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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.