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Clay has advised CMS administrators, state Medicaid Directors, health plan CEOs, technology COOs and a wide range of other clients in the healthcare industry. His unique blend of management consulting, project management, policy making and analytics help deliver on-time, actionable results for a wide array of business challenges. His Weekly Medicaid Roundup is read and loved by more than 10,000 professionals in the Medicaid industry.
His experience includes policy making at both the federal (CMS) and state levels (State of Georgia), management consulting for large organizational change initiatives, big data solution sales and implementation and cutting-edge analytics.
He currently leads key project components related to consultation design, Medicaid subject matter expertise and project management. He has a masters in Health Policy from the Johns Hopkins Bloomberg of School of Public Health and is also a Certified Internal Auditor.
Ms. Lynda Rowe is Senior Advisor for Value-Based Markets at InterSystems, and has for two decades held senior-level positions in health information technology. She was most recently an executive in the health market at Booz Allen Hamilton, where she led a number of consulting projects for the Centers for Medicare and Medicaid and the Office of the National Coordinator within HHS. She provided leadership for quality measurement, health information technology use and adoption, health information exchange, interoperability and standards, and meaningful use engagements. She spent a number of years running the analytics department for Managed Medicaid plans in Massachusetts. She is currently vice chairman of the board of directors at Family Health Center in Worcester. Ms. Rowe continues to focus on the advancement of interoperability, technology use and adoption and government policy through various workgroups and task forces.
Kathy has worked in more than a dozen jurisdictions both as a senior government official and trusted consultant. Her primary expertise is Health and Human Services (HHS); She also has extensive experience in Criminal Justice. Current activities involve developing business intelligence and data science products and services that support the use of data analytics for management of HHS organizations and clients.
Kathy's decades of experience with government technology and management information systems helped her to develop extensive knowledge regarding Integrated Eligibility, MMIS, HIX and SACWIS/ case management systems. . In the public sector she has included managing a budget of more than $130 million and reducing discretionary spending by 9%. As an HHS subject matter expert, she been engaged in thought leadership, product development, business development and project delivery.
Highlights from this episode
- We provide an overview of the series
- Our sponsor expert discusses their vision for the healthcare space and why the supported this project
- Kathy and Clay discuss themes from the interviews
NOTE: The transcript below is a rough approximation of the dialog and has not been cleaned up from the automated transcription service. It is meant to help listeners search/find for key topics.
Hi everyone. This is Clay Ferris. I've got with me Linda row and this is the part of our podcast Series where we get to talk about our sponsor and and we get to hear from them about why they not only what they do and what their vision for the spaces but why they wanted to make this work possible. So I'm very happy to introduce everybody to Linda Row from intersystems and Linda tell us if you wouldn't mind just for our audience may not be familiar with intersystems. Tell them about what you do and in the government.
Your space and your vision for it.
Sure. So intersystems has been in business for well over 40 years where a 1700 employees worldwide software company that's based in Cambridge Massachusetts our mission focuses around healthy data data that has been cleaned normalized and is ready for action, but we've been doing interoperability for as long as we have been in business that's been a core part of our business and our mission.
So it's really important for us that people Able to get the data that they need where they need it healthy data is not just Healthcare data, but many of our clients are in healthcare. For example, Premera Blue Cross epic Mass General Hospital pregnant Women's Hospital northwell health Providence. St. Joe's and many many others in the government space though clay. We've been working with the VA which is our long-standing client, and we've been working with them for nearly 40 years. We work with a number of State hies.
Actually for Medicaid, so we work with the state of Alabama together with our partner cognizant a we've been working with the State Medicaid agency in North Carolina through our relationship with SAS. So there are a number of places that we do this and we also work with some semi private and not-for-profit organizations like manifest MedEx, which is the largest health information Exchange in the state of California Health.
Ethics, which is the Health information exchange based in New York and others like that. So we have this very very large Healthcare footprint both us and internationally excellent was really really a lot of things going on there. Thank you for that that overview for the folks in the audience that weren't familiar. So the the the other question that I have in this for our sponsors are why, you know, why did intersystems choose to make this project possible?
