Medicaid Industry Who’s Who Series: Thomas Novak

Thomas Novak is a featured panelist for the upcoming “New Medicaid Health IT Funding and CMS Guide” Webinar on August 15th. RESERVE your seat today!


Medicaid Who’s Who: Thomas Novak – Medicaid Interoperability Lead with the Office of the National Coordinator for Health IT

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

A: I help build Health Information Exchanges at the state level. The state Medicaid agencies have a lot of carrots and a lot of sticks they can use to drive statewide interoperability in efforts to improve outcomes and control costs and it can be difficult to think through strategy of funding streams, sustainability, standards, architecture, and which use cases actually move the needle on outcomes and cost. I provide a lot of direct support to states to help where needed.

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

A: I am the Medicaid Interoperability Lead with the Office of the National Coordinator for Health IT. I am also detailed 50% to the Medicaid Data and Systems Group at the Centers for Medicare and Medicaid Services. Sitting (virtually) in both places allows me to really manage state level interoperability efforts.

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

A: 16 years. I have had the opportunity to be on all sides of Medicaid. My wife practices pediatric emergency medicine so I’ve moved around a lot as she’s gone from medical school, to residency and fellowship, and now attending. I started at the state level working with Massachusetts’ Uncompensated Care Pool and then rolling out their HIPAA transactions. I spent several years at Health Partners of Philadelphia, the largest urban MCO in Philadelphia. There I worked in Complaints and Grievances as well as helping coordinate plan-wide NCQA accreditation and ran some of our leased networks; all roles that really exposed me to all aspects of Medicaid’s processes. Finally, my provider experience was as the Director of Quality for the AIDS Resource Center of Wisconsin, the largest HIV agency in the state. There I had great support from the CEO and Medical Director who set me loose to see if I couldn’t get us to be the first HIV clinic recognized as a patient-centered medical home in the country by NCQA and we did it, and received enhanced Medicaid support as a result. And finally, I have been with the federal government for over 5 years now. I helped launch the Medicaid Meaningful Use program and supported most of the east coast states, as well as did a lot of work on the regulations and I have now settled into Health Information Exchange as my primary policy focus.

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

A: I truly believe we can save lives by putting the right information in front of the right provider at the right time. The complexity involved in doing as such thoughtfully is attractive, and will be a career well-spent, I believe.

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

A: Aside from building a health information exchange in every state and territory that serves the needs of Medicaid patients,  I do think it would be nice to get back to running. I’ve ran two marathons but my wife and I now have four daughters aged five and under, which is clearly a joy, but carving out time for training is essentially impossible.

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

A: I really enjoy cooking. I have a smoker and a sous vide and various other devices. Whenever I have free time I tend to come up with a fun recipe to try out. Spending an afternoon listening to music, with a glass or two of wine and cooking is probably my favorite leisure activity.

7.   Who is your favorite historical figure and why?

A: Marquis de Lafayette. Sure, he was somewhat just an impulsive post-adolescent, but he abandoned his nobility and sailed across the ocean to support this great experiment of democracy and we arguably owe our freedom to his passion.

8.   What is your favorite junk food?

A: I tend towards savory rather than sweet. As I am half Mexican I have to say chips and salsa. Specifically, chips and salsa from Jacobo’s in Omaha, Nebraska, my hometown.

9.   Of what accomplishment are you most proud?

A: Being a good father to my daughters, of course. But the work behind our State Medicaid Director’s letter (16-003) supporting interoperability for more Medicaid providers (long term care providers, behavioral health providers, substance abuse treatment providers, etc.) was such a satisfying achievement. My youngest twin daughters were born 3 days before it was published, and though I thought, “It’s like we both gave birth!” was a solid joke, my wife never quite agreed.

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

A: I think we could have spent more time facilitating the workflow conversations around Health IT. The Regional Extension Program was demonstrably successful in helping with providers adopting Electronic Health Records, but providers who were not fortunate enough to be connected with a regional extension center may have never received that hands-on support. A sizable number of complaints about EHRs are really complaints about workflow. There might not be someone who took the time to sit down and talk with the provider before implementation, ask about his or her workflow, and then implement the EHR in a way that meaningfully improved efficiency and quality of care.

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

I’ll answer in terms of health information exchange as I can’t help myself:

A.  Public Health Architecture, specifically how Medicaid can respond to Zika, lead exposure or other state priorities. The SMD 16-003 supports states in the architecture and on-boarding to specialty registries, which are part of Meaningful Use. These sorts of systems are integral to whatever case management we need to develop  to address these conditions and those systems can now be supported. States are also thinking of specialty registries in ways that really bring innovation into the Medicaid enterprise. We have states looking at building homelessness registries, registries for school based clinics, advanced directive registries, all great ideas.

B.  On-boarding sounds vague but really is that missing piece hindering semantic interoperability in many cases. A state bringing in a someone to work with a provider on integrating the health information exchange data into his or her workflow and making sure that they are not simply connected to the HIE, but there has been testing and production data exchanged. There’s also the crucial administrative work that on-boarding involves. Looking at contracts. Looking at consent models. Looking at Business Associate Agreements. Looking at encryption standards. Coordinating these things truly gets data moving.

C.  I’ll group encounter alerting and care plan exchange together and they’re the best tools for the really aggressive case management you need in Medicaid to support those with multiple chronic conditions, the super-utilizers, if you will. Knowing where your patients are and are not, and coordinating their care is so critical and not only improves outcomes, but truly moves the needle on costs.


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