to the fact that continuing to spend money on medical care without looking at patients’ social determinants needs is like throwing money into a black hole. If we’re going to bend the cost curve on health care, we need to:

Get physicians and the entire medical community on board with looking at the whole person, and to play a key role in ensuring patients have access to critically needed social services and support that positively impact their health.

Continue to innovate to address Social Determinants of Health needs

Develop technology platforms that are interoperable and allow beneficiaries, their caregivers, and all their providers, whether medical, behavioral/mental health, social community-based services, long term care, etc., to view and share data to ensure people are getting the right care, at the right time, in the right place.

Pam is also speaking at Insight Exchange Network’s 2nd annual Social Determinants of Health Action Forum in Miami, FL November 14-15, 2019.

For more information about the conference, or how to sign up, click HERE.

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

Brian Castrucci, DrPH, MA is President and Chief Executive Officer at de Beaumont Foundation.

Check out his LinkedIn profile HERE.

Which segment of the industry are you currently involved?

I currently work in health philanthropy. As President and CEO of the de Beaumont Foundation, I am fortunate to touch many different areas, including the government public health workforce, partnership development with multisector collaboratives, and policy work. Previously, I spent a decade working in state and local health departments. 

How many years have you been in the Medicaid industry?

I actually have never been in Medicaid, but public health and Medicaid are intimately related. In my past roles as a public health leader, several programs that I oversaw had direct links to Medicaid.

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

Besides my family, Patriots football, and NC State Wolfpack football, I am super passionate about changing communities so that everyone has their best chance at achieving their optimal health. When we say that your zip code has more impact on your health than your genetic code, we are essentially pointing out that we are playing a rigged game – a game that benefits those with and in power at the expense of the poor and vulnerable. That’s not the world I want to leave to my kids. 

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

Personally, I would like to spend some time whale watching in the waters off Seattle. Professionally, the top item is helping transition our national conversation from a focus on healthcare and insurance to one that considers health more holistically. 

What do you enjoy doing most with your personal time?

Of course, spending time with my kids (Evan, 10, and Chloe, 8). As nerdy as this may sound, I also love to write – blogs, books, journal articles, tweets. Sharing ideas is so important, and the Internet and social media have made sharing our ideas so much more egalitarian. Using these tactics effectively is especially important in public health settings: social media gives our field the chance to counter misinformation, engage people and communities directly, and share new findings.

Who is your favorite historical figure and why?

Jimmy Valvano, head basketball coach at NC State from 1980 to 1990. Jimmy V was the consummate underdog – winning the 1983 NCAA basketball championship against all odds. His subsequent battle with cancer led to the creation of the V Foundation. At his last public appearance before his death at the 1993 ESPY Awards, he said something that I have thought about almost every day since: “If you laugh, you think, and you cry [every day], that’s a full day.   That’s a heck of a day. You do that seven days a week, you’re going to have something special.” 

What is your favorite junk food?

Pepperidge Farm coconut cake. My wife hates it, but it was something special that I would get at my maternal grandmother’s house when I would visit as a child. So, it may be the memories that are satisfying more so than the cake. But if the Pepperidge Farm people read this and want to send one over, I wouldn’t object. 

Of what accomplishment are you most proud?

I am most proud of the opportunity I was given to lead the de Beaumont Foundation. Our founding CEO (retired) and Board Chair, James Sprague, was personally entrusted with Pete de Beaumont’s estate upon his passing. Jim has had a role with the Foundation since before it even began, more than 25 years. It was truly an honor to assume the role of President and CEO of de Beaumont and have a role in this amazing Foundation.

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

Nothing. Always hit the ball where it lies. You never know what will happen next. I’ve had success. I’ve had failures. I’ve made good decisions and bad. Each and every one got me to where I am now, and I wouldn’t trade that for anything. 

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

Medicaid will need to expand its allowable costs and broaden its investments. Bugs and bacteria aren’t driving costs anymore. Today, the major contributor of ill health is the lack of strong foundations for community health – housing, food, income equality, education access. Medicaid will need to consider how to address patients’ social needs as part of restoring their health. Related, Medicaid continues to be the largest single line item in most state budgets. Legislators who are concerned about the growing cost burden of Medicaid need to focus on policies that create the environment where everyone can be healthy. Focusing simply on why Medicaid recipients are unhealthy and paying for their healthcare is like feeding the fish but not cleaning the tank. Cost-effective programs that set people up for a lifetime of health, like high-quality, affordable early childhood education, are a key part of this. 

