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Category Archives for Medicaid Industry Who’s Who

Medicaid Industry Who’s Who Series: Joe Reblando

Medicaid Who’s Who: Joe Reblando – Media Relations Consultant for Medicaid Health Plans of America (MHPA)

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

A: Medicaid Managed Care

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

A: Eight years

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

A: Helping tell the story of America’s under served and the industry that serves them. Also motorcycles, dogs, and bourbon.

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

A: To remove the term “bucket list” from the American lexicon 😊

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

A: Spending time with family

 6. Who is your favorite historical figure and why? 

A: Winston Churchill for his charismatic leadership qualities, his courage and resolve in the face of tyranny, and his daily whiskeys.

7.  What is your favorite junk food?

A: Pizza, but not just any pizza – I’m talking about real NY pizza where you fold slices in half before taking a bite

 8.  Of what accomplishment are you most proud?

A: Being quoted in the New York Times in a story by Robert Pear on Medicaid payments to physicians

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

A: Not discovering health care public relations as a profession earlier. However, I think all my varied roles in health care up until now led me to where I am today (and I am a better health care public relations professional for it), so it’s all good.

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

A:

  • States seeking waivers for their Medicaid programs, especially those instituting work requirements
  • Bringing high drug prices down via a total revamp of the Medicaid Drug Rebate Program

 

Medicaid Industry Who’s Who Series: Audrey Taylor

Medicaid Who’s Who: Audrey Taylor – CEO and Founder of netlogx LLC

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

A: netlogx has a wide breadth and depth of experience in the Medicaid Industry with several specializations spanning both State governments and private sector healthcare entities. Our expertise includes: 

  • Medicaid Management Information System (MMIS) replacement and modularity projects supporting 
    • Vision and planning 
    • Public procurements 
  • Integration Verification & Validation (IV&V)
  • Centers for Medicare & Medicaid Services (CMS) Certification 
  • Medicaid Information Technology Architecture Self-Assessment (MITA SSA)
    • Medicaid Policy regulatory Traceability at the state and federal levels
    • Support to Managed Care Entities

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

A: Since the inception of the company in 1998, netlogx has been operating in the health and human services practice area and has actively supported State Medicaid programs for all 20 years. 

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

A: I am passionate about lifting up women to help them follow their dreams and meet their goals; especially those who own, or seek to own, their own businesses. 

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

A: At the netlogx corporate office we have a “Before I Die Wall” and I’ve added that I’d like travel to a destination of my choice with no prior planning.

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

A: Reading is my favorite past time; I find it provides the opportunity to visit other cities, counties and periods of history all with the turn of a page. 

 6. Who is your favorite historical figure and why? 

A: I find the lives of iconic women of history to be illuminating – as I read about Elizabeth I and her choice not to marry, I marvel at how she learned to navigate in a man’s world.

7.  What is your favorite junk food?

A: As a former Brit turned American, I have two:  Here in the U.S. it is a hamburger, ideally with blue cheese, lettuce, tomato and onion. Back in the U.K., it is fish and chips with a side of curry sauce!

 8.  Of what accomplishment are you most proud?

A: My family – my husband is my greatest champion and partner in both life and work and our sons are both a joy and a challenge.  Since our sons are both adults now, it will be all joy from here on in!

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

A:  I feel that I learn more from my mistakes than from my successes, so I guess I’m going to skip the mulligan.

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

A:

  • The funding of new Medicaid Welfare-To-Work programs to determine who bears the direct financial burden for the programs – state budgets or managed care health plans.
  • The impact to State budgets as they begin to plan covering the increased state share of costs for the Medicaid expansion populations when federal program funding at 100% ends by 2020.

 

Medicaid Industry Who’s Who Series: Lisa Holden

Lisa Holden is a featured speaker for the upcoming Medicaid Innovations Conference in Orlando, FL on January, 31st – February 2nd. Use code MM200 for $200 off your registration HERE!

 

Medicaid Who’s Who: Lisa Holden – Vice President Accountable Care for Independent Care Health Plan (iCare)

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

A: We are a Managed Care Organization offering services to Wisconsin Medicaid members and Medicare Advantage Dual Eligible Special Needs Population members.

