HMA Weekly Roundup

WAKELY, AN HMA COMPANY, WHITE PAPERS

Inflation Reduction Act Review – Summary. The Inflation Reduction Act will have a substantial impact on pharmacy costs for Medicare managed care plans. To continue to be successful in the Medicare space, managed care plans will need to know how to optimize pharmacy strategies in this new environment. Read More

HMA WELCOMES

Caprice Knapp, Principal – Salt Lake City, UT

A health economist and evaluator, Caprice Knapp has more than 20 years’ experience working on Medicaid and the Children’s Health Insurance Program (CHIP) in the private sector, state and federal policymaking, and academics.

In the private sector she was the federal policy director for Molina Healthcare, Inc. As an academic, she was an associate professor in the Department of Health Outcomes and Policy at the University of Florida (UF) conducting external quality review activities for Texas and Florida Medicaid and CHIP programs and maternal and child health research. In the policymaking arena, she worked in the Governor’s Office of State Planning and Budgeting in Colorado as well as the U.S. House of Representatives Energy and Commerce Committee as a Robert Wood Johnson Health Policy fellow. Most recently she was the North Dakota Medicaid Director from 2019 to 2022.

Caprice’s career has been focused on vulnerable populations, delivery system reform, and global health. Examples of her funded research topics include an assessment of Florida’s CHIP Reauthorization Grant; an evaluation of fertility-preservation decision making for adolescent girls with cancer; outcomes of concurrent models of pediatric palliative care; and an assessment of the quality, patient experiences, and costs of health and dental plans for children in Florida. Her global health projects also focus on maternal and child health and have been conducted in Africa, Asia, Europe, and South America.

At the University of Florida, Caprice earned a PhD in economics and completed postdoctoral training in health services research. She has authored more than 80 peer-reviewed publications, 60 government reports, and two books.

Carl Mueller, Senior Consultant – Columbus, OH

Carl Mueller is an experienced data and policy analyst with a strong understanding of and interest in healthcare delivery systems, Medicaid, health reform, and value-based payment programs.

Prior to joining HMA, he served as an episodes data scientist on the Episodes of Care program in the Strategic Planning and Innovation team within the Division of TennCare. In this role, he led technical implementation and evaluation of the Episodes of Care program and served as the subject matter expert on all episodes of care content and methodologies. In addition to this role, he has experience on cost estimates and financial modeling, most recently showing the fiscal impact of the program.

Prior to TennCare, he served as a policy analyst at the Hilltop Institute at the University of Maryland, Baltimore County (UMBC). In this capacity, he provided technical assistance to the State Medicaid agency on the Affordable Care Act, helped estimate the financial impact of the Medicaid expansion for Maryland and New Mexico, assisted in annual evaluations of Maryland’s Medicaid program (HealthChoice), and co-wrote policy briefs as part of the Hospital Community Benefit Program.

Prior to Hilltop, he served as a summer research associate with the Congressional Research Service, within the Health Insurance and Financing Section. In this role, he provided support for member briefings, policy papers, memorandums, and section-by-section analyses of health reform legislation.

Carl earned his bachelor’s degree in management from the University of Texas at Arlington and master’s degree in management (health administration focus) from the University of Maryland, University College. He is pursuing his PhD in public administration from Tennessee State University.

Jennifer Hodgson, Principal – Columbus, OH

Jennifer Hodgson is a licensed marriage and family therapist who maintained a private practice and taught in higher education for 24 years prior to joining HMA. The scope of her experience in higher education training environments includes medical education, resident training and fellowship programs (i.e., family medicine, internal medicine, psychiatry), as well as family therapy and medical family therapy master’s and doctoral programs. She co-developed the first Medical Family Therapy doctoral program in the nation and served as major professor to 21 doctoral students during her tenure at East Carolina University.

During her tenure in higher education, she also developed a strong skillset in helping training programs prepare for, apply, and maintain their professional accreditation and certifications. She has expertise designing, innovating, and delivering integrated care in primary, secondary, and tertiary care contexts.

One of Jennifer’s longest consulting contracts (17 years) was focused on developing policies and workflows for sustaining an integrated care model for a multi-clinic Federally Qualified Health Center (FQHC) with a large Latino population. Additional consulting work includes helping programs apply for and maintain accreditation, designing curriculums for medical and mental health providers around workforce retention, delivering training on effective leadership and supervision approaches, facilitating interdisciplinary collaboration, and integrating behavioral health in primary (e.g., FQHC, training, and private), secondary, and tertiary care contexts.

