Medicaid Conversations: Pharmacy Carve-outs and 340B chat with Leslie Latano-Saba
Tag: Interviews
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
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- 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
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- 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
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- 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
Medicaid Buy-In: Episode#3- Interview with Dylan Roberts
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- Guest Bio
- Show notes
Dylan RobertsDylan is the state representative for Colorado House District 26. In that role he serves as the chair of multiple committees, including the Rural Affairs and Agriculture Committee, the Capital Development Committee and the Judiciary Committee. He is also the Deputy District Attorney for Colorado’s 5th Judicial District.
Highlights from this episode
- Demand from his constituents to address the excessive high costs of healthcare and insurance
- Bringing in more competition and new savings measures
- Overview of CO plan / proposal
- Problems with 22 counties that only have 1 option on exchange
- Bill to examine public option proposal in 2019
- Stakeholder meetings and actuarial analysis
- Use of reference-based rates for hospitals as key to allowing plans to offer cheaper products
- Advice on policies and systems states need to have in place for public option to work
- High healthcare costs in CO as driver for change; political pressure to find a solution
- Compared to Washington (state) public option bill in 2019
- Provider support of plan
- Using Medicare rates as benchmark for public option plan facility rates
- Longer term benefits to facilities of public option models
- Predicting uptake of public option model 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#2- Interview with Adam Fox
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- Guest Bio
- Show notes
Adam FoxAdam is theDirector of Strategic Engagement at Colorado Consumer Health Initiative . He advocates for better consumer access to healthcare in Colorado and has been featured as a thought leader on national news outlets such as CNN. In his role at CHHI he focuses on communication strategies, media engagement and driving the policy agenda in his state.
Highlights from this episode
- Background of the public option effort in CO, including the legislative path
- Why its less feasible for CO to pursue a Medicaid buy-in path (the CO Taxpayer Bill of Rights)
- Clarification of Colorado Public Option key details, including
- premiums and subsidies on CO exchange under new option
- increasing number of carriers operating in various counties
- regulatory authority under the CO public option
- benefit design and MLR
- A better understanding of what is meant by the “public/private partnership” model
- Why rate caps for hospitals are key to the plan
- Key changes and systems needed to operate a public option plan
- Importance of strong consumer outreach and enrollment functions
- Effectively engaging legislators in the effort
- Provider pushback on the price controls component
- Plan response to the proposed model
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
Episode#5: Interview with Roger Hebden
Guest bio
Roger is the CEO of Livanta, which is a Medicare Quality Improvement Organization (a QIO). Before his time at Livanta, Roger has spent more than 20 years in IT and healthcare space, including roles at Microsoft, Dell, and Sutherland.
Highlights from this episode
- How medical records still are sent via snail mail and fax as primary mechanism for Medicare QIOs
- FIHR, BlueButton 2.0
- Using member education in an interoperable system that helps patients manage medical records
- Improving communications channels, including the limits of telephones and the opportunities with secure text
- What we make available vs what people use
- The limits of provider portals
the journey to appropriate consent management
Episode # 4- Interview with Mary Alice Hunt
Guest Bio
Mary Alice is the North American Solutions lead at IBM Watson Government Health and Human Services. She has spent nearly 20 years developing solutions for state clients that focus on integrated eligibility, care management and healthcare reform. Before her time at IBM, she taught information technology at the State University of Albany, led product development at Curam and helped to modernize New York State technology systems.
Highlights from Episode
- How quickly technology is advancing and the impact that has on interoperability efforts
- Multiple challenges in interoperability, such as
- Challenges of integrating various types of data being integrated before we are even ready for it in the private sector, and in government world it lagging
- challenge of different terminology for same information
- challenges in matching patient records
- how our patient identifiers change over our lifetime
- A plain language explanation of APIs
- Various topics around patient data access, including:
- Providing patients with meaningful insights about their health using their data
- Challenge of getting data to Medicaid members
- Challenges in consent management
- Importance of starting with the right data model when designing consent management functions
- Key data governance and design insights, including
- designing for exceptions
- making sure data is shared but not propagated; using a central repository model
- challenges of converting data from old system to new system
- 360 degree views of patient data in an interoperable system