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Anne Schwartz is Executive Director at MACPAC – Medicaid and CHIP Payment and Access Commission.

Check out her LinkedIn profile HERE.

Which segment of the industry are you currently involved?

MACPAC is a nonpartisan agency of the federal legislative branch, charged with providing data analysis and advice on Medicaid and CHIP policy issues to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states. Although Medicaid is a federal-state partnership and our authorizing statute allows MACPAC to make recommendations for state action, our work has primarily focused on federal policy issues. That said, in the few short years MACPAC has been in existence, we’ve developed an extensive body of work on how federal policy plays out in the 50 states, D.C., and the territories. In my time at MACPAC, our work has focused on a wide range of Medicaid issues from hospital payment to reauthorization of funding for CHIP to streamlining managed care authorities.

How many years have you been in the Medicaid industry?

I have been with MACPAC since 2012 but I have been working in the health policy field for over 30 years, including stints on Capitol Hill, working with health philanthropies, and being an editor for the journal Health Affairs, all of which involved Medicaid to some extent.

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

Translating research into information that policymakers can use. Researchers and policymakers speak different languages and rarely understand each other. We would be in a much better place if researchers understood the kinds of challenges and questions facing policymakers, and if policymakers used the results from research in crafting policy.

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

I am more of a fan of being open to new experiences than keeping a bucket list.  This fall, I’m looking forward to a rafting expedition in the Grand Canyon.

What do you enjoy doing most with your personal time?

I love active travel and my best vacations with both family and friends have involved hiking, biking, and kayaking.  When I’m at home, you’ll find me reading, trying new recipes, or going to the movies. 

Who is your favorite historical figure and why?

I am inspired by ordinary people who look around, see what needs to be done to make the world a better place, and don’t wait to ask permission to do it, people like John Snow, who, in the 19^th century, took the handle off London’s Broad Street pump to stop a cholera epidemic , and civil rights icon Rosa Parks.  I also admire the fearlessness and tenacity of those who provided shelter to Jews during the Holocaust, and health professionals serving people in war zones.  

What is your favorite junk food?

Sour cream and onion potato chips. Fortunately the street vendors in downtown DC sell these in single portion size.

Of what accomplishment are you most proud?

I defended my doctoral dissertation while working full time and having a five month old baby at home.  My husband and coworkers deserve a lot of credit for supporting me to do this.

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

I wish I had taken a semester abroad when I was in college.  Having since had the opportunity to live overseas, I think every young person should take the opportunity to immerse themselves in a different culture even it’s only for a few months.  In the end, it would have been a far more formative experience than staying at my university to write a senior honors thesis.

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

Prescription drug pricing and coverage, work and community engagement requirements, and additional actions to address the epidemic of opioid use and other substance use disorders.

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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

Carolyn Yocom is Director of Health Care at the U.S. Government Accountability Office

Check out her LinkedIn profile HERE.

Which segment of the industry are you currently involved?

All of it—and none of it—at the same time.  GAO goes anywhere the federal dollar goes, so we interview CMS and the states regarding their Medicaid programs.

How many years have you been in the Medicaid industry?

If you count my days in direct care, it’s been over 35 years.

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

Educating, learning, serving, working on the country’s most difficult problems.

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

Being present in every moment, being the best me possible.

What do you enjoy doing most with your personal time?

Hiking—it’s a family thing—exploring the outdoors.

Who is your favorite historical figure and why?

Harriet Tubman—she was strength and goodness in a time of inhumanity.  She could have run away and been free, but she stayed to help others be free.

What is your favorite junk food?

I have to go with cheese puffs…they’re the best!

Of what accomplishment are you most proud?

My two daughters, one is a teacher, one will be by next fall.  They believe in giving back and helping others. 

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

Mostly golf (smile).  I really believe that all my mistakes have made me “me.”

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

This is the toughest question.  I think Medicaid has generally struggled with two broad issues:

(1) the sustainability of the Medicaid program

(2) how to balance flexibility with accountability.

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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

Lauretta Converse is Director of Payment Reform and Financial Analytics at Rhode Island Medicaid Program

Check out her LinkedIn profile HERE.

Which segment of the industry are you currently involved?

I am currently working as the Director of Payment Reform and Financial Analytics at the Rhode Island Medicaid program. 

How many years have you been in the Medicaid industry?

