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Medicaid Who’s Who Interview: Mark Rakowski

Mark Rakowski is the Vice President at Children’s Community Health Plan.

Check out his LinkedIn profile HERE.

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

Children’s Community Health Plan (CCHP) has participated in the Medicaid program in Wisconsin since our inception in 2006, and currently covers 125,000 members, including 3,200 children in a foster care medical home pilot.  We entered the Marketplace in Wisconsin in 2017, and covered 27,500 individuals in 2018.

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

Beyond the 12+ years that CCHP has been in existence, I have been involved in Medicaid from a provider side over the 20 years that I have been with CCHP’s parent, Children’s Hospital of Wisconsin.

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

Being a parent of two boys myself, I am passionate about improving the health and well-being of children and their families, and advocating for low income populations to ensure that they are not left behind.

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

Something sports-related, for sure.  I have already seen the Packers win a Super Bowl in person (sorry, Pittsburgh fans), so it would probably be taking my sons to an NBA Finals game.

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

Traveling with my family.  We gravitate to beaches (St. John is our favorite), and also have enjoyed New York City as well as Europe.

  1. Who is your favorite historical figure and why?

President Lyndon Johnson – I think his domestic accomplishments are often overshadowed by the Vietnam War, however under LBJ sweeping civil rights legislation was passed, including the outlawing of segregation, improved school funding for poor districts, the National Endowment for the Arts that funds public television was established, and LBJ also initiated Medicare, Medicaid and Head Start.  Before he was a politician, he taught disadvantaged Mexican-American kids in Texas where he witnessed firsthand the effects of poverty and discrimination, and made sure that education was a priority of his administration.

  1. What is your favorite junk food?

Frozen mint Oreos

  1. Of what accomplishment are you most proud?

We built CCHP from scratch and have grown from 26 members our first month to the largest Medicaid plan in our service area, covering almost 20% of all Medicaid members in our state, and are now one of the largest Marketplace plans in the state.

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

I don’t really have any regrets that would need a mulligan.  Mistakes are just opportunities to learn.

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

Addressing how health plans can sustain their investments in housing and other social determinants of health

Figuring out how to better engage providers and align incentives so that value-based arrangements are not just pieces of paper.

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Medicaid Who’s Who Interview: Wanda Seiler

Wanda Seiler is the Senior Director at Alvarez and Marsal, LLC. Check out her LinkedIn profile HERE.

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

I work primarily in Long Term Services and Supports (LTSS).  My areas of emphasis are Medicaid eligibility and Home and Community Based Services.  I’ve assisted states with waiver transformation, quality improvement, critical incident reporting, payment transformation, provider billing documentation, shared living, and the development and implementation of software to support human service administration.

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

I’ve worked in the industry for over 30 years, including as a policy analyst for a state Medicaid agency, and in leading state behavioral health and developmental disabilities agencies.  I’ve been consulting with states for the past 10 years.

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

My passion is developmental disability services and I’m particularly interested in transformative efforts that improve both the efficiency and quality of long term services and supports.

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

I’d like to spend some time in Italy, touring and perhaps taking some cooking lessons to learn the tricks and secrets for preparing great Italian meals.

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

Hiking an boating with my two best friends – my husband and my dog, and doing just about anything with my granddaughters.

6. Who is your favorite historical figure and why?

Abraham Lincoln.  I think his second inaugural address best illustrates his ability as a leader – to know what to say to unite a nation during a critical juncture in our history.  Leadership in never easy, but truly great leaders are distinguished by leading others through difficult times.

7. What is your favorite junk food?

Gabbert’s popcorn – cheese and caramel mix.  Is it obvious that I spend a fair amount of time at Chicago O’Hare?

8. Of what accomplishment are you most proud?

Bringing financial stability to a state developmental disability agency that had a significant structural deficit.  In a single budget cycle, I was able to correct the deficit and over my eight-year tenure as Director of this agency, eliminate all waiting lists for services.  During this time – all service providers achieved and maintained national accreditation demonstrating that efficiency doesn’t have to compromise quality.

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

When working in state government, I didn’t maximize the use of information technology (IT) solutions.  We did a small IT project that yielded significant returns for people and families receiving services.  Frankly – I wish I would have done much more of this during my time in state government.  Information systems are foundational to the effective administration and delivery of human services.

