What's in this issue
From Us to You
A note from Clay
A thought from Kris
A word from Sarai
Consultant Corner
Latest MM Content
Highlights from Never Ending Conference Episode 1
Jobs/Career Help
Reading List
MegaMixTapes
Connect and Interact
CoffeeTalk
Listening Sessions
Buy Stuff
Newest training courses
Newest market intel products
Hire our amazing consultants
About Our Sponsor for this Issue
WEX Health generously made this edition of the newsletter possible with their sponsorship of one of our recent podcast series. Learn more about what Wex is doing the the HHS space.
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Hello, friends.
It's been a busy few months for most of the people I speak with. Well, this weird mix of busy but not. I think we all are tired of COVID (and tired of talking about COVID).
We have packed a ton of great content into this edition of our newsletter. I hope this is something you can sit by the fire (in New England) or the pool (out West) and get a chuckle or an insight or two.
See anything you like? Or don't like? Send me a note. As always, my favorite thing about this gig is hearing from you.
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Right now, we are seeing lots of activity in the market around Medicaid Managed Care procurements, particularly in North Carolina, Ohio and Oklahoma, with others expected soon. The activity ranges from the expected activity of health plans positioning to make their pitch and crafting their responses to the less visible activity of outreach to potential partners, including foster care and behavioral health providers to help bolster their proposals. We will be paying close attention to what will happen next. Not only to assist our clients with particular state markets, but also for the larger trends that will impact Medicaid throughout the country. I spoke recently on a webinar where I discussed the movement with regards to social determinants of health provisions in the RFPs from Ohio and Oklahoma - moving from just touching on them to actually putting concrete metrics in place that will ensure Medicaid programs know when members receive referrals for needed social services and what the outocomes of those referrals are. This is just one area where we are seeing movement in how managed care is being implemented by states and we continue to watch for the innovation that is not just happening in one state, but is a more global movement of change in the overall Medicaid program.
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Hello, Virtual World!
2020 has been...interesting. As we all adjust and take into consideration changes to our professional and personal lives, we are seeing many opportunities opening up virtually. As we track job listings, we are learning how we are moving more towards the virtual realm and how that impacts the Medicaid field. We've found more opportunities opening up to work from home and we want to help. Check out our job listings tab on our site. We also have a great time connecting and networking in our coffee talks that Clay hosts. There are more details provided below.
Our heart is to help, so please let us know how we can.
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Lauretta Converse
Lauretta Converse is a healthcare consultant, providing informed, timely and cost-effective solutions that help states, payors, providers, and investors improve their services to Medicaid and other publicly funded programs. Combining policy expertise with analytical skills, her previous roles include directing Rhode Island's payment reform efforts and serving as the Senate's primary resource on healthcare finance. She lives in New England, where she teaches graduate courses in healthcare management and loves waking up to freshly fallen snow.
LinkedIn profile
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What are your areas of expertise?
Strategy. I specialize in pairing broad industry knowledge with in-depth analysis so that business leaders can make informed strategic decisions. Whether trying to define or refine their strategy, I specialize in providing unbiased, useable briefs that explore potential directions and outcomes. In my work with the Rhode Island legislature, I employed a broad understanding of commercial, individual and Medicaid markets to design a strategy to finance the state's health benefits exchange. The strategy was enacted into law and has result in a sustainable business model.
Analysis. I also specialize in developing insights from large volumes of data and information and then using those insights to recommend solutions. Through researching, forecasting, modeling, data mining, metric design and reporting, I translate qualitative and quantitative data into actionable recommendations. For example, in my work with CVS I created a suite of metrics and dashboards that identified a $4.0 million revenue opportunity.
What do you think is key to a successful client engagement?
The best client engagements have a mutual, clear understanding of issue at hand, the reason for the engagement, or the problem for which a solution is sought. Sometimes it takes a while to get there, but this is part of the work and many times it takes patience. Albert Einstein is quoted as saying that if he had an hour to solve a problem he'd spend 55 minutes thinking about the problem and five minutes thinking about solutions. He believed the quality of the solution you generate is directly proportional to how well you identify the problem you hope to solve. Sometimes this pre-work can be frustrating because we tend to want to jump right to solutions, but it is key to successful engagements.
