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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!

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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!

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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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Medicaid Industry Who’s Who Series: Stacy Mays

Medicaid Who’s Who: Stacy Mays – Chief Operating Officer, UNC Health Alliance and the UNC Senior Alliance

 

Q: In which segment of the industry are you currently involved?    

A: I am leading the transition to Alternative Payment Models (APMs), Value Based Care and Clinical Integration for all payer segments, including Medicaid for a $5 billion academic health care system.

 

Q:  What is your current position and with what organization?

A: My current position is Chief Operating Officer for the UNC Health Alliance and the UNC Senior Alliance, the clinically integrated network and Medicare Next Generation ACO of the University of North Carolina Health Care System.

 

Q: How many years have you been in the Medicaid industry?

A: Although it has not been my exclusive focus, I have been in the Medicaid industry for more than 30 years. My work began with one of the original Robert Wood Johnson grantees responsible for initiating managed care in the Medicaid segment.  There was no roadmap.  In many ways, we were trailblazing!

 

Q: What is your focus/passion?  (industry related or not):

A: From an industry perspective, my passion is creating a care delivery enterprise that promotes clinical excellence and seamless care integration along with financial structures that align incentives for providers and put the patient first. I’ve been an industry innovator my entire career.  With evolving technology and payment models, we have an opportunity to achieve changes that have been discussed for many years but not widely delivered upon.  Behavioral health integration and a focus on social determinants of health are two that are top of mind.

From a personal perspective, my family is my focus.  Supporting my young adult children as they navigate through college to what comes next is extremely important.  If I can help them avoid some bumps along the road, I’ll consider that a success.

 

Q: What is the top item on your bucket list?

A: I’m fortunate that most of the things I have wanted to do in life I’ve been able to do.  My bucket list is simple, spending more time with family and traveling a bit more.

 

Q: What do you enjoy doing most with your personal time?

A: In my personal time, I enjoy working out, volunteering and serving on Boards for causes I care about and spending time with my vast menagerie, especially my two rescue dogs, Petey and Willy, and my cat, Kitten.  The menagerie currently includes four goats and a horse in addition to the domestic animals. It has included many other critters over the years.  

My favorite workout is boxing.  I train several times a week and even get in the ring occasionally to spar with my coach.  Boxing is a great workout, both physically and mentally.  It forces you to let go of all distractions and focus completely on the task at hand.  

I also make volunteering and Board service a priority. Two organizations that I work with currently are a canine rescue that has re-homed over 1000 dogs in the past 10 years and an amazing organization that truly changes lives by providing housing, counseling, job training, child care and other support services to substance addicted pregnant women.

 

Q: Who is your favorite historical figure and why?

A: My favorite historical figure is Albert Einstein.  It’s amazing to me that one individual could challenge so many long held beliefs and change the future course of science in so many profound ways.

 

Q: What is your favorite junk food?

A: Chocolate drizzled popcorn.

 

Q: Of what accomplishment are you most proud?

A: From a career perspective, I’m pretty proud of what we have accomplished here at UNC over the past 2 years.  We created a clinically integrated network partnering with 2,000 independent providers throughout the State and implemented value based contracts serving almost 100,000 individuals; built a Medicare Next Generation ACO with global risk for 22,000 Medicare beneficiaries; and executed a joint venture to own a Medicaid Managed Care plan with 10 other North Carolina health systems.

 

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

A: As a college student, I wished I had studied abroad.

 

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

A: 

  1. Potential impact of changes in federal legislation.
  2. In North Carolina, our planned transition to Medicaid managed care.
  3. Continued innovation, particularly in long term care.
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Medicaid Industry Who’s Who Series: Lauralie Rubel

Medicaid Who’s Who: Lauralie Rubel – State President, WellCare of Nebraska, Inc.

 

Q: In which segment of the industry are you currently involved?   What is your current position and with what organization?  How many years have you been in the Medicaid industry?