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

  1. I think states will likely be challenged by Federal audits focused on long term services and supports.  State systems struggle to perform LTSS rate setting, billing and claiming creating a significant financial risk to home and community-based services.
  2.  Intellectual/developmental disability services are at a critical juncture. Many state I/DD agencies will begin a slow and difficult transition to managed care.  Many will explore value-based purchasing but must first crack the code to determine the outcomes that should be purchased and then how they can be measured.
  3. With control of the US House of Representatives switching following the mid-term elections, Medicaid should be safe from block grants.  It will be interesting to watch the remaining non-expansion states consider their options.  Perhaps the most interesting focus will be on the concept of “personal responsibility” in transitioning non-working Medicaid participants to work.  It will be an interesting, “chicken or egg” discussion in understanding if people need health insurance to maintain employment or if Medicaid will be the carrot, they need to seek and retain employment.  As LTSS tries to navigate through a devastating workforce crisis – every worker will become increasingly important.

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Medicaid Who’s Who Interview: Alison Croke

Alison Croke is President and CEO of Wood River Health Services. Check out her LinkedIn profile HERE.

Which segment of the industry are you currently involved?

I currently serve as the President & CEO of a federally qualified health center in Rhode Island.  We provide medical, dental, behavioral health, case management and other support services to our patients, regardless of insurance status or ability to pay.  We have many Medicaid patients, but we also have patients who are uninsured or underinsured.

How many years have you been in the Medicaid industry?

I have been in the Medicaid industry for 20 years.

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

I grew up attending an all girl Catholic college preparatory academy run by the Sisters of Mercy.   The mercy mission instilled a passion for social justice, the importance of giving back to your community, and the value of women’s leadership.  I enjoy mentoring young women who are interested in health care administration, and I’m lucky to work at an organization whose mission is to improve their local community.

My other passion would be for all New England sports teams, with the Patriots at the top of the list.

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

I don’t have one particular item on my bucket list -and I have no desire to jump out of an airplane.  I would love to travel more and see some of the beautiful cities in Europe like Prague.  And if I happen to meet Queen Elizabeth somewhere along the way, that would be great.  Also, would love to attend certain sporting events once- a Super Bowl, the Kentucky Derby, etc.

What do you enjoy doing most with your personal time?

I love to play with my dogs and take them running.  I also enjoy watching Patriots games.

Who is your favorite historical figure and why?

Queen Elizabeth I is fascinating to me.  She led her country through a historical period where intolerance was commonplace and was able to demonstrate that tolerance and acceptance was the better path.  She allowed England to flourish and become a place where authors and playwrights could thrive, and also position the country for the future position as a super power and global leader.  Without her bravery and determination, we would not have classics like Shakespeare and Marlowe.

What is your favorite junk food?

This is a tough one.  It’s hard for me to resist anything chocolate.   But I also sometimes splurge on movie theater popcorn with butter.  I always feel guilty after though.

Of what accomplishment are you most proud?

When I worked for RI Medicaid, we built many new managed care programs that expanded access to care for members.  I worked on a team that created the RIte Smiles program – a dental managed care program for kids.  By contracting with a managed care plan, the state was able to not only raise rates for providers, but improve the quality of dental care kids received, and create a much larger network of dentists that would treat children on Medicaid.

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

I do not regret any of the career choices I’ve made in the last 20 years, as they have led me to where I am today.  I am sure that as a young professional just out of graduate school I made some naive mistakes and misjudgments.  I have many people to thank for mentoring me through those early years and being very honest with their feedback.  Without their help, I would never have made it!  I have learned to be much more humble in my professional interactions.  Most people do not care what your title is -they care that you are committed to your work and follow through on your word.

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

Now that the Congress does not consist of one majority party, I believe the efforts to repeal and replace the ACA will not receive much traction.   However, state budgets, especially in our state, continue to be stretched by health care expenditures, often making Medicaid programs a target for budget cuts.  I would consider the aging population, the opioid crisis, and better access to mental health treatment are the top 3 issues in the coming months.

 

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Medicaid Who’s Who Interview: Jeff Leston

Jeff Leston is the President of Castlestone Advisors. Check out his LinkedIn profile HERE.

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

We are in the fraud prevention, health identity protection and oversight segment.  We developed tools that use the existing payment (credit/debit) networks to deliver real-time encounter information to health plans right from the point of care. Inexpensive and very effective.