I have been in the industry for seven years.  In that time, I have had payer experience inside a Medicaid agency, provider experience at a national pharmacy, and have worked on Medicaid as state legislative staff.  Each experience has given me a distinct perspective on this very complex program and I believe this helps me advocate for strategies and solutions that are workable for all stakeholders.

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

When it comes to Medicaid, I’m passionate about data and analytics.  Our mission is Goliath-size and our resources are David-size.  There simply aren’t enough resources to go around, so it’s critical that we bring a data-driven discipline to our program so we know what is working and what isn’t- so that we know how to efficiently allocate our very scarce resources.  All of us have our pet initiatives but without data, it’s a free-for-all. It’s like the quote: “If we have data, let’s look at data. If all we have are opinions, let’s go with mine.”

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

A top item on my bucket list is to visit all of our country’s national parks.  I better get going, though, since I’ve only visited 12 and there are 58.  I love mountains, so my favorite ones so far have been Grand Teton and Hawaii Volcano National Park.

What do you enjoy doing most with your personal time?

Tennis.  It’s both physically and mentally challenging, and people regularly play the game into their 80s!

Who is your favorite historical figure and why?

I recently had the chance to visit in person some of Michelangelo’s work .  I’m not an art aficionado by any means but the beauty, variety, and sheer volume of his work left me breathless.

What is your favorite junk food?

Harvest Cheddar Sun Chips

Of what accomplishment are you most proud?

I have three grown daughters who are among the most amazing and interesting people I know.  That I had a part in that continues to amaze me.

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

I wish I could go back and begin working in the healthcare industry earlier in my career.  I spent a decade in a sector of the manufacturing industry that was very stodgy and mature and changed little year to year.  Conversely, the healthcare space is dynamic and will likely look very different in ten years.  The problems we are trying to solve are so difficult that sometimes I think my head will explode, but at the same time I love that part of the work and that I get to be part of creating something new that doesn’t exist yet.

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

That’s hard for me to answer because my perspective is slanted.  Being from a progressive state, I’m somewhat disconnected from the reality that many states are still talking about expansion and work requirements.  Those things aren’t even issues here!  But I’d love to see value-based payment for pharmacy become more important in every state.  And I’m looking for a maturing of actionable ideas around how best to address social determinants of health.  I’m also tracking with the application of blockchain technology to healthcare which would be a total game changer.

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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

Tommy Duncan is CEO of Trusted Health Plans, Inc.

Check out his LinkedIn profile HERE.

Which segment of the industry are you currently involved?

I am the CEO of Trusted Health Plans, Inc. a Medicaid MCO with plans in Washington, DC, and Michigan.

How many years have you been in the Medicaid industry?

I have been in the industry for 10 years, however, have been exposed to the industry since childhood. My mother ran a health plan.

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

At my core, I always want to leave things better than I found them. I want to use whatever talents I have been blessed with to have a positive impact in my personal and professional endeavors. At this point in my career, that means focusing on how Trusted Health Plans can leverage its size and resources to have a meaningful and quantifiable positive impact on the overall quality and outcomes of the American healthcare system. Specifically, how can we partner at the local and national level with other leaders to address the social determinants of health that greatly influence quality of life and overall health for our Medicaid members.

My focus is on Fixing Medicaid’s cost trajectory. Medicaid has a serious cost problem that will soon surpass $1,000,000,000,000 Annually.

Policymakers have continuously failed to address the causes of this problem. Instead of taking the difficult path to find solutions that truly reduce the cost of healthcare, (which is the only way to reduce and control Medicaid spending), we put programs and policies into place following an easy path. These policies and programs never address the problem of increasing cost of care, but rather, temporarily, reduce Medicaid spending by decreasing eligibility, either through reductions in benefits or restrictions like work requirements or drug testing.

Sadly, these attacks on eligibility don’t decrease true costs; they shift the costs to different areas within the budget.

Sick people will still need access to care. With or without Medicaid those in need will see the treatment needed. Treatment usually occurs in the emergency department at a hospital, which is the most expensive cost of entry into healthcare. By law, the hospitals will have to treat the individuals without insurance. Eventually, these treatments stress the hospitals budget to the point of requiring the State to aid them and keep them open. The State will either take dollars from another area in the “budget pie,” perhaps from Education or will raise the sales tax and or income tax. Either way, taxpayers, their families, and the State loses.

