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Medicaid Buy-In: Episode#7- Interview with Laura Colbert

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  • Guest Bio
  • Show notes

Laura ColbertLaura is the Executive Director at Georgians for a Healthy Future, where she advocates for health policies that expand coverage and access for Georgians. Before her current role, Laura worked at Children’s Healthcare of Atlanta, and the CDC. She holds an MPH from Emory University.  

Highlights from this episode

  • GA Healthy Access effort.  
  • Exiting federal marketplace 
  • GA is introducing 2 new plan types: copper and disease management plans
  • State is asking for waiver of 2 requirements in ACA: 1- Not wanting to have plans have to cover all 10 essential health benefits and 2- waiving maximum out of pocket costs for consumers
  • How the new model proposed in GA might impact cost and network in rural areas
  • Possible adverse selection in some of the more comprehensive disease management plans
  • Unpacking the ACA 4 Guardrails for waiver requests
  • Impact of reinterpreting Guardrails to give states more flexibility
  • GA partial medicaid expansion effort
  • Work requirements, copays/premiums
  • Proposal to extend pregnancy medicaid from 60 days post birth to 6 months post birth

About our Sponsor

This was made possible by support from WEX Health. Please take a moment to learn more about what they do by visiting wexinc.co/public-sector

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Medicaid Buy-In: Episode#6- Interview with Barbara Otto

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  • Guest Bio
  • Show notes

Barbara OttoBarb is the CEO of Smart Policy Works, a Chicago-based firm that is is a driving force behind building smarter systems of health and social determinants of health for vulnerable people and places across the nation, state of Illinois, and metropolitan Chicago. Before her time at SPW, she worked at the 9to5 National Association of Working Women and at Ernst and Young. 

Highlights from this episode

  • Previous buy in efforts for IDD populations
  • Medicaid buy in as a path to expand coverage
  • The additional flexibilities and authorities in Medicaid as compared to Medicare. 
  • Unpacking 1332 waivers, including uses beyond just reinsurance
  • How to make Buy In programs successful
  • Importance of well thought out financing model for buy in program stability
  • Why states cant go it alone (ie cant do it without federal matching dollars, and need health system stakeholder participation)
  • The role of actuaries in Medicaid buy in programs
  • Predicting uptake of Medicaid buy ins nationwide

About our Sponsor

This was made possible by support from WEX Health. Please take a moment to learn more about what they do by visiting wexinc.co/public-sector

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Medicaid Buy-In: Episode#4- Interview with Bryan Cutler

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  • Guest Bio
  • Show notes

Bryan CutlerBryan is the majority leader in the PA State House, where he has served for 14 years. Before his time in the legislature, he worked in hospital administration and as a radiology technician. He also is an attorney who currently practices law at Nikolaus and Hohenadel.

Highlights from this episode

  • Background of effort in PA
  • Dealing with impact of decreasing federal funds under ACA
  • Importance of wide support from provider, plan and regulators in getting the 1332 waiver for reinsurance
  • Overview of the public option in PA
  • Legislative groundwork needed to prepare for the public option
  • Timeline for PA exchange rollout
  • Key steps for states to exit federal marketplace successfully
  • Impact of the reinsurance waiver; transparent reporting to consumer comparing costs with and without the 1332 waiver
  • Using a public option model as way to reform Medicaid, including incorporation of social determinants
  • Provider response to the proposed model has been overwelmingly positive
  • Previous provider quality initiatives laid groundwork for smoother transition today
  • Increasing impact of Medicaid spending on other state budget priorities like education and roads
  • Predicting national uptake of public option models

About our Sponsor

This was made possible by support from WEX Health. Please take a moment to learn more about what they do by visiting wexinc.co/public-sector

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Medicaid Buy-In: Episode#3- Interview with Dylan Roberts

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  • Guest Bio
  • Show notes

Dylan RobertsDylan is the state representative for Colorado House District 26. In that role he serves as the chair of multiple committees, including the Rural Affairs and Agriculture Committee, the Capital Development Committee and the Judiciary Committee. He is also the Deputy District Attorney for Colorado’s 5th Judicial District.