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

I’ve been in and around health insurance and health IT world for over 30 years, and about the last 10 in Medicaid.  In the early ‘90s I created the first use of artificial intelligence for health insurance fraud detection at a Blue Cross plan.  Like what Castlestone does, the technology we used was born in the credit card industry.

3. What is your focus/passion?

Professionally and personally related, I hate to get ripped off.  Finding hundreds of thousands of dollars of fraud in a co-op I lived in in New York was part of the inspiration for starting Castlestone.  My personal passions are music and ice hockey.  I’m lucky because I have a great musician and a hockey player growing up in the house.  I also love to follow investments, particularly in technology companies.

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

Other than certain professional goals, I want to teach 8th grade algebra.  I remember being scared out of my wits on my first day of algebra when the teacher just started throwing formulae up on the board.  I decided I could do it better and show students where it applies in the real world and explain it as a language of numbers.  I also want to go to a Stanley Cup Finals game when the Pittsburgh Penguins are playing.

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

My wife and I have 15-year old twins, Adam and Joanna, and we are very involved in their activities.  Joanna is a dedicated musician and performer.  Adam is a hockey player, which takes us a lot of time.  I’m also the President of the high school’s hockey club, which I enjoy.  The most satisfying thing is watching them, and their friends mature and grow skillful in their pursuits.

6. Who is your favorite historical figure and why?

I like to read about people who really changed the world, the way we think, and how society operates.  They were the rebels and often shunned in their own time, until history caught up with them.  Galileo, Charles Darwin, Dr. Martin Luther King, and Sigmund Freud all changed how we perceived the world around us, often against powerful societal and religious forces.  Isaac Newton wanted to explain the elliptical orbits of the planets, so he invented calculus.  Ernest Rutherford figured out the structure of the atom with none of the instruments available to scientists today.  Marie Curie took it a step further to explain radioactivity.  People didn’t know what to make of Jimi Hendrix when they first heard him.  He still sounds great and original today.

My favorite historical figure above all is Roberto Clemente, whom I watched play for the Pittsburgh Pirates growing up.  What he did on the field, off the field, his passion and pursuit of excellence at all times and his concern for the culture he came from should be a role model for a lot of people.

7. What is your favorite junk food?

I have been addicted to pistachio nuts since I was a young boy.  Also, a big fan of tortilla chips and a good hot salsa

8. Of what accomplishment are you most proud?

So far, it is the US House passage of HR 6690, Fighting Fraud and Protecting Seniors Care Act of 2018.  I’ll be even more proud when it passes the Senate.  I’ve been an advocate, analyst and designer of smart-card anti-fraud solutions and data-oriented solutions for a long time.

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

I was once offered a position in New York with a very high-quality research and investment company as a technology analyst.  I wish I hadn’t turned it down so quickly.  I don’t know if I would have taken the position, but I didn’t give it the time and thought it deserved.

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

Managed Medicaid

Some states are moving ahead with Managed Medicaid, (North Carolina) while others are debating its value (Iowa) and a recent article by Chad Terhune of Bloomberg discusses the payments to Managed Medicaid and the limited oversight that accompanies those payments.  Congress is stepping up its hearings on Managed Medicaid oversight and what CMS and the States should do about it.

Work Requirements /Eligibility and Expansion

Hardly a day goes by where there is not a news story about work requirements in various State waiver applications.  Post-election, where some states approved expansion of Medicaid, Congress is or should be looking at oversight of expansion.  The recent story of California enrolling 450,000 ineligible people onto their Medicaid program is not lost on Capitol Hill.  Louisiana’s legislature voted down a bill to allow for income verification.  That brings me to the third point:

Funding the Programs

We are at a point where we really don’t know whether Medicaid is a State program or a Federal Program.  If Medicaid is a Federal Program – the Federal Taxpayer has funded 100% of expansion, now 90%- then increased Federal Standards and oversight are needed.  Congress was making more noise about this with recent reports and hearing.  If it is a State program, States will have to put in place better accountability and integrity measures in exchange for some level of Federal funding.  Right now, we have neither.  Medicaid is now the largest budget line item in many States, and even with 90% Federal Funding, it is beginning to crowd out programs in education and infrastructure, and taxes are increasing to meet the cost.  The program ownership, funding and oversight will become a front and center issue.

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Medicaid Who’s Who Interview: Kili Preitauer

Kili is the Chief Growth Officer at i2i Population Health. Check out her LinkedIn profile HERE.