Well, we're you know, we're trying to elevate the defend the most Medicaid side. We're trying to elevate the discussion of what we think are really really important topics and the Medicaid and Health Care space, but Linda what was sort of the thinking for why you and the intersystems team wanted to make this work possible.
Yeah, so like I said previously we have been doing interoperability with Healthcare organizations for decades. Probably one of the longest standing companies doing that and certainly when the onc and CMS rules came out about a year ago, we follow those we track them because again, we think a lot of the core tenants and what the vision is for being.
Unable to make data available, too.
Patients to Providers to payers to Medicaid plans to States is really an important message. And so we just were so excited about the work that you're doing clay through mostly Medicaid to make folks aware of the importance of interoperability. And again, one of our areas of focus and interest is State business federal government and providing those kinds of technology and solutions to those.
markets We really appreciate you making it possible. We've had a good time working with you in the team on this and I want to make sure that all of the audience had knows how to learn more. So how I think we'll put some you know ways to contact on the landing page that type of thing, but what's the what's your recommendation and just learn more about intersystems?
Yeah, so first I want to say it's been great working with you clay, and I think the podcasts that you've been able to record been just phenomenal. I think a lot of the audience is going to learn a tremendous amount amount about what's going on. And what's happening right now the best way to learn about us in addition to some very specific information will put on the landing page would be our website www.investmentpitch.com.
We actually have a Age repairs or health plans. So that's a great place to go. There's also some information about our government business and another one of our pages. So a couple of places to just get information and clearly there's a contact us page on our website as well. But we'd love to hear from folks would be interested in learning more about us and what we do with Medicaid with mcos and generally in this space.
Well, thank you so much. I know everyone is going to enjoy the series and you've got an episode in their yourself as well. That's that's one of the best ones in there. I appreciate you doing that and thank you again for making this work possible.
Thank you so much. This has just been a great collaboration. So we're really excited about getting this out there.
So that was London Eye talking about why Linda and intersystems team chose to do the project with us, and we do appreciate that and we got to hear about their vision and what they do their vision for this space as well as what they do and up next in this last segment of this this kickoff episode. You're going to hear Kathy Dalton and I so Kathy you can check out her bio on the landing page, but Kathy did some of the interviews and I did some of the interviews and in this piece we're going to kind of talk about our overall thoughts as we look back having completed.
At the session so listening to that and then you'll be done with the with the kickoff episode and then you can listen to all the rest of them.
For this project Kathy Dalton and I were the lead interviewers before we dive into all the different episodes. Let's take a few minutes to share our impression from the conversations. And before we do that Kathy, if you don't mind give the audience a quick little bit about yourself. My name is Kathy Dalton and I am the CEO of a very small Health and Human Services consulting firm called Edge Government Solutions. This is certified.
When own business in New York state and I've spent many years working both as a state and local government policy maker and work my way up from, you know slave to being I worked for the first Governor Cuomo has assistant secretary for Health and Human Services. I've been a commissioner of Social Services. I left the public sector.
I went back to school and got a PhD and my Dissertation was on the implementation of Medicaid Eligibility policies and then I came back to the world and I have been a consultant in I don't know more than half the states on various Health and Human Services issues over time. So and I'm old so I've done everything from you know, welfare reforms before Don't Care Act to 90/10 funding so so it's been a wild ride, but but I tend to look.
Because I work in Health and Human Services. I do get a unique view of how all of the federal programs affect each other and I find that really valuable. Thank you very much for doing the project had a I had a great time doing it and I think we learned a lot together. So I appreciate you doing it. Let's talk a little bit about kind of the themes that I think that listeners will hear as they as they go through the different episodes.
I think what was entered one of the things I'll toss out some ideas.
One of the things that was interesting to me is how we even talked about interoperability and how I mean there's a very technical way right which is similar to which is focused on which is the the nature of the rules themselves, but then a lot of the conversations, I know some of the ones that I had I think someone's you had as well talked about not just the technology but even siloed program areas that type of thing Tell me my takeaway was the technology is going to help make things more interoperable. But that we still will have challenges of making sort of programs be aligned with each other. What are your thoughts on that? I think you're exactly right on the rule itself.
