16th Annual Medicaid Innovations Forum

Data-Driven Strategies for Enhancing Care Delivery, Promoting Health Equity, and Driving Medicaid Transformation

Event Schedule

Pre-Conference Maternal Health Spotlight


Ensuring that Pregnancy-Related Coverage is Focused on the Whole Person: Providing Person-Centered Care Addressing the Physical, Behavioral and Social Needs of Mom and Baby

Leveraging Culturally Competent, Personalized Maternal and Infant Care Models: Linking Women to Equitable Clinical Interventions and Evidence-Based Community Supports

Engaging Medicaid Members with a Maternity Benefit that Meets Their Needs from Conception to Postpartum: Identifying Risks, Addressing SDoH, and Enhancing the Member Experience

Panel Discussion: Transforming Medicaid to Combat the Maternal Health Crisis: Reducing Disparities and Advancing Improved Access to Critical Services that Impact Maternal Morbidity and Support Healthy Outcomes


Panelists:


Jacqueline Collins, RN, CPHQ, MSML,

Senior Director,GA and AR Quality Improvement,

CareSource


Erica Moore-Smith, LCSW,

Supervisor, Social and Community Services,

Inland Empire Health Plan


Chantel Neece DNP, MBA, APRN, FNP-BC, GERO-BC, CPHQ, SSBBP

Sr. Director- Maternal/Child Services & Member SDOH

Sentara Health Plans


Harvey Karp, MD

Co-Founder

Happiest Baby

Welcome Reception

Chairperson’s Welcome


Clay Farris,

Founder and Practice Lead,

Mostly Medicaid


MEDICAID 2025 LANDSCAPE


Taking a Look at the Political Landscape: What Election Results Mean for the Future of Medicaid


Clay Farris,

Managing Editor,

Mostly Medicaid


Value-Based Contracting:  Stop Swimming Against the Tide and Build a Boat


  • Current state of value-based contracting
  • Where it works and doesn’t and why
  • What are we really trying to do, and maybe better ways to do it
  • How do we go forward?

Mike Rapach,

CEO,

CareFirst Community Health Plan of Maryland


Panel Discussion: Addressing Social Needs through Medicaid: Screening for SDoH and Mitigating the Negative Health Impacts of Unmet HRSN


Moderator:


Tiffany Stone,

Deputy Director, Government Programs,

Michigan Association of Health Plans


Panelists:

Kanita Bourne​​​​, LCSW, MPA,

Manager, Social & Community Service,

Inland Empire Health Plan


Julie Joseph, MD

Chief Medical Officer

BlueCare Tennessee

Melissa Smeltzer, MSN, BSN, RN, CPHQ, PAHM

Director, Clinical Quality Improvement

BlueCare Tennessee



CASE STUDY: Bending the Cost Curve: North Carolina’s Successful Strategy Investing in Whole Person Health


Kody Kinsley,

Secretary,

North Carolina Department of Health and Human Services


Morning Refreshment Break


Panel Discussion: Managing the Evolving Pharmacy Benefit in Medicaid


  • GLP-1s – Balancing Access vs. Cost
    • Background – GLP-1 agonists (Glucagon-like-peptide-1): Class of medication that regulates blood sugar, appetite, and digestion. Current indications can include type 2 diabetes, obesity, or both. Examples of GLP-1’s include: Ozempic, Wegovy, and Mounjaro
    • Medicaid coverage for diabetes common, but coverage for weight loss varies significantly by state
    • Levers to Control Use (e.g., Prior Authorization, Utilization Management, Lifestyle Programs)
    • Fraud, Waste, & Abuse Concerns
  • New & Emerging Gene and Cell Therapies (e.g., Sickle Cell, Hemophilia, HIV PrEP)
    • Significant advancement comes with high sticker price
    • Not new per se, but also biosimilars – what does this look like moving forward for Medicaid
  • Expanded Pharmacist Scope of Practice/Authority
    • Pharmacists continue to get more and more added to their ‘list of services’ (e.g., vaccinations, blood pressure readings)
    • How to deal with given workforce constraints

Moderator:


Stephanie Schlomer, MPH,

Regulatory & Quality Strategist, Regulated Markets—Health Insurance Marketplace & Medicaid,

Express Scripts by Evernorth


Panelists:



Tracey Davis, PharmD,

Director of Pharmacy,

AmeriHealth Caritas District of Columbia


Risk Adjustment and Revenue Integrity…then what? Discover the Main Reason Your Plan is Underperforming



Amanda Brown,

Vice President - Revenue Integrity,

CoventBridge Group


Ray Evans,

Vice President – Healthcare Sales,

CoventBridge Group

CARE DELIVERY


CASE STUDY: Integrating Community Health Workers into Healthcare Teams: Leveraging These Key Resources for Health System Navigation and Resource Coordination, Health Promotion and Education, and Screening and Assessment


Jim Milanowski,

CEO,

Genesee Health Plan

Luncheon

Panel Discussion: Leveraging a Care Integration Strategy to Optimize the Patient Experience and Advance Whole Health: Addressing Coverage Barriers and Care Gaps for High-Cost, High-Risk Populations