Jennifer has helped healthcare and school-based systems strategically plan and launch integrated behavioral healthcare programs, as well as hospital-based systems in thinking about family engagement through patent portals using proxy access. A strength of her work includes knowing how to partner with higher educational institutions to develop a pipeline of future medical and behavioral health professionals that will work in these contexts upon graduation.

Her skillset in designing and implementing programs includes leading needs assessments and providing technical assistance to ensure quality and fidelity are maintained. This expertise includes her ability to train and develop quality metrics at the clinical, operational, financial, and educational levels, and conduct research to study lived experiences, outcomes, and inform program/service delivery improvements.

Jennifer has co-written and co-edited textbooks, book chapters, peer-reviewed articles, and other non-peer-reviewed works that focus on growing and training the behavioral health workforce and integrated care delivery systems. She has secured millions of dollars in grant funding at local and federal levels to help support her areas of work.

She completed her post-doctoral fellowship in medical family therapy at the University of Rochester and earned her Doctor of Philosophy in human development and family studies from Iowa State University. She received a Master of Science in applied family and child studies from Northern Illinois University and a Bachelor of Science in psychology from the University of Akron. In October 2022, she was awarded the Collaborative Family Healthcare Association’s “Family Oriented Care Award” for her commitment to ensuring our healthcare system is responsive to the needs of individuals and families.

Lida Riedlinger, Senior Consultant – Albany, NY

Lida Riedlinger uses her healthcare compliance, enterprise risk management, organizational development and leadership expertise to help organizations navigate the changing public health sector.

She is passionate about organization innovation and leadership development at all levels; cross functional workgroups, middle management and new supervisors, and provides executive coaching, strategic planning, and board development training in addition to consulting related to leadership transitions and succession planning. Executives and senior leaders gain clarity on their purpose, values, and business objectives to develop engaged accountable teams and improved performance.

Prior to joining HMA, Lida served as chief compliance officer for a multi-faceted Federally Qualified Health Center (FQHC) serving over 103,000 unique patients in western New York. In this role, she led the creation and implementation of a fully functioning healthcare compliance program that met federal Health Resources and Services Administration (HRSA), New York State Office of Medicaid Inspector General (OMIG) and New York State Department of Health (DOH) regulatory requirements. This work included development of a sub-recipient oversight and monitoring program for two area hospitals. Also, as part of this role she was responsible for the organizational and staff training in all matters of corporate compliance as required by New York State Office of Medicaid Inspector General (OMIG) related to fraud, waste and abuse which includes dissemination and attestation of the code of conduct and conflict of interest disclosure forms annually to all board members and staff. She was responsible for training strategy and curriculum content development that includes new staff orientation and annual mandatory risk management trainings that are relevant and meet all regulatory requirements.

Previously Lida worked as an independent consultant providing organizational consulting and executive coaching services for innovation, transformation, transition, and renewal. She also served as president and chief executive officer of Compeer Inc., which develops, delivers, and supports model programs that inspire and engage communities. This includes more than 4,000 volunteers serving people with mental health challenges by providing a trained supportive mentor from the community to help ease loneliness and isolation.

The National Institute of Mental Health selected Compeer as a model program in 1982 and funded the development of similar programs throughout the nation, Canada and Australia.  Some of Lida’s key accomplishments while at Compeer were recruitment and development of an independent governing body that provides for strategy, governance and sustainability for the Compeer organization and the affiliated programs and constituent communities. This involved operational budget management of Compeer Inc., board level fund raising, relationship management with private foundations for fund development, and organizational strategic transition.

She was also instrumental in establishing Compeer on the Substance Abuse and Mental Health Services Administration (SAMSHA) National Registry of Evidence Based Programs and Practices for community based mental health programs. She facilitated strategic visioning and planning sessions for the Australian National Compeer Conference in Melbourne Australia in March 2012 and organized leadership participation in regional conferences of New York and Pennsylvania Compeer affiliates.

Lida is a fellow of the Northstar Network Healthcare Business Academy and certified in healthcare compliance through the Health Care Compliance Association (HCCA). She is certified in trauma informed care for primary care providers and community-based services through the Substance Abuse and Mental Health Services Administration (SAMHSA).

She earned her bachelor’s degree in communications design from the Rochester Institute of Technology.

