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Medicaid Who’s Who Interview: Meg Murray

Meg Murray is CEO at
Association for Community Affiliated Plans (ACAP)

Check out her LinkedIn profile HERE.

Which segment of the industry are you currently involved?

ACAP is a national trade association, representing 66 non-profit Medicaid Managed Care Plans that serve over 20 million lives in 29 states. Our safety net health plans provide care to nearly half of all people enrolled in Medicaid managed care plans.

How many years have you been in the Medicaid industry?

I started my career in Medicaid managed care in 1994 while working at the Office of Management and Budget, focusing on the Medicaid waivers during the Clinton Administration. Back then, fewer than 3 in 10 Medicaid enrollees were in managed care; today it is closer to 7 out of 10.

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

I’m dedicated to ensuring that all Americans have access to high quality health insurance and high-quality care—especially Americans with lower incomes. This has a lot to do with my family history —  my grandmother suffered a stroke when my father was quite young. The family didn’t have comprehensive insurance, and it took a toll on their financial security. My father used to always tell me how important it was to have good health insurance. That is what motivated me to work to ensure that a family doesn’t experience a financial catastrophe because of an illness.

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

I’d like to spend another year in Germany looking at their health care system, so I could continue to see what the U.S. can learn from the German system. After graduate school, I spent a year in Germany studying their health care system through a fellowship program and was recently back there this past summer for a month to do more studies on the topic.

The German system includes an individual mandate, risk adjustment, a comprehensive set of required benefits, private providers and hospitals, and a robust competitive insurance marketplace. And it’s been that way for more than 135 years. As I pointed out in an op-ed last year, there’s a great deal we can learn from them.

I also want to improve my German language skills—a lot of it came back to me while I was in Germany, but I continue to read detective novels in German in attempts to maintain my skill level.

What do you enjoy doing most with your personal time?

I have two teenage sons, so I enjoy spending my time with them…when they let me! I am also an avid reader and belong to two book clubs. So, I’m constantly reading to keep up—I need to make sure I’m not thrown out! As a runner, my newest endeavor is training for a 10K.

Who is your favorite historical figure and why?

Susan B. Anthony. Right now, I’m fascinated with the women’s suffrage movement, especially considering how long it went on and the immense dedication these women displayed for their cause. Many suffragettes didn’t live to see the 19th amendment enacted. But their legacies live on.

What is your favorite junk food?

No contest: chocolate chip cookies. I try to bake them from scratch, but more often than not, they come straight from the tube. Still just as delicious!

Of what accomplishment are you most proud?

I am immensely proud of the advocacy work ACAP did to fight against the threat of repealing and replacing the Affordable Care Act in 2017, because the repeal would have meant massive cuts to the Medicaid program. We launched a successful social media campaign, “Medicaid is Us,” which resulted in published op-eds across the country, radio ads, more than 5,000 television spots, and news coverage in a wide array of markets.  Most notably, it generated more than 50,000 letters sent to Senators and Representatives, urging them to oppose cuts to Medicaid. We’re proud of our work to stand up and defend Medicaid.

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

Social determinants of health will continue to be important to ACAP Safety Net Health Plans. Looking after and caring for people’s needs holistically has oftentimes shown cost savings while improving health outcomes. However, many safety net plans utilize their own funds to address social determinants. That’s why our plans are constantly sharing best practices and also thinking creatively about external funding sources so they can sustain the great strides they’re making in addressing the social determinants of health.

Another important issue is churning in the Medicaid program. Every year, millions of people enroll in Medicaid, only to lose their coverage due to lost paperwork or slight changes in income, like receiving overtime pay. It’s been a hot-button issue in the news for the past few months, and likely will continue to be. To reduce the level of churning, there are two bipartisan Congressional bills that propose 12-month continuous eligibility for people that have Medicaid or CHIP. The passage of these bills would be monumental in ensuring people don’t lose their health coverage over minor glitches.

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Know someone in the space who’s doing great work and is an all around interesting person?

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Medicaid Who’s Who Interview: David Kumpf

David C. Kumpf is the Chief Product Development Officer at Optimetra, In.c

Check out his LinkedIn profile HERE.

Which segment of the industry are you currently involved?

Broadly, business development for Medicaid MCOs and health and human services organizations working with the Medicaid population (Centers for Independent Living, home care agencies, and the like). While we develop many proposals for our clients in response to state and federal RFPs, we spend as much time on helping our clients identify, select, architect, and position the solutions that will help them be more effective at serving Medicaid beneficiaries in the future.

How many years have you been in the Medicaid industry?

I’ve spent nearly 28 years in healthcare consulting, beginning with commercial healthcare and then the federal TRICARE program. I began working in Medicaid in late 1999 – so, almost 20 years.

