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Medicaid Who’s Who Interview: Richard Edwards

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

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

 How many years have you been in the Medicaid industry?

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

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

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

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

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

What do you enjoy doing most with your personal time?

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

Who is your favorite historical figure and why?

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

What is your favorite junk food?

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

Of what accomplishment are you most proud?

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

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

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

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

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

 


Know someone in the space who’s doing great work and is an all around interesting person?
Send a note to clay@mostlymedicaid.com to nominate them for the next round of Medicaid Industry Who’s Who Interviews.

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Medicaid Who’s Who Interview: Deborah Watkins

Deborah Watkins is Founder and Chief Disruption Officer of Care Bridge International.
Check out her LinkedIn profile HERE.
Which segment of the industry are you currently involved?

Health Data Analytics, specifically involving bodily injury claims. About 20% of workers comp and auto injury claimants have serious enough injuries to qualify for Social Security Disability Benefits, followed by Medicare benefits. A percentage of those individuals eventually receive Medicaid benefits due to the severity of their injuries and income constraints. There is a real opportunity to ensure these individuals receive quality care to promote their independence, while preserving and maximizing these State & Federal funding resources to improve outcomes, but also to ensure the fiscally responsible use of these funds.

How many years have you been in the Medicaid industry?

On the insurance side, over 18 years, but have been in the healthcare space my entire career.

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

Dual Eligibles, individuals who receive both Medicare and Medicaid benefits, as these individuals are the most compromised and most vulnerable in our healthcare system. This small subgroup consumes the largest portion of our healthcare dollars having a big impact on our healthcare GDP. Being a small part of the solution in the healthcare delivery and payer systems, is my passion.

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

To snorkel or scuba dive with humpback whales. I have had an interest in whales since childhood and want to get as close as safely possible.

What do you enjoy doing most with your personal time?

I’m an outdoor girl and enjoy out-of-door activities, particularly trekking in scenic places around the world and downhill skiing.

Who is your favorite historical figure and why?

Abraham Lincoln. He was our President during a very polarizing time in our country’s history during the Civil War and is one of our most respected Presidents. In addition, he experienced tragedy in his own personal life including the loss of his mother at age 9 and the death of a son that led to his wife’s mental health issues, so he was a man familiar with tragedy, yet very resilient. I admire that, because I have a daughter who had an acute head injury at age 9 and suffers with chronic, intractable epilepsy. I understand at a personal level the pain of loss and the challenges caregivers face in navigating a fragmented delivery system and the need for a Medicaid safety net. The story of Honest Abe gives me hope that we can successfully solve our healthcare crisis and reunite.

What is your favorite junk food?

Salt Water Taffy, I love its sticky sweet taste that melts in your mouth; it reminds me of the Boardwalk in Ocean City, MD, not far from where I grew up.

Of what accomplishment are you most proud?

Being an advocate for my daughter, successfully navigating both the healthcare and education systems and adult community resources to help her live as healthy and full a life as possible, to achieve her highest potential despite her afflictions.

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

Well, there are many! But for public consumption, I would like to get back the hours of vacation that I worked instead of enjoying that vacation. Time off, disconnecting from the laptop and the stresses of work, is important to maintaining balance and well-being.  Vacation is important for restoration. I encourage my own employees to use their time off for that purpose, and stop checking email!

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

I think the most important issues involve, not just figuring out how or how much to fund Medicaid, but how best to manage these funds. Throwing money at a program is not the solution, understanding how best to deliver care to Medicaid beneficiaries in the most cost-effective way to obtain the best possible health outcomes is a complex task, but this is what needs to be done. The use of Data analytics offers a powerful means to learning and understanding and seeing the problems and solutions more clearly. Engaging and gathering Data from all stakeholders including payers, beneficiaries, community leaders, caregivers, providers, facilities, pharmacies, and more to create a better understanding of where the opportunities are to build a more efficient ecosystem is what I believe should be the focus in the next six months. It is the hard, but important work that needs to be done to strip out biases’ and false assumptions that are holding us back from better serving the Medicaid population.  