Sharon Castro, Senior Consultant – Tallahassee, FL

Sharon Castro has over 20 years of experience in quality and accreditation and has been a National Committee for Quality Assurance (NCQA) surveyor since 2013.

Prior to joining HMA she worked as director for quality at various large managed care organizations such as Cigna, Kaiser Permanente, and Molina Healthcare. In this role she was responsible for regulatory and accreditation programs for commercial, Medicare, and Medicaid, including long-term services and supports and Marketplace lines of business.

Sharon has subject matter expertise in Centers for Medicare and Medicaid Services (CMS) requirements, NCQA standards and guidelines for health plan accreditation, health equity, utilization management, and credentialing among others, and state regulations. She has led the development and submission of the Centers for Medicare Special Needs Plans Model of Care achieving high scores.

She has successfully led organizations through other NCQA programs: Multicultural Healthcare Distinction and Patient Centered Medical Home (PCMH), Diabetes and Heart/Stroke recognition. As an NCQA surveyor she audits health plans, credentialing verification organizations and other types of organizations’ documentation and files against accreditation/certification/recognition requirements.

Sharon received a bachelor’s degree in information systems from the University of Phoenix, a master’s degree in project management from Colorado Technical University and a master’s degree in public health/health promotion and education from Walden University.

She is from the beautiful Caribbean island of Puerto Rico and enjoys going to the theater to watch musicals and traveling.

NEW THIS WEEK ON HMA INFORMATION SERVICES (HMAIS):
Medicaid Data
Medicaid Enrollment:

• California Medicaid Managed Care Enrollment is Up 7.3%, Jul-22 Data
• California Dual Demo Enrollment is Down 3.4%, Jul-22 Data
• Indiana Medicaid Managed Care Enrollment Is Up 5.6%, Jun-22 Data
• Indiana Medicaid Managed Care Enrollment Is Up 6%, Jul-22 Data
• Kansas Medicaid Managed Care Enrollment is Up 3.3%, Jun-22 Data
• Kansas Medicaid Managed Care Enrollment is Up 3.8%, Jul-22 Data
• Kansas Medicaid Managed Care Enrollment is Up 4.2%, Aug-22 Data
• Louisiana Medicaid Managed Care Enrollment is Up 3.6%, Jul-22 Data
• Michigan Medicaid Managed Care Enrollment is Up 1.8%, May-22 Data
• Michigan Dual Demo Enrollment is Down 1.9%, May-22 Data
• New Jersey Medicaid Managed Care Enrollment is Up 4.1%, Jul-22 Data
• New Mexico Medicaid Managed Care Enrollment is Up 1.6%, Jul-22 Data
• North Carolina Medicaid Managed Care Enrollment is Up 3.6%, Jul-22 Data
• Ohio Medicaid Managed Care Enrollment is Up 0.8%, May-22 Data
• Washington Medicaid Managed Care Enrollment is Up 3.1%, Jul-22 Data
• Wisconsin Medicaid Managed Care Enrollment is Up 3.6%, Jun-22 Data

Public Documents: 

Medicaid RFPs, RFIs, and Contracts:

• Delaware HCBS for Individuals with Intellectual and Developmental Disabilities RFP, Oct-22
• Georgia Integration Platform Maintenance and Operations RFI, Oct-22
• Nebraska Heritage Health Medicaid Managed Care RFP, Awards, Scoring, Proposals, and Protest, Oct-22
• New York Statewide Health Care Facility Transformation Program RFA, Oct-22

Medicaid Program Reports, Data, and Updates:

• Maryland Medicaid HITECH Operational Advanced Planning Documents, FY2021-23
• Mississippi Report to Legislature on Medicaid FFS Non-Emergency Medical Transportation Services, Oct-22
• North Carolina Treasurers’ Office Report on Hospital Medicare Profits, Oct-22
• South Dakota Medicaid HITECH Implementation Advanced Planning Documents, 2011-21
• West Virginia Mountain Health Promise Foster Care Contract, SFY 2023
• West Virginia Mountain Health Promise Legislative Report, Jul-22

A subscription to HMA Information Services puts a world of Medicaid information at your fingertips, dramatically simplifying market research for strategic planning in healthcare services. An HMAIS subscription includes:

• State-by-state overviews and analysis of latest data for enrollment, market share, financial performance, utilization metrics and RFPs
• Downloadable ready-to-use charts and graphs
• Excel data packages
• RFP calendar

If you’re interested in becoming an HMAIS subscriber, contact Carl Mercurio at [email protected].