In this episode of “Conversations with Perry and Friends,” host Perry Cohen, Pharm.D., a longtime member of the Managed Healthcare Executive editorial advisory board, has a wide-ranging discussion with John Baackes, former CEO of the L.A. Care Health Plan, the largest publicly operated health plan in the country. It provides health insurance coverage to more than 2.6 million low-income residents of Los Angeles County.
Cohen and Baackes discuss the government’s role in healthcare. Appproximately half of the U.S. population is dependent on government-funded health insurance, so if there going to be changes in the federal financing of health care, it’s going to have a major impact, Baackes observes
People with Medicaid coverage face hurdles accessing health services, Baackes noted, a problem that he says can be traced back to low Medicaid payment rates.
“What we need is parity in the payments between Medicare and Medicaid, and that doesn’t mean reduced Medicare [reimbursement],” Baackes says. “It means increased Medicaid [payments] to match Medicare, and you would have more providers participating. That would be step one in trying to correct that deficiency that’s there for the Medicaid population.”
Cohen and Baackes also discussed the advent of Medicaid managed care. Most states have contracted out the management of their Medicaid programs to not-for-profit and for-profit health plans.
“Managed care ushered in the era that we’re now in, where we do data collection, we do outcome reporting, and we now pay providers for improvements in those quality outcomes,” Baackes says. “I think managed care did give us the benefit of measurement and accountability that was lacking before. Does that mean it’s perfect? Of course not. We’re in a mess, but we have tools now that we did not have before as a result of managed care.”
Listen to the entire podcast episode on the Managed Care Executive’s website, available
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Dr. Sheila M. Thomas is a Senior Consultant for The Pharmacy Group (TPG), a leading consulting firm specializing in assisting healthcare service providers, information technology firms, and pharmaceutical companies in growing revenue and enhancing the financial performance of their products and services.
Brian is a Consultant for The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology, and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.
Dr. John Vazquez is a Physician Consultant with TPG International Health Academy (TPG-IHA). TPG-IHA has hosted educational programs for senior healthcare executives for 25+ years, holding week-long Educational Summits in over 30 countries across the globe. The Academy is powered by three pillars: education, networking, and cultural immersion.
Sue is a senior consultant for The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.
Gayle is a Senior Consultant with TPG Data Services (TPG-DS). TPG-DS and our team of senior healthcare and clinical consultants are transforming the way providers and payors monitor healthcare information to control costs and enhance efficiencies.
Nancy is a Senior Vice President with The Pharmacy Group, responsible for all financial aspects of the TPG Family of Companies, as well as operational matters. She joined The Pharmacy Group in March 2012, in addition to performing the overall financial management she evaluates project profitability and pricing, manages cash flow, analyzes financial performance, and makes financial recommendations. Additionally, she handles HR functions, and frequently is involved in client contracting.
Jeff joined The Pharmacy Group (TPG) in August 2008 to support its administrative functions. Over the years he has taken on additional responsibilities including marketing initiatives, client communications, and general web support. As a vice president Jeff is primarily responsible for attendee recruitment for all TPG activities, from the planning and strategy of recruitment to the execution and oversight of those initiatives.
Winston Wong is a Senior Consultant with The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology, and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.
Rich Balest has served as a health industry consultant utilizing over 25 years of experience in data mining, data modeling, data warehousing, and information delivery. Rich has comprehensive experience analyzing detailed claims and eligibility from CMS, insurance companies, and managed care organizations including prescription benefit managers (PBM), and account and medical record detailed patient data from hospital patient accounting systems, clinical ancillary systems, and professional and institutional billing systems.
Marjorie Pestel Zimmerman, MS, BS Pharm, is a registered pharmacist with diverse experience in the healthcare industry. During her practice in a large tertiary care center, she held numerous positions, including decentralized clinical pharmacist and Assistant Director of Operations within the pharmacy department. As a consultant for a psychiatric hospital, she performed medical staff drug usage evaluations and led patient medication groups.
In August 2015, Leon Edelsack became the President of TPG Healthcare Consulting (TPG-HC) and also serves as the president of TPG-HC’s sister company, TPG Data Services (TPG-DS), a position he has held since 2009.