Brian is also speaking at Insight Exchange Network’s 2nd annual Social Determinants of Health Action Forum in Miami, FL November 14-15, 2019.

For more information about the conference, or how to sign up, click HERE.

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

Walter Rosenberg, MSW, MS-HSM, LCSW is Director of Social Work and Community Health at Rush University Medical Center

Check out his LinkedIn profile HERE.

Which segment of the industry are you currently involved?

For about the last 11 years, I’ve been with Rush University Medical Center – a large, urban, academic medical center in Chicago.  Within Rush, my main focus is on care coordination, care transitions,
and the population health world, focusing on providing critical non-medical support to our patients in order to improve their health outcomes. 

How many years have you been in the Medicaid industry?

I have been involved with Medicaid for the full 15 or so years of my career, since every job I have ever held relied fully or partially on Medicaid funding.  At Rush, the large Illinois move to managed
care some years back, has made Medicaid a focus of much attention.  In fact, Rush runs a Medicaid ACO for one of the state payers, which has been a source of much learning.  In an era when value based contracts live in an uncomfortable alliance with a slowly
fading fee-for-service funding stream, understanding the impact Medicaid has on our payer mix and developing strategies to improve post-acute outcomes is a top priority. 

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

Within the industry, my passion hovers around that tricky medical and non-medical interface, where the everyday, non-medical lives of our patients meet their acute or chronic medical needs.  Clearly,
the vast, vast majority of us live in the non-medical world.  Our lives there dictate the way we recover from illness or manage ongoing conditions.  Helping the healthcare system effectively bridge the gap between the two is a very tough puzzle.  This is where my passion lies, particularly as it relates to the models of care (Bridge and AIMS) we disseminate across the country via our Center for Health and Social Service Integration (CHaSCI), where I serve as co-director. 

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

I don’t have a bucket list.  I understand how this can create a goal-driven approach to life for many folks and I celebrate that approach when I encounter it.  However, I’m just happy when I occasionally
get to do the things I already love to do. 

What do you enjoy doing most with your personal time?

Personally, top priority is always family.  My incredible, strong, and smart wife, Sonya, and my two children – Vera (9) and Danny (5) – who fill my heart with love and gratitude every day.  Outside
of family, I like to get my hands dirty.  Gardening, cooking, cleaning, knitting, the occasional DIY project – that sort of thing.  At the end of day, though, I am most nourished by reading.  I’ll trade an evening with a book and a cold beer in my backyard for just about anything.  So I suppose you can make that the one recurring item on my bucket list!

Who is your favorite historical figure and why?

I’m afraid I don’t have a personal favorite historical figure.  You know how they say, “Never meet your heroes?”  I think it’s because if you zoom in close enough, you’ll see major flaws in so many of our historic and contemporary heroes, as well as the hand of those that got to write history or make the news.  I believe we will never hear about the truly best people out there.  They probably have pretty crappy PR departments!  Instead, I like to learn what I can from historical lore, and from the inspiring people I meet every day, who will never make it into a history book.

What is your favorite junk food?

Wendy’s, hands down.  I used to work there in high school and believe it or not, it only made me love it more.  Especially their spicy chicken sandwich and chili.  I do not get any marketing dollars from them.  Yet (are you listening Wendy’s??). 

Of what accomplishment are you most proud?

No matter where I look in my nearly 40 years, all I see is an army of people who I had the privilege of benefiting from.  I can’t really point to anything that’s my own, I’ve always either had incredible
helpers or motivators.  Though not at all a singular accomplishment of mine – that honor most easily rests with my boss and mentor, Robyn Golden – I’m proud of CHaSCI (the center mentioned earlier).  Social work is a discipline that is grossly underappreciated
in health care.  CHaSCI has been a great vehicle for spreading the good word about the meaningful impact social work can bring to patients.

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

Another non-answer for me, I’m afraid.  People say hindsight is 20/20, but I never believed that.  No decision is a singular split between option A and option B.  Any fork in the road always leads down
a myriad of other experiences that build on each other and yield something special.  So we may
think a certain choice would have been better, but in 99.9% of the cases, we have no way of truly knowing how life would have unfolded.  From that perspective, though there many “mistakes” I’ve made in my life, I can’t imagine ever changing anything, because my life would be completely different, and I like mine as is, warts and all, as they say. 

