A new study looks at how leading states stack up to Australia on organizing primary care. Colorado, North Carolina, and Oregon have implemented regionally based Medicaid-funded primary health care organizations (PHCOs) as vehicles to strengthen their primary care foundations and improve the capacity of practices. Several countries with highly ranked delivery systems have implemented similar models. This study’s purpose was to determine if and how these kinds of organizations were working with primary care practices to improve their ability to provide comprehensive, coordinated, and accessible patient-centered care that met quality, safety, and efficiency outcomes—all core attributes of a medical home. The study found that the models implemented by the three states and the Commonwealth of Australia were all engaging practices to meet a number of medical home expectations, but the state models were more uniform in efforts to work with practices and focused on arranging services to meet the needs of complex patients.
https://oldsite.nashp.org/wp-content/uploads/2021/12/NASHP-Logo_website_168x157.png00Mary Takachhttps://oldsite.nashp.org/wp-content/uploads/2021/12/NASHP-Logo_website_168x157.pngMary Takach2015-12-08 10:47:352019-09-05 07:01:38Policy Levers Key for Primary Health Care Organizations to Support Primary Care Practices in Meeting Medical Home Expectations: Comparing Leading States to the Australian Experience
The Round Two State Innovation Model (SIM) Test Awards granted by HHS to eleven states (Colorado, Connecticut, Delaware, Idaho, Iowa, Michigan, New York, Rhode Island, Ohio, Tennessee, and Washington) support state efforts to build multi-payer models of health system transformation. As noted in a previous analysis, population health improvement is an important component of the SIM awards. The SIM Funding Opportunity Announcement (FOA) required states to describe how their models would improve population health in a number of areas, including prevention, health equity and the social determinants of health, rates of obesity and diabetes, and healthy behaviors, including reduced tobacco use. The FOA also required states to incorporate new delivery system models into their population health improvement plans.
This chart contains population health strategies, as defined by the states, that the states plan to implement through their SIM Round Two Model Test initiatives. The information in the chart is derived from the states’ proposals and other documents that you will find linked in the text below. Information on the population health components of the Round One SIM Model Test Awards can be found in our previous SIM population health chart. Please note that because the information in these charts was abstracted from early documents, we anticipate that this information may change as the states implement their models.
We encourage our community to share and discuss more details, ideas, issues and emerging products and results on State Refor(u)m. Do you know of state activity or analyses that we should add to this chart? Eager to update a fact we’ve included? Your contributions are central to our community’s ongoing, real-time learning, so tell us in a comment below, or email aclary@oldsite.nashp.org with your suggestions.
Population Health Objectives in the Model
Strategies in the Model to Address Social, Economic, and Behavioral Determinants of Health and Health Equity
Engaging and Integrating Community Health and Prevention into Delivery System and Payment Reform Models
Population Health Metrics Used in Model
Strategies in the Model to Integrate Primary Care and Mental Health and Substance Abuse Disorder Services
Colorado
Colorado seeks to improve population health by establishing a close partnership between public health, behavioral health, and primary care, and prioritizing ten population health focus areas including obesity, substance use, and mental health (SIM p.1).
Colorado state agencies are collaborating to address the social determinants of health using a “life stages” approach to targeting resources. The plan will include data collection on disparities in tobacco use, diabetes, and obesity (SIM p. 2, 11, 62).
Colorado will examine the possibility of long-term reimbursement models for population-based prevention and wellness services (SIM p. 25).Population Health Transformation Collaboratives made up of community health leaders will work with the state’s new Health Extension Service on local community health initiatives (SIM p. 4-5, 10). Targeted local public health agencies will receive funding for community prevention activities and to link practices, community resources, and public health (SIM p. 2).
Colorado will collect data on the progress in 12 core population health target areas:hypertension, obesity, tobacco use, prevention, asthma, diabetes, ischemic vascular disease, safety, depression, anxiety, substance use, safety, and child development (SIM p. 7-8).
Connecticut plans to strengthen primary care and integrate community and clinical care. It also aims to improve prevention and screening, including mental health and substance abuse screening, and chronic illness management (SIM p. 1; 22-23).
Connecticut will convene a multi-sector Population Health Council tasked with setting priorities for health improvement areas, focusing on the barriers most likely to contribute to health disparities. The Health Enhancement Communities initiative focuses resources on the areas of the state with greatest disparities and will include payment incentives to address social determinants of health (SIM p. 2-3). The Equity and Access Council watches for under-service that may result from shared savings incentives.
Connecticut plans to develop sustainable Prevention Service Centers (PSCs) that will offer community-based preventive services. Reimbursement for Community Health Workers (CHWs) may also be part of the plan (SIM p. 2-3; 8). The state will also augment its use of Value-Based Insurance Design (VBID) and shared savings programs to incentivize prevention, health improvement, and management of chronic diseases (SIM p. 8, 12).
Connecticut will report measures for statewide population health targets including tobacco use, obesity, and diabetes (SIM p. 25). The plan also includes quality targets on preventive screenings, asthma, and premature death from cardio-vascular disease. The state will monitor equity gaps on core measures and select areas for improvement (SIM p. 26-28).
The model will complement the state’s existing Behavioral Health Home initiative, which coordinates physical and mental healthcare for Medicaid recipients with serious and persistent mental illness (SIM p. 29).
Delaware
Delaware aims to integrate population health with value-based payment models. It seeks to attribute every patient to a primary care provider (PCP) who is incentivized to address population health issues (SIM p. 1-8).
Delaware emphasizes cross-agency collaboration as part of its strategy to address social determinants of health. Also, as part of its Healthy Neighborhoods strategy, the Delaware Division of Public Health (DPH) will support staff health equity training (SIM p. 5-6).
Delaware’s Healthy Neighborhoods strategy seeks to enlist schools, employers, and community organizations in changing health behaviors. The plan will support a multi-stakeholder community coalition focused on identifying and addressing health needs (SIM p. 1-6).
The proposed population health metrics include measures related to smoking; nutrition; physical activity; prevalence of hypertension, obesity, and diabetes; cancer deaths per 100,000; heart disease deaths; 30-day post-PCI mortality rate; and infant mortality (SIMp. 37).
Delaware’s model will focus on providing team-based, integrated physical and behavioral health care for high-risk patients, including by providing incentives for EHR use to behavioral health providers. It will complement the existing PROMISE program that coordinates care for beneficiaries with mental illness.
Idaho
Idaho will develop a plan to improve population health by integrating population health with primary care and the healthcare delivery system through the use of Patient-Centered Medical Homes (PCMHs) covering 80% of the population (SIM p. 2-4).
Idaho is also planning a virtual PCMH telehealth initiative to serve remote communities. The state’s seven public health districts will also form Regional Collaboratives to integrate public and physical health locally to improve access to care. Idaho will collect data on the social determinants of health as part of a statewide health assessment.
PCMH providers will be allowed to practice at the top of their license to ameliorate workforce shortages. Telehealth initiatives and models for using CHWs and community health emergency medical services personnel in health promotion will also be explored (SIM p. 5-6).
Idaho will use the following population health performance measures to monitor the success of the Model Test: depression, tobacco use, asthma ED visits, hospitalizations, hospital readmissions, avoidable ED use without hospitalization, elective deliveries, low birth weight, adherence to antipsychotic meds for people with schizophrenia, weight counseling for children and adolescents, diabetes, childhood immunizations, adult BMI, and rate of prescribed opioid use for non-cancer pain. Idaho will also collect data on costs and patient experience of care (SIM p. 22-23).
PCHMs will coordinate care with Medical Neighborhoods of ancillary providers, including behavioral health providers. The state’s multi-payer common performance measures include screening for depression, adherence to antipsychotics for people with schizophrenia, and rates of prescribed opioid use for non-cancer pain.
Iowa will provide support and technical assistance to encourage ACOs to develop workforce models, including telehealth, that address provider shortages and reduce the disparities between rural and urban areas (SIM p. 1). New Community Care Teams will connect ACOs with social services and local public health resources to address social determinants of health. Value-based payments will also incentivize ACOs to address the social determinants of health (SIM p. 12-15).
Iowa’s model seeks to expand care delivery into the community setting, and will track communities’ progress on population health initiatives. Community Care Teams will integrate public health and local ACOs to improve outcomes, and will facilitate connections with non-ACO providers (SIM p. 12-13).
Iowa will measure progress in six population health target areas: reducing tobacco use, obesity, hospital-associated infections, and early elective deliveries; and improving patient engagement and health literacy, including diabetes self-management (SIM p. 3-5).
Iowa will continue to incorporate behavioral health providers into its ACO structures, including the use of integrated health homes for individuals with mental illness (SIM p. 7-11).
Michigan is considering payment models that incentivize efforts to address social & environmental determinants of health. They are also planning greater use of and support for Community Health Workers to help reduce disparities (Blueprint p. 10-11, 37-41, 131-135).
Michigan’s Community Health Innovation Regions will work with local public health and cross-sector partners to engage patients and community members in wellness and health promotion activities. Michigan will also explore sustainable financing models for population-level prevention and wellness efforts. Michigan will also seek to allow providers to practice at the top of their license and training to increase access to primary care (Blueprint p. 4-5, 10, 132, 157).
Michigan’s plan includes monitoring access to primary care, clinical quality, patient experience of care, utilization, and other measures from the Michigan Health and Wellness dashboard, including measures related to birth outcomes and teen birth rates, obesity, alcohol consumption, nutrition, physical activity rate, tobacco use, dental health, mental health, STDs (Blueprint p. 72-75; p. 146-151).
New York’s plan has five primary population health goals:1. Prevent Chronic Disease2. Promote Healthy and Safe Environments
3. Promote Healthy Women, Infants and Children
4. Promote Mental Health and Prevent Substance Abuse; and
5. Prevent HIV, STDs, Vaccine-Preventable Diseases and Healthcare Associated Infections (SIM p. 1).
New York’s plan will support population health, preventive services, and integrated behavioral primary care through its advanced primary care medical home model, and through the use of SIM-funded public health consultants and practice transformation teams (SIM p. 1-2).
New York aims to pay for 80% of advanced primary care under a value-based payment model. Further, the project’s Public Health Consultants will also connect the community with public health and clinical resources (SIM p. 2-3). The state will also work to ensure that providers are practicing at the top of their license to improve access to care.
The project, including the advanced primary care model, will be evaluated according to an evolving statewide set of industry-standard quality and efficiency metrics, which includes progress toward prevention and public health goals (SIM p. 20-21).
New York will focus on integrating primary and behavioral health care, and will convene a workgroup to analyze gaps in behavioral health services and make recommendations. Initiatives supported by the new Public Health Consultants may include tobacco cessation for people with mental illness and other efforts to address mental illness and substance abuse disorders (SIM p. 2, 4,7).
Ohio
Ohio plans to target the prevention or reduction of obesity, chronic disease, tobacco use and exposure, and infant mortality; and plans to expand patient-centered primary care (SIM p. 5).
Ohio is testing ways to share data to improve population health, such as building on its current ability to use vital statistics data to indicate when a mother or infant may be at risk of poor health outcomes (SIM p. 6).
Ohio’s episode-based payment model and statewide use of PCMHs are intended to incent providers to work with community-based and public health resources to address social determinants of health (SIM p. 12).
Ohio’s SIM outcome metrics will include population health measures such as flu immunization and tobacco use, as well as care coordination and chronic conditions measures. Measures will be aligned across quality initiatives (SIM p. 24-28).
Ohio merged the formerly separate departments overseeing mental health and substance use disorders. The state is focused on integrated, person-centered care and care coordination for Medicaid beneficiaries with mental illness and other populations (SIM p. 5).
Rhode Island
With the help of community leaders, Rhode Island will develop a population-based plan that responds to the results of community health assessments, and continues efforts to reduce tobacco use and obesity and improve diabetes care management (SIM p. 4; SHIPp. 80-87).
Rhode Island will work with the community to develop community-driven goals for the healthcare system, and use Community Health Teams to help community organizations coordinate with primary care practices to support healthy lifestyles and address the social and environmental determinants of health and health disparities (SHIP p. 69, 75; SIM p. 4-5).
Rhode Island will rely on input from community-based leadership to guide the transformation of Rhode Island’s care delivery system, which will emphasize primary care and patient-centered medical homes, with Community Health Teams focusing on rising-risk and high-risk populations (SIM p. 4-5, 8; SHIP p. 63, 100).
Increasing prevention activities, statewide quality measurement and patient engagement tools are included in Rhode Island’s plan (SHIP p. 73-74), as are reducing over-utilization of unnecessary services, increasing screening and prevention, reducing health disparities, and renewing focus on the social determinants of health, among other aims (SHIP p. 94, 110).
Rhode Island will build on current efforts to integrate behavioral health and primary care through the use of health homes and co-location (SHIP p. 90; SIM p. 8).
Tennessee
Tennessee seeks to improve population health in five priority areas: obesity, diabetes, tobacco, child health, and perinatal health (SIM p. 2, 13).
PCMH providers will be incentivized to address social determinants of health through activities such as addressing environmental asthma triggers, tobacco cessation, and connecting patients to social services (SIM p. 4). Tennessee’s project will also facilitate the sharing of real-time hospital Admitting/ Discharge /Transfer (ADT) data with primary care providers and care coordinators to analyze gaps in care and prioritize resources for the most at-risk patients.
Tennessee plans a population-based, multi-payer patient-centered medical home initiative that will incentivize prevention and primary care. PCMHs will be evaluated on outcomes such as preventing avoidable ED visits and hospitalizations, controlling diabetes and high blood pressure, and screening for depression (SIM p. 22).
At minimum, Tennessee will measure the program’s impact on rates of child immunization, self-reported health status, tobacco use, obesity, and the proportion of diabetics with 2 or more A1C tests in the past year (SIM p. 25-26).
Tennessee will integrate its SIM funding and Health Homes initiative to provide integrated, value-based “behavioral and primary care services for people with Severe and Persistent Mental Illness (SPMI)” (SIM p. 7).
Washington
Washington plans to reduce tobacco use, obesity and diabetes, and increase the portion of the population who receive clinical and community services that reduce preventable conditions (SIM p. 5-6).
Washington will implement regional Accountable Communities of Health (ACH) to integrate the delivery of social services and healthcare services. ACHs will work across sectors, aligning housing, education, local government and the private sector to advance population health and address the social determinants of health (SIM p. 2, 6). Washington also plans to increase the number of communities with environments that promote physical and behavioral health and health equity (SIM p. 5).
Washington plans to engage “individuals, families, and communities” in a system that “supports social and health needs,” as well as improve the health of 90% of Washington residents and their communities by 2019 through prevention and early mitigation of disease (SIM p. 5, 26).
Washington will develop a statewide set of core measures that includes tobacco use, obesity and diabetes (SIM p. 6). It will also incorporate the “Results Washington”performance targets, including children’s vaccination rates, reducing preterm birth and cesarean section rates, increasing the number of residents with a personal healthcare provider, and increasing rates of services for post-discharge mental health consumers (SIM p. 27).
https://oldsite.nashp.org/wp-content/uploads/2021/12/NASHP-Logo_website_168x157.png00NASHP Writershttps://oldsite.nashp.org/wp-content/uploads/2021/12/NASHP-Logo_website_168x157.pngNASHP Writers2015-11-24 15:05:202019-09-03 13:19:48Population Health Components of State Innovation Model (SIM) Plans: Round 2 Model Testing States
Heading into the third week of open enrollment, early outlook has been positive for state-based marketplace (SBM) states. California recently wrapped up a 2,000-mile bus tour to “spotlight” the launch of open enrollment; Massachusetts and Vermont, which in prior years struggled with technical systems, report smooth enrollment via their enhanced systems; Minnesota is touting a new report that showcases the potential for savings for its marketplace consumers; and Maryland has more than doubled its enrollment traffic from this point last year. Where issues are arising, states are flexing their nimbleness to address concerns, such as Rhode Island’s recent steps to ramp up customer service supports and New York’s extension of enrollment deadlines for consumers impacted by the closure of the state’s Co-op.
Many of the improvements states have implemented in recent months, including updated marketing, enhanced purchasing tools, and increased access to assistance, have been in response to time spent over the past year speaking to and learning from consumers. SBMs have been reaching out to the uninsured in their states through the use of surveys, phone calls, and focus groups to learn more about barriers to enrollment. Open dialog between customers and the marketplaces, targeted data collection, and the agility of states to adjust and adapt based on this feedback, represents a unique and important opportunity for those states that have chosen to run their own SBMs. Assessing Customer Satisfaction In fielding consumer surveys, many SBMs found customers have high levels of satisfaction with both the enrollment systems available in their states and the coverage purchased. Surveys conducted in California, Colorado, Connecticut, and New York found that between 85 and 92 percent of their consumers reported they would recommend use of the SBM to friends and family. In Vermont, 82 percent of customers reported that their 2014 selected plan either met their needs “somewhat well” or “very well”. Altering Outreach to Reach the Uninsured
Even with high levels of engagement and satisfaction from existing customers, there are still a significant number of uninsured in many states and an increased need to provide support to identify and enroll these individuals. In mid-2015, Maryland’s SBM conducted a series of focus groups with the uninsured to identify perceived barriers to obtaining coverage. Participants in these groups reported that the complexity of health insurance choices can be “immobilizing” and increased support is necessary to help make decisions. In response, Maryland is expanding its in-person assistance offerings – with larger numbers of “ConnectNow!” enrollment events and the addition of 23 partnership organizations with application counselors (adding to the 35 existing partnerships in the state). Messaging to Improve Consumer Awareness Reports from California, Maryland, and Vermont have found that a significant number of consumers remain unaware of the availability of federal subsidies to improve affordability of coverage purchased through the marketplaces. This knowledge gap is coupled with the results of multiple surveys that found affordability to be the biggest driver of consumer enrollment and plan selection.
Based on these survey findings, messaging becomes an important strategy for the marketplaces to not only ensure that consumers are aware of the opportunity to purchase coverage but that they also know about the tax credits to support affordability. Wanting to improve their efficiency, states have been thoughtful in strategizing where to best allocate resources to maximize reach to desired consumers. A Connecticut survey found that an increased number of consumers engaged with the SBM after receiving brochures and pamphlets in the mail. In response, the state is planning on modifying marketing materials this open enrollment to ensure they are engaging and informative. Supporting Consumer Education and Insurance Literacy Surveys from several SBM states found that consumers are seeking more support in selecting the right plan for their families and, despite considerable gains over the past three years, require refreshers on important health insurance literacy topics. For example, an independent survey conducted in Colorado recommended that the state develop materials to support increased consumer health insurance literacy, including a simple and accessible glossary of important health insurance terms. The state responded by creating a comprehensive list of terms and definitions, which includes a search function and is available directly on the Connect for Health Colorado website. Boosting Call Center Performance Call centers continue to be an important tool for consumer engagement and satisfaction, often representing the SBM’s most public face. In many states, call center utilization grew during last year’s open enrollment period. Despite these increased numbers, most consumers still reported receiving useful information and support from call center representatives. In Vermont, 66 percent of respondents indicated that they were satisfied with the amount of information received. In Connecticut, 65 percent of those who enrolled in a self-purchased, qualified health plan indicated that they were either “very satisfied” or “extremely satisfied” with the call center service.
Some customers, however, have reported long wait times and unanswered questions. In response, states are implementing new strategies to relieve call center back log. In response to feedback from customers, Vermont has placed an increased focus on call center training in 2015. This has already significantly reduced the number of cases that need to be escalated, resulting in customers having answers during their first call to the contact center. Looking Forward Following this open enrollment period, several SBMs have plans to roll out additional consumer surveying, which will allow them to engage with their customers and implement changes to improve the enrollment experience. The District of Columbia is planning to issue a comprehensive survey, including questions that focus on moving consumers from coverage to care, to be completed by July 2016. In releasing its updated proposed strategic plan, Washington State identified consumer surveying as a key tool in 2016 for measuring transparency, engagement and affordability.
NASHP will be tracking the work being done by the SBMs and the federally-facilitated marketplace, as well as the experience of enrollees around the country, and will report on the best practices and lessons learned as we move through this latest enrollment period.
https://oldsite.nashp.org/wp-content/uploads/2021/12/NASHP-Logo_website_168x157.png00NASHPhttps://oldsite.nashp.org/wp-content/uploads/2021/12/NASHP-Logo_website_168x157.pngNASHP2015-11-24 08:00:202019-09-03 13:28:24Talking Coverage: SBMs Keep Lines of Communication Open with Consumers
Date:November 17, 2015 Time: 3:00-4:00pm EST View Webinar Here Download Webinar Slides
Many individuals involved in the criminal justice system are now eligible for Medicaid in states that expanded the Medicaid program under the Affordable Care Act. Health coverage can provide individuals who are leaving incarceration with access to physical and behavioral health services critical to their successful reentry into the community. In some states, correctional agencies have partnered with Medicaid agencies to implement procedures to begin the Medicaid application process as individuals are nearing their incarceration release dates. This webinar features three states—Colorado, New Mexico and Wisconsin—that have initiated efforts to enroll justice-involved individuals in health coverage and explores some of the following questions:
How are states developing procedures to enroll justice-involved individuals in Medicaid, and what types of policy or process changes have they implemented?
What specific assistance is provided to incarcerated individuals who are enrolling in health coverage and how are applications processed?
What strategies have been most successful for states, and what are some of the operational challenges that states are in the process of addressing?
What types of interagency partnerships and coordination are needed to facilitate the enrollment of justice-involved individuals?
How are states promoting access to care for the justice-involved population upon their release from incarceration?
https://oldsite.nashp.org/wp-content/uploads/2021/12/NASHP-Logo_website_168x157.png00NASHP Staffhttps://oldsite.nashp.org/wp-content/uploads/2021/12/NASHP-Logo_website_168x157.pngNASHP Staff2015-11-17 16:00:062019-09-03 13:38:57Corrections and Medicaid Partnerships: Strategies to Enroll Justice-Involved Populations
One of the central elements of the Affordable Care Act (ACA) is to establish “one-stop shopping” through health insurance marketplaces allowing consumers to find and access affordable, high-quality health coverage either through private health insurance, and the subsidies available for those who qualify, or through Medicaid. The ACA and related regulations define a spectrum of marketplace models that can be operationalized: the State-based Marketplace (SBM), where states assume all responsibility for operation and maintenance of a marketplace; the State Partnership Marketplace (SPM), where states assume responsibility for plan management and/or consumer assistance and the Federally-Facilitated Marketplace (FFM) performs remaining functions; and the FFM, in which all marketplace functions are performed by the federal government.
