Medicaid Financing 2018-11-19T19:34:36+00:00

Delivery System Transformation
and Health Policy

State Medicaid programs are working with their federal partners at CMS to innovate at the forefront of payment and delivery of healthcare. States strive to improve health outcomes, improve efficiency, and build sustainable programs. Sellers Dorsey works with policy makers to develop, negotiate, and implement state Medicaid and reform initiatives such as waivers, expansion of managed care to new populations, development of value based purchasing and other alternative payment models. With a deep knowledge of Medicaid managed care programs, we have experience to implement proven concepts as well as insight to develop effective new approaches. Medicaid programs, providers and managed care organizations alike wish to leverage the potential of strategies that reward quality and value, and Sellers Dorsey is a capable partner in this important area.

CLIENTS AND SERVICES
Delivery System Transformation and Health Policy

Sellers Dorsey operates at the intersection of industry, policy, and government, helping an array of clients in these and other ways:

  • Developing and negotiating 1115 Medicaid waivers
  • Delivery and payment reform program development and implementation including delivery system reform incentive payment (DSRIP) programs
  • Devising and implementing new value-based payment (VBP) reforms
  • Facilitating commissions, committees, and task forces to drive stakeholder feedback and support for Medicaid reform initiatives
  • Managed care program planning and procurement
  • Strategic planning and business process redesign (BPR)
  • Understanding and translating state-led reform initiatives around policy, operations, and financing
  • Leveraging value based purchasing and alternative payment model requirements and opportunities
  • Advising on technology and solutions to optimize administrative resources
  • Preparing for and winning new Medicaid business through successful responses to requests for information and requests for proposals to ensure responses meet state requirements
  • Assisting in the readiness review process, ensuring that new programs are ready to meet the needs of the states and beneficiaries
  • Educating stakeholders and improving relationships with members, providers, advocates, and public officials through stakeholder engagement strategies
  • Applying the latest in health care trends, best practices, and regulations to your business, including VBP initiatives

OUR TEAM
Delivery System and Health Policy Experts Who Get Things Done

Sellers Dorsey includes former state Medicaid officials including Medicaid Directors, hospital and health plan executives, clinicians, and provider organization leaders responsible for the development, financing, administration and operation of Medicaid programs and health care delivery in various settings and through both fee-for-service and Medicaid managed care delivery systems. These are just some of the seasoned Medicaid experts at Sellers Dorsey:

Gary Jessee
Managing Director
Pat Brady, MBA
Managing Director
Pam Coleman
Senior Consultant
Ann Spishock
Managing Director
Nancy Kohler
Senior Consultant

Gary Jessee assists states, managed care organizations, service providers, and support vendors working within Medicaid. For 20+ years, he’s worked in health and human services at state and national levels, and his successful tenure in Texas state government comprises several leadership roles, including State Medicaid Director.

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Offering 20+ years’ experience with federal and state health policy, Pat is an authority on Medicaid financing. She provides public and private sector clients with strategic, policy, and technical assistance throughout revenue maximization initiatives and long-term care programs, particularly Medicaid managed care programs.

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Pam Coleman’s expertise is in Medicaid integrated managed care. She’s worked with several states to develop MLTSS and other Medicaid managed care programs, and when she served as Deputy Medicaid Director for the Texas Health and Human Services Commission, Pam administered the Managed Care Operations Department.

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Bringing thirty years of Pennsylvania government experience to Sellers Dorsey, Ann provides our Harrisburg team with strategic guidance and project leadership. On top of Medicaid funding, healthcare reimbursement, and health and human service policy, she is also well versed in PA’s budgeting process, governmental programs, and political acumen, making her an invaluable asset to clients.

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A resident Value-Based Purchasing (VBP) expert, Nancy works with clients on VBP in Medicaid managed care and Medicaid financing. Prior to Sellers Dorsey, she was integral to PA’s Statewide Quality Care Assessment, and her comprehensive experience includes public health program operations, policy development, implementation, fiscal analysis, and strategic positioning.

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CLIENT STORIES
Client Success in Medicaid Delivery System Transformation and Health Policy

Sellers Dorsey has worked in over 30 states and has a keen understanding of the impact of federal policy on state operations and the related implications for Medicaid providers. Our considerable experience has taught us that every state environment is different and requires nuanced solutions to meet regional needs as well as federal regulations.

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EVENTS AND CONFERENCES
Continual Growth in Knowledge and Relationships

Through our ongoing work and our relationships with key decision makers and thought leaders in the private sector and in state and federal governments, Sellers Dorsey remains well informed of the latest rules and guidance from CMS and trends and innovations emerging from the private sector. Our staff regularly communicates with leaders and staff of organizations and affiliations in the industry, and they attend events with these influencers and decision makers year-round.

Please let us know if you would like to meet a member of our team at an upcoming event. If you are an event organizer and are interested in hearing one of our thought leaders speak to your audience please contact us at [email protected].

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Contact Sellers Dorsey

If you would like additional information or wish to speak to any of our experts about issues facing your managed care organization, please get in touch and we will have a conversation at a time that's best for you.