Three Ways To Optimize Managed Care

Three Ways to Optimize Managed Care Programs: Approaches for Effective Core Program Administration

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Published: April 19, 2022

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According to the National Association of Medicaid Directors (NAMD) in 2021, Medicaid directors spent significantly less time working on strategic initiatives and program innovations than they would like. Because of competing priorities, only 25% of their time is spent on key focus areas compared to their goal of 40%. Sellers Dorsey experts, and former state Medicaid Directors, Gary Jessee, Leesa Allen, and Mari Cantwell explored strategies, innovations, and lessons learned in the key programmatic areas of value-based purchasing, managed care procurement, and managed care organization (MCO) contract oversight in the following videos.

1. Value-Based Purchasing and Quality Improvement

Challenges and strategies for balancing standardization and flexibility within value-based purchasing programs.

2. Managed Care Procurement

Managed care procurements present both opportunities and challenges for state Medicaid programs and MCOs.

3. Managed Care Oversight

Effective contract oversight requires the right tools and balancing accountability with administrative burden.

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Contact our Experts

Expertise: Medicaid Managed Care, Medicaid Policy, Value-Based Care
Markets: Hospital and Healthcare Providers, Medicaid Managed Care Plans, Physician Groups, Solution Partners

Leesa Allen

Before joining Sellers Dorsey, Leesa served as both the Executive Deputy Secretary for the Department of Human Services (DHS) and the Commonwealth’s Medicaid Director, and prior to that as the Deputy Secretary for Medical Assistance Programs and the former Executive Medicaid Director for the Commonwealth. In this most recent role, Leesa was responsible for providing direction and oversight for the Department’s 16,000 employees and $30 billion budget, including eligibility and enrollment services, child welfare services, long-term care services for the elderly and intellectually disabled populations, behavioral health services, program integrity, and the statewide administration and oversight of the $30 billion Medicaid program. Leesa played an integral role in the design, development, and implementation of Pennsylvania’s HealthChoices managed care program, including development of the Commonwealth’s managed care waiver and contractual language and program oversight and monitoring. In addition, Leesa was responsible for implementing value-based purchasing and quality incentives for providers and managed care organizations (MCOs) within the HealthChoices program. Leesa was also an active participant with the National Association of Medicaid Directors, selected by her peers to serve on the Board of Directors for the Eastern Region, and is a 2016 Fellow of the Medicaid Leadership Institute.

Current Responsibility

Leesa provides direct client consulting and leadership services including providing objective advice, expertise, and specialized skills in the area of healthcare policy, strategy and management with the aim of creating value, maximizing growth and/or improving the business performance of clients. In addition, Leesa leads Sellers Dorsey’s Research and Policy team, which conducts timely research and tracking of state and federal legislative, regulatory, and judicial actions impacting the Medicaid Program as well as the content and development of the weekly Sellers Dorsey Digest.

Education

Chatham College, BA, English

Gary Jessee

Gary is the recent former Deputy Executive Commissioner for Medical and Social Services in Texas, the largest division in the Health and Human Services System. In that position Gary oversaw four departments and a $50 billion budget, bringing together client services, including eligibility services, Medicaid/CHIP services and functions, and community programs under one coordinated division. Prior to this, Gary served as the State Medicaid Director where he was responsible for overseeing services and supports for more than four million Texans across the state. He also previously served as the Chief Deputy Director for Program Operations in the Medicaid/CHIP Division. Before joining Texas Health and Human Services Commission, Gary served as Assistant Commissioner for the Access and Intake Division at the Department of Aging and Disability Services, where he was responsible for overseeing functions of the Area Agencies on Aging, Local Intellectual and Developmental Disability Authorities, Community Services and Program Operations, Community Living Assistance and Support Services, Contracts, Guardianship services and other specialized programs. Gary is the past President of the Board of Directors of National Association of States United for Aging and Disabilities (NASUAD).

Current Responsibility

Gary serves as Senior Vice President of the firm’s National Medicaid Consulting Practice. Since 2017, he has led the practice’s tremendous growth through business development and overseeing successful client engagements. As a former Medicaid Director, Gary leverages his extensive experience with Medicaid managed care, long-term services and supports, Medicaid market advisory and research, and health care policy to design and implement creative solutions for clients such as state aging and Medicaid agencies, managed care organizations (MCOs), private equity firms, and solutions partners. In his previous roles, Gary led managed care implementations and MCO oversight, and thus understands the operational challenges for both MCOs and providers. His more than 20 years of experience in state service and Medicaid has provided him with unique insight into health and human services programs, legislation and regulations impacting Medicaid, and health care operations. Gary is recognized as a national thought leader on health care trends and best practices and continues to attract peer professionals due to his longstanding relationships within the industry to join Sellers Dorsey’s growing consulting practice.

Education

- - Texas State University, MA, Interdisciplinary Studies
  - Texas State University, BS, Sociology

Mari Cantwell

Mari Cantwell served as the Medicaid Director for the California Department of Health Care Services (DHCS) from 2015 until January 2020. She entered the Director role following her time as the appointed Chief Deputy Director of Health Care Programs, which began in February of 2013. Mari was responsible for the overall management of Health Care Delivery Systems, Health Care Financing, and Health Care Benefits and Eligibility. Prior to her appointment, Mari served as the Deputy Director, Health Care Financing, where she was responsible for the development, promotion, and implementation of health care delivery systems to the beneficiaries of the State Medi-Cal program. Before joining the Department, from 2005 to 2011, Mari worked at the California Association of Public Hospitals & Health Systems as the Vice President of Finance Policy.

Current Responsibility

Mari brings deep expertise in healthcare financing and Medicaid policy, drawing on two decades of leadership in both the public and nonprofit sectors. Leveraging her experience as California’s former Medicaid Director, Mari provides strategic guidance to clients navigating complex healthcare financing challenges, including Medicaid program design, delivery system reform, and federal and state policy alignment. Her unique insights into public health systems and financing structures make her an invaluable resource to clients seeking to improve access, sustainability, and outcomes in healthcare delivery.