 


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: Benjy Green

Benjy Green is Vice President, Business Development of Magellan Health.

Check out his LinkedIn profile HERE.

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

I have been at Magellan for about 18 months now, and loving it. I’m currently working on various Medicaid RFPs, ranging from LTSS to TANF populations in different states.

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

I have over ~20 years experience in Medicaid and Government programs, with areas of focus including provider, state, federal and managed care organizations.

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

My number one focus is my wonderful family, wife Amanda and three teenagers (Ben, Zach and Kate). Outside of that is my passion to help the underserved and vulnerable populations.

I stumbled into this career path by starting in the business office of a small provider. I quickly felt the desire to do more for this population and transitioned into state employment at a Texas Medicaid Agency. I can’t imagine doing anything else, this is what drives me.

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

I’m not sure I have one top item, but we love to travel. We are looking at options in Europe in the near future and plan to visit Scotland for my 50th in a few years to play St. Andrews, the home of golf.

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

Spending time with my family, friends, including my four legged friends. My family is heavily involved with the DFW Labrador Retriever Rescue Club, so in addition to our Jack Russel (Scooter) two labs (Bria and Kenner), we often have a foster dog running around as well.  I also enjoy as much golf as I can get in.

6. Who is your favorite historical figure and why?

I’m not sure I could pick just one. But if hard pressed, I’d go with any of our country’s founders. They were a complimentary mix of writers, philosophers, and politicians who not only led the revolution, but had the foresight to put the structure of this great country in place hundreds of years ago.

7. What is your favorite junk food?

I love chocolate and anything covered in chocolate.

8. Of what accomplishment are you most proud?

I am a first generation college graduate with a Master’s degree. Even though my parents didn’t have the means or opportunity to attend college, they understood the importance of higher education, and pushed my brother and me to graduate from college. As a parent myself, I share the same philosophy, and will do everything possible for my children to have the same opportunities that I did.

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

Running for my neighborhood HOA board! (This is my sense of humor coming through, if you don’t know me personally).

In all seriousness, I’m not a fan of mulligans on the course and therefore wouldn’t take one in life either. I feel the decisions, good or bad, have lead me to where I am today, both professionally and personally. I’m living my best life today, and am very thankful for the experiences that have gotten me to this place.

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

Approach to “managing” members – historically the focus has been on managing the physical health of Medicaid populations. As organizations dig deeper into the data, it’s becoming apparent to be successful we must focus on the behavioral diagnoses (where applicable), then the physical. Here at Magellan, with our more than 40 years of behavioral experience, we are evolving our approach which is making a difference, especially with the vulnerable populations we are entrusted to serve. We are also using technology to our advantage to not only reach the members but gathering data from all streams (physical, behavioral and pharmacy) to better understand how we can make a difference.

SDoH – as organizations improve the importance of the interdependencies in Medicaid populations, the relevance of the Social Determinates of Health is a driver to be successful to improve outcomes within the Medicaid populations.

Opioids – this has a tremendous financial impact on all of healthcare, not just Medicaid. Everyone (payers, pharma and providers) must meet on common ground to address the epidemic and find a solution.

 


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: Bill Henderson

Bill Henderson is the Sr. VP Business Development at Liberty Dental Plan. 

Check out his LinkedIn profile HERE.

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

LIBERTY Dental Plan is a leader in the Medicaid /Medicare industry. A leading National Provider of Dental Managed Care Services since 2001. Providing quality, innovative and affordable dental benefits with the utmost attention to member satisfaction

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

I started back in 1993 partnering with MCO’s within TennCare for vision care. 

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

Increase access to dental services and oral health education to all members, focusing on co-location and prevention. Providing more education to underserved population so they can have a clearer picture of what great oral health is and how it can assist them in their whole-body health.

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

To establish & set up pop-up housing for the social determents and provide fresh vegetables for them, and a clinic to assist them within the housing unit.

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

I travel every week for work but I still like to travel to areas I do not get to see, love to experience local food and culture.

6. Who is your favorite historical figure and why?

Lincoln, to me he put everything ahead of himself & his career. He was concerned about the country and the rights of the people and wanted to make sure he resolved the issues we were having at the time.