In the wake of the U.S. Supreme Court’s recent decision in King v. Burwell, affirming the availability of federal subsidies to states opting to use the FFM model, there is growing interest in state and federal marketplace options and performance. While states implementing both the FFM and SBM model had to overcome hurdles in building and managing multifaceted IT platforms, both are making significant progress in meeting the ACA’s coverage and access goals. However, the advancements and opportunities of SBMs are not as well known as the challenges state and federal marketplaces have faced. This paper seeks to explore and highlight early developments in states that have implemented the SBM model. Full Brief
https://oldsite.nashp.org/wp-content/uploads/2021/12/NASHP-Logo_website_168x157.png00Lesa Rairhttps://oldsite.nashp.org/wp-content/uploads/2021/12/NASHP-Logo_website_168x157.pngLesa Rair2015-07-22 15:21:522019-10-08 18:10:08The State-based Marketplaces: A Focus on Innovation, Flexibility, and Coverage
Oral health is an important part of overall health, however, access to dental coverage for low-income adults remains a challenge, particularly since these benefits are optional for state Medicaid programs. In this webinar, state officials from Colorado, Iowa, and Washington—three states that have recently taken action on their adult dental benefits— share insights on important factors in the decision to add, reinstate, or introduce adult dental benefits; how adult dental benefits fits into the larger health reform discussion in each state; successes and challenges each state has faced since implementation; and future policy considerations. NASHP also provides an overview of a new brief that draws out lessons for state policymakers on these topics. This webinar is supported by the DentaQuest Foundation.
Speakers:
Bill Heller
Provider Relations and Dental Program Division Director
Colorado Department of Health Care Policy & Financing
MaryAnne Lindeblad
Medicaid Director
Washington State Health Care Authority
Dr. Bob Russell
Public Health Dental Director
Iowa Department of Public Health
Moderator:
Andrew Snyder, NASHP
Please contact Najeia Mention at nmention@oldsite.nashp.org for more details.
https://oldsite.nashp.org/wp-content/uploads/2015/01/orthodontist-287285_640.jpg480640NASHPhttps://oldsite.nashp.org/wp-content/uploads/2021/12/NASHP-Logo_website_168x157.pngNASHP2015-07-10 14:00:422019-09-11 07:28:28A Conversation with State Officials on Medicaid Adult Dental Coverage
Walkabout Medical Homes with Mary Takach: A 10-month Study of Australia
February 2015
Reducing inappropriate utilization of the emergency department (ED) is a very common focus of health systems, payers, and practices seeking to improve health care quality and reduce costs. To help break the cycle of non-emergency ED use lists of “superutilizers” are generated from a variety of data sources and care managers are assigned to work with these patients.
In my fellowship research project that is comparing publicly funded primary health care organizations (PHCO) in the U.S. and Australia, I have come across two PHCOs, one from each country, that are working with their local fire departments or ambulance services to capitalize on the skills of paramedics to deter non-emergency transports. CEOs Carol Bruce Fritz of Community Care of Central Colorado and Learne Durrington of Perth Central & East Metro Medicare Local have both identified these programs as one of the proudest accomplishments of their tenure. Using data to analyze where to focus limited resources, pilot programs were launched in target areas.
Each pilot uncovered the need to train paramedics “to work at the top of their license” and integrate them as a member of the larger care team that includes primary care, mental health, and social services. The pilot programs were successful in providing a new tool to approach the complex issue of ED overutilization and lessen the burden on public emergency service resources.
Community Care of Central Colorado, of Colorado Springs, partnered with Colorado Springs Fire Department (CSFD), and two local hospitals to launch a pilot program that focuses on Medicaid patients that have six or more ED visits, plus 30 or more prescriptions filled (exclusions for cancer, end stage renal disease, etc.) in the past 12 months. CSFD reported that greater than 70% of 911 calls were for non-emergent medical reasons.
Medicaid patients enrolled in the program are offered a direct phone number to speak to a paramedic when they need non-life threatening assistance rather than to call for an ambulance. Paramedics are also involved in improving care transitions, meeting with the Medicaid patient within five days of the patient’s discharge from one of the two participating hospitals to do a care transition evaluation.
This evaluation includes a medication reconciliation process, review of the hospital discharge plan with member/family, intervention for primary care provider follow-up visit within seven days of discharge, home safety evaluation, and a patient activation assessment. A standardized checklist adapted from the Coleman Model is used for communication to Community Care of Central Colorado and the primary care provider. The organization plans to expand this pilot program to include strategies that addresses social determinants of health including housing, transportation, and food assistance to name a few.
In Perth, Western Australia, like many other areas, “paramedics are schooled to transport, and ambulances are paid to transport,” explained Durrington. “That’s part of the challenge in reducing non urgent emergency demand.” Despite this fact, Durrington found that the local ambulance service was open to the pilot and wanted to explore options whereby paramedics felt comfortable not transporting to ED.
Apparently, ambulances spend so much time “ramping” or sitting in a bay outside the EDs waiting to get in, that participating in the pilot may save money in the end and patients may get a better outcome. The Perth Central & East Metro Medicare Local, in partnership with St. John Ambulance and the area ‘afterhours medical service’, developed an afterhours primary care referral pathway—and the ambulance service took on training the paramedics on the pathway. The Perth Central & East Metro Medicare Local, like many other Medicare Locals in Australia, uses HealthPathways, based on a model pioneered in New Zealand, to establish formal processes or clinical guidelines for care.
After a paramedic arrives at a home and makes the initial assessment that emergency transportation may not be necessary, he or she then reaches out to the afterhours call services to speak to the primary care physician on call to confirm the approach. This phone call is regarded as a “warm” transfer to the primary care physician and guidance is then given about next steps.
This usually involves the physician-on-call making a home visit. It also may involve the physician recommending that an appointment be arranged with the patient’s primary care provider to be seen the next day or that the paramedic provide some kind of intervention at the home. The project was started in a community where ambulance calls were very high. Durrington believes that when scaled in her catchment area, the new care pathway has the potential to save about 5000 ambulance transports a year.
Fritz summed it up, “If you have complex issues you have to have complex solutions and there has to be a variety of solutions not just one.” Fritz described one frail diabetic woman who called 911 for transport to the ED regularly, who is now getting a peanut butter and jelly sandwich delivered each day at lunch through the pilot. She has stopped calling 911.
Australia Cuisine, Part II. What exactly is vegemite and is it good?
Vegemite was developed almost 100 years ago as a way to use the yeast being dumped by breweries. Concentrate the liquid, add salt (a lot), some celery and onion flavorings and you get a thick black paste that is loved by many Australians who call it their “comfort food”. To be honest, a thin layer on toast with “avo” (avocado) is quite tasty, but straight from the jar is very unpleasant! The best way I’ve enjoyed Vegemite was in ice cream form. A scoop of this gives your taste buds a thrill ride—sweet, savory, and salty, all at once! But comfort food? I’ll stick with the peanut butter and jelly sandwich.
https://oldsite.nashp.org/wp-content/uploads/2021/12/NASHP-Logo_website_168x157.png00NASHPhttps://oldsite.nashp.org/wp-content/uploads/2021/12/NASHP-Logo_website_168x157.pngNASHP2015-02-24 10:06:282019-09-05 14:25:44Pilots in Colorado and Western Australia Integrate Paramedics into Care Team
Colorado’s medical home efforts began in 2001 with the Colorado Medical Home Initiative (CMHI). This program, administered by the state’s Department of Public Health and Environment (CDPHE), was charged with ensuring that all children receive comprehensive coordinated care within a Medical Home. Chapter 346 of the 2007 Session Laws of Colorado required the Department of Health Care Policy & Financing (HCPF), the state agency that administers the Medicaid and SCHIP programs, to work with CDPHE to maximize the number of children served by medical homes in Medicaid and SCHIP. A non-profit organization known as the Colorado Children’s Healthcare Access Program (CCHAP) also works collaboratively with state agencies in the Medical Homes for Children Program.
Colorado is using an Accountable Care Collaborative (ACC) model to expand medical home services for their adult Medicaid population (it is important to note that children are also included in the ACC program). Under this model, primary care medical providers (PCMPs) will contract with regional care collaborative organizations (RCCOs) to provide medical home services to Medicaid enrollees. More information can be found in the RCCO RFP and on the Colorado page of NASHP’s State Accountable Care Activity Map.
Additionally, with the support of The Commonwealth Fund and The Colorado Trust, HealthTeamWorks (formerly the Colorado Clinical Guidelines Collaborative) convened a multi-state, multi-payer pilot in 16 practices along the Colorado Front Range to implement medical homes for adults with chronic conditions. The pilot, which began in 2009, ended in April 2012. Colorado Medicaid participated in early stakeholders discussions but ultimately did not provide enhanced payment to participating practices. Federal Support:
Colorado is one of seven markets selected to participate in CMS’s Comprehensive Primary Care Initiative (CPCi). In this multi-payer initiative, Medicare is collaborating with public and private insurers in the selected states or regions with the goal of strengthening primary care. In Colorado, CPCi launched in November 2012, bringing together ten payers including Medicaid, as well as 74 participating primary care practices with 369 providers in the state.
Colorado has received a duals demonstration grant from the Centers for Medicare & Medicaid Services (CMS) to “coordinate care across primary, acute, behavioral health and long-term supports and services for dual eligible individuals.”
The Title V Maternal and Child Health Program was integral to the establishment and development of the CMHI.
Medical Homes for Children Program: 125-member stakeholder medical home advisory board included provider and family leadership, staffed by Medicaid and included a state-wide survey of providers. Family Voices Colorado has represented parents and families in medical home development since 2000. Accountable Care Collaborative (ACC) Program: The Accountable Care Collaborative Program included stakeholder input through public forums and a formal Request for Information process.
Definition: Medical Homes for Children Program: Chapter 346 of the 2007 Session Laws provided a state-developed definition of medical homes for children as follows: “[A]n appropriately qualified medical specialty, developmental, therapeutic, or mental health care practice that verifiably ensures continuous, accessible, and comprehensive access to and coordination of community-based medical care, mental health care, oral health care, and related services for a child. A medical home may also be referred to as a health care home. If a child’s medical home is not a primary medical care provider, the child must have a primary medical care provider to ensure that a child’s primary medical care needs are appropriately addressed. All medical homes shall ensure, at a minimum, the following:
Health maintenance and preventative care;
Anticipatory guidance and health education;
Acute and chronic illness care;
Coordination of medications, specialists, and therapies;
Provider participation in hospital care; and
Twenty-four-hour telephone care.”
Recognition: Medical Homes for Children Program: Certification using the Medical Home Index; Eleven state-developed qualification standards across eight domains (Accessible; Family-Centered; Comprehensive; Culturally Competent; Compassionate; Coordinated; Continuous; and Community-based). Accountable Care Collaborative (ACC) Program: Under the Accountable Care Collaborative (ACC) Program, practices and providers can become participating Primary Medical Care Providers (PMCPs) if they:
Are certified Medical Home for Children Program providers; or
Focus on primary care, general practice, internal medicine, pediatrics, geriatrics, or obstetrics and gynecology.
Furthermore, PCMPs must commit to nine additional principles that ensure care is patient/family-centered; whole-person oriented and comprehensive; coordinated and integrated; provided in partnership with the patient and promotes patient self-management; outcomes-focused; consistently provided by the same provider as often as possible so a trusting relationship can develop; and provided in a culturally competent and linguistically sensitive manner. Comprehensive Primary Care Initiative (CPCi): Practices were selected for participation in CMS’s Comprehensive Primary Care Initiative through a competitive application process. Under CPCi, practices are not required to attain formal PCMH recognition; however, formal PCMH recognition through NCQA, AAHCC, the Joint Commissioner, URAC, or a state-based recognition program was viewed favorably in practice selection. Additional criteria included:
Health information technology, including attestation to Stage 1 Meaningful Use and engagement with local Regional Extension Center (REC);
Percentage of practice revenue earned from participating payers; and
Participation in practice transformation programs through organizations like quality improvement organizations, RECs, or learning collaboratives.
HealthTeamWorks Multi-payer Pilot: The HealthTeamWorks multi-payer pilot used National Committee for Quality Assurance Physician Practice Connections – Patient-Centered Medical Home (NCQA PPC-PCMH) recognition standards.
Accountable Care Collaborative (ACC) Program: Under the Accountable Care Collaborative (ACC) Program, a total of $20 per-member/per-month (PMPM) is divided among three entities
Primary Care Medical Provider (PCMP): $4 PMPM*
Regional Care Collaborative Organization (RCCO): $13 PMPM
Statewide Data and Analytics Contractor (SDAC): $3 PMPM
Once a RCCO shows cost neutrality, $1 PMPM is withheld from both the PCMP and RCCO, creating a shared quarterly incentive payment pool. The $1 PMPM can be recouped by each entity by meeting Key Performance Indicators: reduced emergency room utilization; reduced hospital readmissions; reduced utilization of medical imaging. A fourth measure, well-child visits, was added in July 2013. * Pediatric PCMPs cannot receive enhanced payments from both the Medical Homes for Children and the ACC programs. They are only eligible to receive the Medical Home for Children Program performance payments for their patients. Comprehensive Primary Care Initiative (CPCi): This four-year multi-payer initiative, launched in November 2012, includes ten payers in the Colorado market: Medicare, Anthem Blue Cross Blue Shield of Colorado, Cigna, Colorado Access, Colorado Choice Health Plans, Colorado Medicaid, Humana, Rocky Mountain Health Plans, Teamsters Multi-Employer Taft Hartley Funds, and United Healthcare.
Medicare pays selected practices a per-beneficiary per-month (PBPM) risk-adjusted care management fee, which ranges from $8 to $40. CMS has indicated that it expects care management fees to average $20 PBPM during the first two years of the initiative. In Years 3 and 4, care management fees will average $15 PBPM. Medicare will also introduce a shared savings component beginning in Year 2, calculated at the market level.
The CPCi solicitation for payers indicates that participating payers (non-Medicare) are expected to follow a similar framework, paying per-member per-month (PMPM) care management fees to participating practices on top of fee-for-service and incorporating a shared savings component. Payment amounts will be negotiated individually with participating practices to comply with anti-trust laws.
HealthTeamWorks Multi-payer Pilot: Participating HealthTeamWorks pilot sites received enhanced care management and performance-based payments on top of fee-for-service reimbursement.
Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Outreach and Case Management & Colorado Children’s Healthcare Access Program (CCHAP) staff will support providers by providing links to community services as well as assistance with medical home certification, quality improvement, and practice coaching.
Provider Hotline supported by Family Voices Colorado, CCHAP, and the Department of Health Care Policy and Financing (HCPF).
Providers have access to Colorado Immunization Registry.
Accountable Care Collaborative (ACC) Program: Under the Accountable Care Collaborative, Regional Care Collaborative Organizations (RCCOs) and the Statewide Data and Analytics Contractor (SDAC) provide support for participating Primary Medical Care Providers (PCMPs). RCCOs provide:
Technical assistance provided through on-site quality improvement (QI) coaching, learning community webinars, and learning collaborative;
Administrative support includes RCCOs providing PCMPs with information and education on Colorado Medicaid and providing assistance with prior authorization requests and payment issues;
Practice support includes RCCOs assisting PCMPs to establish and implement patient-centered medical homes, including supporting practice redesign;
Resources such as a provider website that includes general and specific information about the program and RCCO support services; and
Access to client health, claim, and utilization data provided from the SDAC and assist in the acquisition and analysis of SDAC reports.
Medical Homes for Children Program: Outcomes of interest for the Medical Homes for Children Program tracked by the Colorado Department of Healthcare Policy and Financing and Colorado Children’s Healthcare Access Program include:
Ratio of preventive visits to expected (10 visits by age 2, 1 every year after);
ED utilization rates;
Immunization rates;
Parent satisfaction;
Use of a preventative developmental screening code; and
Provider willingness to take more Medicaid children.
Accountable Care Collaborative (ACC) Program: The primary goals of Colorado’s Accountable Care Collaborative program are to improve health outcomes through a coordinated, client/family-centered system that proactively addresses clients health needs and controlling costs by reducing avoidable, duplicative, variable and inappropriate utilization.
The program’s 2012 Annual Report to the legislature, published in Nobember 2012, reported reductions in hospital readmissions and utilization of high-cost imaging services for ACC enrollees compared to non-enrollees. Emergency room utilization also increased less for enrollees than for non-enrollees. The report also found that ACC enrollees with asthma and diabetes are less likely to be hospitalized or readmitted. Colorado estimates that the program has saved the state $30 million in its first year, exceeding the state’s initial estimate of $20 million. The Accountable Care Collaborative 2013 Annual Report, released in November 2013, reported additional positive findings, including additional cost savings:
Reduced hospital readmissions (15-20%) and high cost imaging services utilization (25%) relative to a comparison population;
Improved chronic disease management, as evidenced by a 22% reduction in hospital admissions among ACC members with COPD who have been enrolled in the program six months or more, compared to those not enrolled, as well as lower rates of exacerbated chronic health conditions such as hypertension (5%) and diabetes (9%) relative to clients not enrolled in the ACC program;
Emergency room utilization by ACC enrollees increased 1.9%, compared to an increase of 2.9% for those not enrolled; and
$44 million gross reduction ($6 million net reduction) in total cost of care for clients enrolled in the ACC Program.
https://oldsite.nashp.org/wp-content/uploads/2021/12/NASHP-Logo_website_168x157.png00Medical Homeshttps://oldsite.nashp.org/wp-content/uploads/2021/12/NASHP-Logo_website_168x157.pngMedical Homes2014-04-01 13:02:372014-04-01 13:02:37Colorado - Medical Homes
Colorado’s Accountable Care Collaborative (ACC) model builds on the state’s medical homes initiatives, active since 2001.
In 2008, Colorado’s Department of Health Care Policy and Financing was initially funded as a “Medicaid Value-Based Care Coordination Initiative” for FY2009-10. The department released a Request for Proposals for seven Regional Care Collaborative Organizations (RCCOs) in 2010, and the program was implemented beginning in spring 2011. The state’s seven RCCOs are responsible for providing medical management, care coordination among providers and services, and support to providers, and are accountable for quality and cost through utilization-based incentive payments and a shared savings program. The ACC Program offers the regular Medicaid benefit package to enrollees who belong to a Regional Care Collaborative Organization (RCCO) through their “Primary Care Medical Provider,” which serves as the enrollee’s medical home.
In an October 2011 brief describing the ACC model, the state discusses similarities and differences between ACCs and accountable care organizations: “Colorado’s Regional Care Collaborative Organizations and the federal ACOs are geared toward outcomes and are focused on reengineering the primary care medical home model. A key difference is that Colorado’s program interfaces directly with clients while the federal ACOs focus on providers.” To learn more about Colorado’s medical home initiatives, including the ACC program, visit the Colorado page of NASHP’s medical homes map.
Last updated December 2013.
Provider Population: Rollout of the Accountable Care Collaborative (ACC) was phased (see slide 15 in link): in the initial phase, Regional Care Collaborative Organizations (RCCOs) chose communities in which to implement the pilot. During the expansion phase, which began in July 2012, implementation is statewide across the program’s seven regions. Each region has one RCCO. RCCOs are expected to work with patients’ Primary Care Medical Providers to coordinate care, ease care transitions between settings, and connect beneficiaries with specialist services as needed.
Patient Population: This program serves Medicaid fee-for-service and Primary Care Physicians Program (a Colorado Medicaid health plan) beneficiaries. Dual eligible and beneficiaries residing in an institutional setting are excluded from the program, as are clients enrolled in Medicaid managed care. The number of children enrolled in the program was initially limited to approximately one-third of the number of total enrollees; the Department plans to remove this limit in October 2012. In addition, beneficiaries are not enrolled if they have a regular provider who is not participating in the ACC program. Enrollment is voluntary and passive for most beneficiaries, though enrollment is mandatory for adult Medicaid beneficiaries without dependent children. In addition to Medicaid beneficiaries, patients with a history of seeing a provider who is participating in the federal Comprehensive Primary Care Initiative will also be enrolled in the ACC program beginning November 1, 2012.
As of June 2013, total program enrollment was 352,236, including 222,862 children. Overall, forty-seven percent of Medicaid beneficiaries in the state are enrolled in the program.
Under the Accountable Care Collaborative (ACC) Program, primary care medical providers contract with one of seven Regional Care Collaborative Organizations (RCCOs) to provide medical home services to Medicaid enrollees. More information can be found in the RCCO RFP.
The Department of Health Care Policy & Financing has developed an ACC Program Improvement Advisory Committee—representing RCCO staff, Primary Care Medical Providers, other provider groups, clients and families, and Department staff—to provide guidance and make recommendations for improvements in the ACC program.
The ACC Program included stakeholder input through public forums and a formal Request for Information process.
Colorado’s Department of Health Care Financing and Policy selected seven Regional Care Collaborative Organizations (RCCOs) through an RFP process in 2010.
Enrolled Medicaid providers who wish to become Primary Care Medical Providers in the Accountable Care Collaborative (ACC) Program must meet one of the following criteria:
A Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC) or a clinic or other group practice with a focus on primary care, general practice, internal medicine, pediatrics, geriatrics, or obstetrics and gynecology; OR
An individual physician, advanced practice nurse or physician assistant with a focus on primary care, general practice, internal medicine, pediatrics, geriatrics, or obstetrics and gynecology
Furthermore, Primary Care Medical Providers must commit to nine additional principles that ensure care is patient/family-centered; whole-person oriented and comprehensive; coordinated and integrated; provided in partnership with the patient and promotes patient self-management; outcomes-focused; consistently provided by the same provider as often as possible so a trusting relationship can develop; and provided in a culturally competent and linguistically sensitive manner.