Most importantly - Favorite junk food?
For junk food, I lean salty rather than sweet. I basically consider the 7 oz. white cheddar PopCorners bag a single serving.
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LATEST VIRTUAL CONFERENCE CONTENT
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Not yet signed up for the Mostly Medicaid Never Ending Conference?
Silly goose.
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HIGHLIGHTS FROM LATEST NEVER-ENDING CONFERENCE EPISODE
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If you missed our latest virtual conference, here are the highlights (and a link to check out the replays).
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Monthly Medicaid News Roundtable
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We review the Medicaid news around the country each month, every 30 days.
Starts at 34 min mark in replay
Highlights:
State budgets during COVID
TX vs CA (ACA and SCOTUS)
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Virgil Dickson
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John McCarthy
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Medicaid Buy-in / The Public Option
STARTS AT 1 hr 39min mark
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Adam Fox
Colorado Consumer Health Initiative
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David Frockt
Washington State Senator
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Healthcare and the Election
STARTS AT 2hr 41 min mark
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Hank Osowski
Managing Partner , Strategic Health Group LLC
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Each episode we give the mic to someone who has a point of view and lots of experience in the space. This month it was Len Kirschner.
Summary of talk
Impact of COVID on Medicaid, next stage of the pandemic
Time mark in replay: 3 hr 43 mins
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Sector: Government
Role: Chief of Medicaid Data Analytics
Requisition No: 249822
Agency: Agency for Health Care Administration
This is an exciting opportunity to help shape the quality of health care in Florida. The Agency for Health Care Administration (AHCA) is the State of Florida agency responsible for oversight of the Medicaid program. The Medicaid program provides low-income families and individuals with access to health care. If you have a desire to use your talent and skills at an organization that provides critical services to millions of individuals and families across the state, AHCA invites you to apply to become an essential member of our team. As one of Florida’s leading state agencies, AHCA’s diverse workforce community of more than 1,400 employees is proud of its efforts to serve the people of Florida...
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A profile of a large employer in the Medicaid space
Organization Name: Molina Healthcare
Company Size: 8,765 employees
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Employee headcount trends last 2 years
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Employee adds by function last 2 years
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Job openings by function
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Glassdoor Reviews (click image to exlore)
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We always need help on client projects. Would love to chat with you about what you love to do and if its a fit with upcoming work. Send us a note to get the conversation started.
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MOSTLY MEDICAID MEGA MIX TAPE
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Let's work together today by listening to the same album.
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Mariah Carey- Merry Christmas, 2019
https://music.amazon.com/albums/B07Y414W29
Let’s work together today while we listen to the same album.
I think there are a few voices that stand atop the highest mountain of singing power.
Whitney. Celine. Tina.
And of course- and perhaps above all- Mariah.
All of us can hear her hit that high note- that only-Mariah-can-hit-it high note- in our heads on command. She does it in several songs. One of the very best instances is on track 2 of this album.
Enjoy this with me today, fellow humans. Hit the high notes today.
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Check out the latest reads our research team has collected, summarized and highlighted. All of these are provided as part of our Curator service on the website (which is completely free, you just need to register).
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Quality of Care for Adults in Medicaid: Findings from the 2019 Adult Core Set (Chart Pack)
This 106-page doc includes a rich data set of outcome measures in the Medicaid population, including:
- Primary Care and Preventive
- Maternal and Perinatal Health
- Acute and Chronic Conditions
- Behavioral Health Care
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Annual Milliman Analysis of Medicaid Managed Care Financial Results
Check out the latest insights on MCO financials from the Milliman team. Especially important as states try to figure out how to set rates in a time of pandemic-driven underutilization.
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NASBO Updated Survey of State Budget Projections
State revenues were projected to increase in the previous survey- but now they have taken significant hits due to COVID. General fund revenues are now at 6% below where they were projected to be. Gaming revenues have taken...
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Magellan Annual Report of Medicaid Drug Trends
The 5th annual report on Medicaid pharmacy trends is out.
