Category: Critical Conversations in Medicaid
Medicaid and Telehealth: Interview with Dr. Shannon Dowler
Guest bio
Dr. Shannon Dowler is a family doctor born, raised and trained in North Carolina. She has spent the past twenty years pursuing health access, equity and quality in Western North Carolina. In 2019 she became theChief Medical Officer for North Carolina Medicaid.
You can also learn more about Dr. Dowler’s work by visiting shannondowlermd.com
Highlights from this episode
- The amazing NC telehealth pandemic roll-out story, including rolling out a 3-year plan in 7 weeks to deploy 367 program flexibilities
- Take-aways from communicating rapid changes to providers using data
- Changes in barriers to telehealth over the last 2 years
- Impact of implementing managed-care simultaneous to the telehealth rollout
- Hybrid home health visits
- Challenges and opportunities using telehealth to move the dial on quality measure
- The danger of over-estimating the cost impact of expanded telehealth visits
- Advice to solution providers innovating in the Medicaid telehealth space
Further Exploration
More talks by Dr. Dowler on a range of issues
Medicaid and Telehealth Episode 1: Interview with Becky Sanders
Guest bio
Becky is a Senior Director for the Indiana Rural Health Association (IRHA), where she engages with the other senior directors of the IRHA Executive Team in strategic planning and guidance for the future of the IRHA. She works with a wide variety of healthcare providers throughout the state of Indiana and maintains relationships with other state organizations to foster public/private partnerships on behalf of the IRHA.
Becky also serves as the Program Director for the Upper Midwest Telehealth Resource Center (UMTRC). In this role, she provides technical assistance and resources for healthcare facilities in Illinois, Indiana, Michigan, and Ohio. The UMTRC serves as a single point of contact for telehealth resources through educational presentations, individualized technical assistance, facilitation, and connections to telehealth information via the website and program staff.
Ms. Sanders has been with the IRHA since 2008. She has a Lean Healthcare Black Belt Certification from Purdue Healthcare Advisors and is a National Rural Health Association Fellow. Becky previously worked in telecommunications for the National Exchange Carrier Association. Ms. Sanders has a Bachelor of Arts degree from Indiana State University and a Masters of Business Administration in Healthcare Management from Western Governors University.
Highlights from this episode
- The impact of the pandemic on telehealth usage by providers
- Trends in infrastructure needed to support broader use of telehealth
- Telehealth trends for Medicaid and Medicaid
- Promising new models with care extenders in pharmacies and libraries
Further Exploration
https://www.umtrc.org/engagement/podcasts/
- https://www.indianaruralhealth.org/
Medicaid and Jail Health Episode 2: Interview with Blaire Bryant
Guest bio
Blaire Bryant is the Associate Legislative Director for Health at the National Association of Counties. In this capacity she works with county officials across the nation to set NACo’s policies on matters related to health policy and the public health system. Blaire holds a B.A. in Biopsychology from the University of Maryland Baltimore County, and a Master’s Degree in Community Health Education from the University of Maryland College Park.
Highlights from this episode
- The challenge of using jails and prisons for mental health care delivery
- Key terms, especially pre-trial detainees, post-conviction, recidivism
- NACO’s partnership with sheriff’s association
- Constitutional issues around removing healthcare coverage for pre-trial detainees
- Key differences between jails and prisons, especially the different continuity of care issues
- Medicaid inmate exclusion policy- key issues, impact, efforts to change
- NACO top objectives- educate federal partners and the general public on the inmate exclusion policy, advocate for change in federal policy to allow pre-trial detainees to continue to receive federal policy, provide resources for local level advocates to pursue change, and create one body of research that examines all the components in the issue
- In depth discussion of recent legislative efforts
- State options to improve right now, including suspending Medicaid enrollment vs terminating it, and options for 1115 waivers
Further Exploration
Blaire’s recommended reads
- NACo Joint Task Force Report with NSA on the MIEP
- NACo/NSA Task Force Home Page
- National Academies of Sciences, Engineering, and Medicine Report: , Decarcerating Correctional Facilities During COVID-19: Advancing Health, Equity, and Safety
- Task Force Report Update Memo (American University)
Medicaid and Jail Health Episode 1: Interview with Dr. Evan Ashkin
Guest bio
Evan Ashkin, MD, is the founder of the Formerly Incarcerated Transition (FIT) Program, which aims to help recently released inmates with chronic illnesses to receive proper medical care upon rejoining their communities. Ashkin also serves as professor in the Department of Family Medicine at the UNC School of Medicine
Highlights from this episode
- The challenge of using jails and prisons for mental health care delivery
- Healthcare needs profile of formerly incarcerated individuals
- Overview of the Transitions Clinic and NC FIT model
- Common misunderstandings about care provided to incarcerated individuals
- Importance of connecting formerly incarcerated individuals with community health workers are also formerly incarcerated
- Medication assisted treatment (MAT) and the opportunity window to avoid overdose deaths
- Lack of teaching about jail health in medical schools
- Tips to get a re-entry program started in your state
Further Exploration
Information about the Transitions Clinic Network and the North Carolina Formerly Incarcerated Transition (FIT) program
Formerly Incarcerated Transition Program
https://transitionsclinic.org/
Meeting Health Needs at Reentry: North Carolina’s FIT Program
Ashkin serves as co-guest editor for November issue of NCMJ – Department of Family Medicine
They’re Out of Prison. Can They Stay Out of the Hospital?