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

A: 35 years

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

A: My passion has always been service to people living in poverty including those with disabilities. For the first eighteen years of my career I was deeply involved in Women’s Health; particularly Access to Prenatal Care and addressing the impact of Racism on Infant Mortality. I chaired our state’s Perinatal Association and March of Dimes Public Affair committee for many years. My passion was to educate policy makers on system barriers that prevented poor women from accessing early prenatal care. My attention was always focused on the need for additional supports to address social determinants of health. My passion for the past sixteen years has been on Domestic Violence, Nonprofit consulting and education; and now Care Management for people living in poverty who suffer from chronic conditions at young ages and need assistance with social determinants of health.   

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

A: Designing a Care Management model of care that addresses social determinants in such a way that the positive outcomes last generations (for eternity). On a private note, riding my horse every weekend.  

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

A: Spending time with my husband and our kids, outside in nature with my horse and dogs.

 6. Who is your favorite historical figure and why? 

A: Don’t have one.

7.  What is your favorite junk food?

A:  Sorry, but I had to give up junk food quite some time ago. I am now a Gluten Free, Dairy Free, Pescatarian, and… I do love my New Zealand Sauvignon Blanc.

 8.  Of what accomplishment are you most proud?

A: Raising our children to be outstanding human beings, having a circle of friends who meet quarterly for twenty years to share how we are refining ourselves into our true essences, standing in the truth of who and what I am.   

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

A: I’ve had bad horse luck for the past four years including a significant injury last year. I need 2018 to be my best horse year ever.  I just bought a horse last weekend and my fingers are crossed.

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

A:

  • Strengthening the impact that managed care has to improve health outcomes, especially in preventing unnecessary readmissions.
  • Advocating for coverage for all people instead of taking a Neanderthal approach that leaves people uninsured.
  • Expanding the opportunity to provide nontraditional care management services that focus on self-management, community inclusion and safe living conditions.

Lisa Holden is a featured speaker for the upcoming Medicaid Innovations Conference in Orlando, FL on January, 31st – February 2nd. Use code MM200 for $200 off your registration HERE! 

Medicaid Industry Who’s Who Series: Randy Ricker

Randy Ricker is a featured speaker for the upcoming Medicaid Innovations Conference in Orlando, FL on January, 31st – February 2nd. Use code MM200 for $200 off your registration HERE!

 

Medicaid Who’s Who: Randy Ricker – Vice President for MLTSS at Optima Health

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

A: Implementing a statewide MLTSS program under a new contract with the Commonwealth of Virginia.

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

A: Currently serving as Vice President for MLTSS at Optima Health in Virginia Beach, VA.

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

A: Eighteen years in the Medicaid business, with some Medicare Advantage thrown in for seasoning!  Thirty six years in the healthcare industry.

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

A: Creating effective teamwork that produces results.

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

A: Participating in John Newcombe’s “Legends” tennis camp.

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

A: Playing or coaching tennis.

 7. Who is your favorite historical figure and why? 

A: President Eisenhower – a truly bi-partisan leader with an incredible history of service to our country in a variety of critical roles.

8.  What is your favorite junk food?

A:  IPAs – while not truly junk food, all those wonderful carbs should make it count!

 9.  Of what accomplishment are you most proud?

A: 38 years of a really fantastic marriage

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

A: My first two years of college!

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

A:

      • CHIP funding
      • Congressional attempts at Medicaid Reform
      • dealing with the opioid crisis and behavioral health issues.

Randy Ricker is a featured speaker for the upcoming Medicaid Innovations Conference in Orlando, FL on January, 31st – February 2nd. Use code MM200 for $200 off your registration HERE! 

Medicaid Industry Who’s Who Series: Steve Konsin, Sr.

Medicaid Who’s Who: Steve Konsin, Sr. – President, Syrtis Solutions

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

 A: Currently in Third Party Liability..but more specifically in “Medical and Pharmacy Claim “Cost Avoidance” vs. Pay and Chase which is     what we try to help our customers either minimize or move away from entirely. 

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

 A: President, Syrtis Solutions.  My business partner and I started the company almost 10 years ago.

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

 A: 12 years directly involved in Medicaid programs

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

 A: Savings and Innovation which has been a constant throughout my career.

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

 A: Go to an F1 race in Monaco.

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

 A: Racing Vintage sports cars…a life-long hobby…

 7. Who is your favorite historical figure and why? 

 A: Benjamin Franklin because he was so diverse in his interests and accomplishments. He demonstrated that you can do just about anything if you put your mind to it…

8.  What is your favorite junk food?

A:  Pimento cheese (its a southern thing I picked up.)