7. What is your favorite junk food?

Street hot-dogs, love them in NY

8. Of what accomplishment are you most proud?

Being able to assist LIBERTY to grow across the country, we’ve built a great team, and winning culture that all the team care about the people we get to serve and the communities we operate in.

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

Not always being home to see the kids growing up

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

A. The cost of end of life

B. States need to flexibility working with MCO’s to manage the programs set forth and develop strong relationships with plans/provider and communities

C. Get a better handle on Social Determents and the cost of care for this populations


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: Amanda Ratliff

Amanda Ratliff is the CEO of ACR Consulting Services & COO of Paragon Technology Partners.

Check out her LinkedIn profile HERE.

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

Network Development for Payers, Managed Care Consulting, Credentialing, FQHC/Radiology and Vision Billing, Directory maintenance and IT Solutions (BigData, encryption, PDM).

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

I have the worst baby face (I literally look 12), but over eighteen years.

I started at Aetna in the member services call center and worked my way up to CEO. I never turned work down – I always did the dirty stuff no one wanted to and kept learning. When it was hard and there was no structure or policy, I kept at it until we had clear sight. Medicaid is a tough industry and doesn’t have a lot of funding. It takes dedicated teams with a true passion and vision. I have been lucky enough to work with some of the greatest teams.

I always wanted to do the best I could with minimal spend. We helped to orchestrate a consolidation of 3 different systems while at an MCO. They were paying 3 different teams and 3 separate software programs. It didn’t make sense. All data should be in one source.

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

My main passion is Contracting and Provider Data Maintenance. I love to contract Providers/Groups/Hospitals and make sure the data collected in the process is correct, clean, valid and complete. Incorrect directories and fat finger typos drive me absolutely INSANE. Also, automation – if there is a way to do something faster – I am visioning how to make it happen.

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

Professionally – I would like to see Provider Data Management (PDM) solution solved so Payers could manage their data, and not be fined for incorrect information.

Personally –  I would love to be able to go to Italy with my husband – his grandfather came over off the boat from Naples and he wants to visit his history (and eat a bunch of pizza and pasta!)

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

Watching non stop episodes of Heart of Dixie on Netflix, women’s bible study, helping others, Horseback riding, and quality time with my 16 yr old son and 10 yr old daughter (if they like me that day).

6. Who is your favorite historical figure and why?

Martin Luther King Jr. – he rose above all odds, stuck to his faith and did what was RIGHT in every scenario. You don’t see people STAND UP like that with deep concern to risk everything. He didn’t give up and he had every right to. His battle is unlike anything I’ve ever experienced and I admire his unwavering passion. That man changed the complete path of our nation, amazing.

7. What is your favorite junk food?

Fritos and Nacho cheeeeeeese

8. Of what accomplishment are you most proud?

Stepping out in faith and opening a business with employees (I never thought of myself as a boss – it’s still weird for me to think about).

My employees are simply the best and often outwit me. Steve Jobs said – “you should hire people who are smarter than you”, and I am thankful that my team is well equipped and have such a deep knowledge of the space.

I just continue to let God lead – he pushed me off the cliff and I haven’t fallen yet! When in doubt, take the risk and TRUST HIM.

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

Not finding Christ sooner……… and picking on my older brother and him always winning!

He stuck me on top of a 6 foot bookshelf, turned the lights off and left Opera music playing so loudly he couldn’t hear my screaming and crying.

Then, one time I asked him what to do about my skinned knee – and he told me to put lemon juice on it…and I DID! I wish I was the oldest and not youngest.

(Yes, I am whining about it after 30 years).

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

A. BigData, lots of data and data analytics. Smaller MCO’s and new MA plans coming in don’t have access to well adopted systems/policies/etc. They lose a lot of revenue in start up or initial bids/risk to secure agreements.

B. Technology – who is coming out with what and why? Is there a list of all this awesomeness?

C. Patient Care and Access – we need more doctors and nurses to care for (and accept) patients. Lots of them are lost in the shuffle, especially the homeless.


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.