Panelists:


Jacqueline Collins, RN, CPHQ, MSML,

Senior Director, GA and AR Quality Improvement,

CareSource

Dorthy K. Young, Ph.D., MHSA

Chief Health Data, Operations and Research Officer

Mississippi State Department of Health

Hospital to Home Continuity of Care for NICU Graduates

Developing a D-SNP Model of Care: Addressing the Barriers that the Dual Eligible Population Faces through Tailored Solutions within a Unified Framework


Chris Esguerra, MD,

Chief Medical Officer,

Health Plan of San Mateo

Leveraging Chronic Care Models that Advance Health Equity and Drive Improved Outcomes

Afternoon Refreshment Break

Panel Discussion: Facilitating Transitions from Incarceration into the Community: Ensuring Continuity of Coverage, Reducing Disparities in Care, and Decreasing Recidivism Rates


Moderator:


Kevin Bagley, DHA, MBA, FACHE,

Former Medicaid Director,

State of Nebraska


Panelists:



Megan Raleigh LISW-S,

Manager of Addiction Services County Corrections,

MetroHealth


Creating Access to Care through Delivering High Quality Networks: Addressing the Unique Needs and Health Equity Considerations of Medicaid Members and Ensuring Network Adequacy

Transforming Medicaid: Integrating Whole Health and Sustainable Solutions for Healthy Aging


In this presentation, we will explore how Medicaid can be leveraged to deliver comprehensive care that addresses physical, mental, behavioral, and health-related social needs. We’ll focus on enhancing the consumer journey and ensuring sustainability in aging services by:

  • Whole Health Approach for Aging Populations: Designing Medicaid solutions that integrate medical care with mental health and social needs, recognizing that mind and body are inseparable for effective, person-centered care.
  • Addressing Health-Related Social Needs: Incorporating housing, nutrition, transportation, and social connectivity into Medicaid strategies to create a supportive environment for older adults.
  • Enhancing Transitions of Care: Developing seamless care pathways from hospital to home or community to long-term care, aimed at reducing readmissions and improving health outcomes.
  • Sustainable Models of Care Delivery: Leveraging cross-sector partnerships and value-based care to ensure continuity, access, and cost-effective care for aging populations.


Mina Chang, PhD,

Deputy Director, Chief Analytics & Compliance Division,

Ohio Department of Aging


Cocktail Reception


SPONSORED BY:


CARE DELIVERY(continued)


CASE STUDY: Leveraging Electronic Visit Verification (EVV) Data to Monitor Service Delivery:  Ensuring Services are Documented, Preventing Fraud and Abuse, and Managing Care and Resources Efficiently


Alexandra (Ali) Fernández, MHS,

Bureau Chief, Bureau of Long Term Care, Division of Medicaid,

Idaho Department of Health and Welfare


Chris Barrott,

Program Manager, Division of Medicaid,

Idaho Department of Health and Welfare

Developing, Testing, and Evaluating Alternative Payment Methodologies: Delivering Medical and Administrative Cost Savings while Enhancing Clinical Quality


CASE STUDY: A Triple Crown of Care: Efficiency, Access, and Continuity with MCOs and KHIE


Managed Care Organizations (MCOs) derive substantial benefits from state-based Health Information Exchanges (HIEs) such as the Kentucky Health Information Exchange (KHIE), which enhance data sharing, improve interoperability, and facilitate superior care coordination, leading to better patient outcomes. KHIE enables MCOs to gain a comprehensive understanding of patient health, supporting effective management of complex and chronic conditions. HIEs like KHIE promote seamless collaboration across healthcare providers, ensuring coordinated and patient-centered care. This interconnected approach not only improves health outcomes but also results in significant cost savings, essential for MCOs aiming to manage expenses while delivering high-quality care. This presentation will illustrate how MCOs leverage KHIE data to deliver superior care with a more complete understanding of their patients.


Andrew C. Bledsoe,

Deputy Executive Director, Office of the Inspector General,

Kentucky Health Information Exchange


CASE STUDY: How New Jersey Leveraged Medicaid-Funded Infrastructure to Expand Interoperability to LTCs


As long-standing facilitators of many statewide healthcare initiatives, the New Jersey Department of Human Services (NJDHS) and New Jersey Health Information Network (NJHIN) are leading the nation by driving cutting-edge interoperability efforts in their state while ensuring healthy outcomes for more than 2.2 million Medicaid beneficiaries.

COVID-19 was the catalyst for a widespread push to connect the state HIE to public health registries—a move that is paying dividends for providers today. Notably, New Jersey is also one of the only HIEs to meaningfully support long-term care facilities, an often-overlooked stakeholder in interoperability efforts. By leveraging existing Medicaid investments in technology infrastructure, 97% of LTCs seamlessly connected to the HIE in just 6 months—an unmatched rapid deployment for this provider cohort.

Today, NJHIN connects and streamlines actionable patient information and this real-time connectivity between public health and the private healthcare industry is key to enhancing information sharing, improving coordination, enabling proactive measures, and supporting data-driven decision making—ultimately leading to more effective and efficient public health ecosystem.