You know, it's ridiculous to say starting with electronic health records as a small start, but but it really does starts all and it says you No beneficiaries should get copies of the information from any care that they get and then they should also that information should be shared with any follow-up provider, right? So that's pretty straightforward.
But it's the beginning of laying the groundwork for what ultimately you would want which is a 360 view of your patients and beneficiaries and that 350 view really is what's going to move us as an industry towards identifying and addressing the social determinants of health, so That that and so when you talk with various expert you really have to be on point with them about what part of this you're really talking about because otherwise you wind up some place entirely different from where you thought you were starting. Well, I think that's a good point.
I think where that became apparent in some of the conversations that I had was asking how long you know, give me the history of this effort how long we I tried to achieve If interoperability and I've been in the vale who you talk to. I mean, there's some people that you know, they actually make a plausible case for you know, the early 1980s. So I think that yeah and that was really interested. There's no I mean, I don't want to give all the spoilers. Everybody will hear a lot of detail and everybody's story when they work through the episode when they work through the discussions, but that it is it is important when we think about where we're where everyone thinks about where this started couple other.
Quick kind of stakeholder perspective things and then we'll just move on into the discussions themselves provider resistance. That's one thing or how providers play in all of this and then another one will tackle that one first, but another big theme I think was related to sort of winners and losers in the vendor technology space. But on that first one, what was your impression around the role of providers?
Obviously they have to use this technology that may or may not adopt it. What did you take away from from this element of the discussion?
I actually took had to take aways that were quite different because it was depending on on kind of who is being referred to so when you talk about providers you could talk about the administration, you know, for example, the hospital presidents and CEOs who have invested millions and millions of dollars into proprietary.
Health record electronic health records and how this rule potentially sets them up to be sharing all that information for free and you know, the the kind of disincentives to to doing that right, but then the other is the issues that many individual providers still face trying to use an electronic health record that they really don't understand.
And putting information into a technology. They don't want to be using any way and that just exacerbate that problem across the the provider field if you will and so, you know, those are when you talk about data quality in particular, that's one of the things you come up against is that all these people who are entering information in these records are not necessarily interested in making sure it's all right.
They're just trying to check the box and move on so, right So, you know, go ahead go ahead. I'm just it's really important you talk about the educational components that have to be part of implementations part of the educational component has to be educating those providers that it really does matter. Now what information you put in there.
Right, right. I did I completely agree that you know, it's the whole garbage in garbage out. We can make interoperable systems, but if they're doing nothing, but sort of transporting junk data than what good has it done. So the last one the last kind of theme and there's a lot of things to cover but I kind of want to just make sure we give the high level view. The last thing I want to talk about is disruption because I believe and this comes out in several conversations.
I believe that this Has the opportunity to bring innovation in the health care space these rules this whole effort towards interoperability, but it is disruptive because it is potentially very threatening to very large-scale incumbent and trench technology providers.
You know, I am hopeful that it will be a very positive thing. Although I think we see early signs in reaction to the rule that there you know and maybe a long road there might be quite quite a fight on this front. What did that's come up in any of your conversations or did you see that as a theme this disrupting healthcare-related interoperability?
I did absolutely see it wasn't described in that manner. I would say so for example in our conversation with Roger. He didn't who talks about from a user's perspective.
He thinks of position eruption potential as really moving Healthcare Leaps and Bounds forward because you have you're going to have a better methodology for communicating with patients and In patients and following patients when they need assistance and it opens the door for Telehealth and other kinds of innovations that are by definition disruptive to the existing system. So that was very positive. So I think that's I think that's a good kind of 50,000 foot View for the themes. I am excited for all the listeners to dive into this. We do cover a ton of ground get in.
To a lot of different perspectives that was for the whole purpose of the project was to to unearth those perspectives. So thank you again Cathy for doing the project and with my pleasure. Thank you very much. And now we'll without further Ado will let folks listen into these conversations.
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