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Medicaid Who’s Who: Michelle Miller, MS, RN, PMP – Chief Nursing Officer with the Colorado Department of Healthcare and Financing

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Michelle received her nursing degree in 1994 from Augustana College in Sioux Falls, South Dakota. She worked until 2004 as a Pediatric and Pediatric Intensive Care Unit (PICU) Registered Nurse, specializing in respiratory disorders, children with special needs, and acute trauma services. Michelle moved to Colorado in 2003 and soon turned her focus to the outpatient clinical setting. She became a nationally certified Organ Recovery Coordinator for Colorado’s Organ Procurement Organization, Donor Alliance Inc., where she focused on increasing successful multi-organ donations in infants and children. In 2006, she accepted a position as a Liver Transplant Coordinator at the University of Colorado Hospital.

Michelle received her Master’s degree in Leadership in Health Care Systems at Regis University prior to joining the Colorado Medicaid team in 2013 as the Pediatric Assessment Tool (PAT) Revision Project Manager. She successfully designed and implemented a PAT pilot study. Michelle transitioned into the Utilization Management (UM) Contract Manager position and made significant contributions to the modernization of the ColoradoPAR Program, the Medicaid Nurse Advice Line, and the Client Over Utilization Program over the past 3 years. Michelle was recently promoted to the Chief Nursing Officer position.

Michelle lives in Larkspur, Colorado where she enjoys gourmet cooking, all forms of exercise, and spending time on her deck with her husband, dogs, and the local wildlife.

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At the Medicaid Innovations Conference, where Clay Farris of Mostly Medicaid is the Event Chairperson, Michelle Miller is presenting the following agenda session:

Bridging the Client Engagement and Care Coordination Gap to Improve Outcomes: The Colorado Medicaid Nurse Advice Line Model

The Colorado Medicaid Nurse Advice Line aids clients in determining the appropriate level of care, provides health education and region-specific referral information based on individual needs, and facilitates care coordination. This session will discuss this patient-centered care coordination model.

You can learn more about this topic and the rest of the agenda at http://www.medicaidinnovations.com/

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

State government

  2. What is your current position and with what organization?

I am the Chief Nursing Officer for the Colorado Department of Health Care Policy & Financing (HCPF).  We administer Health First Colorado (Colorado’s Medicaid Program), the Child Health Plan Plus, and other health care programs.

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

I am fairly new to Medicaid; my nursing career began in 1994 and I joined the HCPF team in 2013.

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

I am passionate about empowering nurses to become leaders, not only at the bedside or in hospitals, but throughout the entire health care industry and the communities for which they serve.  Nursing is consistently rated as one of the most ethical and honest professions, however I am not confident we are utilizing nurses to their full potential. 

I am also passionate about people taking responsibility for their own health and wellness by becoming as involved in their preventative care in much the same way people are with their “sick” care.   Improving one’s health literacy, wellness, and lifestyle changes needs to be a priority for all people regardless of where they receive their medical care.  

In addition, I am very passionate about process improvement.  Innovation is the hot buzz word right now but I am a firm believer that prior to designing new programs or processes we should be certain that our current ones are fully implemented and functioning at capacity.  New does not always mean improved.

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

My bucket list includes a food and wine filled trip to Italy.   I love to cook and would also like to attend some form of professional culinary training.

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

I am an avid reader and quite literally obsessed with food.  My days off are filled with hiking followed by an afternoon of cooking or baking while simultaneously reading a book.

  7. Who is your favorite historical figure and why?

There are too many intriguing individuals to list just one but I will say that I am fascinated by historical figures who were ostracized for their beliefs only to be vindicated after their deaths. 

  8. What is your favorite junk food?

Forget sweets, I love all things salty and crunchy including nachos, buffalo wings, and french fries.

  9. Of what accomplishment are you most proud?

Graduating with my bachelor’s degree in nursing in 1994.  I worked an average of two to three jobs while attending college full time.  I used to study in my car between jobs and while waiting at stop lights.