Under the Accountable Care Collaborative (ACC) program, Regional Care Collaborative Organizations (RCCOs), Primary Care Medical Providers and the Statewide Data and Analytics Contractor receive a total of $20 per-member/per-month (PMPM) for medical home services:
Regional Care Collaborative Organization: $13 PMPM
Primary Care Medical Provider: $4 PMPM
Statewide Data and Analytics Contractor: $3 PMPM
Primary Care Medical Providers will receive fee-for-service reimbursements for medical services rendered to enrolled Medicaid beneficiaries.
In the program’s expansion phase, RCCOs and Primary Care Medical Providers are eligible to receive incentive payments: initial incentive payments will be available for RCCOs and Primary Care Medical Providers that reduce emergency room visits, hospital re-admissions, and utilization of medical imaging. On July 1, 2013, a fourth indicator measuring well child visits was added to this list. PMPM payments to RCCOs and Primary Care Medical Providers will be reduced to $12 and $3 respectively, with $1 from each withheld to support incentive payments based on achievement of performance targets. The state hopes to incorporate a shared savings component at a later date as more beneficiaries enroll in the ACC program.
Legislation passed in June 2012, House Bill 12-1281, will also test innovative payment methodologies “that are designed to provide greater value while ensuring good health outcomes and client satisfaction.” In July 2012, RCCOs were invited to submit abstracts outlining proposed innovative payment methodologies to participate in the “Medicaid Payment Reform and Innovation Pilot Program.” Abstracts will be reviewed during the fall of 2012, and the Department plans to release formal proposal criteria by November 1, 2012. HB 12-1281 requires the state to select one or more proposals for piloting by July 1, 2013. See the state’s Payment Reform Initiative fact sheet for a complete timeline.
Colorado has awarded a Statewide Data and Analytics Contract to Treo Solutions to support its Accountable Care Collaborative. The Statewide Data and Analytics Contractor is responsible for providing secure electronic access to clinically actionable data to the Regional Care Collaborative Organizations (RCCOs) and Primary Care Medical Providers.
Currently, the Statewide Data and Analytics Contractor data repository is storing Medicaid paid claims data, clinical risk group identifiers and predictive risk scores, and Behavioral Health Organization managed care encounter data. Proposals for future data elements to add to the Statewide Data and Analytics Contractor include: clinical data from RCCOs and/or Primary Care Medical Providers (such as data on member care coordination, referrals to non-medial services and medical management activities), disease and immunization registries data, national health survey data, and Colorado Regional Health Information Organization electronic health records data.
The Statewide Data and Analytics Contractor provides RCCOs and Primary Care Medical Providers with access to profiles of individual clients based upon predictive modeling; identification of areas for clinical process improvement at the client, provider, and RCCO levels; and aggregate reporting of cost and utilization performance indicators.
The primary goals of Colorado’s Accountable Care Collaborative program are to improve health outcomes through a coordinated, client/family-centered system that proactively addresses clients health needs and control costs by reducing avoidable, duplicative, variable and inappropriate utilization. In the program’s first year (slide 13), the state will track utilization measures monthly and do quarterly cost savings analyses to track progress toward these goals. In subsequent years, the state plans to track utilization as well as quality and outcomes measures, and will assess stakeholder participation.According to the Accountable Care Collaborative Annual Report (FY2013-14) released by Colorado’s Department of Healthcare Policy and Financing, analysis of the ACC program to date has shown:
15-20% reduction for hospital readmissions and 25% reduction in high cost imaging services;
22% reduction in hospital admissions among ACC members with chronic obstructive pulmonary disease;
Lower rates of chronic health conditions (e.g., hypertension and diabetes) relative to clients not enrolled in the ACC Program;
A slower rate of emergency room utilization increase by ACC enrollees; and
$44 million gross, $6 million net reduction in total cost of care (cost avoidance) for clients enrolled in the ACC Program.
As of July 1, 2011, there were 583,618 beneficiaries enrolled in Colorado’s Medicaid program. Of these, 551,972 were enrolled in some form of managed care.
While the state has a contract with a single comprehensive Medicaid-only managed care organization serving 46,962 beneficiaries, Colorado Medicaid has relied more heavily on primary care case management (PCCM). Since 2011, Colorado Medicaid has been transitioning Medicaid beneficiaries into a new program known as the Accountable Care Collaborative.
A significant portion of managed care enrollment (572,491 beneficiaries) through the state is through Prepaid Inpatient Health Plans covering mental health benefits. Behavioral benefits are provided through five Behavioral Health Organizations in the state.
Medicaid Home and Community-Based Services (HCBS) are provided through waivers, including:
Children’s HCBS Waiver, for disabled children who would otherwise be ineligible for Medicaid due to excess parental income and/or resources;
Children’s Extensive Support Waiver, providing services to children with developmental disabilities or delays that are most in need due to the severity of their disability;
As of 2012, 475,671 individuals were eligible for the Medicaid benefit for children and adolescents in Colorado (also known as the Early Periodic Screening, Diagnostic and Treatment benefit, or EPSDT). According to CMS data from 2012, Colorado achieved an EPSDT screening ratio of 66% and a participation ratio of 51%. 233,244 children received dental services of any kind, with 215,317 receiving preventive dental services.
“Medical necessity means a Medical Assistance program good or service that will, or is reasonably expected to prevent, diagnose, cure, correct, reduce, or ameliorate the pain and suffering, or the physical, mental, cognitive, or developmental effects of an illness, injury, or disability. It may also include a course of treatment that includes mere observation or no treatment at all. The good or service must be: Code of Colorado Regulations 53
Provided in accordance with generally accepted standards of medical practice in the United States;
Clinically appropriate in terms of type, frequency, extent, site, and duration;
Not primarily for the economic benefit of the provider or for the convenience of the client, caretaker, or provider; and
Performed in a cost effective and most appropriate setting required by the client’s condition.”
“Medical Necessity means that a covered service shall be deemed a medical necessity or medically necessary if, in a manner consistent with accepted standards of medical practice, it:
Is found to be an equally effective treatment among other less conservative or more costly treatment options, and
Meets at least one of the following criteria:
The service will, or is reasonably expected to prevent or diagnose the onset of an illness, condition, primary disability, or secondary disability
The service will, or is reasonably expected to cure, correct, reduce or ameliorate the physical, mental cognitive or developmental effects of an illness, injury or disability
The service will, or is reasonably expected to reduce or ameliorate the pain or suffering caused by an illness, injury or disability.
The service will, or is reasonably expected to assist the individual to achieve or maintain maximum functional capacity in performing Activities of Daily Living.”
Colorado offers Family Health Coordinators through its Healthy Communities initiative. The coordinators offer outreach and case management to help children and their families access coordinated health care services. In addition to helping families apply for Medicaid coverage and educating them on how to access benefits (including preventive services) in appropriate settings, the coordinators also work to connect families to a medical home and provider information and referrals to other community programs and resources.
In 2013, Colorado added a well child visit “key performance indicator” to its Accountable Care Collaborative program. Providers and the entities administering the program will be able to earn incentive payments based on performance on this indicator.
Behavioral health benefits are provided by Behavioral Health Organizations, which are contractually obligated to provide or arrange all medically necessary services covered under EPSDT.
Under the state’s Child Mental Health Treatment Act, children (both Medicaid-eligible and non-Medicaid eligible children) with a mental illness and under age 18 have access to a variety of community, residential, and transitional treatment services. Transitional services provided include case management and post-discharge services provided by community mental health centers, while covered community-based services include:
The Colorado Department of Health Care Policy and Financing hosts an EPSDT website for families and health care providers.
For providers, the site offers information on referral processes and the periodicity schedule. A dedicated provider section of the website offers additional information, including a fact sheet on EPSDT and links to state and national resources.
Colorado has also launched a School-Based Health Center Improvement Project in partnership with New Mexico Medicaid and with support from a CHIPRA Quality Demonstration Grant. The project is working with a set of school-based health centers to engage Medicaid-eligible adolescents in their own health care and its goals include increasing the percentage of children and adolescents who have up-to-date immunization records; who receive screens for sexually transmitted disease; who receive screenings for depression; and who receive appropriate follow-up after depression screens. The project is also working to improve care coordination of health care between primary care providers and other providers.
Under the project, the state is offering school-based health centers training in:
disease prevention and management;
data collection;
consultation, referral and coordination of care;
interacting with adolescents; and
enabling adolescents to direct their own health care as they mature.
Through the Colorado Medical Home Initiative, the state supported a “systems-building effort to promote quality health care for all children in Colorado.” Medical home standards for providers serving children in Medicaid or CHIP were developed through a partnership between state agencies in Colorado.
The state has since transitioned its Accountable Care Collaborative model. Seven Regional Care Coordination Organizations are now responsible for providing medical management, care coordination among providers and services, and support to providers, and are accountable for quality and cost through utilization-based incentive payments and a shared savings program.
Colorado Medicaid’s Dental Manual contains information on covered services for children under the EPSDT benefit. The state allows physicians, nurse practitioners, and physician assistants to bill for administering fluoride varnish to children under age 5 during a well-child visit. Dental providers may also provide the service.
Medical personnel offering oral health services to young children enrolled in Medicaid must either receive on-site training from a Colorado initiative that trains health care providers on providing oral health services to children (“Cavity Free at Three”) or they must complete modules of the national Smiles for Life curriculum.
Make more effective use of data, data matching, and demonstrating return on investment (ROI):
Review Medicaid data on individuals with intellectual and/or developmental disabilities (I/DD)to identify those eligible for additional housing supports.
Create data sharing agreementsto share data among Medicaid, I/DD, mental health, and housing
Explore capital investment strategies for affordable housing acquisition and development.
Develop sustainable cross-agency financing.
Partners
Illinois Department of Human Services
Illinois Department of Healthcare and Family Services
Illinois Housing Development Authority
Illinois Council on Developmental Disabilities
State Successes
Received approval for Behavioral Health Transformation Medicaid Section 1115 waiver that includes pre-tenancy and tenancy supports. Under the waiver, five independent pilot programs are currently being implemented. The state is exploring use of 1915(i) Medicaid authority to implement the remaining approved pilot programs, including a tenancy support project to support individuals at risk of institutionalization and homelessness.
Compiled information from a state-operated facility to inform interventions for super-utilizer groups in Chicago.
Examined the Cook County pilot’s success to determine statewide implementation possibilities in more rural areas of the state.
Worked with the Corporation for Supportive Housing (CSH) to develop a state plan for supportive housing. CSH provided education and TA with a particular focus on supporting individuals living with developmental disabilities. This population remains a priority for the Illinois team.
Facilitated five rounds of funding for supportive housing developments of 25 units or less through the Permanent Supportive Housing Development Program, with approximately 100 units approved per round. The 2020 Request for Applications has been released, and IHDA is encouraging applicants to develop larger and more creative housing projects.
Next Steps
Continue review of health and hospital projects for potential state system data matching and housing initiative opportunities.
Continue work on pre-tenancy and tenant supports for Illinois residents.
Explore expansion or new avenues for services typically covered through Medicaid Section 1115 waivers for other populations, especially I/DD populations.
Why Palliative Care Is Important for States
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it.
To address this gap, NASHP convened a cross-agency group of state policy leaders to provide guidance in developing a framework for how states, as agents of change, can foster access to quality palliative care services. Recognizing that policy development is always driven by the varied goals and priorities of individual states, NASHP’s Seven Ways State Policymakers Can Promote Palliative Careoffers a roadmap to help policymakers identify state-specific opportunities, areas of alignment, and ideas to aid future planning. Building on the roadmap, this toolkit provides additional concrete resources for states.
MaryAnne Lindeblad brings a broad health care and administrative background to the top position in the Washington State Medicaid program. Lindeblad, has been an active health care professional as well as a leader spanning most aspects of health care including acute care, long-term care, behavioral health care, eldercare and services for people with disabilities. Prior to her appointment as State Medicaid Director, she served for two years as the Assistant Secretary for Aging and Disability Services Administration in the Department of Social and Health Services. Previously, she was Director of the Health Care Services Division of the Medicaid program.
Lindeblad held a variety of leadership positions over the years, including Assistant Administrator of the Public Employees Benefits Board. During the 1990s, Lindeblad also worked in the private sector, serving as Director of Operations for Unified Physicians of Washington.
In 2010, she was selected for the inaugural class of the Medicaid Leadership Institute. In 2015 she was inducted into the Eastern Washington University Chapter of the Upsilon Phi Delta Society. She currently chairs the executive committee for the National Academy for State Health Policy, previously served on the board of the National Association of Medicaid Directors, and the Olympia Free Clinic. Lindeblad holds a bachelor of science in nursing from Eastern Washington University and a masters in public health from the University of Washington
Erin C. Fuse Brown
Erin C. Fuse Brown
Associate Professor of Law Center for Law and Society, Georgia State University
Erin C. Fuse Brown, J.D., M.P.H., is an Associate Professor of Law and a faculty member of the Center for Law, Health & Society at Georgia State University College of Law. She specializes in health law and policy, and her research focuses on health care markets, consolidation, and cost-control. Fuse Brown has published articles in leading legal and medical journals about hospital prices, medical billing and collection, health care competition and consolidation, consumer financial protection in health care, and state health reforms. She has consulted with NASHP on legal analysis and proposals for how state all-payer claims databases can move forward following the Supreme Court’s decision in Gobeille v. Liberty Mutual Insurance Co. and on state strategies to control health care prices. She received a J.D. from Georgetown, an M.P.H. from Johns Hopkins, and a B.A. from Dartmouth College.
Victoria Veltri, JD, LLM, is the Executive Director of the Office of Health Strategy, appointed to serve as the first head of this agency in 2018. She was reappointed by Governor Ned Lamont in 2019 to oversee the office’s mission to implement comprehensive, data driven strategies that promote equal access to high quality health care, control costs and ensure better health for the people of Connecticut.
From 2016 to 2018, she was the Chief Health Policy Advisor in the Office of Lt. Governor Nancy Wyman, coordinating the state’s health reform initiatives.
She is a member of the Board of Directors on the Connecticut Health Insurance Exchange (d/b/a Access Health CT). Ms. Veltri has extensive legal experience in health care advocacy and in legislative policy and she lectures frequently at colleges, universities conferences on Connecticut’s health care initiatives.
Prior to joining Lt. Governor Wyman’s staff, Ms. Veltri was the State Healthcare Advocate.
Trisha Schell-Guy
Trisha Schell-Guy
Acting General Counsel
New York State Office of Addiction Services and Supports
Trisha Schell-Guy is the Acting General Counsel for the NYS Office of Addiction Services and Supports. In this role, Ms. Schell-Guy provides legal advice, guidance and policy making support to the NYS OASAS Commissioner, agency Executive staff and all agency divisions. Prior to her appointment as General Counsel, Ms. Schell-Guy served OASAS as Deputy Counsel for 5 years and as Associate Counsel for 5 years.
Ms. Schell-Guy also served as Senior Attorney for the NYS Office of State Comptroller and NYS Department of Motor Vehicles. Prior to her state service, Ms. Schell-Guy was engaged in the private practice of law for 13 years where she practiced in various areas of civil and criminal practice.
Ms. Schell-Guy has co-authored an article on Confidentiality and patient issues related to the sharing of substance use disorder treatment information for the Health Law Journal of the NYS Bar Association and has made numerous national and local presentations on issues pertaining to prevention, treatment and recovery issues impacting New Yorkers and the states system of care.
Ms. Schell-Guy resides in Glenmont, New York with her husband, two children and several pets.
Michael MacKenzie
Michael MacKenzie
Deputy Chief, Antitrust Division
Office of the Attorney General
Michael MacKenzie serves as an Assistant Attorney General and Deputy Chief of the Antitrust Division in Massachusetts Attorney General Maura Healey’s Office. Prior to joining the Attorney General’s Office in 2011, he worked as an associate at Sachnoff & Weaver (now part of Reed Smith) and Eimer Stahl in Chicago. Mr. MacKenzie received his J.D. from Harvard Law School in 2006 and graduated from Yale University in 2003 with bachelor’s degrees in English and political science.
Jordan Kiszla is a Project Manager at the District of Columbia Department of Health Care Finance where she leads telehealth policy and behavioral health transformation activities. Ms. Kiszla was previously an Associate Program Officer for the Federal and State Health Policy Program at the Commonwealth Fund. Ms. Kiszla holds an M.P.H. with a concentration in health policy from George Washington University.
Jessica Altman has served as Pennsylvania’s Insurance Commissioner since August 2017. In this role, she regulates the insurance marketplace, oversees licensed agents and insurance professionals, monitors the financial landscape of companies in Pennsylvania, educates consumers, and ensures residents are treated fairly. She is chair of the Health Insurance and Managed Care Committee for the National Association of Insurance Commissioners and Vice Chair of NASHP’s Health Care Access & Finance Steering Committee. She previously served the U.S. Department of Health and Human Services’ Center for Consumer Information and Insurance Oversight; and the health division of the White House Office of Management and Budget as a policy analyst. She completed her Masters in Public Policy from Harvard University and received her Bachelor of Science in Policy Analysis and Management, concentrating in Health Care Policy, from Cornell University.
Christopher Smith
Christopher Smith
Deputy Director
Adult Community Care Group, Division of Adult Services, New York State Office of Mental Health
Dr. Smith spent the last 7 years focused on Managed Medicaid implementation and systems transformation in the public behavioral health system in NYC. He is now also working on statewide initiatives, including Crisis System development, Telemental Health implementation and Integrated Care. Dr. Smith was a clinical administrator at Bellevue with responsibility for Forensic, Psychiatric Emergency and Substance Abuse Services. He also spent a decade working on Schizophrenia risk and prevention research at the Zucker Hillside Hospital.
Oliver Droppers
Oliver Droppers
Deputy Director for Policy Research, Legislative Policy and Research Office
Oregon Legislature
Dr. Droppers joined the Oregon Health Authority in 2010, as the project director for a five-year CMS CHIPRA Quality Demonstration project in Oregon, and also staffed the Oregon Medicaid Advisory Committee, which advises the operation of Oregon’s Medicaid program. While at OHA, Oliver also served as a senior analyst on a variety of legislatively created task forces and work groups aimed at expanding coverage for children and adults. In January 2017, Oliver transitioned to Legislative Policy and Research Office (LPRO), which provides centralized, professional and nonpartisan research to the Oregon Legislature. Oliver has staffed the House and Senate Health Care Committees. Currently, Oliver serves as the Deputy Director for Policy Research in the Oregon Legislature. Dr. Droppers is an adjunct faculty member at the OHSU-PSU School of Public Health. When Dr. Droppers is not engaged in public policy, he enjoys time with his two children and partner, and can be found exploring the Olympic National Park.
Ben Money
Ben Money
Deputy Secretary for Health Services
North Carolina Department of Health and Human Services
E. Benjamin Money, Jr. joined the North Carolina Department of Health and Human Services in 2019 as the Deputy Secretary for Health Services. His portfolio includes the Division of Public Health, Division of Health Services Regulation, the Office of Minority Health, and the Office of Rural Health. Ben previously served as President and Chief Executive Officer of the North Carolina Community Health Center Association (NCCHCA) during a 10-year period of unprecedented growth in organizations, clinical sites and patients served. In this role, Mr. Money was a the vice-chair of the National Association of Community Health Center Primary Care Association Leadership Committee, the Chair of the Southeast Health Care Consortium, a member of the boards of the NC Institute of Medicine, the NC Health Care Quality Alliance, the NC Health Information Exchange Advisory Board, the NC Safety-net Advisory Council, the Care Share Health Alliance and the public health practice advisory committees for both the East Carolina Brody School of Medicine and the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. Ben’s 36-year career in health care began in community mental health and includes 11 years in local public health and 18 years with community health centers. He holds a master’s degree in public health nutrition from the University of North Carolina Chapel Hill. Mr. Money recently completed a certificate in Climate Change and Health from the Yale University School of Public Health.
Barbara Paulson
Barbara Paulson
Director of Children and Youth Services
Department of Behavioral Health
Barbara Paulson is the DC Department of Behavioral Health Deputy Director, Child and Youth Services. She is a seasoned behavioral health clinician with over 30 years of experience providing direct services to children, adolescents and their families. This includes delivering care as a private practitioner.
Barbara has held a variety of senior leadership positions. She served as the site director for Family Services in NW Ohio, Program Deputy Director for Family and Child Services of Washington, D.C. and as Clinical Program Administrator for Prevention and Early Intervention at the D.C. Department of Behavioral Health. During her tenure at the Department, she led the School-based Mental Health Program and developed the Healthy Futures program, the early childhood mental health program which now currently operates in over 60 locations.
She is nationally recognized for her expertise in school mental health programs and policies, early childhood mental health consultation and education and substance use prevention. Barbara has presented at numerous national conferences on the Healthy Futures early childhood mental health consultation program and school mental health. She has provided numerous additional trainings and workshops for educators, clinicians, and community based providers.
Barbara is a Licensed Independent Social Worker in the District, and an LCSW in Maryland. Barbara received her Bachelor’s degree from Bowling Green State University in Child and Family Community Services and her Master’s degree in Social Science Administration from Case Western Reserve University in Cleveland, Ohio.
Steve Pearson
Steve Pearson
Founder and President
Institute for Clinical and Economic Review
Steven D. Pearson, MD, MSc is the Founder and President of the Institute for Clinical and Economic Review (ICER), an independent non-profit organization that evaluates the evidence on the value of medical tests, treatments, and delivery system innovations to encourage collaborative efforts to improve patient care and control costs. Dr. Pearson is also a Lecturer in the Department of Population Medicine at Harvard Medical School.
