A Time to Reflect

November 28, 2016

This is one of my last two blog posts as executive director of MAHP. A bittersweet moment to be sure, but one that naturally forces you to look both backward, to appreciate what changes may have taken place, and to look forward to anticipate future events and how well positioned we may be. 

I have been privileged in my life to have witnessed signifcant advances in health care policy in Michigan and to have helped shape some of those initiatives. I feel blessed to have been able to work for and with many individuals who lead with their heart and soul on health care. As I tell folks, “not too bad for a kid from Bad Axe.” I hope I can be indulged by some reflection.

Let's Start at the Beginning

My career in health care started innocently through a series of ad hoc choices...after finishing undergraduate program at Eastern Michigan, would I pursue a law degree, which would be likely out of state or would I take the opportunity to enroll in graduate school at University of Michigan School of Public Health—as I was accepted for both options? The latter was path of least resistance and one that I took. I didn’t have to move and through that “fork in the road” my future path was determined. 

The next “fork in the road” was in finding a way of combining my undergraduate degree in political science with the training at the School of Public Health—and that opportunity was presented early as a newly enrolled graduate student with a decision to be involved with the Model Committee Staffng Project in Health—a Robert Wood Johnson Foundation demonstration project operating in seven different states, including Michigan. This project provided paid professional staffng to the house and senate health committees in these states to work on agreed upon legislative initiatives. The project in Michigan was just wrapping up their first initiative which was development of model legislation for Health Maintenance Organizations (PA 264 of 1974) and as a graduate student, I was fortunate enough to learn firsthand lessons of the convergence between self-interest groups, politics, and state policy—and as an important by-product, developed life-long friends.

Move forward a few years to when I had a position in state government— within the state budget offce but in health planning—where we were required to develop state positions on health care cost containment, the role/impact of institutional health care capacity that drove certifcate of need decisions and early discussions on such current issues of health professional shortages, need for state policy on hospice care, and the growing cost of Medicaid as part of state budget. Again, many longtime friends/colleagues were established that continue to this day. 

A Fork in the Road

As funding for health planning expired, the next fork in the road was a choice between state budgeting on public health— the choice was budget and taking primary responsibility for the State Mental Health executive budget and start of involvement with special Medicaid financing options. The merger of the then Departments Mental Health and Public Health and the Medicaid Program to constitute the new Department of Community Health was the next path along with the opportunity to be on the ground floor on new initiatives for Medicaid regarding managed care. I was “volunteered” to be part of a core team to develop the framework for advancing managed care for the Medicaid program. This initiative had five components (Comprehensive Health, Children’s Special Health Care Services, Long Term Care, Behavioral Health and services for persons with Developmental Disabilities) which would all be launched simultaneously which the intent to ultimately merge into a single managed care program. Suffice it to say, this long term goal for Medicaid managed care is still in progress. I stayed in Medicaid to administer the managed care initiative. As point of context, while we now have 11 contracted Medicaid health plans in 2016...at one time1998-2000, Michigan had contracts with 33 Medicaid health plans and I can recite the ultimate disposition of each one. The initial decision of letter the “marketplace work” was correct, and through mergers, acquisitions, subsequent re-procurements, the number of health plans has been reduced while the total enrollment has more grown by more than sixfold. I have fond memories of my years in state government and return to this later.  

Like many state employees, the math behind the offer of “early retirement” was too good to pass up and I left state employment and joined the Michigan Association of Health Plans in 2002. My intent was to capitalize on my experience in budget and Medicaid while taking time to understand the various issues facing commercial health plans who were members of MAHP. The luxury of time quickly disappeared as my predecessor; Gene Farnum succumbed to cancer soon after I joined MAHP and I assumed an interim executive director role and ultimately, following a search process, assumed the executive director role. I only wish that I knew then what I know now regarding various nuances of regulations, state policy and federal actions affecting the commercial market. Our legislative focus had to grow simply in order to survive and continues to grow to this day. Challenges on the small market and individual market brought many interest groups together and strategies of collaboration once again were successful. Working through the intricacies of the Affordable Care Act (because we had to), understanding how the insurance exchanges would work and differing responsibility of state exchange vs. federal exchange; developing messaging regarding affordability and underlying cost pressures; and continue to strike a balance internally between needs of our members who had Medicaid products and those who had commercial products were all in play and will continue.

All of these paths provided personal value and relationships and my need now to acknowledge those who shaped my career that I will share more in depth next week in my next post.

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