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

Three related priorities come to mind:  1) We have to understand how merge the community and health care funding streams.  Community Based Organizations (CBOs) significantly impact health outcomes and are part of the larger patient continuum.  Separating funding streams makes it much harder to align processes and priorities.  There is a great deal of opportunity to address this, particularly on the managed care side, with some early efforts already underway. Medicaid can be a leader in disseminating the impact.  2) I very much hope that technology – medical records, in particular – can help CBOs and health care organizations work on the same longitudinal patient goals, rather than the episodic approach that is currently the norm.   3) We need to get better at providing role clarity for the allied health professionals.  Social workers, navigators, community health workers, medical assistants, nurses, etc. all have critical roles to play in the care of our patients. 
Unfortunately, since there are some tasks that all of these disciplines are able to provide, it has been very challenging to create a well-defined, comprehensive health care team.  I’m hoping that some of our CHaSCI work, as well as the work of many like-minded organizations across the country can help us to meet that goal. 

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

Sharon Raggio, LMFT, LPC, MBA  is President and CEO Mind Springs Health

Check out her LinkedIn profile HERE.

Which segment of the industry are you currently involved?

Mind Springs Health is the leading provider of mental health and addiction treatment on the western slope of Colorado and lives out its mission of providing recovery and resiliency to people, families, and communities through its excellent continuum of behavioral health care services – from mobile crisis response to 12 outpatient offices to West Springs Hospital, the only psychiatric hospital between Denver and Salt Lake City.  We are pleased to be in over 100 schools as well as in locations with over 100 different partners.  We believe it is critical to our mission that we offer our services where people are, as that is a secret sauce ingredient to engagement and change. 

How many years have you been in the Medicaid industry?

We have been in the Medicaid business since our inception in 1972!  Personally I have worked in Community Mental Health for over 40 years….yes…. I started when I was 12! 

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

I personally love what Community Mental Health offers!  It is a sacred honor to be a partner in creating change in an individual, family, or community.  There is nothing that fills my heart like Community Mental Health!  The best news is that people can and do recover!  I am very pleased that we are starting to recognize the co-morbidity between physical & mental health and excited to be at whole-person planning tables. 

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

Absolutely going to Italy!  I had the good fortune of living in Europe for many years as a young adult and now I’d love to go back with my family.  The Italian culture is unique! 

What do you enjoy doing most with your personal time?

Beside travel, which expands me as a person, I love to walk with our two standard poodles, Timbuktu and Corrina.  We live in western CO and have rich outdoor beauty to explore.  I also love to read good mystery books. 

Who is your favorite historical figure and why?

Marie Curie, a Polish and naturalized-French physicist and chemist who conducted pioneering research on radioactivity. She was the first woman to win a Nobel Prize, the first person and only woman to win it twice, and the only person to win it in two different scientific fields. She was also the first woman professor at the University of Paris.  Some of her more famous quotes include “Nothing in life is to be feared. It is only to be understood.” And when questioned about being a woman with a family & working   in science she replied “Well, it has not been easy”.  

What is your favorite junk food?

It has to be vanilla ice cream with chocolate syrup on a very hot day!  Nothing quite like that sensation of cold ice cream, hot chocolate souse, and a hot day!  YUM! 

Of what accomplishment are you most proud?

We recently were honored to receive the IHI Sherman Award for Patient Engagement.  Our amazing staff developed “Rapid Recovery Clinics” for people with depression and the model allows patients to choose when they want to be seen, how often, and who they want to see of their treatment team.  The results are amazing, with 68% of people moving into a recovery phase from depression in only 6 weeks!  That means people are doing well, our clinical staff know they made a difference, and our offices can serve more people in need!  A triple win! 

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

I have come to understand that relationships are what are important in life.  My do-over would involve absolutely involve healing a relationship.  It is important to be quick to recognize when I make a mistake or push too hard on a relationship.  Forgiveness goes along with this concept. 

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

I think state governments struggle with how to fund and pay providers for Medicaid.  While there are many ideas about value-based payments, there is a grand experiment occurring with how to make that actionable and what the valued outcomes should be.  Additionally, specific to the world of behavioral health, we have a crisis-level shortage of providers.  Funding prevention and resiliency-building programs is a policy I hope States will shift towards in the near future. 

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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