The only way to control the Medicaid spending surge is through revolutionary changes to healthcare delivery. We need policy changes that remove the 85% Medical Loss Ratio (MLR) coupled with competitive price bidding for contract awards. Cost management innovations and at risk downstream contracting with providers and vendors would also produce true cost of care savings.

MCOs who get innovative with programs that control the cost of care will survive and thrive. Those that are currently happily accepting the annual increases given for Medicaid won’t survive. Without attempting to reduce true costs, these companies are part of the skyrocketing costs of care within the entire system.

We need to make changes now. We need a sustainable program of care.

As a taxpayer, father, husband, CEO, concerned citizen, aiding in this change has become my passion.

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

My top bucket list item would be to take a company public and ring the opening bell at the NYSE.

What do you enjoy doing most with your personal time?

Spending time with my family and watching my son’s basketball games, attending his practices are some of my most enjoyable times.

Who is your favorite historical figure and why?

My favorite historical figure is Barack Obama, who defied all odds to become President through self confidence.

What is your favorite junk food?

My favorite junk food is Salt and Vinegar Peanuts.

Of what accomplishment are you most proud?

I am proud to be an attentive partner to my wife and highly engaged father to my children.

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

I wish I could go back and sell my Accretive stock at the high of $35.00 /share instead of the $18.00 per share that I sold.

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

I believe that we need to inject Capitalism into the system, and create incentives for true cost reductions by implementing the three changes to Medicaid that are outlined in my book, Trillion Dollar MEDICAID Monster.

• Remove 85% MLR
• Make managed care contracting decisions based on price
• Move all Medicaid recipients from Fee for Service programs to Managed Care

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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

Steven Jenkins leading operations for a provider start-up.

Check out his LinkedIn profile HERE.

Which segment of the industry are you currently involved?

I presently lead the Clinical Strategy and Accreditation teams for Anthem, one of the nation’s leading health benefits companies. One in eight Americans receives coverage for their medical care through Anthem-affiliated health plans including ~6M Medicaid recipients in 21 states plus the District of Columbia.

How many years have you been in the Medicaid industry?

I began in 2001 at a small regional Medicaid plan in Memphis, TN. That plan was purchased by Amerigroup in 2007, and Amerigroup was subsequently purchased by Anthem in 2013. Since beginning my career in Medicaid close to 18 years ago, I have been fortunate to work across many different areas with some incredible leaders and outstanding teams.

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

At my core, I always want to leave things better than I found them. I want to use whatever talents I have been blessed with to have a positive impact in my personal and professional endeavors. At this point in my career, that means focusing on how Anthem can leverage its size and resources to have a meaningful and quantifiable positive impact on the overall quality and outcomes of the American healthcare system. Specifically, how can we partner at the local and national level with other leaders to address the social determinants of health that greatly influence quality of life and overall health for our Medicaid members.

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

I’d like to visit Wales, specifically the area where my ancestors migrated from in the 1700’s.

What do you enjoy doing most with your personal time?

I love to read and am presently working my way through all of the previous Pulitzer Prize winning fiction novels. In addition to reading, I love watching movies, playing golf, and running. I’ll also admit that video games are a guilty pleasure.

Who is your favorite historical figure and why?

My favorite historical figure is Dr. Martin Luther King, Jr. I have always admired his courage and dedication to non-violent protest, and the profound impact that his work continues to have particularly in the part of the world I call home. Despite not living to see his 40^th birthday, he is a true testament to how rich and impactful a life can be when dedicated to a cause larger than one’s self.

What is your favorite junk food?

Oreos. Hey, they’re vegan!

Of what accomplishment are you most proud?

Probably completing the NY Marathon in 2014. It served the triple purpose of helping me get in better shape, teaching my kids that difficult goals can be accomplished, and my wife got a few great days of shopping and sight-seeing in NYC with our only daughter.

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

I wish I’d spent more time videotaping my kids when they were younger. We love watching those older videos and there’s never enough footage.

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

As we ramp-up to the 2020 election, funding and policy implications will continue to be highly politicized. I think additional key issues will include 1) impact of proposed changes to the 2016 managed care final rule, 2) Medicaid expansion, and 3) analysis of the viability of certain waivers including work requirements and the impact on further proliferation.

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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

Brooke Boswell is Chief Operations Officer, Special Populations at Shared Health (BCBST)

Check out her LinkedIn profile HERE.