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

A: Healthcare Technology, no that’s not an oxymoron.

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

A: My entire career, straight out of college. The actual count of years will remain a highly guarded secret.

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

A: Advising my husband on how to run his company. 🙂

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

A: I’d love to have a beer with Barack Obama and George W. Bush at a backyard bbq. Can you imagine the stories?

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

A: Drinking homemade tomato wine. It’s amazing. Big opportunity.

6. Who is your favorite historical figure and why?

A: Genghis Khan. I’d ask him how to conquer healthcare.

7. What is your favorite junk food?

A: Can I pick two? Pork rinds and pickled papaya. (If you knew where I was raised, that would make sense)

8. Of what accomplishment are you most proud?

A: Out drinking Clay Farris at the last MHPA annual conference.

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

A: I’d be happy to redo the last 5 years of my life, BUT I’d redo it the exact same way. 🙂

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

  1. Drug spend (specialty drugs our pace IP spend
  2. Clinical integration (combining EHR data with claims data to actually make a difference)
  3. i2i, we’re killing it! 🙂

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Medicaid Who’s Who Interview: Thomas Kaye

Tom Kaye is an incredibly knowledgeable pharmacy executive. Check out his LinkedIn profile.

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

A: As healthcare is very broad, I have  been very fortunate to participate in many sectors. I have for the last 25 years focused on Medicaid fee for service and managed Medicaid under 1115b and 1915b waivers, commercial and Medicare part D, SNP and a few other venues. My most current assignments  has been work with several of the national top 5 insurance companies with focus on their movement into Medicaid managed care. Medicaid managed care involves states filing  of waivers with CMS for state participation as an experiential program to reduce state Medicaid costs.  New to the market  for Medicaid are the commercial power houses  insurers eager to join the ranks. My past experience has also contained hospital, ancillary infusion services, compounding, new drug development, sales and marketing for pharmaceutical with PBM services

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

A: Over 25 years

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

A: Focus Currently my ability to assist with consultative effort for changing  the velocity of pharmacy expense to plans and stakeholders. Minimally , cost avoidance  with existing tools and emerging tools are offered to lower costs  of claims / benefits.  I find that most cost reduction exist as incremental efforts, common sense issues.  The low hanging fruit as some mention, is generally picked already and there may be no gain in cost reductions utilizing this approach.

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

A: Bucket list flows over the top currently, but the top would be a train voyage stating in Canada, traversing though the great wood lands, valleys, national parks, upper north country of America and ending in southern California after 10 days.  The train has crystal glass roofs, great food and sleeping accommodations.

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

A: I enjoy wood working and engineering as a DIY “MAKER” The lack of intensity and the pleasures of wood are very rewarding and often humbling.

6. Who is your favorite historical figure and why?

A: I would choose Nikola Tesla, inventive, problem solver, and futurist.

7. What is your favorite junk food?

A: Fried pork skins, love the crunch and salt, not much flavor; might be similar to rice cakes. Pork skins go better with beer.

8. Of what accomplishment are you most proud?

A: Raising a family of three children and maintaining marriage to the same woman for 47 years. Having successfully raised the children who are married with 5 grand kids.

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

A: Redo’s are always hard, but I would take one for the multiple moves of family around the country for job opportunities.  This was disruptive for the kids.

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

1. Financially, plans are being asked as are providers to take less in compensation due to the ever-rising costs of care and supplies.  This is NOT sustainable for more than 3 years due to the drag it will place on GDP and tax burdens of the people.  We have been witnessing to the failure of the most recent design of healthcare modeling, costs and untruths. Yes the likely hood of a new program will evolve, but with this come more regulations and restrictions that take  provider time from patientsThere likely will be a deployment of new benefits which involve personal responsibility from the members.  Plans WILL move from a Risk corridor arrangement as currently set,  to an admirative services only payment process such as we have with various Medicare programs. Single payer may still be living

2. Infrastructure and telecommunications will need to be harmonized. Some relaxation as to HIPAA regulations will be needed to allow more robust communications with all stakeholders and data sharing for measurements.  Today we see a quagmire of efforts to use mobile devices, electronic communications etc.  This is a great idea ; however we have the highest costing patients (members over 50 YO) bucking the improvements and struggling with new forms of communications.  The demographic is not willing to adopt many of the new areas of communication based on lack of understanding, fear and frustration.  It will take a few years for this to subside.