November 01, 2019, 80 (6) | North Carolina Medical Journal
Spotlight on the Safety Net | North Carolina Medical Journal
Dr. Ashkin’s recommended reads
After Prison, Healthy Lives Built On Access To Care And Community
Allison Roth – Insane: America’s Treatment of Mental Illness
Michelle Alexander. The New Jim Crow: Mass Incarceration in the Age of Colorblindness
Episode#7: Interview with Elena Nicolella
Guest bio
Elena is the Executive Director of the New England States Consortium Systems Organization (NESCSO), where she has served for the past 4 years. Before her time at NESCSO, she played various roles in Rhode Island HHS agencies, including Medicaid Director.
Highlights from this episode
- Defining interoperability in terms of the CMS final rule.
- Defining what data the rule requires to be shared by Medicaid agencies, especially around adjudicated encounters/claims
- Member identity verification for data exchange in third party applications
- Limits to states’ authority over whether to provide data to 3rd Party Apps, or what happens after the provide it
- Expected member interest / appetite for more access to data.
- Impact of expiration of the HITECH Act funding
Episode#6: Interview with Ed Cantwell
Guest bio
Ed is the President and CEO at the Center for Medical Interoperability. He has served in that role for the past seven years. Before that, he has been in executive leadership in multiple technology companies, particularly in the wireless and telecom industry. He also spent 11 years in the United States Air Force.
Highlights from this episode
- The critical goals of building a trust platform and data standardization; HIPAA as barrier to trusted health system
- 21st century cures act use of open API / forcing more exchange
- Differences between federal policy approach and industry association approach to trusted exchange and data standards
- Overlap of CMS/ONC efforts
- How meaningful use morphs into interoperability
- Issues with proprietary data and interoperability; information blocking as a concept
- How pressures on providers from various regulatory bodies makes it hard for providers to embrace yet another paradigm change
- The idea of surveillance capitalism
Medicaid Buy-In: Episode#7- Interview with Laura Colbert
Listen to the Podcast
- Guest Bio
- Show notes
Laura ColbertLaura is the Executive Director at Georgians for a Healthy Future, where she advocates for health policies that expand coverage and access for Georgians. Before her current role, Laura worked at Children’s Healthcare of Atlanta, and the CDC. She holds an MPH from Emory University.
Highlights from this episode
- GA Healthy Access effort.
- Exiting federal marketplace
- GA is introducing 2 new plan types: copper and disease management plans
- State is asking for waiver of 2 requirements in ACA: 1- Not wanting to have plans have to cover all 10 essential health benefits and 2- waiving maximum out of pocket costs for consumers
- How the new model proposed in GA might impact cost and network in rural areas
- Possible adverse selection in some of the more comprehensive disease management plans
- Unpacking the ACA 4 Guardrails for waiver requests
- Impact of reinterpreting Guardrails to give states more flexibility
- GA partial medicaid expansion effort
- Work requirements, copays/premiums
- Proposal to extend pregnancy medicaid from 60 days post birth to 6 months post birth
About our Sponsor
This was made possible by support from WEX Health. Please take a moment to learn more about what they do by visiting wexinc.co/public-sector
Medicaid Buy-In: Episode#6- Interview with Barbara Otto
Listen to the Podcast
- Guest Bio
- Show notes
Barbara OttoBarb is the CEO of Smart Policy Works, a Chicago-based firm that is is a driving force behind building smarter systems of health and social determinants of health for vulnerable people and places across the nation, state of Illinois, and metropolitan Chicago. Before her time at SPW, she worked at the 9to5 National Association of Working Women and at Ernst and Young.
Highlights from this episode
- Previous buy in efforts for IDD populations
- Medicaid buy in as a path to expand coverage
- The additional flexibilities and authorities in Medicaid as compared to Medicare.
- Unpacking 1332 waivers, including uses beyond just reinsurance
- How to make Buy In programs successful
- Importance of well thought out financing model for buy in program stability
- Why states cant go it alone (ie cant do it without federal matching dollars, and need health system stakeholder participation)
- The role of actuaries in Medicaid buy in programs
- Predicting uptake of Medicaid buy ins nationwide
About our Sponsor
This was made possible by support from WEX Health. Please take a moment to learn more about what they do by visiting wexinc.co/public-sector
Medicaid Buy-In: Episode#4- Interview with Bryan Cutler
Listen to the Podcast
- Guest Bio
- Show notes
Bryan CutlerBryan is the majority leader in the PA State House, where he has served for 14 years. Before his time in the legislature, he worked in hospital administration and as a radiology technician. He also is an attorney who currently practices law at Nikolaus and Hohenadel.
Highlights from this episode
- Background of effort in PA
- Dealing with impact of decreasing federal funds under ACA
- Importance of wide support from provider, plan and regulators in getting the 1332 waiver for reinsurance
- Overview of the public option in PA
- Legislative groundwork needed to prepare for the public option
- Timeline for PA exchange rollout
- Key steps for states to exit federal marketplace successfully
- Impact of the reinsurance waiver; transparent reporting to consumer comparing costs with and without the 1332 waiver
- Using a public option model as way to reform Medicaid, including incorporation of social determinants
- Provider response to the proposed model has been overwelmingly positive
- Previous provider quality initiatives laid groundwork for smoother transition today
- Increasing impact of Medicaid spending on other state budget priorities like education and roads
- Predicting national uptake of public option models
About our Sponsor
This was made possible by support from WEX Health. Please take a moment to learn more about what they do by visiting wexinc.co/public-sector