Health Policy and Program Design

Recent Projects.

State Medicaid Agency

  • Worked with state Medicaid leadership to design a Medicaid ACO (Accountable Care Organization) strategy, including development of an initial pilot and final program design.
  • Supported state/federal negotiations for a Medicaid Global Waiver, including development of a multi-year global budget model of Medicaid program enrollment and cost projections.
  • Designed and developed a legislative strategy to contain inpatient and outpatient hospital fees. 

 

State-Based Health Benefits Exchange

  • Worked with state leadership to design and develop an ACA implementation strategy that best fit the state’s specific goals and objectives.
  • Worked hand in hand with state leadership to design, develop and implement a state-based Exchange, including vendor relationships, financial analysis, coordination with other states, stakeholder communication, and interfacing with federal authorities.
  • Currently supporting day-to-day operations of state-based Exchange with an on the ground team in the areas of marketing, business process management, customer service, data analysis, and strategy.

 

 State Insurance Regulators

  • Worked with state regulators to design and develop health care affordability standards, leveraging a rate review process to hold health plans and providers accountable to primary care investments and innovative payment approaches.
  • Conducted official review of a Certificate of Need (CON) Application for a service expansion at a hospital to assess the public need, affordability, and clinical competence of the proposal.
  • Worked with state regulators to evaluate the proposed merger of two dominant hospital systems.
  • Led multi-departmental effort within state government to develop strategies to address rising cost of health insurance and the growing uninsured. Designed multi-year plan for comprehensive health insurance reform, targeting health insurance access for all state residents.

 

Major Hospital Network

  • Provide strategic and analytical support for a major hospital network’s participation in a Medicaid ACO Pilot program and full scale Medicaid ACO program.
  • Served as facilitator to support the development of ACO contracting principles while enhancing relationships between hospital network and local community partners in the ACO project.
Back to Top