In this presentation, Jennifer D’Angelo, Chief Operating Officer and the Executive Vice President of NJII Healthcare Division will discuss how New Jersey collaborated to leverage established Medicaid funded infrastructure to support the most vulnerable patients across the care continuum. They will also share how other states can model their approach and stretch Medicaid grounded investments to expand interoperability programs to other stakeholders and support new use cases.


Jennifer D’Angelo,

Chief Operating Officer & Executive Vice President, Healthcare,

New Jersey Innovation Institute (NJII)


HEALTH EQUITY/HRSN


Panel Discussion: Operationalizing Health Equity Efforts in Medicaid: Identifying and Eliminating Barriers to Health Equity, Reducing Racial and Ethnic Disparities, and Closing Gaps to Accessing Essential Services


Panelists:


Gabriel Uribe, DSW,

Director, Health Equity Operations,

Inland Empire Health Plan


Chris Esguerra, MD,

Chief Medical Officer,

Health Plan of San Mateo


Sufian Chowdhury,

Co-Founder and CEO,

Kinetik

Morning Refreshment Break


Cultural Innovations for Advancing Health Equity in Medicaid: Lessons from African Principles

This presentation will explore how African cultural practices and principles can play a transformative role in Medicaid innovations to advance health equity. With a focus on the integration of values such as Sankofa, Eban, Ubuntu, and Sawubona, we will demonstrate how these principles can be adapted into healthcare practices to reduce health disparities and improve the quality of care for Black, Indigenous, and Medicaid populations. By sharing stories of systemic issues in healthcare, this session will demonstrate how cultural values can foster trust, build community-driven solutions, and drive culturally competent care, creating a more equitable Medicaid system.

Application in Medicaid:
Medicaid could adopt a community-centered approach, providing a sense of security around patients. Incorporating community health workers who understand the cultural contexts and needs of Medicaid populations will build stronger bonds of trust, ensuring patients feel protected and respected within the system. Medicaid must create systems where patients, especially from marginalized communities, feel seen, heard, and valued so that healthcare providers can acknowledge and respond to the full humanity of each patient.

By the end of this presentation, participants will:

  • Develop a deep understanding of how key African cultural principles can be applied to innovate Medicaid services and improve healthcare delivery for marginalized populations
  • Learn how these values can serve as tools to foster cultural competency, helping healthcare providers to better connect with and serve Medicaid patients from diverse backgrounds
  • Learn how to implement cultural frameworks that foster trust and respect within Medicaid, resulting in more equitable healthcare outcomes for Black, Indigenous, and Medicaid populations


Rosemond Sarpong Owens, CDM/MPH,

Director, Health Equity Integration,

Blue Cross Blue Shield of Minnesota

CASE STUDY: Building a Community-Based Social Service Network: Partnering with CBO’s to Deliver Specific Social Needs


Gabriel Uribe, DSW,

Director, Health Equity Operations,

Inland Empire Health Plan

BEHAVIORAL HEALTH


Panel Discussion: Building Out the Behavioral Health Continuum of Care:  Integrating Behavioral and Physical Health, Improving Mobile Crisis Services, and Advancing Substance Use Services and Supports


Moderator:


Diane Arms,

Director, Community Behavioral Health,

The Council on Recovery



Panelists:


Alyssa M. Ward, Ph.D., LCP,

Behavioral Health Clinical Director, Virginia Medicaid Line of Business,

Anthem HealthKeepers Plus


Christina Eyman, DBH, MHA,

Behavioral Health Integration Manager,

The Council on Recovery


Milla Jones, M.Soc.Sc.,

Program Coordinator, Strategic Initiatives, Medicaid & Long-Term Care,

Nebraska Department of Health and Human Services

Luncheon

Providing Behavioral Health Services to Medicaid Patients in Primary Care: A Payer/Provider Collaboration


Margaret Paroski, MD, MMM,

President & CEO and Chief Medical Officer,

Catholic Medical Partners


Barry Stelmach,

Chief Financial Officer,

Catholic Medical Partners


Carmela Costiniuk, B.Sc. OT, MHA, D. EdD (C),

Vice President, Population Health and Clinical Operations,

Catholic Medical Partners

OhioRISE: Youth Behavioral Health System of Care Coordination


  • History and goals of OhioRISE
  • View of the first 18 months of the program
  • Projecting the future of OhioRISE in meeting the needs of youth with complex BH needs

Marti Taylor,

CEO, OhioRISE, Vice President,

Aetna/Medicaid

Supplementing and Expanding SUD Services: Leveraging On-site MMCO SUD Licensed Care Managers and Non-Licensed Peer Specialists


Stella V. Pappas, LCSW-R, ACSW,

Vice President, Behavioral Health,

Healthfirst


Graisy M. Pichardo, LMSW,

Director, Behavioral Health,

Healthfirst

Outreach, Engagement and Whole Health for SMI: A Peer-Led Approach for Individuals Disconnected from Mainstream Services


Joe Parks, MD,

Chief Medical Officer, firsthand, Medical Director,

National Council for Mental Wellbeing

Conclusion of Conference