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

I wish I had prioritized staying in touch with friends as I moved from state to state.  I grew up in North Dakota but left after high-school and then traveled across the southwest during my time as a traveling nurse.  I have met some extraordinary people who I simply lost touch with over the years.

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

There are so many challenges it is difficult to choose only three but I would have to say the future of the Affordable Care Act, improving patient access to care while incorporating strategies to address the social determinants of health, and controlling the rising cost of health care including the increasing cost of pharmaceuticals.

 

Sara Hall is a featured panelist for the upcoming Indiana State Medicaid Spotlight Webinar on November 18^th. RESERVE your seat today!

 

Medicaid Who’s Who: Sara Hall – HIP Employer Link program director at the Office of Medicaid Policy and Planning

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

A: I work at Indiana Medicaid on the policy side.

 2.  What is your current position and with what organization?

A: I am the HIP Employer Link program director at the Office of Medicaid Policy and Planning in Indiana’s Family and Social Services Administration (whew, that’s a mouthful!)

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

A:  I have been at Indiana Medicaid for a year and a half.  Prior to this, I worked as a Navigator assisting clients at a Behavioral Health Center which is where I first starting working with Medicaid programs and understanding their complexities from a member perspective.

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

A:  I am really focused on all Americans having access to quality, affordable healthcare.  Probably sounds like a stock answer, but after working with people as a Navigator I got a look into peoples’ lives.  This was especially true when the ACA was passed and it took Indiana an extra year to get approval for HIP 2.0.  So there was a year when a lot of low income Hoosiers simply fell into the “coverage gap.”  I had the opportunity to see people before and after our alternative Medicaid expansion.  Healthcare really changes lives and I feel privileged to be a part of that.  But, as this audience knows, it doesn’t always work perfectly or as smoothly as it should.  My passion is to continue to make improvements to existing systems and/or help create new systems so that all lives can be improved by healthcare access.

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

A: Traveling the Tran-Siberian Railway from Moscow to Beijing.

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

A:  My 14-year-old daughter is my primary focus.  We like to travel and are planning on backpacking through Belize this summer.  I also like painting, pyrography, and I am currently studying for the GRE….in between watching turn of the century British dramas on Netflix.

 7.  Who is your favorite historical figure and why?

 A: Paul Goodman, because he was a very interesting person who had very interesting ideas.

 8.  What is your favorite junk food?

A:  All of them.  But I really like candy….specifically gummy peaches and Pop Rocks.

 9.  Of what accomplishment are you most proud?

A: Career wise, it would be the development and growth of the HIP Employer Link program I am currently directing.  Personally, it is my daughter and how she is growing into a responsible, smart, bold young woman.

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

A: In the second grade, I picked my nose and ate it in front of the whole classroom.  It was a poor decision that haunted me well into third grade.

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

A:  1.)  Obviously, the election.  Medicaid moves at the whim of politics and it is important that programs are funded, staffed, and properly managed when there are legislative changes so that benefits are not lost or decreased for members. 

 2.)  The results of Managed Care Organizations.  Indiana has been working with managed care for a while, but those contracts got bigger with HIP 2.0.  Over the next 6 months we will start to see the results on a number of our performance measurements.  Many other states are working for MCOs for the first time and will also start seeing more results of those relationships.  It will be important for the MCOs to prove that things are working better under their management. 

 3.)  Addiction and mental health services.  The opioid epidemic has hit Indiana hard (along with many other states).  Our Medicaid programs do not always offer ways for people to gain and maintain sobriety through their current health care plans.  Indiana also has a huge gap in mental health providers in and outside of Medicaid.  If we don’t have enough doctors/counselors/case workers to help people who are suffering it will be difficult to see this epidemic decrease.

Sara Hall is a featured panelist for the upcoming Indiana State Medicaid Spotlight Webinar on November 18^th. RESERVE your seat today!