Previously, he has served as a Visiting Scientist in the Department of Bioethics at the NIH, a Special Advisor on Technology and Coverage Policy at the Center for Medicare and Medicaid Services, and the Vice Chair of the Medicare Evidence Development and Coverage Advisory Committee (MedCAC). His publications include over 125 peer-reviewed articles and commentaries on the role of evidence in the health care system, and the book No Margin, No Mission: Health Care Organizations and the Quest for Ethical Excellence, published by Oxford University Press.
Michelle Mello is Professor of Law at Stanford Law School and Professor of Medicine in the Center for Health Policy/Primary Care and Outcomes Research in the Department of Medicine at Stanford University School of Medicine. She conducts empirical research into issues at the intersection of law, ethics, and health policy. She is the author of more than 200 articles on medical liability, public health law, pharmaceuticals and vaccines, biomedical research ethics and governance, health information privacy, and other topics. The recipient of a number of awards for her research, Dr. Mello was elected to the National Academy of Medicine at the age of 40. From 2000 to 2014, she was a professor at the Harvard School of Public Health, where she directed the School’s Program in Law and Public Health. She holds a J.D. from the Yale Law School, a Ph.D. in Health Policy and Administration from the University of North Carolina at Chapel Hill, and an M.Phil. from Oxford University, where she was a Marshall Scholar.
Trish Riley, Executive Director of the National Academy for State Health Policy, built that organization as CEO from 1988-2003. She led Maine’s Governor’s Office of Health Policy and Finance, and was Federal liaison during the ACA deliberations. Riley held appointive positions under five Maine governors. She served on the Kaiser Commission on Medicaid and the Uninsured, and was a member of MACPAC, an Institute of Medicine’s Subcommittee and served on the Board of the NCQA.
Pam MacEwan
Pam MacEwan
Chief Executive Officer
Washington Health Benefit Exchange
Pam MacEwan is the Chief Executive Officer for the Washington Health Benefit Exchange. Prior to joining the leadership team at HBE, Pam served as Executive Vice President for Public Affairs and Governance for Group Health Cooperative. She directed Medicare and Medicaid program performance and strategy, government relations, public policy, communications, and consumer governance serving on Group Health’s leadership team for 16 years. Previously Pam served as a Commissioner with the Washington Health Services Commission implementing the Health Services Act. She worked with a broad coalition to pass health reform legislation. Pam has served on several health policy initiatives in the public and private sector, chairing the Association of Washington Health Plans, serving on the Washington State Hospital policy committee, the King County Health Action Plan, and the Children’s Health Initiative. She holds an MAT in history from Brown University and a BA in economics from The Evergreen State College.
Todd Landry
Todd Landry
Director
Office of Child and Family Services, Department of Health and Human Services
Dr. Todd A. Landry is the Director of the Office of Child & Family Services for the State of Maine. Dr. Landry holds a Bachelor’s degree in Chemistry from Lamar University, Beaumont, Texas and a Master’s degree in Business Administration (MBA) from the Cox School of Business at Southern Methodist University, Dallas, Texas. He earned his Doctorate degree in Educational Leadership from the Simmons School of Education and Human Development at Southern Methodist University, Dallas, Texas, in 2018. Landry most recently was chief executive officer of Lena Pope in Fort Worth, Texas, a nonprofit that serves children and families with an array of prevention and early intervention services, including childcare, public education, mental health counseling, and juvenile justice. He previously served as director of Nebraska’s Division of Child and Family Services and sits on national boards, including the Child Welfare League of America.
Molly Voris
Molly Voris
Senior Policy Advisor for Public Health and Health Care
Office of Governor Jay Inslee
Molly Voris (pronouns she/her) is the Senior Policy Advisor for Public Health and Health Care for Washington Governor Jay Inslee. In this role, she leads policy development and advises the Governor on health care issues, including advising the Governor on COVID-19 policy since the beginning of the pandemic.
Prior to her role in the Governor’s Office, she served as the Chief Policy Officer for the Washington Health Benefit Exchange for nine years. Molly previously worked at the National Governors Association on state health insurance coverage issues when the ACA was enacted, and at the Kaiser Family Foundation on Medicare issues when Medicare Part D was enacted.
Molly has an M.P.H. from George Washington University and bachelor degrees in political science and Spanish from the College of Charleston in South Carolina. She lives in Olympia, Washington with her spouse, three kids and their dog.
John Straus
John Straus
Founding Director
Massachusetts Child Psychiatry Access Program
Dr. Straus is a primary care pediatrician and the founding director of the Massachusetts Child Psychiatry Access Program (MCPAP). Begun in 2004, MCPAP was the first statewide program designed to address the shortage of child psychiatrists. Dr. Straus was responsible for the expansion of MCPAP to include MCPAP for Moms to address perinatal depression, mental illness, and substance use. MCPAP is the model for the implementation of access programs in 38 other states and for the federal legislation in the 21st Century Cures Act which led to the 21 state pediatric HRSA grants and 7 state maternal HRSA grants. He is president of the National Network of Child Psychiatry Access Programs, a non-profit dedicated to providing technical assistance and support to child psychiatry access programs. In 2019, Dr. Straus designed the Massachusetts Consultation Service for Treatment of Addiction and Pain (MCSTAP) to assist adult PCPs with their patients with SUD and chronic pain issues.
Rep. Drew Gattine is in his fourth term in the Maine House of Representatives. He is House Chair of the Appropriations and Financial Affairs Committee and previously chaired the Health and Human Services Committee.
Rep. Gattine has over 25 years of experience in implementing and operating programs designed to deliver more effective and efficient health care. He is nationally known on the topic of program integrity and has presented at numerous national conferences on this subject. He is also a former state assistant attorney general.
Rep. Gattine is passionate about helping vulnerable people access high quality health care and live better lives. His service has been recognized by organizations such as AARP, Disability Rights Maine, Maine Council on Aging, Maine People’s Alliance, Cancer Action Network Maine and The Maine Primary Care Association.
Rep. Gattine lives on a small family farm in Westbrook with his wife, Elizabeth. They have two children and a bunch of animals.
Ana Novais
Ana Novais
Deputy Director of Health
Rhode Island Department of Health
Ana Novais holds a master’s degree in Clinical Psychology, UCLN, Belgium, and is a graduate of the Northeastern Public Health Leadership Institute, University at Albany, and Leadership RI. Ana has worked in public health for more than 30 years, including 5 years in Cabo Verde, 5 years in Portugal, and 23 years in the US.
Ana has worked for the Rhode Island Department of Health since 1998, first as a children’s health Education and Outreach Coordinator and later as Chief of the Office of Minority Health and Director of the Division of Community, Family Health, and Equity. In this role, Ana led the department’s efforts to develop and implement a framework for achieving health equity at the state and local levels through Rhode Island’s “Health Equity Zones” initiative.
In her current role as Deputy Director, Ana is charged with implementing the Department’s strategic priorities across all divisions and assuring the alignment of departmental resources and operations with these priorities.
Melissa Jordan
Melissa Jordan
Interim Division Director
Florida Department of Health
Melissa Jordan has worked at the Florida Department of Health, primarily in the field of applied epidemiology, since 2003. Since November of 2019, Melissa has served as the Interim Division Director of Community Health Promotion, managing an office of approximately 300 public health professionals and an annual budget of approximately $1 billion in state and federal funding. In this role, she is responsible for a wide range of health promotion activities including tobacco and chronic disease prevention, family health services, and WIC. She is leading Florida’s public health efforts to improve drug overdose surveillance and implement innovative prevention strategies.
Karl Fernstrom
Karl Fernstrom
Manager, Health Data Services Center
Minnesota Department of Health
Karl Fernstrom, Manager of the Health Care Data Service Center in the Health Economics Program at the Minnesota Department of Health: Karl Fernstrom leads the operational efforts for the acquisition and maintenance of health care administrative data for the Minnesota Department of Health which includes the MN APCD, MN HDD, and CMS data streams. In this role he also oversees the creation and release of MN APCD Public Use Files, collaborates with the Health Services Research unit on emerging research questions and policy issues relevant to health care research and health reform within the state. His background is in chronic disease epidemiology with areas of focus on conducting research using electronic health record and administrative data.
Julie Evers
Julie Evers
Medicaid Health Systems Administrator, Bureau of Long Term Services and Supports
Ohio Department of Medicaid
Julie has 30 years of experience in long term care policy with the Ohio Department of Medicaid. Her policy experience includes long term care facilities, home health, reimbursement and electronic visit verification. Recently she has been focused on issues facing long term care facilities as they address the impact of the COVID-19 pandemic.
Vinita Bahl
Vinita Bahl
VP of Data Analytics
Center for Improving Value in Health Care
Vinita is Vice President of Data and Analytics at CIVHC and has decades of experience directing analytical work at a variety of health care organizations. Prior to joining CIVHC in 2019, Vinita served as Director of Performance Assessment & Clinical Effectiveness at the University of Michigan Health System. Vinita has expertise in the design and development of performance measurement systems, development of analytic capabilities to respond to new payment and care delivery models, analysis to drive performance improvement, and design of public reports. She holds Masters of Public Policy and Doctor of Dental Medicine degrees from Harvard University.
Michelle Alletto
Michelle Alletto
Chief Program and Services Officer
Texas Health and Human Services
Michelle Alletto serves as the Texas Health and Human Services Chief Program and Services Officer. She provides oversight to the programs that make up the full Texas HHS medical and social service array including Medicaid, food assistance and women’s health programs, residential care for people with intellectual and developmental disabilities, and behavioral health services.
Michelle has over a decade of experience working in public health and management. Recently, she worked with the Milbank Memorial Fund, advising a multi-state collaborative on Medicaid long-term services reform. She previously served as deputy secretary for the Louisiana Department of Health (LDH), the deputy director for the LDH Birth Outcomes Initiative, and the assistant director for public policy at the Association of Maternal and Child Health Programs in Washington, D.C.
Alletto holds a master’s degree in public administration from the Maxwell School of Citizenship and Public Affairs at Syracuse University.
Katie Wunderlich
Katie Wunderlich
Executive Director
Maryland Health Services Cost Review Commission
Katie Wunderlich began her tenure as Executive Director of the Health Services Cost Review Commission in September 2018. In that role, she has lead the Commission through the transition from the hospital-based All-Payer Model to the Total Cost of Care Model, which focuses on hospital and non-hospital system transformation to enhance patient care, improve health, and lower costs. In order to successfully transform the delivery system, the new Total Cost of Care Model gives the State the flexibility to tailor initiatives to the Maryland health care context, encourages providers to drive health care innovation, and provides new tools and resources for primary care clinicians to better meet the needs of patients with complex and chronic conditions and help Marylanders achieve better health status overall. Previously, Ms. Wunderlich was the Principal Deputy Director at HSCRC overseeing the Center for Provider Alignment and Engagement that works with hospitals, physicians and other health care providers in partnership with patients to achieve the goals of the new model and transform healthcare delivery. Before joining the HSCRC in 2016, Ms. Wunderlich was a Deputy Legislative Officer in Governor Hogan’s Legislative Office. She also served as Director of Government Relations for the Maryland Hospital Association and as a budget analyst for the General Assembly’s Legislative Services department. She has a Masters in Public Policy from George Washington University.
Julia Tremaroli
Julia Tremaroli
Data Intake Analyst
Center for Improving Value in Health Care
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Julia Tremaroli has worked as the data intake analyst for the CO APCD at the Center for Improving Value in Health Care (CIVHC) for over two years. Day-to-day, she engages data submitters to ensure their submissions to the CO APCD are timely, accurate, and of high-quality. She also works as an analyst on several projects that utilize data from the CO ACPD, including the support for HB19-1174 Surprise Medical Billing legislation. Julia is driven by the goal of achieving the Triple Aim: lower costs, improved quality, and healthier people.
Julia holds a degree from the University of Denver in Business Information and Analytics.
Thomas Smith
Thomas Smith
Chief Medical Officer/ Medical Director
Division of Managed Care, New York State Office of Mental Health.
Dr. Smith is Chief Medical Officer, New York State Office of Mental Health (NYS OMH); Co-Director, NYS OMH Center for Behavioral Health Integrated Performance Measurement, and Special Lecturer in the Department of Psychiatry at Columbia University. He oversees clinical and quality aspects of the New York State public mental health system with a focus on improving access to prevention, recovery and rehabilitation services for persons with serious mental illness (SMI). He is the recipient of numerous NIMH and foundation grants for studies of engagement strategies for persons with SMI, services for persons with first episode psychosis, and care management approaches for high-need persons with SMI.
Dr. Smith earned his M.D. at Wayne State University School of Medicine and completed his psychiatry residency at the University of Chicago before coming to New York where he has had extensive experience as a clinician, hospital administrator, and researcher, initially at Weill Cornell from 1989 – 2001. He moved to Columbia in 2001 and in 2008, joined the behavioral health services research division at the New York State Psychiatric Institute. Dr. Smith participated in the design and implementation of New York State’s behavioral health Medicaid Managed Care redesign and has played a lead role in OMH programs that support population health monitoring for engagement in care and adverse events. He also oversees NYS OMH mental health parity enforcement efforts as well as initiatives to develop system level quality and performance measures.
David Seltz
David Seltz
Executive Director
Massachusetts Health Policy Commission
David Seltz is the first Executive Director of the Massachusetts Health Policy Commission (HPC). The HPC is a first-in-the-nation independent state government agency charged with bending the health care cost curve and providing data-driven policy recommendations regarding health care delivery and payment system reform. Prior to this role, Mr. Seltz was the Special Advisor on health care for Governor Deval Patrick (MA) and Senate President Therese Murray. Through these positions, he advised the passage of historic health care access reform legislation in 2006, a forerunner to the Affordable Care Act of 2010. Subsequently, he worked on landmark cost containment legislation in MA, which has also become a model of success for many states. Mr. Seltz is a 2003 graduate of Boston College and originally from Minnesota. He was a recipient of Modern HealthCare’s 2015 Up and Comer Award and serves as a member of the Executive Committee to the National Academy of State Health Policy (NASHP).
Erinn Sanstead researches, develops, and evaluates procedures and strategies to produce Minnesota All Payer Claims Database Public Use Files (PUFs). In this role, she provides technical assistance on appropriate uses of administrative health care claims data and conducts data validation to assess PUF validity, completeness, and security. Her background is in infectious disease epidemiology with experience in decision modeling and cost effectiveness analyses.
Rachel Sachs is an Associate Professor of Law at Washington University in St. Louis. Her research explores the interaction of intellectual property law, food and drug regulation, and health law. Her scholarship has appeared in journals including the Harvard Law Review, the Michigan Law Review, the New England Journal of Medicine, and the Journal of the American Medical Association. Sachs was previously an Academic Fellow at the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics and a Lecturer in Law at Harvard Law School.
Gail Propsom
Gail Propsom
Chief
Quality Management and Special Initiatives Section, Wisconsin Department of Human Services
Gail Propsom has worked for the Wisconsin Department of Health Services in a policy capacity for almost 30 years, developing and implementing policy on such varied issues as welfare reform, child support, employment and training, juvenile justice and child welfare. Since 2001, she has worked on long term support policy, including Olmstead implementation, Real Choice Systems Change Grants and Money Follows the Person. She currently manages a Section that oversees program quality, data analytics and several special projects, including implementation of the Home and Community-Based Services Settings rule, Money Follows the Person, housing issues for people with long-term care needs and efforts to support tribal involvement in long-term care.
Norman Oliver
Norman Oliver
Virginia State Health
Commissioner State of Virginia
Dr. Oliver is the State Health Commissioner at the Virginia Department of Health. Prior to this appointment, Dr. Oliver served as the Deputy Commissioner for Population Health for VDH. Before accepting the Deputy Commissioner position, he was the Walter M. Seward Professor and Chair of the Department of Family Medicine at the University of Virginia School of Medicine.
Dr. Oliver has a long record of accomplishments in research and community health work, regarding health inequities. Most recently, his research interests have focused on the area of improving our understanding of the role of racial discrimination, bias, and prejudice in establishing and maintaining these health inequities and the understanding of the interplay between race and socioeconomic position in these disparities.
Dr. Oliver attended medical school at Case Western Reserve University, where he also obtained his Masters degree in medical anthropology. He trained in family medicine at Case, and he then practiced broad-spectrum family medicine in rural Alaska for 2 years before joining the UVA Department of Family Medicine in 1998.
René Mollow
René Mollow
Deputy Director, Health Care Benefits and Eligibility
California Department of Health Care Services
René has been with the California Department of Health Care Services (DHCS) since 1995. In the Medi-Cal program, she serves as the Deputy Director for Health Care Benefits and Eligibility (HCBE). She provides leadership for benefit and eligibility policy planning, development, implementation, and evaluation of health care services and delivery systems under Medi-Cal and for the Children’s Health Insurance Program (CHIP). HCBE is comprised of five divisions and one office: Benefits, Eligibility, Pharmacy Benefits, Primary and Rural Indian Health, Dental, and the Office of Family Planning. René works to ensure that policies, procedures, and related activities in HCBE conform to applicable state and federal policies, statutes and regulations. She assists the Directorate, Administration and State Legislature in determining program direction consistent with legislative intent and consults with the Director and State Medicaid Director on issues of significant policy impact involving both Medi-Cal and CHIP. René has played a major role in policy planning, development, and implementation on matters pertaining to health care reform implementation and coverage expansions for children and young adults under Medi-Cal.
Mary McIntyre
Mary McIntyre
Chief Medical Officer
Alabama Department of Public Health
Mary G. McIntyre, M.D., M.P.H., SSBB is Chief Medical Officer for the Alabama Department of Public Health (ADPH). Dr. McIntyre received her B.S. in biology from Winston Salem State University in Winston Salem, NC. She earned her medical degree from Meharry Medical College in Nashville and served as resident physician in Internal Medicine at the George Hubbard Hospital in Nashville, TN. She obtained a master’s of public health in Health Care Organization and Policy from the University of Alabama at Birmingham. She studied Lean and Six Sigma at Villanova University from 2010-2011. She is board certified in Public Health and General Preventive Medicine through the American Board of Preventive Medicine. She joined ADPH in January 2011, and served as Assistant State Health Officer for Disease Control and Prevention and State Epidemiologist before taking her current position. Prior to beginning her public health career, she served in various roles at the Alabama Medicaid Agency for 14 years. She provided primary care for 11 years before joining the state. She is a member of the Council of State and Territorial Epidemiologists (CSTE), the American Public Health Association (APHA), the Alabama Public Health Association (Alpha), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Medical Association (AMA), and the Medical Association of the State of Alabama (MASA). She is most proud of being a wife and mother to four amazing adults and a grandmother to three.
Dena Stoner
Dena Stoner
Senior Policy Advisor
Department of State Health Services
Dena Stoner, Director of Innovation Strategy for the Texas Health and Human Services Commission’s Intellectual and Developmental Disabilities / Behavioral Health Division, has over 40 years of policy, design and implementation experience, including long term services, acute medical care, managed healthcare and behavioral health. She currently concentrates on behavioral health, directing research and demonstration projects and making systemic changes to the state’s Medicaid program. Her work has been featured in peer-reviewed publications. Some of her current projects include the state’s Money Follows the Person behavioral health pilot and a randomized trial of self-direction for adults with serious mental illness. She also chairs the National Association of State Mental Health Program Directors’ Finance Policy Division, serves on the National Research Institute’s Board of Directors, is a member of the Executive Committee of the National Academy for State Health Policy (NASHP) and chairs NASHP’s Long Term and Chronic Care Committee.
Jason McGill
Jason McGill
Assistant Director, Medicaid Program Operations & Integrity
Washington State Health Care Authority
Jason serves the state through public leadership for our Medicaid program, including joint stewardship of the program key elements such as Medicaid managed care oversight and program integrity. Working across divisions, he is leading managed care strategic planning and working on establishing performance metrics along with other major tasks of managing this large program. He previously served two Governors for Washington state as senior health policy advisor. He led the Governor’s health and related strategic vision, goals and policy initiatives, including long term care. His service has spanned critical times during the deep recession to implementing the Affordable Care Act that has resulted in expanded Medicaid and exchange health coverage to over 800,000 people in Washington. He also currently serves on the NASHP board and a member of the long term care committee.
Mike McCormick
Mike McCormick
Aging & People with Disabilities Interim Director
Oregon Department of Human Services
With more than two decades of state service, and a majority of those with the Department of Human Services, Mike McCormick has extensive knowledge of the agency’s program structure, client needs and policy guidelines.
Mike served as the Deputy Director of the Aging and People with Disabilities program in 2012 and from December 2015 to October 2019, when he assumed the Interim Director position. Mike was a key leader in securing approval for Oregon’s 1915(K) State Plan Option. He then used these tools to dramatically expand the percentage of individuals receiving services in their own home.
Prior to his work with Aging and People with Disabilities, Mike led the Department’s Office of Rates, Contracting and Research. During his tenure, Mike provided leadership on financial management, effective use of data in administering programs and establishing fair, competitive rates for long-term care providers.
During his leadership role for the Provider Audit Section, Mike adopted a data analytics approach towards assessing risk of errors, fraud and abuse in Oregon Health Plan’s medical programs. Under Mike’s leadership, millions of tax dollars were recovered and ultimately were used to fund needed services for Oregonians.
Originally from Baltimore, Maryland, Mike graduated from University of Oregon with a BS in Business Administration.
Patti Killingsworth is an Assistant Commissioner for TennCare and the Chief of Long-Term Services & Supports (LTSS). She is a nationally recognized leader and highly sought-after expert and adviser in home and community-based services (HCBS), managed long-term services and supports (MLTSS), value-based purchasing for LTSS, and initiatives to improve care for beneficiaries dually eligible for Medicare and Medicaid. She has worked in Medicaid programs for over two decades, leading system redesign initiatives in multiple states. Her commitment is to transforming LTSS systems to better meet the needs of older adults and people with disabilities and their families, promoting the development and expansion of cost-effective HCBS options, and ensuring that that the voice and perspective of older adults, people with disabilities, family members, and other key stakeholders is brought to bear in policy and program decision-making processes.