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

Bringing clarity, direction, and solutions for complicated problems. I love situations in which a room of a dozen people are trying to address an issue and are having a circular conversation about what to do; I listen, and then help illuminate a path – or choices – for them.

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

I don’t think of life as being about ticking off items on a bucket list, but rather about seeking ways to learn, improve, and enjoy in different dimensions of mind, body, spirit, and family. What can I learn? How can I improve? So I’m always looking for opportunities to increase the breadth and depth of my knowledge about many subjects and for ways to try to raise my standard of practice for the things I already know how to do.

What do you enjoy doing most with your personal time?

Playing guitar. Riding a bicycle. Watching good TV or movies with my wife. Reading. Discovering great new (or new to me) music. And, apparently, being a Yorkie rancher (we have three).

Who is your favorite historical figure and why?

That’s practically impossible to answer. There are so many that have contributed (in positive ways) to shape the world we live in. Aristotle, Plato, Newton, Einstein, Curie, Washington, Adams, Lincoln, and scores of others. In my adolescence, I was a fan of General George Patton. More recently, Steve Jobs. The common thread between the last two is the single-minded obsession with realizing a vision – Patton with building the Third Army into a force for winning the war in Europe, Jobs with making complex technology intrinsically easy to use.

What is your favorite junk food?

Peanut M&Ms. Pizza, too, but if done right, it’s not so much junk food.

Of what accomplishment are you most proud?

Personally, having a wonderful wife to whom I’ve been married for 38 years; we have two successful children and a grandson.

Professionally, building Optimetra, with the help of my business partner (Holly Smith), into a successful consulting practice that has created exceptional results for our clients. Holly is running the company now as CEO, and I’m looking forward to where she takes the company next.

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

I’m not a believer in obsessing over the past – everyone tries to make decisions based on the knowledge and ability they had at the time. Steve Jobs, in a commencement speech, said “You can’t connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something – your gut, destiny, life, karma, whatever.”

I do want to learn from what I did. I can’t always change it, but I can make different choices the next time. Or, if the context and timing is right, share it with others: “hey – I know you’re about to do such-and-such – you might consider…”.

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

At Optimetra, we are guiding our clients toward a unique value position in the market. Population health, value-based purchasing, and quality improvement are not independent disciplines – they are inextricably linked as part of a single system and member experience. In modern Medicaid, it is imperative to differentiate your organization from your competitors by listening to your customer(s) and prioritizing initiatives that have the highest probability of producing measurable improvements.

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Know someone in the space who’s doing great work and is an all around interesting person?

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Medicaid Who’s Who Interview: Krista Drobac

Krista Drobac is a Consultant and Lobbyist in Washington, D.C.

Check out her LinkedIn profile HERE.

Which segment of the industry are you currently involved?

I am a consultant and lobbyist in Washington, D.C. I represent health plans, Medicaid contractors and vendors interested in advancing value-based care. I analyze Medicaid and Medicare policy issues and advocate for change.

How many years have you been in the Medicaid industry?

My first job involving Medicaid was working on Capitol Hill in 2002. I worked for Senators Stabenow and Durbin, and then moved to Illinois where I was the Deputy Director of the Department of Healthcare and Family Services, which served more than 2 million Medicaid beneficiaries. That number has increased to more than 3 million today. I returned to D.C. in 2008 and served the Medicaid program at CMS. Finally, I led the Health Division at the National Governors Association’s Center for Best Practices where we sought to help Governors improve quality and lower costs in the Medicaid program. 

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

My passion is social determinants of health. I was deeply influenced by Dr. Jeff Brenner at the Camden Coalition in 2011. He let me spend some time with his integrated team and visit complex Medicaid patients in their homes. I experienced first-hand the challenges of managing housing, nutrition, medication adherence, fall risks, transportation among other things. Through this hands-on experience, I came to the conclusion that to achieve well-being among Medicaid beneficiaries and save money, we must look beyond clinical care. I now lead a coalition called Aligning for Health…trying to do my small part to advance the ball on this topic.

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

I hope to show my kids the world beyond our neighborhood. They aren’t quite old enough yet, but when they can comprehend a broader world, my husband and I want to take them places that will help them understand and empathize with the daily experiences of others less fortunate, which I hope will energize them to seek solutions as I do now. 

What do you enjoy doing most with your personal time?

Skiing of any kind. I don’t get to do it often enough. Of course, skiing with my family is the perfect combination. 

Who is your favorite historical figure and why?

It sounds so boring, but Abraham Lincoln. He was a courageous leader at a time when we needed it. We could use some of his wisdom, wit, grit, oratory skills, self-deprecation and inspiration today  

What is your favorite junk food?