Look for adoption and proliferation of IT super hubs and servers that embrace block-chain type transactional information.  The use of similar hubs and techniques such as with twitter, Facebook to improved communications to patients, providers and payment process. Legislation will be offered to embrace much more for IT compatibility across all systems. Increased transparency to cost of services will evolve though IT systems to align awareness of true prices instead of predatory pricing we see today with many oncology and transplant medications. The increased use of real time data for “Value based” care will be coming along.

3. Science never stands still. The ethical issues growing out of research is complex and often too perplexing for the human mind to cope with.  Improved understanding of the elements of humans will be pushed to the front of research. Payment for research will need to be allowed.

Look to see within the next 5 years and maybe sooner a better understanding of pathophysiology of human disease- gene sequences and informative attributes of cause and effect.  Phage deployment and advanced nanobots with  Crispr/Cas9 and newer versions of gene manipulations are moving at light speed to approved therapy.  The possible end of a PCP visit other than the patient attending a diagnostic session to take samples for a gene related medication to be made as personal medications.  The market disruption may be phenomenal as we know it today. Curative actions/steps may out pace chronic treatments with current consumption of marginal medications. The mere removal of chronic conditions such as diabetes, COPD, arthritis, cardio vascular issues would be very disruptive regarding payment, profits  and how payments are to be arranged?

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Medicaid Who’s Who Interview: Bill Lucia

Bill Lucia has decades of experience in the healthcare system industry, specifically in the IT area. Check out his LinkedIn profile.

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

A:  My company, HMS, is a healthcare IT organization that works with multiple Medicaid stakeholders including more than 300 Medicaid payers, 45 Medicaid agencies, at-risk providers and Medicaid recipients to assure the financial integrity of Medicaid and assist our clients in understanding and managing their members.

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

A: I actually started at HMS working with safety net providers who were heavily dependent on Medicaid, 21 years ago.

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

A: My true north and passion is to help make our healthcare more efficient and effective so that everyone can lead healthier lives, not worrying about the cost of healthcare or deciding between healthcare services and putting food on the table.

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

A: I have two — first I’d like to open a shelter for abandoned and abused animals. Its at crisis proportions in our nation and we just don’t do enough. And yes this ties to health because pets can be great emotional support for the chronically ill and disabled. My second is to retire and spend half of my time in Italy living “La Dolce Vita”.

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

A: Even though I travel all the time for business, I still love to travel the world and explore other cultures. I’ve visited over 20 countries but have many more to see.

6. Who is your favorite historical figure and why?

A: Leonardo da Vinci is one of my favorite historical figures. He is best known as the artist who created the Mona Lisa and the Last Supper, but he was a true renaissance man as he was also an architect, musician, engineer, scientist and inventor. Da Vinci was ahead of his time and sketched the first parachute, helicopter, motor car and other inventions that are essesntial to modern day life. His story inspires me to be creative and innovate.

7. What is your favorite junk food?

A: Ok, two…dark chocolate with nuts (which is not junk food, it’s good for you!) and piza (it’s in my blood).

8. Of what accomplishment are you most proud?

A: Leading HMS’s growth from a small services vendor in one line of business to one of the Top 25 healthcare IT companies in th U.S. and focused on a very critical mission of making the healthcare system more effective. We’ve built a “want to” versus “have to” culture at HMS because all of our employees know the value we bring.

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

A:  Ah only one? Well personally, it would be that I wasn’t in town when my Beagle passed away. Holding an animal during it’s last breaths reminds you how fragile life can be and being abe to thank them for unconditional love.

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

A: Well, in no specific order… First, we have to aggressively attack the Opioid crisis, which disproportionately impacts the Medicaid program. Advanced analytics exist to help us do this and crack down on prescribers but also be more predictive about addiciton.

Second, we have to share more data across the healthcare system and across the entire Medicaid program. HMS recently developed a risk intelligence tool, ELLI, that does just that and enables Medicaid Managed Care plans to understand their member at enrollment, accelerating care management, avoiding costly ER visits and better engaging the member by understanding social determinants of health.

Third, we have to be careful about policy changes to Medicaid under the auspices of reform or revoking the Affordable Care Act. States need both flexibility in how to manage their programs but assurances that changes to the federal/state partnership are very carefully thought through to avoid disruption to the members, their families and providers.