Ashley Harrell
Ashley Harrell
Senior Program Advisor
Department of Medical Assistance Services, Virginia
Ashley Harrell is the Senior Program Advisor in the Behavioral Health Division at the Virginia Department of Medical Assistance Services. Ashley’s role in the Virginia Medicaid agency in most recent years was leading the implementation of the transformation of the Medicaid Substance Use Disorder (SUD) treatment services – “Addiction and Recovery Treatment Services or ARTS”. ARTS has been recognized nationally as the model for States implementing SUD Demonstration Waivers. Ashley is also the Project Director for Virginia’s Section 1003 Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. Virginia is one of fifteen states awarded the Grant to increase SUD treatment and recovery provider capacity. Prior to this, Ashley managed the Maternal and Child Health Division at the Medicaid agency to improve access to and enhance services for women and children eligible for Medicaid. Ashley is licensed in Clinical Social Work in Virginia, with degrees both in Master’s and Bachelor’s in Social Work from Virginia Commonwealth University.
Jeffrey Hayden
Jeffrey Hayden
Senator
State of Minnesota
Sessions:
Wednesday Plenary: Legislatures Confront the Pandemic’s Aftershock – High Unemployment, Less Revenue, and Ongoing Health Threats
Senator Jeff Hayden was first elected to the Minnesota Senate in 2011 after serving in the state House of Representatives for four years. Sen. Hayden is the ranking DFL member on the Senate Human Services Reform committee; he also serves on the Commerce, Health and Human Services, and Finance committees. Hayden was elected by his peers as Assistant DFL Leader in 2016.
Senator Hayden has advocated for progressive policies in his community for decades and has been at the forefront of economic justice and health care issues throughout his legislative career. He authored the statewide minimum wage increase and helped pass a guaranteed school lunch program for all children regardless of their families’ ability to pay. He has pushed for enacting a single-payer health care system to expand access to affordable health care and has continually advocated for increased funding of Child Care Assistance Programs. He also authored the African American Family Preservation Act, which would protect the best interests of children and promote the stability and security of African American families. In 2015, Sen. Hayden co-chaired the Senate’s first Select Committee on Disparities and Opportunities which has invested more than $100 million into communities of color. And after more than 30 years, Senator Hayden was successful in securing the first increase in the Minnesota Family Investment Program since 1986. In 2019, Jeff authored and successfully passed legislation that removes certain racial restrictive covenants from housing deeds in the Twin Cities.
Joe Flores
Joe Flores
Deputy Secretary of Finance
Virginia Office of the Governor
Joe was appointed Deputy Secretary of Finance in January 2018. He provides guidance to the Governor and Secretary of Finance on a range of fiscal policy issues especially those related to Health and Human Resources (HHR). Joe is currently heading up efforts to identify, monitor, track, and provide counsel on expenditures from federal stimulus bills to address the impact of COVID-19 in Virginia. He helped lead Governor Northam’s successful Medicaid expansion efforts that included strategic planning, policy design, fiscal analysis, stakeholder engagement, legislative negotiations, and communications. Joe previously served as Deputy Secretary of HHR for Governor Terry McAuliffe.
For two decades, Joe was a fiscal analyst serving legislators in Texas, Minnesota, and Virginia on the breadth of fiscal policy issues in health and human resources. As a non-partisan legislative fiscal analyst, he was a resource to lawmakers, agency officials, advocacy groups, the media, and the public on issues related to health care, social services, public health, behavioral health, developmental disabilities, children and adult services.
Sarah Emond
Sarah Emond
Executive Vice President and Chief Operating Officer
Institute for Clinical and Economic Review
With over 20 years of experience in the business and policy of health care, Sarah leads the strategic operations of the Institute for Clinical and Economic Review, a leading non-profit health policy research organization, as Executive Vice President and Chief Operating Officer.
Prior to joining ICER, Sarah spent six years in the corporate communications and investor relations department at a commercial-stage biopharmaceutical company, and several years with a health care communications firm. Sarah began her career in clinical research at Beth Israel Deaconess Medical Center in Boston.
Sarah holds a Master of Public Policy degree with a concentration in health policy from the Heller School at Brandeis University and received a bachelor’s degree in biological sciences from Smith College. Sarah speaks frequently at national conferences on the topics of prescription drug pricing policy, comparative effectiveness research, and value-based health care.
Stacie Dusetzina
Stacie Dusetzina
Professor
Vanderbilt University School of Medicine
Stacie Dusetzina is an Associate Professor of Health Policy and Ingram Associate Professor of Cancer Research at Vanderbilt University School of Medicine. She is a health services researcher focusing on the intersection between health policy, epidemiology, and economics related to prescription drugs. She received her PhD in Pharmaceutical Science from the University of North Carolina at Chapel Hill (UNC) in 2010 and post-doctoral training at the Department of Health Care Policy at Harvard Medical School in 2012.
Dr. Dusetzina’s work focuses on prescription drug prices and affordability for consumers, with a special focus on high-priced or complex drugs. Her body of work has led to her participation in the President’s Cancer Panel’s workshops on Access to Cancer Drugs, her appointment to a National Academies of Sciences, Engineering, and Medicine committee on Ensuring Patient Access to Affordable Drugs, and testifying before the Senate Aging Committee on the same topic in 2019.
Shannon Dowler
Shannon Dowler
Chief Medical Officer
North Carolina Medicaid, Division of Health Benefits, North Carolina Department of Health and Human Services
Dr. Dowler joined NC DHHS as the Chief Medical Officer for North Carolina Medicaid in 2019. Her past experience with Medicaid includes chairing the Physician Advisory Group for Medicaid (an independent legislated non-profit whose sole purpose is advising Medicaid on clinical policy) for many years. In the COVID pandemic she has led efforts across DHHS related to Telehealth and Health Equity with a focus on increasing testing in Historically Marginalized Populations.
Dr. Dowler obtained her medical degree from East Carolina (Brody) School of Medicine and completed a Family Medicine Residency and Fellowship in Asheville at MAHEC. She has spent her career in the service of non-profits including: the local health department providing full spectrum care (OB without deliveries) as well as a long standing role in the STD clinic, as CMO for a large FQHC in WNC, and most recently served as Associate Chief Quality Officer and Chief of Community Medicine for Mission Health System.
Steven Costantino
Steven Costantino
Director of Healthcare Reform and Financing
Delaware Health and Social Services
Steven M. Costantino is currently the Director of Health Care Reform for the Delaware Department of Health and Social Services. His emphases is on driving payment and delivery transformation to more value-based and integrative care models across multiple payers of services. He is actively engaged in the development and implementation of a health care quality and cost benchmark for the State of Delaware Department of Health and Social Services. He was the lead on approval of a 1332 waiver application to CMS for reinsurance. He is also actively involved in the development of an MCO/ACO application process for Medicaid.
As Commissioner and of the Department of Vermont Health Access and Medicaid Director (2015-2017), he provided leadership and strategy for many of Vermont’s expansive Health Care Reform
As Secretary of the Executive Office of Health & Human Services (2011-2015), he applied his extensive experience in government and a variety of fields relating to health and human services to improve the quality of life of Rhode Island residents.
He was elected to the Rhode Island House of Representatives from 1995 to 2010. He was appointed to the House Committee on Finance in 1999 and rose to the position of Chairman in 2004, retaining that leadership position for seven years.
He was Executive Director of the Drug and Alcohol Treatment Association of RI from 1986 to 1995.
He is a graduate of Dartmouth College obtaining a Masters in Health Care Delivery Science, class of 2020.
Eileen Cody
Eileen Cody
State Representative,
Washington’s 34th District Washington State House of Representatives
Representative Eileen Cody was raised on her family’s farm in Iowa. After graduating from high school, Eileen earned an Associate’s degree in nursing from the College of Saint Mary and a Bachelor of Science degree in nursing from Creighton University.
Eileen recently retired after working at Kaiser Permanente (formerly Group Health Cooperative) in Seattle for the past forty years. In addition to her work at Kaiser Permanente, Eileen is a founding member of District 1199 NW/SEIU Hospital and Health Care Employees Union.
First appointed and subsequently retained to the House of Representatives in 1994, Eileen has dedicated her legislative career to achieving affordable, quality healthcare for all residents of Washington state. Eileen currently serves as chair of the House Health Care and Wellness committee. Most recently, Eileen was instrumental in the creation and passage of Cascade Care, Washington state’s public option plan.
Emma Chacon
Emma Chacon
Operations Director
Division of Medicaid and Health Financing, Utah Department of Health
Emma Chacon is the Operations Director with the Division of Medicaid and Health Financing, Utah Department of Health. This position serves as a deputy to the State Medicaid Director. In her role, Ms. Chacon oversees, all aspects of Utah’s Medicaid and CHIP programs including the claims processing, program integrity, coverage and reimbursement policy, eligibility policy, managed care, and long term services and supports.
Prior to her current position, Ms. Chacon served as an Assistant Director for the Division and as the Director of the Bureau of Managed Health Care. In this position she was responsible for the administration of managed health care for physical, behavioral and dental health for both Medicaid and CHIP for the State of Utah. During her tenure the State of Utah implemented Medicaid reform through the creation of Medicaid Accountable Care Organizations. She is also part of Utah’s team to implement Medicaid expansion.
Prior to joining the Department of Health in 2005, Ms. Chacon served as the Director of the Office of Recovery Services, Utah Department of Human Services which is the Child Support Enforcement agency for the state of Utah. Ms. Chacon served in this capacity for 12 of her 29 years with the Utah Department of Human Services.
Dean Rosen has played a leading role in developing and advancing health policy for more than 20 years. He has a deep understanding of America’s complex health care system and an equally intimate knowledge of politics and process. A partner at Mehlman Castagnetti, Dean joined the firm to direct its health care practice in September 2005 after five years as the chief health care advisor to Senate Majority Leader William H. Frist (R-TN). Dean has held senior positions in both the U.S. Senate and the House of Representatives, serving in the Congressional Leadership as well as on key health care committees. He also served in several senior positions with the Health Insurance Association of America. He has helped shepherd through Congress major legislation involving a variety of policy areas, including Medicaid and Medicare reform, FDA regulation, health insurance coverage and health
care quality. Throughout his career, he has forged strong working relationships with key decision-makers on both sides of the political aisle in Congress and within the broader health policy community.
Chris Jennings
Chris Jennings
Founder and President
Jennings Policy Strategies Inc.
Chris Jennings is a decades-long health policy veteran of the White House, the Congress and the private sector. He served President Obama as Deputy Assistant to the President for Health Policy and Coordinator of Health Reform, and in a similar capacity in the Clinton White House for nearly eight years. In his decade with the U.S. Senate, he served as the Deputy Director of the Special Committee on Aging for three Senators (Glenn, Pryor, and Melcher). He also served in a major role for the U.S. Bipartisan Commission on Comprehensive Health Care. Mr. Jennings has advised eight Presidential campaigns, the 2008, 2016 and 2020 Democratic Platform Drafting Committees, and multiple gubernatorial and Senate candidates. Jennings Policy Strategies (JPS) is a nationally respected health care consulting firm committed to assisting foundations, purchasers, health systems, and aligned stakeholders develop policies to ensure higher quality, more affordable and sustainable health care.
Richard Figueroa
Richard Figueroa
Deputy Cabinet Secretary
Office of California Governor Gavin Newsom
Richard Figueroa is a Deputy Cabinet Secretary in the Office of Governor Gavin Newsom where he is responsible for health and human services issues. He was previously the Director of Prevention and the Affordable Care Act for The California Endowment. He has served twice previously in the California Governor’s Office, where he was a Deputy Cabinet Secretary and Health Care Advisor for Governor Arnold Schwarzenegger and Deputy Legislative Secretary for Governor Davis where he was responsible for health care, human services and health insurance issues.
Erika Ferguson
Erika Ferguson
Director of the Office of Healthy Opportunities
North Carolina Department of Health and Human Services
Erika Ferguson serves as the Director of the Office of Healthy Opportunities for the NC Department of Health and Human Services. In this role, she leads the Department’s comprehensive strategy to effectively deliver health, not just health care by addressing the medical and non-medical drivers of health including housing, food, transportation and interpersonal safety. Erika started her career managing a homeless shelter in the Mississippi Delta and has since served in a variety of capacities across health care and human services including positions at Duke University and the World Health Organization. Erika holds a BS in Public Health from the University of North Carolina Gillings School of Global Public Health and Duke University and a Master of Public Policy from the Harvard Kennedy School of Government.
Chris DeMars
Chris DeMars
Transformation Center Director
Oregon Health Authority Transformation Center
Chris DeMars, MPH, is the Director of the Oregon Health Authority (OHA) Transformation Center and the Deputy Director of OHA’s Delivery System Innovation Office. In addition, she plays a lead role in the agency’s value-based payment and social determinants of health work. Before joining the OHA in 2013, Chris spent eight years as a senior program officer at the Northwest Health Foundation, where she managed the foundation’s health care reform grant making. Prior to working for the foundation, Chris spent six years as a senior health policy analyst for the U.S. Government Accountability Office, contributing to numerous reports for Congress on Medicaid, Medicare and private health insurance payment policy. Chris has also held positions at Kaiser Permanente Northwest and health-policy consulting firms, including Health Management Associates, and she began her career as a policy analyst intern at Indiana’s Office of Medicaid Policy and Planning. Chris holds a Master of Public Health degree from the University of Michigan School of Public Health and a bachelor’s degree in English literature from the University of Michigan.
Ms. Dickerson has over 30 years of experience in the field of public health and strategic policy development. Currently, she serves as Bureau Chief for Long-Term Services and Supports in the Ohio Department of Medicaid since 2017. Her primary focus is to develop and implement state Medicaid policies in the areas of nursing and intermediate care facilities, home and community-based waivers, maternal and child health and developmental disabilities. Ms. Dickerson also coordinates with the Centers for Medicare and Medicaid Services and interpret federal guidelines, draft legislative language and perform comparative analysis to determine the most appropriate delivery of services for individuals and families. Previously, she was Section Chief for Interagency Policy in the Ohio Department of Medicaid 2011-2017, Project Manager for the Ohio Department of Job and Family Services 2010-2011; Chief of Human Resources for the Ohio Office of Budget and Management 2008-2010; Assistant Director for the Ohio Tobacco Prevention Foundation from 2003-2008 and held various management positions within the Ohio Department of Health 1990-2003; and she also worked as a contract administrator with the federal government from 1988-1990. Ms. Dickerson has extensive experience in administering health services programs through collaborative partnerships with state agencies, local health departments, managed care organizations, hospitals, pharmacies and community-based organizations. In addition, she has been instrumental in creating non-traditional health education programs for under-served populations and has been nationally recognized for her statewide leadership in the implementation of efforts in high-risk communities. Ms. Dickerson holds a Masters degree in Health Services Administration from Central Michigan University and a Bachelor’s degree in Health Education from Otterbein University, Westerville, Ohio.
Marie Ganim
Marie Ganim
Health Insurance Commissioner
State of Rhode Island
Marie Ganim, Ph.D., is the Health Insurance Commissioner for the State of Rhode Island. In this role, she ensures the solvency of health insurers, protects consumers, encourages the fair treatment of providers, and works to improve health care quality, accessibility, and affordability. The Office of the Health Insurance Commissioner was created in 2005 to oversee both health insurance regulation and health policy for the state. Addressing the cost of health care through alternative payment and delivery models has been the focus of the Office’s reform agenda.
Cindy Gillespie
Cindy Gillespie
Secretary Arkansas Department of Human Services
State of Arkansas
Cindy Gillespie was appointed secretary of the Arkansas Department of Human Services by Governor Asa Hutchinson in March of 2016. She oversees Medicaid, child welfare, juvenile justice and other programs that support the well-being of the state’s most vulnerable populations. Her previous career includes serving as a principal at the multinational law firm Dentons where she led the Health Policy and Health Insurance Exchange Teams, as an advisor to Massachusetts Governor Mitt Romney on health policy and federal programs, and as senior management for both the Salt Lake and Atlanta Olympic Games.
Jean is a Registered Nurse that has over 30 years in hospital, home care and hospice administration. She holds a masters of science degree in nursing as a clinical nurse specialist and masters degree in hospital administration. She is currently completing her 20th year in the South Dakota State Legislature serving in both House and Senate. She has served on Health and Human Services Committee, chairing for four years in the Senate, Judiciary Committee and Local Government. She has served ten years on Joint Appropriations Committee serving as the Senate Chair. She currently is Vice Chair of House Appropriations and Chair of the Interim Rules Committee. She is a member of the RSG Steering Committee and serves on the Executive Committee for NCSL. She is a small business owner/operator of a Sports Bar and a Fitness Center and operates a small farm operation. She is married and has four children and six grandchildren.
Heather Korbulic
Heather Korbulic
Executive Director
Silver State Health Insurance Exchange
Heather Korbulic is the Executive Director of the Silver State Health Insurance Exchange, Nevada’s state agency that runs and operates the online health insurance marketplace known as Nevada Health Link. Heather has over a decade of experience in human service specifically related to health care policy. She specializes in government affairs, public relations, coordinated project management and strategic planning. Under Heather’s direction the Nevada Exchange was the first state to successfully transition functionality away from the platform to operate as a fully autonomous state based exchange. Heather has a degree from the University of Oregon and is a Certified Public Manager.
Kevin Patterson
Kevin Patterson
Chief Executive Officer
Connect for Health Colorado
Kevin Patterson has served as Chief Executive Officer of Connect for Health Colorado since April of 2015. He previously served as chief administrative officer and interim chief of staff to Gov. John Hickenlooper and has an extensive history of public service. Kevin brings a strong understanding of local, state, and federal government and stakeholder engagement to this role. For his time at Connect for Health Colorado, Kevin has been focused on improving the customer experience so they can focus on health insurance with tax credits implications. Kevin has held many senior leadership roles for the city and county of Denver. He was elected to the Denver Board of Education in 2001 and 2005. Kevin graduated with a B.A. in Teaching from Sam Houston State University and holds both a Master’s of Public Administration and a Master’s of Urban Regional Planning from the University of Colorado at Denver. Kevin is known as a collaborative non-partisan problem solver for Colorado issues.
Jennifer Sullivan
Jennifer Sullivan
Secretary
Indiana Family and Social Services Administration
Jennifer Sullivan, M.D., M.P.H. was appointed as Secretary of the Indiana Family and Social Services Administration by Governor Eric J. Holcomb effective January 9, 2017. Prior to this appointment, she served as the Deputy State Health Commissioner and Director for Health Outcomes at the Indiana State Department of Health. Dr. Sullivan is currently a Professor of Clinical Emergency Medicine and Pediatrics at Indiana University School of Medicine. She served as the Division Chief for Pediatric Emergency Medicine and was the Program Director for the Emergency Medicine and Pediatrics Residency from 2007-2015. Dr. Sullivan continues to work clinically in the Riley Hospital for Children Emergency Department.
She earned her undergraduate degree from the University of Houston Honors College and her Masters in Public Health at the Richard Fairbanks School of Public Health at Indiana University. She earned her Medical Doctorate at Indiana University School of Medicine and is board certified in Emergency Medicine and Pediatrics.
Dr. Sullivan is dedicated to building effective and efficient delivery of health care and social services to Hoosiers. She takes a public health approach to policy decisions and is committed to strategic alignment across government and the private sector to improve health outcomes and fill unmet social needs. She was recognized in 2019 as the recipient of the APHSA Friedman Health and Human Services Impact Award and is a 2017 Indianapolis Business Journal Woman of Influence.
FSSA is a health care and social service delivery and integration agency. The mission of FSSA is To compassionately serve our diverse community of Hoosiers by dismantling long-standing, persistent inequity through deliberate human services system improvement.
Judy Theriot
Judy Theriot
Medical Director
Kentucky Department for Medicaid Services
Judith Ann Theriot, MD, CPE, is the Medical Director for the Kentucky Department for Medicaid Services and has served in that capacity since May 2019. Prior to that, she was the Commission for Children with Special Health Care Needs’ Medical Director from July 2013 through May 2019. Dr. Theriot attended medical school at the University of Louisville (UofL) then went on to complete her Pediatric residency and a chief resident year before joining the faculty at UofL. Dr. Theriot served as the director of the General Pediatrics Clinical Research Unit and prior to that as the medical director of the Children and Youth Project; a multidisciplinary primary care clinic serving the inner-city high-risk children of Louisville Kentucky. Dr. Theriot is a certified physician executive and is a professor of Pediatrics at UofL. In addition to her administrative duties with Medicaid, she continues to see patients weekly in clinic at UofL and teach pediatric residents.
Marylou Sudders
Secretary
Executive Office of Health and Human Services
Marylou Sudders serves as the Secretary of Health and Human Services for the Commonwealth of Massachusetts, overseeing 12 agencies and MassHealth, with a combined budget of $24 billion and 22,000 public employees delivering essential services that touch the lives of 1 in 4 state residents. Since joining Governor Baker’s cabinet in January 2015, Sudders has advanced strategic policy priorities, including: restructuring MassHealth into a population-based health coverage system, reforming the child welfare system, addressing the opioid epidemic, integrating physical and behavioral health care, and strengthening community-based services. Sudders co-chairs the Governor’s Interagency Council on Housing and Homelessness, the Governor’s Interagency Council on Aging, and chairs the Autism Commission and the board of Massachusetts Health Connector, the state’s health insurance marketplace. Sudders has held leadership roles across the public and private sectors, including serving as the Massachusetts Commissioner of Mental Health, a non-profit CEO, and associate professor and program chair at Boston College School of Social Work, a top ten nationally-ranked program. Sudders holds a bachelor’s degree with honors and a master’s degree in social work from Boston University, and honorary doctorates from the Massachusetts School of Professional Psychology and Bridgewater State University. She is the recipient of many civic, social work, and professional honors.
Tim Peterson test
Speaker
Tim has over 20 years of experience implementing state government systems, including end-to-end management of the entire software development lifecycle from contract negotiations and project initiation, through implementation, certification, and post-production operations. For the past several years, Tim has serves as the project manager for Montana Program for Automating and Transforming Healthcare (MPATH) initiative. The MPATH project is replacing Montanas 33 year old legacy Medicaid Management Information System (MMIS) using a modular strategy leveraging existing COTS/SaaS solutions. Tim led the development of Montanas modularity replacement strategy that resulted in the Modularity Blueprint for the replacement of the remaining legacy components supporting the Montana Healthcare Programs. Additionally, he recently led the implementation of the Departments Population Health Data Analytics module to support Montanas Medicaid program.