9.  Of what accomplishment are you most proud?

A:   Working thru and succeeding with some very difficult life challenges 

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

A: When I missed a shift for the lead on the last lap going on to the front straight of Watkins Glen in the 50th running of the Collier cup race. The race I won 25 years earlier…man I wish I had won that trophy to put next to the earlier one…

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

 A: 

  • The status of the economy as a whole.
  • The future or demise of the ACA.
  • The current administrations actions.

 

 

Medicaid Industry Who’s Who Series: Jeff Myers

Jeff Myers is the President and CEO for the upcoming Medicaid Health Plans of America (MHPA) Conference in Washington, DC on October 29th -31st. Use code MHPA17-MM200 for $200 off your registration HERE!

 

Medicaid Who’s Who: Jeff Myers – President and CEO, Medicaid Health Plans of America (MHPA)

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

A: Four (dog) years

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

A: Leaving the world a better place than I found it – if that includes motorcycles, sailing, or Medicaid reform, then all the better

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

A: Hearing one of my children say “you know, Dad, you’re right.”

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

A: With three kids, there is no such thing.

5. Who is your favorite historical figure and why? 

A: And this is risky (it is what I said to the Board): Joan of Arc – she did what she thought she was called to do, and was willing to burn at the stake for her beliefs.

6.  What is your favorite junk food?

A:  whiskey

 7.  Of what accomplishment are you most proud?

A: Hiking the Andes over an old Jesuit trail with my now-wife and not scaring her off.

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

A: Every mistake is a learning opportunity and chance for growth, and every mulligan I have ever taken on the golf course has ended the exact same way as the first shot.

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

A:

      • CMS decision(s) on all of the pending waivers;
      • Congressional decisions on  the future of the funding structure for Medicaid;
      • CHIP extension of current and future reauthorization
      • (since this is only 6 months)

 

Jeff Myers is the President and CEO for the upcoming Medicaid Health Plans of America (MHPA) Conference in Washington, DC on October 29th -31st. Use code MHPA17-MM200 for $200 off your registration HERE!

Medicaid Industry Who’s Who Series: Richard Topping

Richard Topping is on the Board of Directors for the upcoming Medicaid Health Plans of America (MHPA) Conference in Washington, DC on October 29th -31st. Use code MHPA17-MM200 for $200 off your registration HERE!

 

Medicaid Who’s Who: Richard Topping – CEO, Cardinal Innovations Healthcare

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

A: Nine Years

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

A: Finding ways to provide all Americans with access to health, education and economic opportunities.

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

A: To visit St. Petersburg, Russia.

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

A: Cycling

5. Who is your favorite historical figure and why? 

A: Winston Churchill, because he persevered and succeeded against difficult odds.

6.  What is your favorite junk food?

A:  Pizza

 7.  Of what accomplishment are you most proud?

A: Leading Cardinal Innovations through Medicaid transformation and driving policy reform.

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

A: All of my golf games.

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

A: Federal Financing; State System Design; Industry Consolidation

 

Richard Topping is on the Board of Directors for the upcoming Medicaid Health Plans of America (MHPA) Conference in Washington, DC on October 29th -31st. Use code MHPA17-MM200 for $200 off your registration HERE!

Medicaid Industry Who’s Who Series: Jim Milanowski

Jim Milanowski is the conference chairperson for the upcoming Health Plan Innovations for Care Coordination Conference in Scottsdale, AZ on September 13th – 14th. Use code MM300 for $300 off your registration HERE!

 

Medicaid Who’s Who: Jim Milanowski – President and Chief Executive Officer of the Genesee Health Plan

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

A: I run the Genesee Health Plan. We provide an outpatient health care coverage to those who do not qualify for the Medicaid Expansion or the ACA, or are waiting to enroll/become eligible for these coverages. Our staff are all trained to enroll people in the Medicaid Expansion or the ACA exchange. Finally, we do member onboarding and health risk assessments for Medicaid Expansion enrollees for two Medicaid Health Plans.

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

A: I have been in the Medicaid industry for over 25 years, starting off as a Case Manager for mental health clients.

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

A: With understanding of health care coverage being so overwhelming to most people, making sure that the people we assist are educated on what coverage they qualify for and how to use their health benefit to becoming healthier.

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

A: I am a big sports fan, so attending a Super Bowl would be right at the top, especially if the Detroit Lions would ever make it.

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

A: Spending time with my two sons, who are 22 and 18. They still like hanging out with their father!

6. Who is your favorite historical figure and why? 

A: Abraham Lincoln. During a stressful and chaotic time in our history, he stayed focus on the task at hand and found time to spend with his family.

