M a k i n g O h i o B e t te rM a k i n g O h i o B e t te r

John McCarthy, Medicaid Director

November, 2015

NAMD Fall Conference:Leadership in Times of Change

M a k i n g O h i o B e t t e rO H I O D E PA R T M E N T O F M E D I C A I D M a k i n g O h i o B e t t e rO H I O D E PA R T M E N T O F M E D I C A I D

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Since January 2011

• Implemented both a new MMIS and eligibility system

• Reprocured and implemented a new managed care delivery system

• Started reporting on six retrospective episodes in value based purchasing

• Created a new Ohio Department of Medicaid

• Slowed the rate of growth in Medicaid from 9% to 3%

• Provided health care coverage to over 600,000 people

• Reduced the rate of insurance in half for both adults and kids

• Started care management of inmates upon release

• Rebased a number of provider rates

• Came into compliance with Ohio’s 5 year rule review (over 375 rules)

• And much more

M a k i n g O h i o B e t t e rO H I O D E PA R T M E N T O F M E D I C A I D M a k i n g O h i o B e t t e rO H I O D E PA R T M E N T O F M E D I C A I D

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Leadership

One major question you need to answer:

Why would anyone choose to follow you?

M a k i n g O h i o B e t t e rO H I O D E PA R T M E N T O F M E D I C A I D M a k i n g O h i o B e t t e rO H I O D E PA R T M E N T O F M E D I C A I D

1.

Rucci, 2014 11/10/2015

What is Leadership:The Value Proposition1

LeadershipActions

EmployeeCommitment

CustomerSatisfaction

ValueCreation

• A vision they relate to• Teams they value being a part of• Leaders they choose to follow

M a k i n g O h i o B e t t e rO H I O D E PA R T M E N T O F M E D I C A I D M a k i n g O h i o B e t t e rO H I O D E PA R T M E N T O F M E D I C A I D

2.

Rucci, 2014 11/10/2015

Employee Commitment 2

• The best Leaders….

Create Commitment

• An operational definition:» Gaining the discretionary energy, effort, and ideas from people who voluntarily

choose to follow your vision.

M a k i n g O h i o B e t t e rO H I O D E PA R T M E N T O F M E D I C A I D M a k i n g O h i o B e t t e rO H I O D E PA R T M E N T O F M E D I C A I D

The Best Leaders

• Their actions are guided by the three P’s3

:

Passion Have a personal passion for what they do. They would continue to do it if they were independently wealthy. They would also continue to do it if they werecompensated very little.

Performance As much as they enjoy winning, they hate losing even more. They keep score. They set high standards. They hold themselves and their people accountable. They are tough minded.

Principle Cheating in order to win does not count. When faced with a decision that puts profit ahead of principle, principle will always win.

3.

Rucci, 2014 11/10/2015

M a k i n g O h i o B e t t e rO H I O D E PA R T M E N T O F M E D I C A I D M a k i n g O h i o B e t t e rO H I O D E PA R T M E N T O F M E D I C A I D

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Examples of the three P’s

• Passion» As a Medicaid Director you already have this, just look at your paycheck

and Andy’s article

• Performance» How many SPA’s did you get approved last year? Do five more this year

• Principle» It is always easier to let that provider group have a little more money,

but is that the right policy choice with the right incentives

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Often a Medicaid Director Must Look Up

• Your leadership style must fit within the Governor’s leadership style

» Mover and shaker vs. Don’t rock the boat» Politically deaf vs. Politically savvy» Damn the torpedoes full steam ahead vs. Patience is a virtue

• Where do you fit in?» Are you a cabinet member?» Are you a part of a larger organization?

• There must be someone who is the decider with sister agencies» Remember your agency is not always right nor free of sin

M a k i n g O h i o B e t t e rO H I O D E PA R T M E N T O F M E D I C A I D M a k i n g O h i o B e t t e rO H I O D E PA R T M E N T O F M E D I C A I D

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Organizational Structure

• Just because it was inherited does not make it right

• Look at other states and ask them what works and what does not work

» There is no perfect structure

• Redundancy is important» It is too easy to have that one person that knows “X”

• You may need help» Consider contracting for organizational change management

• You are a multi-billion dollar insurance company

M a k i n g O h i o B e t t e rO H I O D E PA R T M E N T O F M E D I C A I D M a k i n g O h i o B e t t e rO H I O D E PA R T M E N T O F M E D I C A I D

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Management Training

• In many Medicaid agencies staff do not have business school backgrounds, nor do they have training in management

• Important to put an emphasis on management training» Consider contracting with your state university business school to

obtain senior executive training

» Make the time for training – it pays off in the long run

• Tie this training to decision making and hiring

M a k i n g O h i o B e t t e rO H I O D E PA R T M E N T O F M E D I C A I D M a k i n g O h i o B e t t e rO H I O D E PA R T M E N T O F M E D I C A I D

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Management Buy-in

• The training means nothing if your management team does not buy-in to your philosophy

• Senior management needs to be a part of creating mission, vision, objectives, etc.

• Must be built into everyday management

M a k i n g O h i o B e t t e rO H I O D E PA R T M E N T O F M E D I C A I D

• Rucci, Tony. “Introduction to Leadership Legacy” August 2014. PowerPoint presentation.

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References