Highlights from this episode

  • Demand from his constituents to address the excessive high costs of healthcare and insurance
  • Bringing in more competition and new savings measures
  • Overview of CO plan / proposal
  • Problems with 22 counties that only have 1 option on exchange
  • Bill to examine public option proposal in 2019
  • Stakeholder meetings and actuarial analysis
  • Use of reference-based rates for hospitals as key to allowing plans to offer cheaper products
  • Advice on policies and systems states need to have in place for public option to work
  • High healthcare costs in CO as driver for change; political pressure to find a solution
  • Compared to Washington (state) public option bill in 2019
  • Provider support of plan
  • Using Medicare rates as benchmark for public option plan facility rates
  • Longer term benefits to facilities of public option models
  • Predicting uptake of public option model nationwide

About our Sponsor

This was made possible by support from WEX Health. Please take a moment to learn more about what they do by visiting wexinc.co/public-sector

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Medicaid Buy-In: Episode#2- Interview with Adam Fox

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  • Guest Bio
  • Show notes

Adam FoxAdam is theDirector of Strategic Engagement at Colorado Consumer Health Initiative  . He advocates for better consumer access to healthcare in Colorado and has been featured as a thought leader on national news outlets such as CNN. In his role at CHHI he focuses on communication strategies, media engagement and driving the policy agenda in his state. 

Highlights from this episode

  • Background of the public option effort in CO, including the legislative path
  • Why its less feasible for CO to pursue a Medicaid buy-in path (the CO Taxpayer Bill of Rights)
  • Clarification of Colorado Public Option key details, including
    • premiums and subsidies on CO exchange under new option
    • increasing number of carriers operating in various counties
    • regulatory authority under the CO public option
    • benefit design and MLR
  • A better understanding of what is meant by the “public/private partnership” model
  • Why rate caps for hospitals are key to the plan
  • Key changes and systems needed to operate a public option plan
  • Importance of strong consumer outreach and enrollment functions
  • Effectively engaging legislators in the effort
  • Provider pushback on the price controls component
  • Plan response to the proposed model

About our Sponsor

This was made possible by support from WEX Health. Please take a moment to learn more about what they do by visiting wexinc.co/public-sector

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Medicaid Buy-In: Episode#5- Interview with John Sweeney and Cheryl Gardner

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  • Guest Bio
  • Show notes

John SweeneyWEX Health

John Sweeney is a thought leader on the WEX Public Sector team, focused on connecting WEX innovation to evolving client needs in the Medicaid and health marketplace verticals. Prior to joining the WEX team, John served in various other healthcare technology roles throughout his 20+ year career, including nearly 10 years at IBM companies.  John also serves as the Director of the Hale Center Theatre, where he has directed 30 productions over the last 16 years. 

Cheryl GardnerGardner Strategies

Cheryl Smith Gardner is the founder of Gardner Strategies, a health policy and strategy company. Cheryl combines functional knowledge and experience in state health policy design with a notable background in strategic management and program administration. Her clients include state government agencies, technology firms, and policy shops. 

Prior to founding Gardner Strategies, Cheryl served as the Chief Executive Officer at beWellnm (New Mexico’s health insurance exchange), as the Executive Director of the Arkansas Health Insurance Marketplace (AHIM), as a Senior Practitioner at Deloitte Consulting, as a director in the Health Insurance Exchange practice at Leavitt Partners, and in the Utah Governor’s Office of Economic Development as the Director of Policy and Strategy of the Utah Health Exchange office. 

Her leadership and expertise in the areas of state health policy, insurance exchanges, and health system reform often draws national attention as she is frequently cited in a number of respected publications including the Washington Post, Politico, The Wall Street Journal, USA Today, and the New York Times. Cheryl is a highly sought after public speaker and has participated multiple times as a presenter, panelist, and moderator at a number of national conferences including those sponsored by the National Conference of State Legislatures (NCSL), the Republican Governors Association (RGA), the National Conference of Insurance Legislators (NCOIL), and America’s Health Insurance Plans (AHIP).

