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Episode#7: Interview with Elena Nicolella

Guest bio

Elena is the Executive Director of the New England States Consortium Systems Organization (NESCSO), where she has served for the past 4 years. Before her time at NESCSO, she played various roles in Rhode Island HHS agencies, including Medicaid Director.

Highlights from this episode

  1. Defining interoperability in terms of the CMS final rule.
  2. Defining what data the rule requires to be shared by Medicaid agencies, especially around adjudicated encounters/claims
  3. Member identity verification for data exchange in third party applications
  4. Limits to states’ authority over whether to provide data to 3rd Party Apps, or what happens after the provide it
  5. Expected member interest / appetite for more access to data.
  6. Impact of expiration of the HITECH Act funding
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Episode#6: Interview with Ed Cantwell

Guest bio

Ed is the President and CEO at the Center for Medical Interoperability. He has served in that role for the past seven years. Before that, he has been in executive leadership in multiple technology companies, particularly in the wireless and telecom industry. He also spent 11 years in the United States Air Force.

Highlights from this episode

  1. The critical goals of building a trust platform and data standardization; HIPAA as barrier to trusted health system
  2. 21st century cures act use of open API / forcing more exchange
  3. Differences between federal policy approach and industry association approach to trusted exchange and data standards
  4. Overlap of CMS/ONC efforts
  5. How meaningful use morphs into interoperability
  6. Issues with proprietary data and interoperability; information blocking as a concept
  7. How pressures on providers from various regulatory bodies makes it hard for providers to embrace yet another paradigm change
  8. The idea of surveillance capitalism
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Medicaid Buy-In: Episode#7- Interview with Laura Colbert

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  • Guest Bio
  • Show notes

Laura Colbert
Laura is the Executive Director at Georgians for a Healthy Future, where she advocates for health policies that expand coverage and access for Georgians. Before her current role, Laura worked at Children's Healthcare of Atlanta, and the CDC. She holds an MPH from Emory University.  

About our Sponsor

This was made possible by support from WEX Health. Please take a moment to learn more about what they do by visiting wexinc.co/public-sector

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Medicaid Buy-In: Episode#6- Interview with Barbara Otto

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  • Guest Bio
  • Show notes

Barbara Otto
Barb is the CEO of Smart Policy Works, a Chicago-based firm that is is a driving force behind building smarter systems of health and social determinants of health for vulnerable people and places across the nation, state of Illinois, and metropolitan Chicago. Before her time at SPW, she worked at the 9to5 National Association of Working Women and at Ernst and Young. 

About our Sponsor

This was made possible by support from WEX Health. Please take a moment to learn more about what they do by visiting wexinc.co/public-sector

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Medicaid Buy-In: Episode#4- Interview with Bryan Cutler

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  • Guest Bio
  • Show notes

Bryan Cutler
Bryan is the majority leader in the PA State House, where he has served for 14 years. Before his time in the legislature, he worked in hospital administration and as a radiology technician. He also is an attorney who currently practices law at Nikolaus and Hohenadel.

About our Sponsor

This was made possible by support from WEX Health. Please take a moment to learn more about what they do by visiting wexinc.co/public-sector

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Medicaid Buy-In: Episode#3- Interview with Dylan Roberts

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  • Guest Bio
  • Show notes

Dylan Roberts
Dylan is the state representative for Colorado House District 26. In that role he serves as the chair of multiple committees, including the Rural Affairs and Agriculture Committee, the Capital Development Committee and the Judiciary Committee. He is also the Deputy District Attorney for Colorado's 5th Judicial District.

About our Sponsor

This was made possible by support from WEX Health. Please take a moment to learn more about what they do by visiting wexinc.co/public-sector

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Medicaid Buy-In: Episode#2- Interview with Adam Fox

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  • Guest Bio
  • Show notes

Adam Fox
Adam is theDirector of Strategic Engagement at Colorado Consumer Health Initiative  . He advocates for better consumer access to healthcare in Colorado and has been featured as a thought leader on national news outlets such as CNN. In his role at CHHI he focuses on communication strategies, media engagement and driving the policy agenda in his state. 