A: I currently serve as the state plan president for WellCare Health Plans under Nebraska’s Heritage Health program.  Integrated managed care is new to Nebraska.  Heritage Health integrates medical, pharmacy and behavioral healthcare benefits into a single comprehensive and coordinated system for Nebraska’s Medicaid and CHIP clients.

My managed care career began in 1996 as a provider relations representative for a provider-owned TennCare MCO.  Since that time, I’ve held a variety of roles in network contracting, operations, provider relations, new market development, mergers and acquisitions, associate training and government relations. 

 

Q: What is your focus/passion?  (industry related or not):

A: Navigation of the healthcare delivery system is complex for even the savviest consumer.  I am devoted to the simplification of care coordination and to shifting financial incentives from volume of service provided to value of care received.

A key to success in any role is the ability to apply life lessons and personal experience to the job at hand.  As the oldest daughter of a mother with serious and persistent mental illness, I spent many hours during my teens and twenties trying to help coordinate her care among various providers of physical, behavioral, institutional and pharmacy services.  Today I am the wife of a disabled Navy veteran whose Type II diabetes has resulted in several difficult health conditions including a kidney transplant and a below knee amputation.

In both circumstances, I’ve been the primary advocate and care coordinator for my family.  Managing their medications, their appointments, transmission of medical records, confirming benefits and out-of-pocket expenses… sometimes my husband says that he doesn’t know what he would do without me.

Translating these complexities into my professional career, it’s readily apparent that we have millions of persons with Medicaid coverage who face similar challenges every day.  Who can they count on to help them?  The answer – when done well – is managed care.

 

Q: What is the top item on your bucket list?

A: The top item on my personal bucket list is to write a book (or two).  As the primary caregiver for a husband with diabetes, much of the clinical jargon required me to research the disease process so I could be a useful advocate.  I’d like to write a book for non-clinicians who are caring for a diabetic.  I hope that what I have learned over the years will help others understand what it all means and what to expect.  For my second book, I want to write something that isn’t health care related, is completely fictional and totally hilarious.

 

Q: What do you enjoy doing most with your personal time?

A: Writing; taking day trips with the family;  spiritual development; and anything related to being in or near a body of water.

 

Q: Who is your favorite historical figure and why?

A: Gosh this was hard – there are so many people I’ve studied and admired.  A few years ago, though, I had occasion to research several hymn writers and I was profoundly moved by the story of Fanny Crosby.  Blinded as a small child due to corneal infection, Fanny’s visual impairment never deterred her faith or her love of writing poetry and hymns.  She achieved national recognition as a poet in the early 1850s and she delivered recitations to Congress and to President James K. Polk.  While Fanny is most well-known for her prolific hymn writing, her generosity and mission work in some of New York City’s most impoverished communities set her apart as one of my personal heroes.

 

Q: What is your favorite junk food?

A: Diet coke and a quart of fresh boiled peanuts, preferably from a roadside vat manned by authentic boiled peanut experts.

 

Q: Of what accomplishment are you most proud?

A: While I can’t take credit for their many successes, I’ve been privileged to hire and train some of WellCare’s top performers, particularly in provider- and member-facing positions in our markets.  A servant’s mindset can be hard to detect during a job interview, but I’m very proud to say I had a hand in building a committed workforce of genuine “people” people – many of whom have gone on to become servant leaders themselves.

 

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

A: I’ve learned over the last twenty-plus years that most anti-managed Medicaid and Medicare sentiment comes from a committed, well-intentioned desire to protect the rights of individuals dependent on these programs.  There have been times over the years where I took feedback too personally and did not pause to listen – really listen – and then address the matter at hand with an objective, solution-oriented response.  This has been one of my greatest personal and professional life lessons.

 

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

A: 

Quality – the concept of “quality” must extend beyond HEDIS metrics and into service delivery and good communication.  Whether we’re referencing prompt claims payment, or effective member and provider education, or timely transportation to appointments… the assurance of quality service delivery to our members, providers and government clients will be a key determinant in a managed Medicaid program’s success.