Highlights from this episode

  • Defining Medicaid Buy In and Public Option as one more chapter in the continuation of expanding coverage
  • Medicaid Buy in Vs Medicare Buy In; Compared to Medicare for All
  • States controlling their own destiny with Medicaid Buy In customization
  • How long we have been trying to implement Medicaid Buy In
  • Buy in as part original ACA design via Public Plan/Option
  • Range of readiness for Medicaid Buy in across states
  • The importance of choice for all health insurance consumers
  • Importance of where the idea of Buy in originates within a state stakeholder system
  • How preliminary eligibility criteria can determine broader uptake
  • Importance of different states sharing what they are doing with other states
  • 2 kinds of readiness: Policy readiness and technology readiness
  • Technology is there. Its better than ever and its cheaper than ever
  • Challenges of working through bureaucracy of the policy side
  • Key tech systems that need to be in place or enhanced to deliver Medicaid Buy In / Public Option through a state marketplace
  • Impact of simplifying Medicaid eligibility systems integration requirements on costs of technology
  • Importance of making consumer shop and compare experience best it can be for increasing uptake for Medicaid Buy In
  • Opportunity to customize plans for consumers based on their specific healthcare needs
  • Getting the data needed to customize plan offerings to consumer needs
  • Predicting when we will see more Medicaid Buy In programs

About our Sponsor

This was made possible by support from WEX Health. Please take a moment to learn more about what they do by visiting wexinc.co/public-sector

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Medicaid Buy-In: Episode#1- Interview with Henry Chao

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  • Guest Bio
  • Show notes

Henry ChaoCTO, FEI Systems

Henry Chao is Chief Technology Officer (CTO) at FEI Systems. As CTO, Mr. Chao leads FEI’s enterprise architecture activities. He guides solution development for both Federal and State Medicaid initiatives. In addition, he coordinates product alignment with FEI’s State and commercial health care business. Prior to FEI, Mr. Chao was the Deputy Chief Information Officer and Deputy Director of the Office of Information Services at the Centers for Medicaid & Medicare Services (CMS). In these roles, he was a key agency executive driving improvements and optimization of operational systems and effective change management. At CMS he also served as CTO at the Office of Information Services, Deputy Director of the Information Systems Design and Development Group, and more. Mr. Chao also served as the Chief Information Officer (CIO) of the Office of Consumer Information and Insurance Oversight at the Department of Health and Human Services (HHS) Office of the Secretary. At CMS and HHS, he assumed leadership roles in planning and executing legislative initiatives to transform health care. He led efforts to leverage modern Agile approaches to establish secure, cloud-based IT infrastructure to support CMS programs, including the Insurance Marketplace for the Affordable Care Act (ACA). Mr. Chao brings FEI 20 years of experience formulating strategies, leading solution development, and delivering program capabilities for Federal and State health care initiatives. Mr. Chao has a Bachelor of Arts in Economics from St. Mary’s College. Recently, Mr. Chao authored the book Success or Failure? The Untold Story of Healthcare.gov.

Highlights from this episode

  • The beginning of the story  
    • Marketplaces as part of incremental story of Medicaid expansion, but biggest leap to date
    • The ACA Public Option
    • Original design for Public Option in ACA
    • How having the original Public Option at ACA launch would have allowed more consistency of original implementation
    • The healthcare.gov launch
  • Risks and challenges
    • Risks of focusing on the technology vs identifying key elements needed to solve for the problem
    • Challenge of solving problems for which there are no real precedents
    • How long it takes for technology changes to settle in large scale implementations
  • The complexity of the stakeholder environment
    • The breadth of the stakeholder environment in large system implementations
    • Impact of process re-engineering across a wide stakeholder base for most public sector technology projects
    • The service delivery chain of healthcare systems makes technology projects even more complex
  • Lessons learned for states around healthcare marketplaces
  • Multiple insights for technologists and and policy makers, especially the importance of:
    • decoupling dependencies and managing what we can actually control
    • constantly breaking down larger problems into their smaller parts
    • measuring results against what actually exists today
    • quality communication. Without it you get impossible deadlines and people still expecting good outcomes
    • Anticipating stakeholder reaction to tech system changes
    • Driving to an implementation date in public policy, but launch dates are not the finish line (they are the starting line)
  • Determining when its ok to continue to patch systems vs a system replacement
  • Key takeaway: Technology doesn’t mean anything if you don’t understand the business problem. 

About our Sponsor

This was made possible by support from WEX Health. Please take a moment to learn more about what they do by visiting wexinc.co/public-sector