 

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Medicaid Who’s Who Interview: Friso van Reesema

Where passion for serving others and career meet, there lies Friso van Reesema. Check out his LinkedIn profile.

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

A:  I’m predominantly involved in supporting community-based Medicaid managed care plans and FQHCs. I support both the payer and provider partner on communicating with vulnerable Medicaid beneficiaries including Duals, CHIP and MLTSS.

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

A: My support for Medicaid beneficiaries officially started in 2012, with patient education and engaging vulnerable populations with communications and technology, as well as joining a non-profit Board for health equity. At CipherHealth, I’m continuing in the journey with a strong focus on Medicaid Managed Care Organizations. The passion that these clinical and non-clinical teams have for supporting the vulnerable is commendable. It’s a privilege to arm these teams with tools to improve the quality of their lives from a whole-person perspective. Great progress over the past 6 years!

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

A: Serving others, especially those with fewer means, is an innate passion that my grandfather passed along to me. He served on the Red Cross in the Netherlands and engaged the royal family in this global organization for disaster relief. Those genes made it to my mom and now to me. I’m passionate about education; whether it’s listening to the homeless or members of a local Boys and Girls Club to understand how to support them with education, insights and guidance. Being at the intersection of patient and provider communication is awesome. Bridging the health literacy and time scarcity gap supports both parties. It’s in my nature to help out.

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

A: Speak 8 languages and travel to all 7 continents with my wife and two boys! This way we can order fresh, nutritious and local food in the local language to avoid ordering cow’s tongue. I’d like to do more with my cultural anthropology and public health master degrees by diving deeper into cultural competency in population health communications and tying them to social determinants that I identify from traveling and research to support local health plan outreach, assessments and care coordination.

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

A: Keeping the adrenaline and competitive juices flowing by playing tennis in a men’s league is fun and healthy for me, but I really enjoy being on and in the water with my family either sailing or watching them tube and yell with excitement.

6. Who is your favorite historical figure and why?

A: A favorite and lesser known historical, yet current, leader of deconstructing racial disparities and bias is Archbishop Desmund Tutu of South Africa. Tutu is a favorite, because I met him through my grandfather while they were actively supporting South African public health initiatives including sexual assault, HIV prevention, childhood vaccines, etc. Besides bringing back great memories of working with my family, Tutu has an amazing humour and smile that wins over even those jealous of his power as former Archbishop of Cape Town, helping to dismantle apartheid with Nelson Mandela. He received the Noble Peace Prize and is beyond modest about his accomplishments. He’s a ‘must-meet-and-have-dinner-with’ type of legend.

7. What is your favorite junk food?

A: Deep fried ‘bitterballen’ from Holland with mustard sometimes tops Garden Catering’s Chicken Nuggets and cones.

8. Of what accomplishment are you most proud?

A: My two boys and wife are proud of my role in the community. I’m also jazzed by reactions from family and friends around a 5K Mud Run getting local, vulnerable and affluent families together in a muddy course to raise money for our local Boys and Girls Club, which started with 40 participants six years ago and now is maxed out at 800 runners and walkers raising over $175,000 per year for the prominent safety net community program and facility.

Professionally, I’m proud of my longstanding friendships with healthcare executives I’ve partnered with to achieve stretch goals supporting corporate strategy. One such relationship is with Cindy Hallam, when we empowered providers and members with shared decision making for chronic low back pain in Louisiana. The plan won an important State bid beating out National payers with a competitive advantage in provider engagement and involving people in their treatment options around chronic low back pain.

In my previous role educating providers on pain management and anesthesia, I am proud as a CT citizen for empowering community health clinic teams with educational lunch scenarios around how to identify and manage aberrant opioid seeking behaviors. After 3 months of education and empowerment, a local retail pharmacy was held up for oxycontin, because of the reduction in prescribing, which improved provider satisfaction and the State budget.

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

A:  As a golfer, I take my fair share of mulligans or provisionals. Live is too short for regrets. I have made plenty of less than perfect career and personal decisions that I learn from, remind myself and share with others, which often produces a laugh. Being Dutch, transparency sometimes results in “foot in mouth” syndrome. Life without apologies would leave me mute.