About our Sponsor

This was made possible by support from WEX Health. Please take a moment to learn more about what they do by visiting wexinc.co/public-sector

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Episode#5: Interview with Roger Hebden

Guest bio

Roger is the CEO of Livanta, which is a Medicare Quality Improvement Organization (a QIO). Before his time at Livanta, Roger has spent more than 20 years in IT and healthcare space, including roles at Microsoft, Dell, and Sutherland.

Highlights from this episode

  1. How medical records still are sent via snail mail and fax as primary mechanism for Medicare QIOs
  2. FIHR, BlueButton 2.0
  3. Using member education in an interoperable system that helps patients manage medical records
  4. Improving communications channels, including the limits of telephones and the opportunities with secure text
  5. What we make available vs what people use
  6. The limits of provider portals

the journey to appropriate consent management

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Episode # 4- Interview with Mary Alice Hunt


Guest Bio

Mary Alice is the North American Solutions lead at IBM Watson Government Health and Human Services. She has spent nearly 20 years developing solutions for state clients that focus on integrated eligibility, care management and healthcare reform. Before her time at IBM, she taught information technology at the State University of Albany, led product development at Curam and helped to modernize New York State technology systems.


Highlights from Episode

  • How quickly technology is advancing and the impact that has on interoperability efforts
  • Multiple challenges in interoperability, such as
    • Challenges of integrating various types of data being integrated before we are even ready for it in the private sector, and in government world it lagging
    • challenge of different terminology for same information
    • challenges in matching patient records
    • how our patient identifiers change over our lifetime
  • A plain language explanation of APIs
  • Various topics around patient data access, including:
    • Providing patients with meaningful insights about their health using their data
    • Challenge of getting data to Medicaid members
    • Challenges in consent management
  • Importance of starting with the right data model when designing consent management functions
  • Key data governance and design insights, including
    • designing for exceptions
    • making sure data is shared but not propagated; using a central repository model
    • challenges of converting data from old system to new system
  • 360 degree views of patient data in an interoperable system
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Medicaid Buy-In: Episode#5- Interview with John Sweeney and Cheryl Gardner

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  • Guest Bio
  • Show notes

John Sweeney
WEX Health

John Sweeney is a thought leader on the WEX Public Sector team, focused on connecting WEX innovation to evolving client needs in the Medicaid and health marketplace verticals. Prior to joining the WEX team, John served in various other healthcare technology roles throughout his 20+ year career, including nearly 10 years at IBM companies.  John also serves as the Director of the Hale Center Theatre, where he has directed 30 productions over the last 16 years. 

Cheryl Gardner
Gardner Strategies

Cheryl Smith Gardner is the founder of Gardner Strategies, a health policy and strategy company. Cheryl combines functional knowledge and experience in state health policy design with a notable background in strategic management and program administration. Her clients include state government agencies, technology firms, and policy shops. 

Prior to founding Gardner Strategies, Cheryl served as the Chief Executive Officer at beWellnm (New Mexico’s health insurance exchange), as the Executive Director of the Arkansas Health Insurance Marketplace (AHIM), as a Senior Practitioner at Deloitte Consulting, as a director in the Health Insurance Exchange practice at Leavitt Partners, and in the Utah Governor’s Office of Economic Development as the Director of Policy and Strategy of the Utah Health Exchange office. 

Her leadership and expertise in the areas of state health policy, insurance exchanges, and health system reform often draws national attention as she is frequently cited in a number of respected publications including the Washington Post, Politico, The Wall Street Journal, USA Today, and the New York Times. Cheryl is a highly sought after public speaker and has participated multiple times as a presenter, panelist, and moderator at a number of national conferences including those sponsored by the National Conference of State Legislatures (NCSL), the Republican Governors Association (RGA), the National Conference of Insurance Legislators (NCOIL), and America’s Health Insurance Plans (AHIP).

About our Sponsor

This was made possible by support from WEX Health. Please take a moment to learn more about what they do by visiting wexinc.co/public-sector