Calder Lynch is a featured panelist for the upcoming Nebraska State Medicaid Spotlight Webinar on October 21^st.

RESERVE your seat today!

 

Medicaid Who’s Who: Calder Lynch – Nebraska Medicaid Director

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

A: I’m a state health policy nerd, but I like to think I work at the intersection of policy and politics – where we really can make things happen. However, my real passion and focus comes after the policy-making—at the executing and operationalizing of reforms and programs. That’s the fun stuff!

 2.  What is your current position and with what organization?

A: I am the Director of the Division of Medicaid and Long-term Care within the Department of Health and Human Services for the State of Nebraska. Put more simply, I’m the Nebraska Medicaid Director.

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

A: I’ve been in my role here in Nebraska for a little over 18 months. Before this, I worked in the health care and Medicaid arena for the State of Louisiana for about six and a half years.

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

A: We’ll always have the debates about what government should and shouldn’t do, can or can’t provide–but the fact is that we are going to do something, we should do it well. Good government is non-partisan, and a well-run government is something every citizen and taxpayer deserves. And in my experience some of the most dedicated and passionate people work in the health and human services programs of the public sector. In Nebraska, we are totally rethinking and restructuring how our Medicaid program is administered – from our eligibility and MMIS systems, to our managed care programs, our policies & regulations, our staffing structure, and our contract oversight. With the right tools, planning and leadership, we can accomplish amazing things. My passion is to help create that structure and empower our team to show how effective we can be at making programs, processes, and outcomes better for the people we serve and the citizens who fund out programs.

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

A: I am excited about our vision for modernizing the systems that support our Medicaid program and how we view our role and structure in the future. We like to talk about how we are implementing a “No MMIS” approach – where the state will no longer own or operate a claims processing system. I would love to see us completely decommission or legacy self-administered system and move to a services based architecture.

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

A: I like to cook, especially for others. I really enjoy sharing a good meal that I’ve prepared, and I’ve enjoyed bringing my Cajun flavors to Nebraska. I also enjoy traveling, especially when it leads to spending time with friends and family in places that lend themselves to photography and being outdoors.

 7.  Who is your favorite historical figure and why?

 A: While not my favorite in terms of his beliefs or politics, I have always been deeply fascinated by Huey Long. As a child, I actually appeared as an extra in a TV movie about him called ‘The Kingfish.’ He is an incredible figure in American politics, and particularly for me in Louisiana history. His story is both a cautionary tale against government corruption and an interesting lesson in the roots of populism that I think continue to have influences on today’s politics.

 8.  What is your favorite junk food?

A: I’m a Louisiana native, and it’s not all that often I can get my hands on some Zapp’s Cajun Crawtator potato chips. And that’s probably a good thing!

 9.  Of what accomplishment are you most proud?

A: I think one of the most important functions of a leader and manager is the recognition and cultivation of talent. I am most proud of the team of folks we’ve assembled here in Nebraska, where we have our complete leadership team in place for the first time in a number of years. Seeing their daily successes, growth, and future potential is the most rewarding part of my job.

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

A: One of the very first projects I was given to manage was the carve-in of pharmacy to managed care in Louisiana, coupled with the implementation of a new reimbursement methodology. We did it, and in many ways it was successful. But it was a lot of change very quickly. Looking back, I would have recommended some different policy prescriptions as it related to how the benefit would be managed in a carve-in environment (like retention of a common PDL). Sometimes the trick to implementing lasting reform is to work incrementally. I learned some important lessons that have influenced our decision-making here in Nebraska.

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

 A: In the short term, the most impactful thing will be the federal leadership transition and the selection of new leadership at CMS. This will ultimately have tremendous impact on how the recent flurry of federal regulations will be implemented, like the managed care regulation and guidance around specific provisions like the IMD rule.

 Other timely things to watch will be how CMS applies the Access Rule to ongoing state plan amendments, the impact of Part B premium increases on state budgets and the expiration of the Money Follows the Person program.