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

Shared Health specializes in managed care solutions for the underserved, chronically ill and long-term services and supports populations (LTSS).  We utilize our 20+ years of managed care experience to help our partners better care for their members.  We offer a full range of services – anywhere from consulting and a la carte administrative support to full-service agreements. My particular area is Special Populations; more specifically LTSS. One of the exciting things within Shared Health is that we are entering the Medicare space (think D-SNP) so we will get to learn something completely new. We are also looking for the next opportunity…gotta make sure Rob Summitt earns his keep!

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

I submitted my resume on a floppy disk. Ya know…I used to be one of the youngest people on whatever team I was in…now, well…not so much!  I have been in the Medicaid industry, in some form or fashion, for going on 18 years.

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

I had a 5^th grade art teacher tell me one time, “Honey, we are here to serve.”  That has been a driving passion ever since. I want to help make people’s days brighter – whether that is helping someone get the services they need, creating a process change, or telling a joke to get someone to laugh.  Even though the Shared Health team has banned me from telling jokes…I sneak one in every now and then! We like to have fun over here @Shared Health.  We always have some kind of fun group text going…much to Tracy Purcell’s chagrin. She has threatened to change her number if we don’t take her off the group texts.

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

I would absolutely LOVE to be a back-up singer on the Grand Ole Opry! I don’t want to be front and center or in the spotlight, I just want to wear all black, stand in the back, sing harmony, dance, and maybe shake a tambourine if the mood strikes!

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

It’s hard to pick just one!  I enjoy going ‘home’ and spending time with my family. My parents live in Winchester, TN (Middle TN…close to the Jack Daniels Distillery – in fact, that was my 3^rd Grade Field Trip).  It is so nice to get to the country and get away from all the hustle and bustle of city life. My favorite spot in the house is the front porch. We can sit there for hours swinging, rocking, reading, talking, or just hearing the sounds of country life. We also enjoy a good bonfire, riding or hiking in the woods, and watching Daddy shoot off his canon (think 20 foot long metal pipe, 1 foot in diameter, filled with acetylene from his welder, and then light it…it makes one heck of  BOOM!)  It is especially fun when my nephews are there!

6. Who is your favorite historical figure and why?

I would have to say Albert Einstein. In addition to our commonality of unruly hair, I admire his ability to take extremely complex concepts and break them down to where anyone can understand them. He had so many great quotes, but one of my favorites, and one that continues to encourage me as I seek to learn and truly understand is, “If you can’t explain it simply, you don’t understand it well enough.” 

7. What is your favorite junk food?

Does red wine count as a junk food?!?!  By the way, that was NOT me that got banned from Wal-Mart by riding around on an electric scooter drinking wine from a Pringles can…although, I did use the Pringles concept in college to sneak whiskey into the Kentucky Derby…I was obviously in the infield. In fact, I went to the Derby 4 years before I ever saw a horse!  Since wine isn’t classified as a food, I choose Pizza…with really thin crust, and ranch dressing for dipping!  I’m a dipper! Before you ask…Papa John’s, they know Ben Moran by name. In fact, they sent him a t-shirt that reads: “Who’s Your Papa?”. It hangs in his closet next to the one that reads “Hoosier Daddy”.

8. Of what accomplishment are you most proud?

Helping to implement Tennessee’s LTSS program for BCBST in 2010, and joining the Shared Health team in 2014 to help other Health Plans outside of Tennessee to develop, implement and operate their LTSS programs. In addition, being part of a “start-up” company that has been profitable since our inception 5 years ago…this definitely keeps our token bean counter, Will Aclin, happy.  I am blessed to be a part of the Shared Health team – I could not have hand-picked a better group of folks to work with! 

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

I am a firm believer that everything happens for a reason…(and now I hear John Cole in my ear saying “Yeah, sometimes that reason is because you made a bad decision”). I feel like I am meant to be where I am at this point in my life, and if I had done things differently, I would likely be elsewhere. However; if I had to choose one, I would have gone to Nursing School. But, after cramming 4 years of undergrad into 7 years, I don’t think I have it in me!  For some reason, after watching Billy Madison, I don’t think school would be as ‘fun’ the second time around!

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

Special Needs Plans (i.e., D-SNP, FIDE SNP, I-SNP) and their role in managing and/or coordinating with the LTSS Population

Increase in Primary Care Case Management (PCCM) Models

Innovative approaches to addressing Social Determinants of Health

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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