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What is Curator?
We read a LOT in the HHS space. And we highlight and summarize and collect it all. At some point we realized that could be valuable to others so we started sharing it on our website. Want to see our highlighted, summarized news items? All you need to do is sign up for a free account on our website and get access to everything we put into Curator.
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RFP NAME: OIG Medicaid Audit Recovery (State of Wisconsin Department of Health Services)
Scope summary
The Wisconsin Department of Health Services (DHS), Office of the Inspector General (OIG) is seeking to establish a contract for Medicaid Recovery Audit services. The Recovery Audit Contractor (RAC) is intended to identify and recoup overpayments and identify underpayments made to Medicaid providers by DHS.
The Department of Health Services does not guarantee to purchase any specific quantity, or pay any minimum contract price during the term of the contract. Proposals that require a minimum number of commodities or services be ordered will be disqualified.
Deadlines
12/3- Written questions due
1/14- Proposals due
11/2021- Contract start date (estimated)
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RFP NAME: Information Technology Professional Services (Vermont Department of Buildings and General Services, Office of Purchasing and Contracting Agency of Digital Services (ADS))
Scope summary
State of Vermont lacks State resources to support development and implementation of MESP projects; therefore, the State requires IT professional resources to augment internal capacity.
ADS currently has contracted professionals who represent a significant investment by the State in developing their “institutional knowledge” about the existing projects they have been supporting. Your proposal must include a transition plan that addresses how to minimize the impact to the State due to potential contractor attrition and possible transition of professionals from existing vendors.
Deadlines
No Question and Answer Period
Responses Due December 7th
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RFP NAME:Assessment and Realignment of Human Services and Public Health: Redesign of Program and Service Delivery (Iowa Department of Human Services)
Scope summary
The purpose of this Request for Proposal (RFP) is to identify and select an experienced and qualified Contractor to assist the Iowa Department of Public Health and the Iowa Department of Human Services (hereafter “Departments”) in planning, organizing and implementing redesign of programs and services of the Departments with a focus on the following objectives:
● Identify clear, shared program goals.
● Align and integrate programs, practices and policies to improve delivery of services and most effectively leverage available funding sources.
● Establish a “no wrong door policy” providing comprehensive and seamless access to the array of services and supports available to those in need.
● Identify cross-cutting technology systems to capture client and population level information across programs, and other appropriate data sharing that meet the standards and needs identified by federal and state funding opportunities.
● Align individual provider and program level licensing, certification and accreditation reviews.
● Identify effective and appropriate workload distribution and methods for ongoing client management, including caseload management.
● Identify community based stakeholders (organizations and community members) and other stakeholders to provide input and guidance to the Departments’ programmatic and policy efforts through opportunities for collaboration and partnership, including and especially those organizations working with the populations served by the Departments as well as community members who participate in/have a relationship with the Departments’ programs and services.
● Identify potential for expanded funding sources.
● Engage all levels of staff including field, front line and program staff to inform the Departments’ established goals and project plans.
● Create an organizational structure that optimizes delivery of services, supports efficiency and ease of work for staff, and integrates the Departments’ programs and services with community and other available resources.
Deadlines
Nov 9- LOIs due
Dec 7- Proposals due
Jan 25- Awardee announced
Mar 1- Project implementation meeting
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We put on a series of ongoing virtual meet and greets for our audience of our audience. No agenda other than show up and chat.
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Market Surveys and Listening Sessions
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We are continuously conducting surveys and interviews to understand the needs of different parts of our audience. We also give away stuff if you talk to us. Sign up below.
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We help a wide range of clients address challenges in the Medicaid and HHS space.
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Medicare Special Needs Plans 101
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All-Access Subscription (All Courses, 1 Year)
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Market Intelligence Products
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Medicaid Black Book Subscription (1 Year Access)
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$4,999.99
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New vendor reviews this month
Latest M&A and Investment report released
Health plan analysis udpate December
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HHS GreenBook (presales)
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We have helped sales teams for 20 years navigate opportunities in the HHS space. Now we are packaging all that insight, opportunity data and contact information into The HHS Greenbook.
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