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Medicaid Who’s Who Interview: Sharon Raggio

Sharon Raggio, LMFT, LPC, MBA  is President and CEO Mind Springs Health

Check out her LinkedIn profile HERE.

Which segment of the industry are you currently involved?

Mind Springs Health is the leading provider of mental health and addiction treatment on the western slope of Colorado and lives out its mission of providing recovery and resiliency to people, families, and communities through its excellent continuum of behavioral health care services – from mobile crisis response to 12 outpatient offices to West Springs Hospital, the only psychiatric hospital between Denver and Salt Lake City.  We are pleased to be in over 100 schools as well as in locations with over 100 different partners.  We believe it is critical to our mission that we offer our services where people are, as that is a secret sauce ingredient to engagement and change. 

How many years have you been in the Medicaid industry?

We have been in the Medicaid business since our inception in 1972!  Personally I have worked in Community Mental Health for over 40 years….yes…. I started when I was 12! 

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

I personally love what Community Mental Health offers!  It is a sacred honor to be a partner in creating change in an individual, family, or community.  There is nothing that fills my heart like Community Mental Health!  The best news is that people can and do recover!  I am very pleased that we are starting to recognize the co-morbidity between physical & mental health and excited to be at whole-person planning tables. 

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

Absolutely going to Italy!  I had the good fortune of living in Europe for many years as a young adult and now I’d love to go back with my family.  The Italian culture is unique! 

What do you enjoy doing most with your personal time?

Beside travel, which expands me as a person, I love to walk with our two standard poodles, Timbuktu and Corrina.  We live in western CO and have rich outdoor beauty to explore.  I also love to read good mystery books. 

Who is your favorite historical figure and why?

Marie Curie, a Polish and naturalized-French physicist and chemist who conducted pioneering research on radioactivity. She was the first woman to win a Nobel Prize, the first person and only woman to win it twice, and the only person to win it in two different scientific fields. She was also the first woman professor at the University of Paris.  Some of her more famous quotes include “Nothing in life is to be feared. It is only to be understood.” And when questioned about being a woman with a family & working   in science she replied “Well, it has not been easy”.  

What is your favorite junk food?

It has to be vanilla ice cream with chocolate syrup on a very hot day!  Nothing quite like that sensation of cold ice cream, hot chocolate souse, and a hot day!  YUM! 

Of what accomplishment are you most proud?

We recently were honored to receive the IHI Sherman Award for Patient Engagement.  Our amazing staff developed “Rapid Recovery Clinics” for people with depression and the model allows patients to choose when they want to be seen, how often, and who they want to see of their treatment team.  The results are amazing, with 68% of people moving into a recovery phase from depression in only 6 weeks!  That means people are doing well, our clinical staff know they made a difference, and our offices can serve more people in need!  A triple win! 

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

I have come to understand that relationships are what are important in life.  My do-over would involve absolutely involve healing a relationship.  It is important to be quick to recognize when I make a mistake or push too hard on a relationship.  Forgiveness goes along with this concept. 

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

I think state governments struggle with how to fund and pay providers for Medicaid.  While there are many ideas about value-based payments, there is a grand experiment occurring with how to make that actionable and what the valued outcomes should be.  Additionally, specific to the world of behavioral health, we have a crisis-level shortage of providers.  Funding prevention and resiliency-building programs is a policy I hope States will shift towards in the near future. 

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Medicaid Who’s Who Interview: Robert Garnett

Robert Garnett, MBA, CHIE, is President, Amerigroup Tennessee at Anthem, Inc

Check out his LinkedIn profile HERE.

Which segment of the industry are you currently involved?

Amerigroup Tennessee is a Medicaid Managed Care Health Plan and is part of the Medicaid Central Region and Government Business Division at Anthem, Inc. We are privileged to serve approximately 400,000 Tennesseans in the TennCare program across TANF, SSI, LTSS, and IDD (ECF) products. TennCare is regarded by most as one of the most advanced and innovative Medicaid programs in the country, so it is both exciting and daunting to be on the forefront of the industry. We have a terrific team of experienced and passionate leaders at Amerigroup Tennessee and it is my absolute honor to lead them and deliver on our promise to not only meet the needs of our members, our providers, and the State of Tennessee, but do so with a keen eye towards the future.

How many years have you been in the Medicaid industry?

I’ll be honest and admit that I didn’t know the difference between Medicaid and Medicare when I first joined Amerigroup in 2007. I have been privileged to stay involved in Medicaid ever since, serving in a variety of Corporate and health plan roles over 12 years. I was selected into Amerigroup’s Leadership Development Program (LDP) early on in my career and it was nothing short of a life changing experience to get exposure to our Executive Leadership Team and spend time in Business Development, Government Relations, Product Development, and Quality during a time of so much growth and industry maturation. Since 2011, I have spent the majority of my time in the Southeast serving on the health plan Operations side and in leadership roles in Georgia, Kentucky, Louisiana, and now in Tennessee since 2014.

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

I am passionate about collaborating and engaging with our providers, community-based organizations, and the State of Tennessee to achieve excellence in providing care and solutions to the Medicaid population through innovative, engagement-focused approaches. Amerigroup’s focus on addressing our members’ barriers to health has potential to revolutionize how we think about our healthcare system. It’s exciting to be in a role and at a company with the ability to impact these social determinants of health. Leveraging technology and engaging our members where they are presents significant opportunity to identify and combat some of the large social barriers to care that are at the heart of the challenge we face every day as a Medicaid Managed Care organization in improving the health of our members.  