Transparency – One of the things I admire most about Nebraska’s Heritage Health program is the commitment to transparency.  The state agency and by extension the MCOs have an inherent obligation for responsible stewardship of public resources.  Transparent communication of capitation payments, encounter data reconciliation, care management outcomes, MCO performance metrics and program integrity findings will improve public awareness of the return on investment in managed Medicaid. 

 

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Medicaid Industry Who’s Who Series: Elena Nicolella

Medicaid Who’s Who: Elena Nicolella – Executive Director, New England States Consortium Systems Organization (NESCSO)

 

 

 

 

 

  1.  What is your current role and in what sector of the industry?

   A: The New England States Consortium Systems Organization is a private, non-profit whose mission is to support State Government Health and Human Service agencies meet their goals.  We focus on: providing training and resources related to Medicaid to State employees, pursuing multi-state procurements, and supporting the effective use of information technology to support the Medicaid Enterprise.

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

 A. 20 years (yikes!)

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

   A: Supporting the delivery of publicly-financed services and supports in ways that are responsive to the needs of people as opposed to the requirements of specific programs.

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

   A: Finish all the ironing.

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

   A: Day trips around New England with the family.

  6.  Who is your favorite historical figure and why?

    A. She is only “historical” to me – but my grandmother.  She was a character!

  7.  What is your favorite junk food?

   A: Olneyville NY System Hot Wieners (it’s a Rhode Island thing)

  8.  Of what accomplishment are you most proud?

   A: Remembering to learn something every day.

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

  A: So many….in general, implementing an initiative without deliberately taking the time to understand the impact on others.

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

   A: As States hold their breaths waiting for the outcome of new health care legislation or regulation, I think it is important to take the time to understand, embrace, and fortify their core values and whether or not they are implementing their programs in service of those values.  This will help guide States’ responses to new mandates or opportunities.

 

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Medicaid Industry Who’s Who Series: Kelli Todd, MPH

Medicaid Who’s Who: Kelli Todd, MPH – Program Manager for Iowa Managed Care Ombudsman Program

Kelli Todd is presenting a CASE STUDY: Transitioning Medicaid LTSS to Managed Care: Challenges, Opportunities and Lessons Learned during the Medicaid Managed Care Congress in Baltimore, MD, May 22 – 24.

 

  1.  What is your current role and in what sector of the industry?

   A: Program Manager for the Iowa Medicaid Managed Care Ombudsman Program in the Office of the State Long-Term Care Ombudsman.

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

 A. 4 years in Medicaid, 8 years in public policymaking and research.

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

   A:  Improving the health of the public.

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

   A: To live a life of travel

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

   A:  Reading, running, spending time with friends and family, and traveling

  6.  Who is your favorite historical figure and why?

    A. Not historical, but a couple of authors I enjoy reading are Jared Diamond, Atul Gawande, and Doris Kearns Goodwin

  7.  What is your favorite junk food?

   A:  Chips!

  8.  Of what accomplishment are you most proud?

   A:  White House Fellowship candidate and mentoring

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

   A:

1. Risk algorithms and improved risk pooling for payment for long-term services and supports

2. Acknowledging the influence of and adequately addressing social determinants of health

3. Engaging of and improving outreach to Medicaid members

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Medicaid Industry Who’s Who Series: Regina Shapiro

Regina is a featured panelist for the upcoming Medicaid Star Search webinar on April 3, 2017. Join us as we talk with innovative Medicaid vendors as they evolve in the space.

 

Medicaid Who’s Who: Regina Shapiro – Director of Business Development for DataWing Software

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

A: DataWing Software expertise is with enrollment/eligibility and payment reconciliation.  Any delegated or attributed population that has a data file distributed from the sourcing state or plan can benefit from our solutions.    I work with Medicaid MCOs, Medical groups/IPAs and FQHC organizations that work with Medicaid beneficiaries.  Our solutions ensure that the accurate eligibility information can be maintained in the varied benefit administration systems used by our clients.  Having accurate data means the accurate benefits are provided to members/patients and that the servicing groups/plans can ensure they are receiving the correct payments for those members. 