Mark Greenberg
Speaker
Mark Greenberg is a Senior Fellow at the Migration Policy Institute in Washington, D.C. His work focuses on immigration issues affecting children and families and implications of immigration enforcement and policy for health and human services programs and agencies.
From 2009-17, Mr. Greenberg worked at the federal Administration for Children and Families (ACF) and was ACF Acting Assistant Secretary from 2013-17. ACF includes the Office of Refugee Resettlement and a wide range of other programs assisting low-income and vulnerable children, families and communities. Previously, Mr. Greenberg was Executive Director of the Georgetown Center on Poverty, Inequality and Public Policy; Executive Director of the Center for American Progress’ Task Force on Poverty; Director of Policy for the Center for Law and Social Policy; and a legal services lawyer at the Western Center on Law and Poverty and Jacksonville Area Legal Aid.
Marie Zimmerman oversee and lead the major functions Minnesotas Medicaid program, Medical Assistance, and its Basic Health Plan, MinnesotaCare, the program which provide health coverage to 1.2 million Minnesotans. This includes: agency-wide Medicaid policy development and implementation; Centers for Medicare & Medicaid Services (CMS) federal relations; health care program eligibility policy and operations (state-run and county oversight); benefits policy; pharmacy benefit management; health services and dental services advisory committees; managed care contracting, provider rate-setting; purchasing strategies and delivery systems reforms; enrollee and provider customer service; provider enrollment and training; provider claims payment; and benefit recovery and program integrity functions.
Most recently Zimmerman has been working as a Vice President at Hennepin Healthcare, but prior to that she served as Minnesotas State Medicaid Director for 4 years, and several roles at DHS over the past decade that included leading the development and launch of the departments purchasing reform initiatives including direct provider contracting through the Integrated Health Partnership program, managed care organization oversight and purchasing reforms, and integrated managed care products for seniors and people with disabilities. Additionally, Zimmerman served as the Health Care Administration policy director, deputy director of managed care and payment policy division and as the budget and legislative director.
Thomas Novak
Speaker
Thomas Novak is the Medicaid Interoperability lead in the Office of Policy at ONC where he supports the advancement of Medicaid interoperability in the drafting and review of federal regulations. He is detailed part time to the CMS Medicaid Data and Systems Group where he provides direct support to State Medicaid agencies and state governments on Health Information Exchange funding and strategy.
Virginia Dize is Co-Director of the National Aging and Disability Transportation Center (NADTC) and Program Director at the National Association of Area Agencies on Aging (n4a). She has more than thirty years’ experience in Aging programs, the last 10 years focused on transportation for older adults and people with disabilities. Prior to joining the staff of n4a, she served as an Associate Director of the National Association of State Units on Aging. Ms. Dize oversees n4a’s transportation initiatives, including work on the Inclusive Coordinated Transportation Partnership project funded by the U.S. Administration for Community Living (ACL) and she previously served as co-director of the National Center on Senior Transportation (NCST; 2008-2015). She has managed several rounds of demonstration grants under the NCST and NADTC. She has a Master of Science degree in Gerontology from Virginia Commonwealth University and a Bachelor of Arts degree in American History from Mary Washington College.
Tara Murphy is the Deputy Director of DSRIP Statewide Investments at MassHealth. Since January 2017, she has led the design, roll out, and management of a $115 million portfolio of Statewide Investment programs aimed advancing Massachusetts efforts to transform healthcare payment and care delivery and improve health outcomes for its MassHealth population. Prior to MassHealth, Tara served as the founding Administrative Director for the Kraft Center for Community Health Leadership at Partners HealthCare, a then-new entity focused on improving access to high quality healthcare in traditionally underserved communities by strengthening the workforce in community health centers. She previously held leadership roles in global health, first at the Harvard T.H. Chan School of Public Health and then at the Clinton Health Access Initiative. She has also consulted at numerous community health centers and nonprofits.
Tara is a Board member at ParentChild+, a national nonprofit that uses early education and home visiting to help families build a brighter future for their children and themselves. She holds an MPH from Boston University School of Public Health and an MBA from the MIT Sloan School of Management.
Dr. Tisha Holmes is an Assistant Professor in the Department of Urban and Regional Planning at Florida State University. She conducts interdisciplinary work on planning for hazards and risks in order to reduce physical and social vulnerabilities and seek ways to build resilience in vulnerable, marginalized communities. Her research also emphasizes active community participation in research, education and decision-making processes to address the present and potential impact of climatological risks.
Holmes is collaborating with researchers in FSU Geography and the Center for Climate Ocean Atmospheric Prediction Studies (COAPS) to evaluate efforts of climate change adaptation planning in US local public health agencies and their engagement with vulnerable populations through the CDC’s Building Resilience Against Climate Effects (BRACE) program. She is also conducting research on adaptation approaches to sea level rise in Florida and developing work on climate resilience planning in the Caribbean.
Joe Bryant is currently the Health Care Policy Advisor to Governor John C. Carney (Delaware). Joe has been in his current position since 2017. During his time in the Carney Administration, Joe has successfully championed many of the Governor’s top health policy initiatives. In addition to his work in the Governor’s Office, he serves as a Captain in the Delaware Army National Guard.
Joe graduated with a B.A. from Maryville College (TN) in 2008. As a senior, he successfully defended his thesis paper, “Concussions in sports: How educated are athletes about this diagnosis?” In 2012, he graduated from the University of Maryland Eastern Shore, with a M.S. in Rehabilitation Counseling.
Prior to his current position, Joe worked as a Constituent Relations Liaison during Rep. John Carney’s time in the U.S. House of Representatives. He was Rep. Carney’s liaison for matters concerning the Centers for Medicare and Medicaid Services and Social Security Administration. In addition, Joe has several years of experience as a professional mental health counselor.
Wilmarie González has been working for almost 14 yrs. as a PA public servant, first with the Department of Aging, and now with the Department of Human Services as a top executive collaborating with local, state and federal agencies. Wilmarie has represented the state before legislative and executive branches in strengthening advocacy systems. Wilmarie has led teams in state studies and evaluations on elder abuse, financial exploitation, and guardianship issues impacting the aging population; Wilmarie has been a featured speaker at local, state and national forums covering topics from advocacy, protection, quality strategy, performance measures, and state funded programs.
Wilmarie is leading the new MLTSS Community HealthChoices programs quality strategy impacting Medicaid and Medicare services for the dual population. It includes establishing sound quality components that include early implementation strategy, performance measures, performance improvement projects, long-term evaluation while collaborating with internal and external stakeholder engagement.
Wilmarie has served as a board member in national, state and local organizations influencing public policy, education, older adults, and the arts. Former member of the PA Supreme Court Elder Law Task Force and Advisory Council on Elder Justice in the Courts, and current member of the PA Judicial Conduct Board.
Wilmarie is a graduate of Rosemont College with a Masters in Management, and Eastern University with a Bachelors in Organizational Management.
Tom Curtis
Speaker
Tom Curtis serves as the manager of Quality Improvement and Program Development for Medicaid managed care at the Michigan Department of Health and Human Services (MDHHS). In this role, he is responsible for establishing, administering, and evaluating Michigans managed care performance monitoring, improvement, and innovation activity in Medicaid. This role includes supporting the department’s Health Equity, Social Determinants of Health, Payment Reform, and Behavioral/Physical Health Integration policy efforts in the Medicaid managed care program. Tom worked previously as the State Administrator for Michigan’s State Innovation Model (SIM) project, and as a Senior Quality Analyst with the MDHHS Managed Care Plan Division, where he developed performance improvement partnerships with Medicaid health plans. Tom worked for many years on local community engagement and organizing efforts before joining MDHHS.
Kierra Barnett
Speaker
Kierra S. Barnett is a PHD candidate in the College of Public Health at The Ohio State University and a Graduate Research Associate at the Kirwan Institute for the Study of Race and Ethnicity. Kierra’s work focuses on the impact of social determinants of health (i.e. socioeconomic conditions, education, and natural, built and social environments) on racial and ethnic health disparities. Her dissertation research specifically explores John Henryism (an active coping mechanism against stressors), socio-economic status, and health disparities among Blacks.
Having joined the Kirwan Institute in 2013, Kierra has collaborated with state, county and city public health departments, as well as non-for-profit organizations, to assess health outcomes, such as infant mortality, and make policy and practice-based recommendations to address the disparities. After completing her doctoral degree, she intends to continue her scholarship to better understand health among Black populations across the socio-economic gradient.
Kierra also holds a Masters of Public Health from OSU and a Bachelors of Science in Community Health from the University of Illinois.
Chris Taylor is the Chief Inclusion Officer for the state of Minnesota. In his role, he facilitates change across the state system of government, creating more inclusive state agencies and promoting equity in state programs and services.
Taylor received his Bachelor’s degree from the University of St. Thomas and a Master’s degree from the Cooperstown Graduate Program for Museum Studies. He is currently working on a Doctorate of Education in the Organization Development and Change program at the University of St. Thomas.
Aletha Maybank, MD, MPH recently joined the AMA in April 2019 as their inaugural Chief Health Equity Officer and Vice President. Her role is to embed health equity in all the work of the AMA and to launch a Center for Health Equity.
Prior to this in 2014, Dr. Maybank became an Associate Commissioner, and later a Deputy Commissioner, and lunched the Center for Health Equity, a new division in the NYC Department of Health and Mental Hygiene geared toward strengthening and amplifying the Health Department’s work in ending health inequities. Under her leadership, and in a short amount of time, the health department made great strides in transforming the culture and public health practice by embedding health equity in the health department’s work. This work has been recognized and adapted by other City agencies and has captured the attention of the CDC and WHO.
She also teaches medical and public health students on topics related to health inequities, public health leadership and management, physician advocacy, and community organizing health. Currently, Dr. Maybank serves as President of the Empire State Medical Association, the NYS affiliate of the National Medical Association. In 2012, she co-founded “We Are Doc McStuffins,” a movement created by African-American female physicians who are inspired by the Disney Junior character, Doc McStuffins.
Dr. Maybank holds a BA from Johns Hopkins University, an MD from Temple University School of Medicine, and an MPH from Columbia University Mailman School of Public Health. She is a pediatrician and board certified in Preventive Medicine and Public Health.
Dee Jones is the Executive Director of the North Carolina State Health Plan, which provides health care coverage to more than 725,000 teachers, state employees, retirees and their dependents. Jones has responsibility for the day-to-day strategy and operations of the Plan, working closely with the State Treasurer and the Plan’s Board of Trustees to monitor the financial condition of the Plan, implement quality improvements and maintain cost-effective programs for Plan members.
Before joining the Plan in 2017, Jones held executive leadership roles within the State at NC Department of Health and Human Services and NC Department of Administration. In addition, her private sector senior leadership experience across strategic operations and financial roles includes 11 years with Time Warner Cable and six years at Siemens Energy & Automation.
Dee holds an M.B.A./Accounting degree from the University of Phoenix and B.A. degrees in Accounting and Business Management from NC State University.
Elisabeth Arenales has been the Senior Policy Advisor on Health for Governor Jared Polis since January 2019. Prior to working for Governor Polis, she spent twenty years as the Health Program Director for the Colorado Center on Law and Policy. CCLP is Colorado’s unrestricted legal services program and focuses on family economic security. Elisabeth is recognized as a health policy expert and has a strong track record of protecting, preserving, and expanding access to health care, particularly for lower-income Coloradans. She has helped to shepherd legislation and programs that increased coverage, reduced health access barriers and led to significant changes in the Colorado health landscape.
Lisa Beauregard is the Director of the Home and Community Based Services Policy Lab at the Massachusetts Executive Office of Elders Affairs where she previously served as a research analyst. She competed a Ph.D. in Public Policy at the John W. McCormack Graduate School of Policy and Global States at the University of Massachusetts Boston in 2019. Previously, Dr. Beauregard received a Masters in International Political Economics from The Catholic University of America and a Bachelors of Arts, cum laude, in Political Science, from the College of the Holy Cross.
Jessica Rhoades
Speaker
Jessica Rhoades is an accomplished health care policy and advocacy leader with broad expertise and experience in Medicaid, the Affordable Care Act, health insurance and payment and delivery system reform. She has served as health care policy advisor to two governors. She also served as Policy Director for the Montana Department of Public Health and Human Services, where she oversaw the state’s Affordable Care Act and Medicaid expansion and served as Montana’s State Innovation Model Design Director, resulting in Montana’s largest ever public-private value-based payment initiative. Her work in the private sector includes working in public affairs for a national health care provider covering 14 states. Most recently, Rhoades led the effort to pass Montana’s reinsurance legislation and waiver submission.
Erica Phillips
Speaker
Ms. Phillips is a business development professional with 30+ years experience helping organizations apply data to solve complex problems.
Erica joined Esri, the global leader in Geographic Information Systems (GIS) 3 years ago as the lead on Federal Health agencies. She works with agencies such as CDC, FDA, NIH and SAMHSA and with State Health Departments applying GIS to address public health issues such as the opioid crisis and access to health care. Erica advocates the idea that Place Matters for Health and utilizes Esris technology to support innovative approaches to public health challenges.
Prior to joining Esri, Erica worked for Nielsen Claritas and VNU/Mediamark focused on developing and supporting data-driven solutions. Highlights include the work she did with the Ohio Department of Health to define food deserts and the communities impacted by them.
A native New Yorker, Ms. Phillips is a graduate of Hunter College with a BA in Economics.
Ellie Hartman, Ph.D., BCBA-D, graduated from the University of Minnesota in Educational Psychology with a concentration in special education where she taught Behavior Analysis and Classroom Management and became a Board Certified Behavior Analyst – Doctorate (BCBA-D). Dr. Hartman was an evaluator for Wisconsin’s SSDI two for one pilot, Wisconsin’s Medicaid Infrastructure Grant (MIG), and the Administration on Intellectual and Development Disabilities (AIDD)’s Partners in Employment grant, called Let’s Get to Work in Wisconsin. Dr. Hartman is currently a Senior Scientist at the University of Wisconsin, Stout Vocational Rehabilitation Institute (SVRI) and is the Project Manager for Wisconsin PROMISE. As the Project Manager for Wisconsin PROMISE, Dr. Hartman, has been coordinating and leading the PROMISE inter-agency leadership and work groups, including facilitating a inter-agency Management Information System (MIS) for PROMISE program evaluation and data analysis. As a Senior Scientist at SVRI, Dr. Hartman works in close collaboration with the faculty and staff at SVRI and University of Wisconsin, Madison Rehabilitation Psychology and Special Education (RPSE).
Chethan Bachireddy is the incoming Chief Medical Officer for the Virginia Department of Medical Assistance Services (Medicaid). He is a physician, researcher, and public servant dedicated to improving health for vulnerable populations. In his new role, he is engaging in efforts related to the opioid epidemic, maternal/child health, value-based payment, and the social drivers of health. Prior to coming to Virginia, he was a National Clinician Scholar at the University of Pennsylvania where his work focused on two areas: 1) improving health for populations with high rates of HIV infection, substance use disorders, mental illness, and justice involvement and 2) applying insights from behavioral economics and clinical trial design to test strategies and technologies to help form healthy habits. He hails from Deep East Texas, studied economics and neurobiology at Harvard, attended medical school at Yale, trained in Internal Medicine at Brigham and Women’s Hospital/Harvard Medical School, and completed a Masters in Health Policy Research at the University of Pennsylvania. He is excited to learn and collaborate to improve the health and well-being of the individuals, families, and communities who call Virginia home.
Jeremy Vandehey, J.D. is the Director of the Health Policy and Analytics Division for the Oregon Health Authority, which is responsible for developing and implementing the state’s vision for health reform. His teams’ work includes policy analysis, health care cost and quality reporting, advancing evidence-based care and best practices, spreading the use of electronic health records, advancing payment reform, and purchasing health care for nearly 300,000 public employees. Before joining OHA, Jeremy served as Health Policy Advisor to Governor Kate Brown. Jeremy previously led government relations for Kaiser Permanente’s Northwest Region and served as the legislative director for OHA during the design and implementation of Oregon’s coordinated care organizations. Jeremy received his Juris Doctor from the University of North Dakota School of Law and his undergraduate degree in public policy and administration from Western Oregon University.
Jaime S. King is the Bion M. Gregory Chair of Business Law and a Professor of Law at the University of California Hastings College of the Law. She is the Associate Dean and Co-Director of the UCSF/UC HastingsConsortium on Science, Law and Health Policy, the Co-Founder and Co-Director of the UCSF/UC Hastings Master’s Program in Health Law and Policy,and the Director of the J.D. Concentration on Law and Health Sciences. She is the Co-Founder and Executive Editor of The Source on Healthcare Price and Competition, a multi-disciplinary web-based resource about healthcare price and competition.Professor King received the Hastings Foundation Faculty Award for Outstanding Scholarship in 2015 and the Best Antitrust and Mergers Article of 2017 at the American Antitrust Institute Annual Meeting with her co-author Erin Fuse Brown.Professor King has testified before Congressional committees on health insurance mergers and price transparency and currently sits on the Board of the American Society of Law, Medicine, and Ethics. She holds a Ph.D. in Health Policy from Harvard University, a J.D. from Emory University, and a B.A. from Dartmouth College.
Carissa Dougherty, LCSW, has over 18 years experience providing direct clinical practice, program management, and policy work. Ms. Dougherty previously managed an array of permanent and transitional supportive housing programs for persons with mental health and substance use issues. She has co-chaired the local homeless Continuum of Care and provided Mental Health First Aid training to hundreds of homeless service and housing providers.
Ms. Dougherty currently serves as Director in the Office of Mental Health Coordination. She leads a team of program specialists and policy analysts responsible for stakeholder engagement, system coordination, and policy initiatives. Prior to this role, she served as a Senior Advisor with a focus on coordinating services to address the housing needs for persons with IDD and behavioral health disabilities, exploring the sustainable financing options for health and housing initiatives, and promoting policies and programs that support such endeavors.
With over 30 years of healthcare experience, Ms. Ledbetter serves as the Chief Data Officer and Chief of the Enterprise Data Operations Branch in the Information Services Division within the California Office of Statewide Health Planning and Development (OSHPD). Ms. Ledbetter serves on the National Association of Health Data Organizations (NAHDO) board of directors. She is an active member of the California Health Information Association (CHIA), and the American Health Information Management Association (AHIMA). Ms. Ledbetter has a bachelor’s degree in Health Information Management from The Ohio State University and holds a Masters in Health Services Administration from St. Mary’s College.
Vanessa Avery was appointed as the Associate Attorney General for Enforcement, Litigation and Investigations by Connecticut Attorney General William Tong in January 2019. She manages all aspects of affirmative enforcement by the office, including multi-district cases involving antitrust and government program fraud, consumer protection, the opioid epidemic, the Affordable Care Act, immigration, the environment, privacy and data security, as well as cases pending locally. Previously, she was an Assistant United States Attorney in the Civil Division of the U.S. Attorney’s Office, District of Connecticut. She handled a broad variety of cases on behalf of the United States, its agencies and employees. Prior to that, she was a Trial Attorney for the Department of Justice Civil Division in Washington, D.C. She also spent over a decade in law firm practice focusing on business and financial litigation. Vanessa earned her degrees at Yale University and Georgetown University Law Center.
Terry Cothran is currently the Director at Pharmacy Management Consultants (a division of the University of Oklahoma College of Pharmacy). His team provides support to the Oklahoma Health Care Authority (state Medicaid agency) in managing the pharmacy benefits for our state Medicaid members. His practice has expanded into areas of Medication Therapy Management, Antibiotic Stewardship, Alternate Payment Models (APMs)/Value-Based Contracting, Academic Detailing, and programs to reduce over prescribing in nursing homes. The APM initiative has gained attention nationally from CMS as the first state Medicaid to initiate an APM intended to reduce prescription and healthcare costs.
Craig Nale is Policy and Legal Director to Senator Troy D. Jackson, the President of the Maine Senate. Craig’s work focuses primarily on the areas of healthcare and health and human services. Craig practiced law at a firm in Portland, Maine, for two years prior to joining the Maine Legislature in 2014. Craig is a graduate of Boston University and the University of Maine School of Law.
Stacey was named Interim Director for the Office of Health Analytics, Oregon Health Authority (OHA), in early 2019. OHA’s Office of Health Analytics is comprised of research, policy, and analytic staff who collect, organize and analyze data which they use to inform efforts to improve Oregon’s health care system. Previously Stacey was the Research and Data Manager within Health Analytics, and before that she managed a team focused on population health data for the Oregon Public Health Division. Stacey received her B.S. in Industrial and Operations Engineering and her Master of Public Health from the University of Michigan.
Ms. Bresaw serves as Program Director for the New Hampshire (NH) Governor’s Recovery Friendly Workplace (RFW) initiative and Vice President of Public Health for Granite United Way. As Program Director, Ms. Bresaw works in close coordination with the Governors Office, the NH Department of Business and Economic Affairs, and the Community Development Finance Authority to administer the initiative. Through this initiative, Ms. Bresaw and her team work to empower employers to challenge stigma and provide supportive work environments for people in recovery and those impacted by substance use disorders. Ms. Bresaw’s role focuses on program development, coordination and alignment, monitoring and evaluation, and sustainability planning. At Granite United Way, Ms. Bresaw oversees public health strategies and initiatives and works to align these efforts with existing collaborations, partnerships, and Community Health Improvement Plans. In addition, Ms. Bresaw provides overall leadership and coordination to statewide public health efforts on behalf of Granite United Way, with a particular focus on addressing NH’s current opioid crisis.