7.  What is your favorite junk food?

A:  Pizza

 8.  Of what accomplishment are you most proud?

A: Our organization, Genesee Health Plan has provided hands on assistance to over 75,000 county residents in the last ten years.

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

A: When the ACA came out in 2014, we spent that original open enrollment period getting as many people enrolled into coverage as quickly as possible, without spending an adequate time one on one educating them on options and benefits. We have slowed down our approach since that first year.

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

A:  1. Deciding what happens with Medicaid funding at the national level.

2. To start developing a health care safety net if Medicaid Expansion goes away.

 

Jim Milanowski is the conference chairperson for the upcoming Health Plan Innovations for Care Coordination Conference in Scottsdale, AZ on September 13th – 14th. Use code MM300 for $300 off your registration HERE!

Medicaid Industry Who’s Who Series: Tom Meyer

Tom Meyer is the featured panelist for the upcoming Special Topic Webinar: 21st Century Cures Act on September 21st. RESERVE your seat today!

 

Medicaid Who’s Who: Tom Meyer – Chief Program Integrity Officer, HHAeXchange

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

ASoftware and services for the home care industry

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

A: 11 ½ years

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

A: Creating efficient processes

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

A: Touring the USA

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

A: Cycling (think Tour de France, only slower)

6. Who is your favorite historical figure and why? 

A: George Washington.  Though he had many accomplishments, I most admire him for having voluntarily surrendered power (twice!)

7.  What is your favorite junk food?

A:  Chocolate

 8.  Of what accomplishment are you most proud?

A: My three daughters.

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

A: My lame marriage proposal.

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

A:  1. The replacement or adjustments to ACA (Obamacare)

2.  Value Based Payment Methodologies (and the data to support them)

3.  Funding Levels

Tom Meyer is the featured panelist for the upcoming Special Topic Webinar: 21st Century Cures Act on September 21st. RESERVE your seat today!

Medicaid Industry Who’s Who Series: Preston Cody

Preston Cody is the featured panelist for the upcoming Washington State Medicaid Spotlight Webinar on Monday, August 7th. RESERVE your seat today!

 

Medicaid Who’s Who: Preston Cody – Division Director, Division of Medicaid Program Operations and Integrity, Washington State

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

A: Medicaid Program Integrity, Medicaid Managed Care, value-based payment, network adequacy, physical/behavioral health integration, mental health parity, Medicaid Administrative Claiming, Non-emergency Medical Transportation, Interpreter Services, and other activities related to Medicaid Program operations.

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

A: Division Director, Division of Medicaid Program Operations and Integrity, Washington State Health Care Authority (the single state Medicaid agency in WA)

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

A:  20+

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

A:  I’m passionate about ensuring the clients we serve receive the best care possible and those staff who serve clients on a daily basis get the direction, tools and support to do their jobs effectively with a high-level of satisfaction. As a veteran I serve as the executive sponsor for the agencies Veterans Employee Resource Group which focuses on recruiting, retaining and supporting our veteran employees. I find this an extremely rewarding process.

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

A: Simply to live each day to the fullest and enjoy the journey.

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

A:  On a personal note, I am happily married and have five children and two grandchildren who I love spending time with. My family and I love to camp, boat and ride ATV’s on the Pacific Northwest coast, it’s an amazing place to live! However, during football season we switch gears to watch our beloved Seattle Seahawks. Go Hawks! Work-life balance is critically important and something we encourage staff to focus on in our agency.

 7.  What is your favorite junk food?

A:  Any type of Mexican food, it’s all amazing!

 8.  Of what accomplishment are you most proud?

A: Effectively transition the WA State subsidized Basic Health program to Medicaid coverage under the ACA effective 1/1/2014.

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

A: Great question. Years ago our organization was directed by our state Legislature to immediately terminate coverage for a large group of clients with less than 1 day notice. We complied with the requirement which was immediately challenged and was ultimately settled years later. If I had the opportunity for a do over I would have done a better job describing the impact and delaying implementation which would have accomplished the same outcome with far less disruption and ensured clients received timely due process.   

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

A:  1.  Ensuring there is no erosion of coverage resulting in a decrease in population health, increased uncompensated care and massive disruption in the health care system.

2.   Effective implementation of behavioral and physical health integration in WA Medicaid.

3.   Completion of the first year of value-based payment requirements with our managed care organizations.

Preston Cody is the featured panelist for the upcoming Washington State Medicaid Spotlight Webinar on Monday, August 7thRESERVE your seat today!

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