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

A:  I would not say that I am in the Medicaid industry, I would say that I am in the software industry and my clients include healthcare and related organizations.   I have over 28 years of software experience, the past 7 have been 100% focused in Healthcare solutions.

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

A:  Doing everything I can to ensure that the information about peoples insurance is accurate.  In 2005, my oldest son was a pedestrian hit by a car going 45 mph.  He is my walking, talking miracle, one of the 2% that survive but his accident was life changing for our entire family.   I discovered, through my own experience, the challenges that happen with inaccurate information about patients and their insurance coverages.   I had insurance, good insurance, but my plan was not “in-network” to the hospital where he was taken by life flight.  I spent hours analyzing the EOB documents to try to understand why was a doctor with the same date, same procedure code paid at varied levels of coverage.  That hospital billed me for the balance of all charges not covered by my insurance plan.   My MOOP did not matter to them.  A few years later, I learned about DataWing Software and realized that I wanted to work for this company to help to ensure accuracy about patient/member benefits.   Now, every day, I feel that what I do could prevent another mom with the paperwork nightmare I had and so they can focus on their child’s recovery.  I know the challenge I had was with the coding, but I feel like DataWing Software is making a real difference to the patients/members. 

My other passion is the preservation of the true foundation Appaloosa horse.  I have been fortunate to have achieved much with our program including our blood lines are carrying forward with the Nez Perce Appaloosa Horse registry.  Our colt, Mamin Glory Rising, is even documented with the Smithsonian.

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

A: Australia

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

A:  Anything Equine related.  My Re-Creation is in the saddle so whenever I can, I ride.  I love spending time in the barn, mucking stalls or brushing horses.  I schedule 30 minutes daily to just break away from work and say hi to the herd.

  1. Who is your favorite historical figure and why?

A:  One…. That is hard.  There are so many historical people that made a difference in the world.   Maybe not one that many have heard of is Drew Kleibrink.  He had the passion to change the world.  He had a way of making people think about the voting decisions they were making.  His passion was to make the world a better place through the political process.   Don’t Stay Calm, Go Change the World.  That was Drew. 

Chief Joseph was a peaceful man forced to flight and fight.  He was an exceptional leader.  He is one of my favorite historical figures because of my passion to preserve the true appaloosa, the horse of the Nez Perce.   I have participated in the Chief Joseph Trail Ride several times, retracing the 1300 mile trail taken by Joseph and his people from the Wallowa’s to just 20 miles south of Canada in Montana where he said “Hear me, my Chiefs! I am tired; my heart is sick and sad. From where the sun now stands I will fight no more forever.”  

  1. What is your favorite junk food?

A:  Mt Dew

  1. Of what accomplishment are you most proud?

A:  My kids, while very different individuals with unique passions and interests, are both responsible and caring men.  I have been very successful in teaching them to be the best they can be.

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

A:  I would tell my parents that I was accepted to Stanford University.

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

A:  The change the new administration is proposing to repeal the ACA will take away benefits from those members of our population that need help the most.  The children, elderly and disabled and poor, working or not.  Health Insurance is expensive for everyone and the costs seem to continue to rise every year.   If our population is struggling to keep a roof over their head and food on the table, then they will not be able to pay for insurance that is there to keep them well.  Things will go undiagnosed and so a preventable issues becomes a costly illness.   Medicaid expansion helped so many.

Coordination for wellness.  What is the Benjamin Franklin saying, “an ounce of prevention is worth a pound of cure”.   Wellness care is key to controlling costs.   As budgets tighten and Medicaid continues to shift to managed care, there is a need to be proactive to maintain wellness and share information among care givers.   Physical, dental and mental health are all needed for the wellness of a person.   Being proactive to care for the Medicaid population will reduce the expenses of preventable illness.   As the plans shift to a managed care model, many are going back to a partial or full risk capitation model.  The aggregate total revenue to care for the population can only be successful if you can prevent avoidable expensive illness.

