Make sure you stay up to date on the Roundup, industry news, the webinars and Who's Whos.
We talked with Carie Summers of the Georgia Hospital Association to learn about the current year’s Medicaid budget and provider revenue fees.
We chatted with Tom Novak of ONC/CMS about new Medicaid HIT funding now available to a broader set of providers than previously possible.
Medicaid Who’s Who: David Evans – VP of State Government Programs with Geisinger Health Plan in PA
A: I currently am responsible for the 175,000 plus Medicaid members in the MCO where I work. I am also responsible for approximately 10,000 CHIP members.
A: I am the VP of State Government Programs for the Geisinger Health Plan in Pennsylvania.
A: Although I have been in the healthcare industry for over 30 years (half of which have been in managed care), I have only been involved in the Medicaid portion for the last 4 years.
A: For most of my healthcare career I have been involved in quality and process improvement in one form or fashion. That is why I jumped at the opportunity 4 years ago to move into the Medicaid industry, to take my quality experience into a new line-of-business for Geisinger Health Plan at the time.
A: To spend time in Alaska. I love the outdoors and that would be the ultimate for me.
A: Fly fishing. Nothing beats the quiet and solitude of standing in a trout stream fly fishing.
A: Abraham Lincoln. Certainly regarded as possibly the best US President, Lincoln’s humane personality and democratic eloquence are what makes him stand out among all political figures.
A: Pizza, although I don’t consider it a junk food.
A: Starting to work with the Geisinger Health Plan at the infancy of NCQA Accreditation and HEDIS reporting and helping to build that program into one of the top 10 Commercial programs in US is an accomplishment I am very proud of.
10. For what one thing do you wish you could get a mulligan?
A: In reality nothing. I have certainly made some mistakes over my life and career, but I would rather learn from them and move on than attempt a do-over.
A: Although there are a number of issues that are impacting Medicaid currently, for me personally, building a service oriented program for Managed Long Term Services and Supports will be the most important. Pennsylvania is moving MLTSS into managed care and Geisinger Health Plan will be ready.
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Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2ayIdex
Or you can click the one for optimist readers – http://bit.ly/2ayIKgB
THE HEART OF IT ALL STATE WANTS BENNIES TO PUT SOME CASH IN THEIR PIGGY BANK- Ohio wants bennies to put the lesser of 2% of their income or $8.25 / month (or the cost of about 1.5 packs of cigarettes, which would get a chain-smoker through about 4PM one day) into a health savings account (which would be mostly funded by the state). Ohio number crunchers say the plan would save about $1B over 5 years compared to current spending. Whoa! A Medicaid “savings” number that means less actual dollars spent? Not some crazy “but we would have spent more if aliens landed and all enrolled in our program, so this plan “saves” money” savings estimate? The real kicker – bennies who can’t cough up the $8.25/month would be disenrolled. I give this 1 snowball out of 5’s chance (in Hell) of CMS not laughing this out of town.
KEYSTONE STATE CONTRACTS KINKED-UP OVER PROTESTS- All those new MCO contract awards we’ve all been watching the last 18 months in PA? Yeah, not gonna happen anytime soon. The latest round of implementations was supposed to start Jan 1, but a judge sided with Aetna this week on a move to delay until April. Aetna protested part of the state’s proposal review methodology. Now bidders have until August 22nd to submit proposals under the restarted RFP process.
EMPIRE STATE OF THE SOUTH TELLS PROCUREMENT PROTESTORS TO STUFF IT- GA officials let the losers have their say (Americhoice, Humana and Amerihealth Caritas), but in the end said “no thanks, you still lose.” The new GA CMO (That’s an MCO everywhere else except GA) contracts were supposed to start this month, but now are delayed until at least August 2017. Losing MCOs can still take it to the courts if they want to (the current protests were handled by the state Dpt of Administrative Services).
AUDITOR TURNS OVER ROCKS IN OLD NORTH STATE, FINDS (INFERS) UP TO $17M IN NO-NO PAYMENTS FOR DME- For audit geeks nationwide, NC has been a hit parade of sorts the past few years. And the hits keep on coming. Beth Wood (the state auditor) took a national estimate of DME fraud rates and applied them to NC Medicaid claims to come up with the potential NC loss. Then she reviewed NC DMA payment review policies and said they weren’t up to snuff. A PCG post-payment review contract was also cited as an example of poor vendor management (per Wood, NC DMA staff did not do any verification of the PCG results).
NOT THAT ANYONE’S WATCHING, BUT BLUE-GRASS STATE EVIL PLAN TO ROLL-BACK EXPANSION MISSED FIRST DEADLINE- The Good Guvn’r Bevin’s office missed an internal deadline related to submitting its infamous 1115 waiver to CMS this week. Reason cited? Way more comments than expected.
CONGRATS DUE TO ADVANCEMED- They just want a $77M contract from CMS to provide fraud consulting. Congratulations!
WELLCARE BOOSTS M&A TEAM- Tuesday’s earnings call was encouraging for those of us excited to see the WC comeback into the Medicaid space continue. CEO Ken Burdick focused on criteria for targets in both the Care’ and Caid’ spaces (and largely avoided speculation around the WC role in the event of a breakdown in the Anthem/Cigna deal).
FARRIS’S FANTASTIC FRAUD FOLLIES– Just not enough space this week. Plenty in the twitter feed, I promise. Head on over there and get your fix. My favorite this week is probably either the St.Joes story or the Tenet one.
That’s it for this week. As always, please send me a note with your thoughts to firstname.lastname@example.org or give me a buzz at 919.727.9231. Get outside (I got lemongrass plants on clearance for $1 this week!) and keep running the race (you know who you are).
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