It’s a tough call between Cheetos and Garrett’s Caramel Corn but if pushed on an answer, it’d have to be the caramel corn.

Of what accomplishment are you most proud?

Helping to change federal policy to allow for coverage of remote patient monitoring in Medicare. In 2018, CMS started paying clinicians for asynchronous monitoring of patient biometric data. The future of health care is in the home, and anything we can do to advance health care services where people live is a great accomplishment.

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

High school sports. I didn’t practice enough and rode the bench. But then, I wouldn’t love Garrett’s Caramel Corn so much – life is a series of trade-offs!

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

·         CMMI models testing various approaches

·         Finalizing the MCO rule, and starting the QHP development process

·         Watching North Carolina’s waiver unfold

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Know someone in the space who’s doing great work and is an all around interesting person?

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Medicaid Who’s Who Interview: Anne Schwartz

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 19th 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?

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Medicaid Who’s Who Interview: Carolyn Yocom

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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Medicaid Who’s Who Interview: Lauretta Converse

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

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Medicaid Who’s Who Interview: Tommy Duncan

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

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Medicaid Who’s Who Interview: Steven Jenkins

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 40th 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?

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Medicaid Who’s Who Interview: Brooke Boswell

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 5th 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 3rd 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
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Medicaid Who’s Who Interview: Richard Edwards

Richard Edwards is Chief Program Officer at Community Based Care, LLC
Check out his LinkedIn profile HERE.
Which segment of the industry are you currently involved?

Community Based Care and its family of providers serve people who have long-term service and support needs, primarily with intellectual and/or developmental disabilities, most often through Home and Community Based Services.

 How many years have you been in the Medicaid industry?

I’ve been in behavioral health, broadly speaking, since 1995 — mostly as a member of provider organizations.

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

Within the industry, I’m especially interested in the balance between the civil rights origins of our field — deinstitutionalization; access; reasonable accommodations — and the need to integrate with healthcare systems and models of care. We have — especially since deinstitutionalization — built habilitation and community integration into the Medicaid system, and in some very significant ways, it has never been a perfect fit, because of the influence of the medical model over healthcare funding structures. The fee-for-service reimbursement system is a good example: a procedure or service or medication might address a symptom, but it does not make us healthy. Extending that concept, being healthy is a goal, but it is not the only or even the ultimate goal. Better health provides a foundation on which other quality of life pillars can be built. We seek to aid people in achieving their best possible health so that they can have an improved quality of life. Public funding sources like Medicaid, in this sense, help people with extraordinary challenges do very ordinary things that most people — including me — take for granted. That is what keeps me coming back to this work.

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

Outside of work, seeing the Northern Lights. Something I haven’t done.

What do you enjoy doing most with your personal time?

I am happily married with two amazing daughters — spending time with my family is very important to me. If we can be outside together — that’s a perfect afternoon.

Who is your favorite historical figure and why?

Difficult question, but I would say Martin Luther King Jr. — a prophet for our times, speaking to the most difficult issues of our culture. To borrow several phrases, his words leave you with no defense; his actions bent the arc of history. His life, speeches, and writings have had a permanent effect on how we talk and think about racism, prejudice, and discrimination.

What is your favorite junk food?

Peanut M&Ms. I can’t (won’t) walk past a bowl without grabbing a handful.

Of what accomplishment are you most proud?

There isn’t anything in my career, or my life, that I have accomplished on my own, so it feels a little awkward to say “proud”. I think my greatest accomplishments are still ahead of me. And, even then, I am sure I will benefit from a lot of help.

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

 Only one? The good news in life and work is there will always be more tests to bring your average up — if you take the time to assess and learn from your mistakes. If I had to pick one, not the biggest mistake I ever made, but just stupid on purpose…I once spouted off to a friend over email — commiserating with her about a workplace change that I knew there were multiple sides to, but, we were old friends, and I was just trying to be sympathetic. That email got forwarded (inadvertently) to my supervisor who was, in part, responsible for the change, and who took my jerky comments very personally. I caused a lot of pain with my thoughtlessness, to someone whom I very much respected. I learned several lessons on that one. Years later, I’m still sorry about it.

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

Addressing constitutionality questions about the ACA will drive activity at the state levels where expansion is still in discussion. In my home state of NC, for instance, there is a lot of interest across the political spectrum in expanding Medicaid, in some limited fashion, but questions about the status of the ACA could delay any serious conversation. Success/failure of new models — like the I/DD Health Home model in NY — to address integrating healthcare and long-term services and supports for people with I/DD. Some of these models are very promising but combining these two practices has always been harder than it looks. While these models are new and should be given time to mature, I think their viability will be evident sooner than later.

 


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.