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Medicaid Industry Who’s Who Series: Jennifer Sweet

Join Jennifer Sweet April 17-18 in Chicago to hear from policy insiders, MCO leaders and state officials who will provide a clearer picture of the future of Medicaid expansion and financial alignment, as well as proposed Medicaid regulations! Register using code HMP139 for a 15% discount at https://goo.gl/9ISGFT.

Medicaid Who’s Who: Jennifer Sweet – Medicaid Segment Lead for Florida Blue

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

 A: I am on the payer & managed care side of the industry.  I am working in Florida where the Medicaid population is largely managed by MCOs.

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

A: I am the Medicaid Segment Lead for Florida Blue. 

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

A:  For about a decade, and before that, in commercial health insurance.

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

A:  In terms of work, I am committed to doing things “right” for this population – and that entails everything from delivery of quality and appropriate services to the people who need these services to being an effective steward of taxpayer funds and a good partner to our state Agency.  We are all on the same side, serving our communities, is how I see it.  Personally, outside of work, I love to travel and experience other cultures, languages and architecture.

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

A: I work with a not-for-profit, the Lyceum Fellowship, that awards travel grants to talented students of architecture.  My goal is to ensure this organization is funded and managed such that it survives long after I do.

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

A:  I appreciate finding spaces of quiet down time on the weekend to simply read, walk my dog, hang with family and friends.  

 7. Who is your favorite historical figure and why?

 A:  I enjoy reading both history and biography so picking a favorite is hard.  I enjoy learning what motivated the person who has a significant accomplishment, and where he or she drew the strength to fight for the accomplishment. Abraham Lincoln is a prime example.  But brave, grand acts are interesting to read about in much lesser known characters as well.   It’s also interesting to get a glimpse of how others think and frame the questions of their time.  Ruth Bader Ginsburg and Oprah Winfrey come to mind as I say that, or Margaret Thatcher.

 8. What is your favorite junk food?

A:  Popcorn, specifically, hot air popped with butter and salt.  Always has been my favorite, I was never a chips-cheetos-fritos kind of kid. 

 9. Of what accomplishment are you most proud?

A:  I am very proud of my son and my family but I don’t consider them an “accomplishment” per se.  So I’d have to say that there isn’t a single grand accomplishment but rather, all the wins along the way – whether in education, business, hobbies, love – they all add up to a core accomplishment that is my life.  I am happy with it.

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

A:  I don’t want a mulligan so much as a repeat performance of some great moments in my life.  The times when things fell short, well, they are what they are and they are behind me now.

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

A:  Knowing that the changes ahead (at both state and federal levels) are likely to be significant & fundamental, any list has to include effectively planning the response to those changes.  But in the meantime, I’d say: 

  1. Align payers and providers through appropriate contracting that establishes partnerships as a means of improving not only the lives our members/patients and our respective businesses, but to contribute to  improvements in the very fractured US health care marketplace.   
  1. Improve the whole world of data in Medicaid – as in: capturing more accurately the services we deliver, communicating this effectively to others (e.g., providers, the state Agency), and advancing the way we use this data in search of more effective, efficient management of care. 
  1. Make space to be innovative, to find solutions that move us forward – not easy to do in the din of everyday operations and life.
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Medicaid Industry Who’s Who Series – Dr. James Bush

Dr. James Bush is the featured panelist for the upcoming Wyoming State Medicaid Spotlight Webinar on March 6th. RESERVE your seat today!

 

Medicaid Who’s Who: Dr. James Hall – Chief Medical Officer, Wyoming Medicaid

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

A: Wyoming Medicaid Medical Director

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

A:  10 years

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

A:  Quality improvement

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

A: A smooth transition to high-value care and revitalized primary care.

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

A:  Travel, hunting and music.

  6. Who is your favorite historical figure and why?

 A: Marcus Tullius Cicero. Defender of the Roman Republic.

  7. What is your favorite junk food?

A:  Pizza

  8. Of what accomplishment are you most proud?

A: 37 years of marriage and two great children.

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

A: Some ill-chosen business partners.

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

A:  What will stay or go from the ACA, the transition to High value high quality care, and the evolution of HIE. ​

 

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