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

A:

  1. Support Medicaid recipients with a hybrid Medicaid/exchange product that makes financial sense for them and their family including the impact of work requirements for the potential to graduate to an exchange product for the family. Use incentives just like in the commercial market to change health behaviors!
  2. Medicaid programs and waivers to improve housing stability with incentives for beneficiaries, government, Medicaid MCOs and health systems, as well as the life sciences is paramount for emergency department diversion and reducing unnecessary medical expenditures.
  3. Collaborate more with community-based organizations and social services to optimize resources and exchange data on activities and clinical + non-clinical information to identify opportunities to support beneficiaries and those that manage their health and wellbeing.

 

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Medicaid Who’s Who Interview: Cindy Becker

Cindy has decades of involvement in the Medicaid industry. Check out her LinkedIn profile.

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

A: Most recently, I’ve worked with behavioral health expansion, integration with physical health, and community engagement. However, I’ve been involved with Medicaid policy, funding, and implementation throughout my career.

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

A: I’ve worked at both the state and local levels for more than 25 years. During this time, I held senior executive positions at the state’s Medicaid agency, one of the largest metropolitan counties, and Managed Care Organizations. I’ve also been intimately involved with health reform in Oregon from drafting legislation to transforming service delivery to engaging diverse communities.

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

A: I’m solutions-focused and passionate about creating high performing systems through effective policy analysis, planning, communications, metrics, and relationships. Figuring out how to make things work is the ultimate challenge, particularly when working in the Medicaid space! I’m also a big believer in process improvement and especially like Peter Drucker’s quote: “There is surely nothing quite so useless as doing with great efficiency what should not be done at all.”

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

A: I would love to go on a photographic safari.

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

A: I enjoy painting and crafts, probably because they have a beginning, middle, and end (unlike much of the work in the health arena).

6. Who is your favorite historical figure and why? 

A: Golda Meier – I admire her leadership, tenacity, non-traditional approach and her many accomplishments. She was a force to be reckoned with who worked relentlessly to achieve her goals.

7. What is your favorite junk food? 

A: Donuts!

8. Of what accomplishment are you most proud? 

A: Early on in my last position, the communities I worked with identified a major gap in services for children and youth. I’m very of proud of bringing public and private sector stakeholders together to create–and fund–community mental health crisis services for children and drop-in services for transition-aged youth experiencing behavioral health issues.

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

A: Years ago, I was involved in a major agency reorganization which didn’t go smoothly. One of the main reasons was the director’s negative feelings towards middle management, feeling they were the cause of the agency’s problems. While I supported that approach at the time, it was a great lesson learned as I went on to leadership positions. In fact, successfully working with middle management became a critical component in subsequent change initiatives that I lead.

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

A:

a. Tracking and strategizing any federal health reform changes to the ACA — everyone is waiting for the next shoe  to drop.

b. Engaging non-traditional partners and communities to:

  1.      Expand and integrate behavioral health and physical health services
  2.      Focus on social determinants, specifically housing and food insecurity
  3.      Increase health equity among marginalized populations.
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Medicaid Who’s Who Interview: Erhardt Preitauer

With years of experience, Erhardt’s heart and focus is healthcare. Check out his LinkedIn profile HERE.

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

A: At CareSource, we serve about 2 million members across the Medicaid, Medicare, and Marketplace programs.

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

A: As I think about the answer to this, I suddenly feel old!  Probably been a dozen years or so with a major focus on Medicaid.     

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

A: Other than chasing a couple of kids around, I get up in the morning excited to make a difference in the lives of our members.  Many of our members come from very complex situations or have very significant needs.  We are making a difference.  

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

A: To be able to write with the grace, wit, and wisdom of Clay Farris? 

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

A: Back to chasing kids around.  And good red wine. 

6. Who is your favorite historical figure and why? 

A: So difficult to pick just one!  I suppose it would have to be a founding father.  To have such a grand and different vision, and to have the courage to get it done against all odds. 

7. What is your favorite junk food? 

A: So difficult to pick just one!  I’ll have to go with the “sweets” category on this one.  Nothing beats a good cookie with ice cream on it. 

8. Of what accomplishment are you most proud? 

A: I’ve had a couple of jobs where we have made a huge difference in many lives.  I’m proud to have been a part of teams that have had such an impact.  But I hope the best is yet to come! 

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

A: So difficult to pick just one!  I’ve definitely had a few “character building” moments for sure.   

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

A: I think it is important that key decision makers understand the wonderful work that is being done, and more importantly understand the overall and long-term benefit to society that Medicaid coverage brings.