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

Professionally, I would love to be regarded as a leader in the movement to address social barriers to care when all is said and done. Improving the fundamental way care is delivered would be a monumental change in the health care system, but a change in my opinion with huge return for all. Personally, I would love to make it to Australia with my wife. We had the pleasure of going to New Zealand before we had our children and it was a truly fantastic part of the world unlike any other place I have ever been.

What do you enjoy doing most with your personal time?

Nothing helps get my energy level up and my day off to a great start than getting a workout in, particularly when the activity is out on the trails in the Tennessee woods near my house. I am someone that truly enjoys nature and the outdoors and whether it’s on a trail in Tennessee or climbing a mountain in Colorado, it’s always enjoyable and helps me put everything into perspective. It also happens to be where I do my best innovative thinking and problem solving.  

Who is your favorite historical figure and why?

Without George Washington’s leadership, many other great leaders in our country’s history- Abraham Lincoln, Martin Luther King, Jr, Franklin Roosevelt, etc. wouldn’t have had the opportunity to have had the impact they did if not for Washington’s tenacity, steadfastness, and his ability to make decisions during difficult times and as our country’s first President.  I’d particularly recommend “Washington,” by James Thomas Flexner, which provides a very interesting and different look into his life.

What is your favorite junk food?

My wife threw a candy themed party for my 30th birthday and so that pretty much speaks for itself. I am a huge movie buff and a trip to the theatre isn’t complete without a box of Junior Mints to enjoy.

Of what accomplishment are you most proud?

I was extremely fortunate to be the project leader for Amerigroup Georgia’s RFP submission for Foster Care when the population first moved into managed care and we were selected to be the first managed care organization to lead it. The process and solution development exemplified everything about teamwork and buckling down against tight timelines and a challenging environment that I enjoy most in this industry. The opportunity to create innovative solutions and best practices that improve the care for such a vulnerable population was extremely rewarding both professionally and personally.

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

Missing my twins’ 2nd birthday for a business trip. It was an important lesson in proper work life balance. What that taught me is that more often than not, there is someone else that is more than ready to jump in and it affords them experience that they otherwise might not get and ensures you remain focused on the most important things in life. It also demonstrates and supports your leadership philosophy to live by the words you preach.

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

Health care reform, specifically work requirements, block grants, and other waiver requests clearly pose the greatest area of change, opportunity, and disruption in Medicaid Managed Care.

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Medicaid Who’s Who Interview: Mark Shaffer

Mark Shaffer is Vice President of Medicaid Operations at BlueCross BlueShield of South Carolina

Check out his LinkedIn profile HERE.

Which segment of the industry are you currently involved?

I work in BCBSSC’s Celerian Group, where I am responsible for the Medicaid Operations Division. The Celerian Group is a collection of companies that primarily provide services to Government Programs. My team currently delivers Medicaid related services including Claims Processing, Provider Enrollment, Provider Call Center services, Eligibility application processing, and Third Party Liability functions.

How many years have you been in the Medicaid industry?

I started in Medicaid back in 1988, I like to think those of us with this length of service have a genetic predisposition rather than a defect, but only history will decide that. I have been fortunate to work in a wide variety of market segments over my career and the breadth of this experience has certainly kept things interesting over the years.

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

Meeting new people and helping them if I can. My father, a retired Marine, recently recounted that when I was in Kindergarten living in Korea when they met new people, they would say “oh, you are Mark’s parents”.  Growing up I lived in 11 houses before the age of 13 and my wife of 30 years and I have just completed our 11th move to our 6th State! No matter the different backgrounds and perspectives over the years it is amazing how much we are alike and share the same needs. By the way, everyone also thinks their traffic is terrible!

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

My wife and I have discussed creating a behavioral health charity to help working families that are struggling with children with behavioral health needs. Unfortunately for working parents, the current system does not provide the support necessary to help children when needed.

What do you enjoy doing most with your personal time?

I love motorcycles and the camaraderie of riding with friends. It really doesn’t matter where we go it is about getting away from the day to day and enjoying the ride and the shared experience.

Who is your favorite historical figure and why?

If you asked which historic figure I would want to meet, it would be Jesus. Just too many answers that could be cleared up in a single meeting! But since that isn’t the question, my favorite other historic figure is Peter the Great. While he is known for conquering additional territory and expanding his empire he also lead a cultural renaissance to modernize his country based on his experiences with Western Europe leaving a lasting legacy on the world.

What is your favorite junk food?

Bacon. Although bacon should never be referred to as junk food.

Of what accomplishment are you most proud?

Helping to raise my three adult children and having them all out of my house!

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

In the early 90’s when I was with Electronic Data Systems (EDS), we implemented the FLORIDA system (integrated eligibility). The system served Florida well for decades (all systems end up being legacy systems at some point), unfortunately EDS and the State ended up in a protracted legal dispute. The dispute negatively affected the company, reduced competition in the market, and disrupted service to the citizens. I think I would have made different recommendations to my leadership if we had a mulligan.

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

Expanded use of social determinants of health

Disruption from early adopters using AI and related technologies in the health insurance space

The impacts continuing industry consolidation

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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: 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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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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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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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: 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