Born and raised in NH, Ms. Bresaw received her Master of Social Work Degree in 2004 from the University of New Hampshire, with a concentration in community and administrative practice. She has worked in the field of public health and substance use disorders since 2004. In her current role, Ms. Bresaw provides ongoing technical assistance and support to key sectors to ensure the use of best practice approaches in public health and prevention. Ms. Bresaw has significant experience in the development of strategic plans, logic models, evaluation plans, and work plans designed to impact crucial public health issues in our communities. Ms. Bresaw currently serves as Co-Chair of the Prevention Task Force of the Governor’s Commission on Alcohol and Other Drugs. She also serves as Vice President to the Board of the NH Public Health Association.
Sarah Finne, DMD, MPH brings over 30 years of experience from both private practice dentistry and public health supervision of a large school-based dental program in New Hampshire to her work in Dental Medicaid. Sarah remains active professionally as a member of the board and immediate past president of the Medicare-Medicaid-CHIP State Dental Association, as a member of the Association of State & Territorial Dental Directors, the ADA, and the International College of Dentists. She supports community oral health access through board membership with the NH Dental Society Foundation and the Greater Derry Oral Health Collaborative Corporation. Sarah holds a DMD degree from the University of Pennsylvania School of Dental Medicine as well as a Master’s in Public Health Administration from the University of Massachusetts-Amherst.
Sarah Brummett, is Director of the Office of Suicide Prevention at the Colorado Department of Public Health and Environment. The Office is legislatively mandated as the state coordinating body for suicide prevention, intervention and postvention efforts. The Office sets statewide priorities and works with state agencies and community organizations to develop and implement effective strategies, including a community grant program, means restriction education initiatives, the Zero Suicide initiative, education and awareness programs, emergency department and hospital outreach and education, the Colorado-National Collaborative, federal grant-funded initiatives, Mental Health First Aid, and a school grant program.
Before joining CDPHE, Ms. Brummett practiced family and appellate law in both Colorado Springs and the Denver Metro area. Ms. Brummett received her JD from the Sturm College of Law, University of Denver and also a Master’s of Forensic Psychology from the Graduate School of Professional Psychology, University of Denver.
Sabrina Corlette is a Research Professor at the Center on Health Insurance Reforms (CHIR) at Georgetown University. At CHIR she directs research on health insurance reform issues. Her areas of focus include state and federal regulation of private health insurance plans and markets and evolving insurance market rules. Prior to joining the Georgetown faculty, Ms. Corlette was Director of Health Policy Programs at the National Partnership for Women & Families, where she provided policy expertise and strategic direction for the organizations advocacy on health care reform, with a particular focus on insurance market reform, benefit design, and the quality and affordability of health care. From 1997 to 2001, Ms. Corlette worked as a professional staff member of the U.S. Senate HELP Committee. After leaving the Hill, Ms. Corlette served as an attorney at the law firm Hogan Lovells, where she advised clients on health care law and policy relating to HIPAA, Medicare and Medicaid, and the Food, Drug and Cosmetic Act.
Ms. Corlette is a member of the D.C. Bar and received her J.D. with high honors from the University of Texas at Austin and her undergraduate degree with honors from Harvard University. She lives in Alexandria, Virginia with her husband and two daughters.
Richard N. Gottfried has chaired the NY State Assembly Health Committee since 1987 and represents a district in Manhattan. He works to expand publicly funded health coverage; protect patient autonomy, especially in reproductive and end-of-life care; and support safety-net health care providers. He sponsors the “New York Health” bill to create a state single-payer universal health plan and sponsored NY’s medical marijuana law. He’s a lawyer (Columbia, JD ’73) but does not have a private practice. Member of NY Academy of Medicine, National Academy for State Health Policy, Reforming States Group, NYC Bar Association, and NY Civil Liberties Union.
Richard N. Gottfried has chaired the NY State Assembly Health Committee since 1987 and represents a district in Manhattan. He works to expand publicly funded health coverage; protect patient autonomy, especially in reproductive and end-of-life care; and support safety-net health care providers. He sponsors the “New York Health” bill to create a state single-payer universal health plan and sponsored NY’s medical marijuana law. He’s a lawyer (Columbia, JD ’73) but does not have a private practice. Member of NY Academy of Medicine, National Academy for State Health Policy, Reforming States Group, NYC Bar Association, and NY Civil Liberties Union.
Regan Foust, PhD is the Director of Strategic Partnerships and a Research Scientist at the Children’s Data Network at USC. An experienced researcher, project manager, and data translator, she works closely with data, research, and funding partners to pursue and communicate the CDN’s transdisciplinary research agenda, inform childrens’ programs/policies, and build the capacity of government agencies to make better use of their own data. Formerly, as Senior Manager, Data and Research for the Lucile Packard Foundation for Children’s Health, she managed kidsdata.org, guided development and implementation of child health and well-being initiatives, and stewarded strategic data and communication partnerships. She also comes with prior experience replicating effective youth development interventions and evaluating and improving child welfare and educational programs. Dr. Foust holds a doctorate in Educational Psychology from the University of Virginia and a B.A. in Psychology from U.C. Davis.
Paul Precht is a Senior Policy Advisor in the Medicare-Medicaid Coordination Office at CMS whose portfolio includes policy issues impacting Dual Eligible Special Needs Plans. Prior to starting at CMS in 2010, Mr. Precht was the Policy Director for the Medicare Rights Center, a nonprofit advocacy and service organization based in New York.
Paige Duhamel is the Healthcare Policy Manager and lawyer for the Office of Superintendent of Insurance for the State of New Mexico. She began her work in the health insurance arena in law school with research on the impact of discriminatory health insurance benefit design on marginalized populations. Prior to joining the New Mexico’s Office of Superintendent of Insurance, she worked in a consumer advocacy law firm focusing on health care reform implementation and women’s access to health care. In the four years that Ms. Duhamel has been with OSI, her work has focused on regulatory and legislative policy development, including the Surprise Billing Protection Act, legislation to align New Mexico law with the Affordable Care Act, protections against unscrupulous purveyors of short term and limited benefits plans, and guarantees for network adequacy and prompt and transparent benefit utilization review.
Dr. Nicole Gastala is board certified in Family Medicine and is currently a Clinical Physician, Researcher, and Director of Behavioral Health and Addiction Medicine at Mile Square Health Center at the University of Illinois Hospitals and Health Science System, in Chicago, IL. Her interests include treating whole families with a special focus on preventative health care, group visits, and medication-assisted treatment for opioid use disorder. She is a graduate of Loyola University Stritch School of Medicine in Chicago and completed her residency at the University of Iowa in Family Medicine.
Michael White has worked in the field of substance use disorder for over 9 years with an additional 3 years working with children and families. Michael specializes in substance use disorder program development between community agencies and judicial systems and has developed, implemented, and supported the integration of Medication Assisted Treatment into county and state correctional facilities located in Alaska, Arizona, Montana, North Dakota, Wisconsin, and Texas. At Community Medical Services Michael supervises a team that closely works with Superior Court Drug Court Programs along with coordinating care to and from county and state correctional facilities. His experience also includes working within family courts, Department of Child Safety, and obtaining resources for pregnant women with substance use disorders by collaborating with community partners. Michael supports efforts of collaboration in Alaska, Arizona, Indiana, Michigan, Montana, North Dakota, Ohio, Texas, and Wisconsin. Michael is a national presenter in the areas of Collective Impact as an effective tool for the continuum of care, pregnancy and opioid dependence, along with Opioid treatment within Criminal Justice systems. Michael is a two-time graduate of Arizona State University with a Bachelor of Science in Sociology and a Masters in Criminal Justice with an emphasis in Counseling. He has been proud to sit on the board for the Maricopa County Reentry Program and was a member of the Coconino County Criminal Justice Coordinating Council. Currently, Michael is associated with the Maricopa County Correctional Health Coalition, is an executive board member for Hushabye Baby, and was recently appointed as a board member to Arizona Governor DougDucey’s Substance Abuse Task Force.
Meredith Ray-LaBatt, MA, MSW, works as the Deputy Director of the Division of Integrated Service for Children and Families at the New York State Office of Mental Health. For more than twenty years, Meredith has worked on behalf of children and their families, spending much of her career working to address the complex needs of children with mental health challenges who become involved with various other child-serving systems, including substance use, juvenile justice and child welfare. Most recently, Meredith has been working to transition children and childrens mental health services into Medicaid managed care, under the Medicaid Redesign efforts within New York State. This cross-system effort is working to create greater access and better align children’s behavioral health services for youth with various needs; including those in foster care, with serious mental health challenges and substance use disorders. Meredith holds Masters degrees in Criminal Justice and Social Welfare from the New York State University at Albany.
Megan O’Reilly is the Vice President for Federal Health and Family issues in AARP’s Government Affairs Office. Prior to joining AARP, Megan was the Director in the Office of Legislation at the Centers for Medicare & Medicaid Services. Megan worked on Capitol Hill for 13 years for both Rep. George Miller on the Education & Labor committee and Congresswoman Anna Eshoo. Megan holds a JD from DePaul University and a BA from American University.
Matthew Statman LMSW, CAADC is Manager of the University of Michigan Collegiate Recovery Program, Adjunct Lecturer at the Eastern Michigan University School of Social Work, private social work practitioner and member of the Motivational Interviewing Network of Trainers. Matt earned his bachelors degree in Social Work from Eastern Michigan University and his masters degree from the University Of Michigan School Of Social Work. Matt is a person in recovery from a substance use disorder who has spent his career helping those with substance use disorders initiate and sustain recovery.
Mark Schulz
Speaker
Mark Schulz is the LTSS Systems Consultant for the Minnesota Board on Aging and a Legislative Liaison for Minnesotas Aging and Adult Services Division. In these roles he is reshaping the states long term care system to reduce its reliance on institutional care in favor of home and community-based service options and reforming those supports. He brings together key individuals and groups that have the talents and resources needed to develop, foster, fund and implement new, integrated community services at the local level.
Mark has served as an Ombudsman for Long-Term Care learning firsthand the complex reality our most vulnerable adults live with each day. Before that role, he served with the US military in various leadership positions with responsibility for small and large-scale, multi-faceted teams and complex financial situations. Mark received a JD from William Mitchell College of Law and a BS in engineering management from the United State Military AcademyWest Point.
Margarita Alegría
Speaker
Margarita Alegría is the Chief of the Disparities Research Unit at the Massachusetts General Hospital and a Professor in the Departments of Medicine and Psychiatry at Harvard Medical School, where she has served since 2004. Dr. Alegria was Director of the Center for Multicultural Mental Health Research at Cambridge Health Alliance from 2002-2015 and a former Director of the Center for Evaluation and Sociomedical Research at the University of Puerto Rico. Dr. Alegría is the Principal Investigator (PI) of four National Institutes of Health(NIH)-funded research studies and a grant funded by the William T. Grant Foundation. She has published over 200 papers, editorials, intervention training manuals, and several book chapters, focused on improving health care for diverse racial and ethnic populations. In October 2011, she was elected as a member of the National Academy of Medicine in acknowledgement of her scientific contributions to her field.
Linette Scott, MD, MPH, is the Chief Medical Information Officer and the Deputy Director of the Information Management Division in the California Department of Health Care Services. In this role she works across the Department and with stakeholders to ensure that reliable data and information are available, and used to drive improvements in population health and clinical outcomes through the Department’s programs and policies. Dr. Scott is a Board Certified Physician in Public Health and General Preventive Medicine. She has a Doctor of Medicine from Eastern Virginia Medical School, a Masters in Public Health from University of California, Davis, and a Bachelors of Arts in Physics from University of California, Santa Cruz. Highlights from her career include serving as a General Medical Officer with the United States Navy, first as squadron physician with the Regional Support Group and later as the military physician for an Active Duty clinic; as a Public Health Medical Officer with the California Department of Health Services; as the California State Registrar and Deputy Director of Health Information and Strategic Planning in the California Department of Public Health, and as the Interim Deputy Secretary for Health Information Technology at the California Health and Human Services Agency.
Leann is the director of the Equity and Inclusion Division for the Oregon Health Authority, joining the agency in 2010. Leann has 25 years of leadership experience developing equity, diversity and inclusion programs. Past employers include Clark College, the City of Vancouver and the YWCA She also has served as a consultant to multiple organizations including the Vancouver Police Department, Portland General Electric, Bonneville Power Administration, Hewlett-Packard and the Southern Poverty Law Center. Leann is a qualified administrator for the Intercultural Development Inventory and holds a master’s degree in Industrial/Organizational Psychology with focus in Multicultural Organizational Development and Indigenous Psychology.
Kevin Martin
Speaker
Kevin Martin is the Fee for Service Rates Manager at the Colorado Department of Health Care Policy and Financing. He oversees the maintenance and reform of payment methodologies for inpatient and outpatient hospitals, Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and pharmaceuticals. He has 13 years of healthcare experience ranging from systems management to program integrity and mostly focusing on data analysis in various forms. Recently he has been involved in several large payment reform efforts including, implementation of the Enhanced Ambulatory Patient Grouper methodology for outpatient hospitals and developing a per member per month payment model for FQHCs.
Mr. DeCerchio currently serves as the program director of the In-Depth Technical Assistance Program of the Substance Abuse and Mental Health Services Administrations (SAMHSA) National Center on Substance Abuse and Child Welfare, and the Deputy Project Director of the National Quality Improvement Center for Collaborative Community Court Teams, funded by the Childrens Bureau in the Administration on Children, Youth and Families. Prior to joining the staff of Children and Family Futures, Mr. DeCerchio served as the Assistant Secretary for Substance Abuse and Mental Health with the Florida Department of Children and Families Services from 2005 to 2007, and as the state Substance Abuse Director from 1995-2005. In November 2001, Governor Jeb Bush appointed Mr. DeCerchio as Deputy Director for Treatment to the Florida Office of Drug Control, and in 2004 he was appointed by Secretary Tommy Thompson to serve on CSAT´s National Advisory Council. Mr. DeCerchio has been a volunteer Guardian Ad Litem for children in foster care since October 2008.
Katie Gudiksen
Speaker
Katherine L. Gudiksen, Ph.D., M.S., is a Senior Health Policy Researcher for The Source on Healthcare Price and Competition at the University of California, Hastings College of the Law. Her work focuses on policies to address rising healthcare costs with an emphasis on state-level interventions to promote competition. While at The Source, she developed the pharmaceutical page to track and analyze state legislation to address rising drug prices. She is a graduate of the UCSF/UC Hastings Master of Science in Health Policy and Law program, where she studied policy solutions to address market inefficiencies in the pharmaceutical industry. She also holds an A.M. and Ph.D. in Chemistry from Harvard University and a B.S. and B.A. from Hope College. Prior to joining The Source, she was co-founder and Director of Technology at Nidaan Inc., a cancer diagnostics company working to develop technologies designed to detect biomarker signatures for aggressive prostate cancer.
Kate McEvoy is the Director of the Division of Health Services at the Connecticut Department of Social Services. In her role as Director of Medicaid and CHIP, Kate has had the privilege of overseeing major transformation in Connecticut HUSKY Health, migrating from capitated managed care arrangements to a self-insured, managed fee-for-service approach. This has streamlined and simplified the program for both members and providers, freed up resources for an extensive array of care delivery and value-based payment interventions, and enabled the program to reduce both per member, per month costs and overall spend. During Kates tenure, Connecticut has expanded Medicaid and utilized a broad range of tools and funding under the Affordable Care Act to cover new services, take a person-centered approach, and enable choice and self-direction for older adults and people with disabilities.
Kate is a graduate of Oberlin College with a B.A. in Economics and English, received her law degree from the University of Connecticut, and graduated from the CHCS/NGA Medicaid Leadership Institute. Her background is in community-based services for older adults, and she is the author of Connecticut Elder Law, a treatise that is republished each year. Kate is currently serving as the President of the Board of Directors of the National Association of Medicaid Directors, and on the executive committee of the Reforming States Group.
Karynlee Harrington
Speaker
Karynlee Harrington is the Executive Director of the Maine Health Data Organization (MHDO) & the Maine Quality Forum (MQF). Both State agencies are responsible for promoting the transparency of health care costs and quality in the State of Maine. MHDO is the State of Maines All Payer Claims Database, and is also responsible for collecting hospital encounter, quality, financial and organizational data, and pharmacy data from the supply chain. MQF is responsible for improving health care quality in the state. Prior to her current role, Ms. Harrington served as the Vice President of Sales & Customer Support for CIGNA HealthCare of Maine and New Hampshire. Ms. Harrington has over 25 years experience working in health care. She earned her B.S. from the University of New Hampshire in Health Management and Policy.
Julia Wacloff
Speaker
Julia Wacloff, is the Dental Director for the Arizona Department of Health Services. Julia works with ADHS leadership and management on a variety of public health functions as related to oral health and has been in her current position for ten years. She was responsible for developing the first comprehensive state oral health plan for Arizona. Prior to joining the Department, she served as an epidemiologist with the Centers for Disease Control and Prevention, Division of Oral Health. She has over 20 years of experience in various public health settings providing needs assessment, policy development and quality assurance at local, state and national levels.
Johnnie (Chip) Allen currently serves as the first Director of Health Equity at the Ohio Department of Health. In this position Mr. Allen is responsible for developing agency-wide goals, objectives and strategies to eliminate health disparities and promote health equity for all Ohio residents. Additionally, Mr. Allen works in partnership with national public health organizations, state cabinet-level agencies and a variety of public health programs to target services to disenfranchised groups, measure program performance and assess outcomes.
Mr. Allen has served in various public health capacities. These include working as a Disease Intervention Specialist, HIV Program Manager and the Chief of the Center for Health Promotion. Mr. Allen has implemented statewide social marketing activities to respond to chronic diseases; developed enterprise-wide program evaluation systems; and pioneered the use of market research analytic tools with GIS mapping capability to respond to health inequities.
Mr. Allen earned a Bachelor of Arts degree in Black Studies from The College of Wooster and a Masters in Public Health from Tulane University.
John-Pierre Cardenas
Speaker
John-Pierre Cardenas is the Director of Policy and Plan Management at the Maryland Health Benefits Exchange, where he was the primary author of Marylands state innovation waiver to establish the state reinsurance program. Mr. Cardenas has played a critical role in the shaping of important health coverage legislation in Maryland including the Maryland Easy Enrollment Health Insurance Program. Mr. Cardenas also manages agency relationships with state and federal legislators and regulatory industries; oversees the implementation and administration of the State Reinsurance Program; and provides end-to-end management and oversight of carrier relationships ranging from consumer enrollment to experience. He has been with the Maryland Health Benefits Exchange since 2013 in a variety of roles before assuming his current position in 2017. Mr. Cardenas previously worked as a research intern at the Health Benefits Exchange and the Johns Hopkins Bloomberg School of Public Health. He received his Master of Science in Public Health from the Bloomberg School in 2014 and has a Bachelor of Arts in public health studies from the Johns Hopkins University.
Jodi Manz
Speaker
Jodi Manz, MSW serves as the Assistant Secretary of Health and Human Resources in the Office of Governor Ralph Northam, a role she continued after serving four years under former Governor Terry McAuliffe. As Assistant Secretary, Jodi supports the development of health and behavioral health policy in the Commonwealth. She staffs the Governors Advisory Commission on Opioids and Addiction, the Governors Executive Leadership Team on Opioids, and coordinates the substance use disorder crisis response among Virginias state agencies. She holds a Bachelors Degree in Religious Studies, and she spent several years working in Chicago before returning to Richmond to complete the graduate program in Social Work Administration, Planning, and Public Policy at Virginia Commonwealth University.
Jason Rachel
Speaker
Jason Rachel, Ph.D. is the Director for the Division of Integrated Care at the Virginia Department of Medical Assistance Services (DMAS). In this role, he is responsible for providing executive leadership in the management and implementation of both current and new integrated care programs. Dr. Rachel directs and oversees all operations, policies, contract compliance and quality monitoring activities within the division to provide high quality, person-centered coordinated care services. His former roles include serving as a Senior Research Leader at Truven Health Analytics providing technical assistance to state Medicaid home and community-based programs on their quality framework and as Virginia’s Money Follows the Person (MFP) Project Director at DMAS. Dr. Rachel received his doctorate in Health Related Sciences with a specialization in Gerontology from Virginia Commonwealth University, School of Allied Health Professions.
Jane Wishner
Speaker
Jane Wishner is New Mexico Governor Michelle Lujan Grisham’s Executive Policy Advisor for Health and Human Services. An attorney with extensive experience as a litigator, researcher and advocate, Ms. Wishner left the private practice of law to become the founder and first Executive Director of the Southwest Women’s Law Center in Albuquerque, New Mexico, where she led the Center’s systemic advocacy in the areas of discrimination, domestic violence, Title IX, reproductive health and women’s access to comprehensive health care coverage and services. She organized and led New Mexico’s consumer advisory group on implementation of the Affordable Care Act, served on the Market Regulation work group of the New Mexico Exchange Advisory Task Force and was a consumer representative on the Board of Trustees of the University of New Mexico Hospital, the state’s leading safety net hospital. Ms. Wishner left the Southwest Women’s Law Center to spend more time on health care policy work. She served as a qualitative researcher at the Urban Institute’s Health Policy Center in Washington, D.C., where she led several studies and co-authored numerous research reports, journal articles and briefs related to healthcare access, Medicaid, the private insurance market, opioid use disorder treatment, and the Affordable Care Act. Ms Wishner returned to New Mexico to work as the Policy Director for Michelle Lujan Grisham’s campaign for Governor, served on the Governor-Elect’s transition team, and joined Governor Lujan Grisham’s Administration in January 2019.
ane Beyer began her career as a legal services attorney in Tacoma Washington. She served as legal counsel to the Washington State House of Representatives for twenty years, working on a broad range of health, behavioral health, long term care, human services and criminal justice issues. She was Washington State’s Medicaid director from 1995 through 1998, and Washington State’s Behavioral Health Commissioner from 2012-2015. She has served as the Senior Health Policy Advisor to Washington State Insurance Commissioner Mike Kreidler since January 2017.
She graduated with honors from the University of North Carolina School of Law and is admitted to practice in Washington State and the District of Columbia.
James A. Clair
Speaker
Jim provides executive consulting services to technology-enabled companies in the pharmacy services and SaaS space. He is presently an Executive Consultant to CSSHealth, a Buffalo, NY technology-enabled company that provides Medication Therapy Management and Adherence services to health plans and pharmacy benefit managers. He is the Chair of the Board of Directors for Reveal Rx, a technology company that enables the review of pharmacy claims by health plans and PBMs. He formerly was CEO of Goold Health Systems, a healthcare management/pharmacy benefits administrator that more than tripled in size during his tenure. GHS was sold to Change Healthcare in 2013, and Jim ran the GHS wholly-owned subsidiary as well as their PBM business until mid-2016. From 2017 to 2018, Jim was CEO of Tricast, LLC, a technology-enabled pharmacy auditing company that sold to a competitor in 2018Q2.
Heidi Haley-Franklin
Speaker
Heidi Haley-Franklin is the Vice President, Programs at the MN ND chapter of the Alzheimer’s Association in Minneapolis, MN. Heidi has over 20 years of experience working with individuals and families in private practice, group homes, long-term and home health care settings. In her current position, she oversees all of the Association’s programs and services, and provides clinical supervision and ongoing education to those who directly work with individuals impacted by Alzheimers disease and related dementias. Heidi holds a Master’s degree in Social Work from the University of St. Thomas in St. Paul, MN, a BA from the University of MN, Morris, and is a Licensed Independent Clinical Social Worker.
After serving one term as a Representative in the Maine House, Heather ran for the State Senate and is currently serving her first term, representing part of Portland and Westbrook, Maine. A former public school teacher and attorney, Heather now owns and runs Rising Tide Brewing Company with her husband, Nathan, in Portland. Under Heather’s leadership, Rising Tide has created two dozen jobs and helped spur the revitalization of the East Bayside neighborhood of Portland. Rising Tide has been committed to giving back to the community, with significant on-going support for the Maine Island Trail Association, the Good Shepherd Food Bank, Full Plates Full Potential, Portland Trails and many other organizations. Heather also served for many years on the Portland Development Corporation board, a quasi-municipal organization that administers the city’s economic development revolving loan funds and job creation grant programs. Heather and her husband live in Portland with their teenage son.
Heather Winfield-Smith is the Vaccine Supply and Distribution Section supervisor for the Hawaii Department of Health, Immunization Branch. In her role as Section Supervisor, she coordinates the Hawaii Stop Flu at School Program, a school-located influenza vaccination program that conducts annual clinics in over 180 participating schools, statewide. Heather also coordinates the Hawaii Vaccines For Children (VFC) Program which supplies hundreds of thousands of doses of vaccine annually to VFC-participating providers for administration to Hawaiis eligible children. Heather has a Master of Social Work degree from the University of Hawaii and over 20 years of experience working at the Hawaii Department of Health Immunization Branch. The health of Hawaiis children, families, and communities are the motivation for Heather’s work and she is honored to have a role in ensuring their protection from the potentially devastating outcomes of vaccine-preventable diseases.
Hazel Alvarenga is the State Opioid Coordinator in the Office of the Director at the Arizona Health Care Cost Containment System. Hazel assists the Clinical Initiatives Project Manager with the management of the State Opioid Response (SOR) grant with the aim to reduce the effects of the opioid epidemic in Arizona. Prior to her current role, Hazel served as the Opioid State Targeted Response (STR) Project Coordinator and Opioid Epidemiologist at AHCCCS. She holds a masters of public health degree in research epidemiology and global health from Loma Linda University and a bachelor’s degree in biological sciences from The University of California Irvine.
Gary Cohen has been a pioneer in the environmental health movement for thirty years. Cohen is President and Co-Founder of Practice Greenhealth and Health Care Without Harm. He was also instrumental in bringing together the NGOs and hospital systems that formed the Healthier Hospitals Initiative. All three were created to transform the health care sector to be environmentally sustainable and serve as anchor institutions to support environmental health in their communities.
Cohen was Executive Director of the Environmental Health Fund for many years. He has helped build coalitions and networks globally to address the environmental health impacts related to toxic chemical exposure and climate change.
Cohen is a member of the International Advisory Board of the Sambhavna Clinic in Bhopal, India, which has been working for over 25 years to heal people affected by the Bhopal gas tragedy and to fight for environmental cleanup in Bhopal. He is also on the Boards of the American Sustainable Business Council, Health Leads and Coming Clean.
He has received numerous recognitions for his achievements, including: The MacArthur Foundation’s Fellows Award (2015), the White House’s Champion of Change Award for Public Health and Climate Change (2013), the Huffington Post’s Game Changer Award for Health (2012), the Frank Hatch Award for Enlightened Public Service (2007), and the Skoll Award for Social Entrepreneurship (2006).
Erica Guimaraes is a program coordinator in the Office of Community Health Workers at the Massachusetts Department of Public Health, where she assists in promoting best practices for CHW integration into health care and public health teams. She also supports implementation of CHW certification in MA, including developing processes for CHW training program approval. Prior to joining DPH, Erica worked for 11 years in the Community Health Worker field, in the roles of a CHW, CHW supervisor and CHW program manager, at community based organizations and clinical settings. Erica holds a bachelor’s degree in Psychology.
Ms. Stout directs the Suicide Prevention Resource Center (SPRC) project at EDC, leading a team that provides resources and capacity building services to state and local leaders, health and behavioral health agencies and organizations, federal suicide prevention grantees, and national stakeholders involved in suicide prevention efforts across the country. She has worked in the suicide prevention field for 12 years, with a focus on building state and tribal suicide prevention workforce and infrastructure capacity for strategic, comprehensive, evidence-informed suicide prevention programs. Ms. Stout serves as a subject matter expert on substance abuse and suicide prevention collaboration, strategic planning, accessing and using surveillance data for program planning and evaluation, and knowledge translation and dissemination. She has presented widely at national and local conferences, as well as participating in federal and other national advisory groups, including a current national effort to develop recommendations for state suicide prevention infrastructure. Ms. Stout holds a Masters of Science in Health Communication, and has worked with state and local audiences to build capacity in strategic and effective messaging and campaigns for behavior change.
Doug Thomas is the Director of the Division of Substance Abuse and Mental Health, for the state of Utah. He serves on the Board of Directors of the National Association of State Alcohol and Drug Abuse Directors (NASADAD), and the National Association of State Mental Health and Programs Directors (NASMHPD), and is an active member of the Utah Substance Abuse Advisory Council. Doug has worked in the mental health and substance use disorder field for over 24 years in various capacities as a direct service provider and administrator. He has worked in both urban and rural settings and previously oversaw County services implementing evidence-based service delivery models; expanding prevention, treatment and recovery support services in rural Utah including work with tribal government. Doug is passionate about prevention and early intervention and integrating prevention efforts into systems to produce lasting outcomes to reduce risk and increase the well-being of individuals, families, and communities.
Dawn Lambert co-leads the Community Options Unit within Connecticut’s Department of Social Services. Within that role, her focus is on person-centered strategy and innovation. With over 25 years of experience in long-term services and supports, she currently serves as an appointed member of the National Academy for State Health Policy, an advisor to the AARP’s Public Policy Institute in Washington DC and a consultant to the Department of Justice regarding community options for older adults and people with disabilities.
A nationally recognized expert in health indicators and health disparities, CDR David T. Huang is the branch chief of the Health Promotion Statistics Branch, which provides data and statistical support to the national Healthy People initiative at the CDC’s National Center for Health Statistics (NCHS). He is a member of the charter class of Certified in Public Health (CPH) professionals and has contributed to articles appearing in the Journal of the American Medical Association (JAMA), American Journal of Public Health, Annual Review of Public Health, American Journal of Epidemiology, Journal of Public Health Management and Practice, and Morbidity and Mortality Weekly Report (MMWR), in addition to serving as a contributing author on several federal publications on Healthy People 2010 and 2020. CDR Huang’s education includes a PhD in Industrial Engineering from the Georgia Institute of Technology and an MPH in quantitative methods from the Harvard T. H. Chan School of Public Health.
David Crall is the legislative analyst for the Oklahoma Senate Health and Human Services Committee, a position he has held since July 2017. David staffed the Oklahoma Attorney General’s Commission on Opioid Abuse in fall 2017 and drafted several pieces of legislation resulting from the work of Commission during the 2018 and 2019 legislative sessions. After voters legalized medical marijuana in Oklahoma through ballot initiative, David was the lead Senate staffer on the bicameral Medical Marijuana Working Group, which held public meetings with experts from the marijuana industry, state agencies, law enforcement, the medical field, the Oklahoma business community and NCSL throughout the summer of 2018 to study how best to implement the new medical marijuana program. David drafted the resulting Oklahoma Medical Marijuana and Patient Protection Act, which created a regulatory framework for the program, as well as various other pieces of legislation relating to medical marijuana.
David Cassetty
Speaker
David serves as the Deputy Commissioner of Insurance in Las Vegas, and oversees the consumer services and enforcement sections of the Division. Prior to assuming this position, David spent 4 years as the General Counsel for Vermont’s Department of Financial Regulation, managing 8 attorneys in the regulation of the insurance, banking and securities industries. David also has spent many years as an assistant attorney general, in Vermont and American Samoa, and started his law career in private practice in Florida, where he was board certified in appellate practice, mostly working on behalf of insurance companies.
Dave Richard is the Deputy Secretary, NC Medicaid, where he leads North Carolina’s $14 billion Medicaid and NC Health Choice programs for the states Department of Health and Human Services (DHHS).
Richard’s vision for Medicaid is to ensure a sustainable, person-centered and innovative Medicaid program for more than two million North Carolinians who use Medicaid. As the programs undergo transformation to even better fit the needs of state and its residents, he is committed to the fundamental goal of improving the health and well-being of all residents. Richard believes the right way to achieve success is to work closely with stakeholders in all aspects of Medicaid.
Prior to leading Medicaid, Richard was the Deputy Secretary for DHHS Behavioral Health and Developmental Disability Services and the State Operated Healthcare Facilities divisions. He joined DHHS in May 2013 as the Director of the Division of Mental Health, Intellectual and Developmental Disabilities and Substance Abuse Services. Richard joined DHHS after leading The Arc of North Carolina, an advocacy and service organization for people with intellectual and developmental disabilities, as its Executive Director for 24 years.
Richard has a bachelor’s degree in education from Louisiana State University.
Daphnne Brown is the Director of Family Involvement & Outreach for Families Together in New York State. She provides support to families, advocates and service providers on family driven care, systems advocacy, and family empowerment. Daphnne provides training and technical assistance to family-run and provider agencies in preparation for the transformation to Medicaid Managed Care. She has served as the family engagement consultant for the past 7 years on the NYS System of Care Expansion grant and currently trains family / youth peer advocates on the High Fidelity Wraparound process. Daphnne has a B.S. in Business Administration from SUNY College at Brockport and is a Credentialed Family Peer Advocate.
Daniel Tsai is the Assistant Secretary for MassHealth and Medicaid Director for the Commonwealth. Tsai was appointed in January 2015 by Governor Charlie Baker to oversee the state’s $16 billion Medicaid program, which covers over one in four residents in the Commonwealth. In his role, Tsai is responsible for ensuring a robust and sustainable MassHealth program that best meets the needs of members. That includes developing new policies, payment models, and operational processes that improve the way health care is delivered to 1.8 million low-and moderate-income residents and individuals with disabilities.
Before joining HHS, Tsai was a Partner and leader in McKinsey & Company’s Healthcare Systems and Services practice. He has significant experience on the design and implementation of innovative, state-wide health care payment systems for Medicaid, Medicare, and Commercial populations, and has worked closely with multiple state Medicaid programs, private payers, and health services companies. He received a Bachelor of Arts in applied mathematics and economics from Harvard University.
Assistant Secretary Tsai lives with his wife and son in Cambridge. He volunteers at a local community health center in Boston’s South End.
Connor McDonnell is a Housing Integrator with Oregon Housing and Community Services (OHCS) where he leads efforts to reduce homelessness and expand affordable housing options for Oregon’s most vulnerable residents. This work includes initiating the Oregon Rural Peer Network for Supportive Housing and crafting a Permanent Supportive Housing program in Oregon. Prior to OHCS, he worked in a homeless shelter as a housing case manager, for elected officials, and in various levels of government working in different capacities at the nexus of health and housing. He most recently came to State government by way of HUD where he is most proud of creating the HUD Resource Locator which maps out all the federal housing programs across the U.S. Connor has a Master’s in Public Administration from The Hatfield School at Portland State University and a B.S. in Psychology from Virginia Tech.
Colleen Sonosky, JD is the Associate Director of the Division of Children’s Health Services in the Health Care Delivery Management Administration in the District of Columbia’s Department of Health Care Finance (DHCF). DHCF is the agency responsible for the administration of the Medicaid program and the Division of Children’s Health Services oversees policies and procedures for Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services benefit—the pediatric component of the Medicaid program for children under 21. Ms. Sonosky also serves as the District’s EPSDT Coordinator and CHIP Director and represents DHCF on the District-wide Child Fatality Review Committee, Interagency Coordinating Committee for Early Intervention, and the State Early Child Development Coordinating Committee (SECDCC) where she co-chairs the Health/Wellbeing Subcommittee. She has also served on many national work groups concerning maternal and child health, including CMS’ National EPSDT Improvement Working Group, National Academy for State Health Policy’s (NASHP) Future of Children’s Coverage Workgroup and is a Member of NASHP’s Steering Committee on Health System Performance and Public Health.
Previously, Ms. Sonosky was the Director of Public Policy Research for the March of Dimes Foundation, the Vice President of Policy at FirstFocus, and the Senior Director of Programs and Policy for the Children’s Defense Fund. From 1993 to 2003, she served as Assistant Director and a lead researcher on maternal and child health policy at the Center for Health Policy Research (now housed in the Department of Health Policy) at The George Washington University. Ms. Sonosky is an Adjunct Assistant Professor in the Departments of Health Policy and Prevention/Community Health at the George Washington University School of Public Health and Health Services, where she has taught courses on maternal and child health policy.
Mr. Clinton Lasley is the Director of the Division of Alaska Pioneer Homes operating six state owned assisted living homes including the states only State Veterans Home. Mr. Lasley has been with the Department of Health and Social Services for six years, serving first in the Division of Public Health before moving to the Division of Alaska Pioneer Homes in 2016. Born and raised in Alaska, Mr. Lasley has 25 years of business management and organizational leadership experience with a passion for elders and promoting public health.
Catherine Kirk Robins works as a Deputy Director for the Maryland Citizens’ Health Initiative on issues surrounding prescription drug affordability. As a part of the MCHI team, Ms. Kirk Robins played an integral role in mobilizing a broad coalition to support the passing of Maryland’s landmark anti-price gouging and Prescription Drug Affordability Board legislation. Ms. Kirk Robins has worked to develop, progress, and implement state-level policy to address prescription drug affordability, and continues to collaborate with other state initiatives to improve legislative approaches to this issue.
Elizabeth Tilson serves North Carolina as the State Health Director and the Chief Medical Officer for the Department of Health and Human Services. In this role, she promotes public health and prevention activities, as well as provides guidance and oversight on a variety of cross-Departmental issues.
Dr. Tilson received her BA in biology from Dartmouth College, earned her Medical Degree at Johns Hopkins University School of Medicine, and a Masters of Public Health from the University of North Carolina – Chapel Hill. She completed a Pediatric residency at Johns Hopkins Hospital and a General Preventive Medicine/Public Health Residency at the University of North Carolina – Chapel Hill and is board certified in both fields. She has been active and has served in leadership roles in many local, state, and national pediatric, public health and preventive medicine organizations.
Beth Waldman is a Senior Consultant at Bailit Health with national expertise in health care policy, program development and implementation, specializing in Medicaid and CHIP programs and coverage for the uninsured. Beth’s work includes assisting states and other stakeholders in delivery system and payment reform design; care management and health home program design; behavioral health reform, including integration, opiate prevention and treatment; quality measurement; managed care procurements; and long-term services and supports strategy and integration.
Prior to joining Bailit Health, Beth worked for 12 plus years within the Massachusetts Medicaid program and served as the Massachusetts Medicaid Director from 2003 – 2006. Beth is a graduate of Union College in Schenectady, NY. She holds a law degree from Boston College Law School and a master of public health degree from the Harvard School of Public Health.
Sessions:
MCH PIP Ancillary Meeting (CLOSED INVITATION ONLY MEETING)
Beth Kuhn
Speaker
Beth Kuhn is Chief Engagement Officer at the Kentucky Cabinet of Health and Family Services, leading policy and operational efforts to better integrate workforce, health and human service programs. She was until recently Commissioner of the Kentucky Department of Workforce Investment, collaborating with many partners in a system of Kentucky Career Centers providing employment, vocational rehabilitation, veterans, and other workforce services to employer and individual customers. Prior to her appointment as Commissioner in December of 2014, Beth served as Sector Strategies Director, assisting with the design and implementation of industry sector-based approaches to workforce and economic development.
Beth has over 30 years of experience creating and implementing innovative workforce programs. She previously served as Director of Workforce Development at the Vermont Department of Labor, as Project Director at the United Way of Chittenden County (VT) where she developed employer partnerships to improve retention and advancement of entry-level workers, and as Vice President of WFD, Inc., a human resources consulting firm providing employee benefits, women’s advancement, and public-private partnerships to Fortune 100 companies including Ford Motor Company, GE, and IBM.
Beth has a BA in Public Policy from the James Madison College of Michigan State University, and a Master’s in Industrial and Labor Relations from Cornell University.
Ben Steffen serves as the Executive Director of the Maryland Health Care Commission. The Maryland Health Care Commission is an independent regulatory agency whose mission is to plan for health system needs, promote informed decision-making, increase accountability, and improve access to health care and health care coverage in Maryland. The MHCC administers the certificate of need program, the establishment of Maryland’s Health Information Exchange, and cost and quality reporting initiatives for hospitals, nursing homes, and health plans. Prior to assuming this position, he served as the Director of the Commission’s Center for Information Services and Analysis. This Center has analytic and operational responsibilities for health care practitioner initiatives in the state including development of an All Payer Data Base and the Patient Centered Medical Home Program. Mr. Steffen serves as a spokesperson for the Commission at state and national levels on state health care expenditures, physician work force, physician uncompensated care, and information security. Before joining the MHCC, he served as a budget analyst in the Health, Housing, and Income Security Division of the Congressional Budget Office, among activities he worked on the modeling that produced the estimates of reforms that ultimately led to the Medicare Prospective Payment System. Mr. Steffen holds a Master’s Degree from American University and has completed post-graduate work at the University Of Michigan. He is a former Peace Corps volunteer to Nepal.
Mr. Bassiri is Chief of Staff to the Medicaid Director at the New York State Department of Health. Prior to joining the Department of Health in May of 2019, he worked as Senior Policy Advisor for Health in the Office of Governor Andrew Cuomo under the Deputy Secretary of Health and Human Services. His role in the Governor’s Office involved policymaking and implementation of strategic health initiatives, specifically related to the pharmaceuticals, insurance expansion, and Medicaid delivery system reforms.
As a California native, Amir earned his B.A. in both Economics and Psychology from the University of California, Davis, before earning a Master’s in Social Work (M.S.W) from Columbia University.
Alfred has served in various staff and management capacities in private industry, county and state government serving vulnerable populations since 1996.
Alfred has worked for the Division of Quality Assurance since 2001. Alfred has served the Division of Quality in a variety of roles, Assisted Living Surveyor, Assisted Living Regional Director, Director of the Bureau of Technology, Licensing and Education and currently Director of the Bureau of Assisted Living.
While in DQA, Alfred has been instrumental in establishing collaborative statewide working relationships with counties, care management organizations, advocates and industry representatives to help improve the quality of care in assisted-living settings.
Alex Blandford oversees and executes the CSG Justice Center’s health policy portfolio and works to improve access to health care for people in the criminal justice system through federal, state, and local policy. Prior to joining the CSG Justice Center, Alex was a project coordinator for the Institute for Evaluation Science in Community Health, which is housed in the Graduate School of Public Health at the University of Pittsburgh. As a project coordinator, she oversaw a variety of research projects, including one examining the Pittsburgh region’s emergency response to mental health crises, and another evaluating the region’s Crisis Intervention Team training for police officers. She earned her BS in psychology and BA in French from the Pennsylvania State University and her MPH at the Graduate School of Public Health at the University of Pittsburgh.
Alana Knudson, PhD, serves as a Program Area Director in the Public Health Department at NORC at the University of Chicago and is the Co-Director of NORC’s Walsh Center for Rural Health Analysis. Dr. Knudson has over 25 years of experience implementing and directing public health programs, leading health services and health policy research projects, and evaluating program effectiveness. Her research and policy project findings have informed state, Tribal, and Federal health policy. She also has state and national public health experience having worked at the North Dakota Department of Health and for the Association of State and Territorial Health Officials (ASTHO). Dr. Knudson serves on the Board of Trustees for the National Rural Health Association, the Board of Directors for the Maryland Rural Health Association, and the Board of Directors for the Rural Health Foundation. She is also a member of the RUPRI Health Panel.
A lifelong Oklahoman, Ashley has dedicated herself to the people of Oklahoma. Ashley currently works at the Oklahoma House of Representatives as a Legislative Assistant, after serving as Director of Constituent Services for Lieutenant Governor Todd Lamb and after running the Senate soundboard while working as Secretary for the President Pro Tempore of the Senate. She is pursuing her degree at Oklahoma State University, majoring in Biochemistry and Molecular Biology with a minor in Political Science. Ashley is active in her political party at the state level, recently served as the Speaker of the House of Oklahoma Intercollegiate Legislature, and volunteers with a nationally accredited animal rescue, Tornado Alley Bulldog Rescue. When she is not saving dogs, Ashley enjoys fishing, reading, and cooking (although not at the same time). Ashley visited Chicago this summer for a Women in Government conference and is ecstatic to return to Chicago so quickly to attend NASHP’s’ Annual Conference.
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
