In this episode of The Move to Value Podcast, guests Jennifer Houlihan and Jennifer Gasperini join us for a deep and wide-ranging conversation on the evolving landscape of value-based care. We explore North Carolina’s leadership in Medicaid transformation, the critical role of provider voice, and the infrastructure needed to support long-term success.
From navigating administrative burdens to anticipating federal policy shifts, we also discuss how health systems can stay nimble, build smarter data strategies, and engage patients in more meaningful ways. Whether you’re a provider, policymaker, or system leader, this episode offers timely insight into where healthcare is headed—and what it will take to get there.
Transcript
So I think that has been an opportunity and you know being able to leverage some of the infrastructure you're building for Medicaid obviously can be used for not just Medicaid. So I think that's been a real opportunity and I know that you know the plan and some of that work will be rebid next year. So I think those are some strong sentiments as provider groups and CINs were voicing strong support that we really want to have providers really with a strong voice at the table able to do this work and have the infrastructure though needed and support to do this as a partner with the payers in the state
Thomas Royal:Welcome to the Move to Value Podcast, powered by CHESS Health Solutions.
In this episode, we continue our conversation with Advocate Health’s Jennifer Houlihan and Jennifer Gasperini, taking a deep dive into Medicaid transformation in North Carolina, a state leading the way in innovation and provider engagement. They also chime in on infrastructure, data strategy, regulatory shifts while we explore how health systems are adapting—and where opportunities lie in a time of rapid change.
Thomas Royal:Jennifer Houlihan. Jennifer Gasperini. Thanks for sticking around so that we could continue this conversation. I have a couple of more questions in various topics, but one of the things I'd like to talk about is Medicaid and let's zoom in on North Carolina, which is where our organization is centrally located. How is Medicaid transformation progressing and what changes do you anticipate over the next five years?
Jennifer Houlihan:I would say North Carolina has been very innovative and progressing in this space, you know with their first with their 1115 waiver that was approved under Trump One's first administration, it had many kind of innovations including healthy opportunities, the advanced medical home, Tier 3, which was really focused on provider engagement. So I I think from my lens, Medicaid has been very progressive in ensuring it's not just been about, you know, transferring kind of to the PHPs or the health plans, if you will, but ensuring that there was a strong provider voice, an engagement thing through healthy opportunities, Advanced medical home. So I think we've seen a lot of progress there.
I think they've also tried to be, you know the state department has also tried to be very innovative, although now cancelled. Really wanted to create strong alignment with models like Making Care Primary and also looking at set up sort of the MSSP chassis for some thoughtfulness and what was has been nice about that is sort of taking.
In some of the themes we've just talked about in terms of alignment around quality measures. Reducing some of that administrative burden, really taking a look at a more holistic sort of Medicare, Medicaid or really creating a chassis for all of value. And that's what we want. And of course, North Carolina has large health systems, but it has a lot of small, independent providers. So I think they've also really tried to look at an approach that it is more broad and takes into consideration the needs of practices. And so everything from quality reporting and the you know the burden there. So I think
we've made a lot of progress in the state of North Carolina and really I think when it comes to Medicaid innovation, they're probably in the top three to five states that are held out as examples of some of the innovation that they've done, especially because it's been very focused on moving you know to value a strong emphasis on quality, of course first, but then wanting to think about how creating that basis for a future where it's more of an ACO or value based construct.
Thomas Royal:Well, that's great. So just you touched on this a bit, but you know what are what are the biggest challenges or opportunities facing Medicaid providers in North Carolina today?
Jennifer Houlihan:Well, I think much like in our last session where we talked about administrative burdens with quality reporting I think that is still one of the challenges that we continue to see because you know of course we're part of a large health system, but a lot of the provider groups, whether they're with a CIN or other group are participating in other contracts, so this idea that we have multiple different quality sets and reporting requirements. I think in North Carolina Medicaid looking at all the PHPs and the we've got standard plans and we've got the tailored plans for behavioral health and some new Children's Health plans coming online. There's quite a few plans, even in the Medicaid space. So again looking at all the requirements and trying to comply with all of those and some of the core pieces to our data sharing, getting attribution. Making sure that's correct 'cause. That's so important to having strong quality performance ensuring that those, you know, denominators are correct. So, I think all of those have been creating challenges from an opportunity side. I think there has been a, you know, one really good thing about the 1115 waiver in North Carolina. Is it really put a lot of strong investment in for providers again for that Advanced Medical Home portion and I think what that's done for providers is have some infrastructure support to be able to invest and do this work. And I think it's not a small number in terms of some of those PMP payments.
So I think that has been an opportunity and you know being able to leverage some of the infrastructure you're building for Medicaid obviously can be used for not just Medicaid. So I think that's been a real opportunity and I know that you know the plan and some of that work will be rebid next year. So I think those are some strong sentiments as provider groups and CINs were voicing strong support that we really want to have providers really with a strong voice at the table able to do this work and have the infrastructure though needed and support to do this as a partner with the payers in the state versus just as a kind of a downstream recipient, you know, et cetera.
Jennifer Gasperini:Yeah, I'll say after a big 10 year break from North Carolina State policy work, I was really struck returning to this work at how much of a voice providers have and the the great opportunities to shape and influence the policies. So I think that's a really big opportunity for providers in North Carolina.
Thomas Royal:That’s outstanding. So let's move over and talk about health system strategy.
Advocate plays a key role in this space, and what strategies are being implemented to adapt to the evolving regulatory and policy environment and changes that may come with a returning administration. But with new faces.
Jennifer Gasperini:That's a great question, I think the advice that I've been giving a lot is to be nimble, to be ready to expect the unexpected and as Jennifer mentioned, what might we might think is true today may not be tomorrow. And so we just really needing to be adaptable and ready to pivot quickly, I think to the winds of the new administration, priorities that will see probably evolve over the next four years.
Jennifer Houlihan:I think that just to add on to that, that there has been sort of, you know looking at some of the potential policy changes that may happen and may not to Jennifer's point. So I think there has been a lot of modeling and what if scenario planning just to look at if we see changes that may happen in the Medicaid space or site neutral or, you know, shifts that may or may not happen in some of the fee schedule piece on the provider side.
So I think there there's so many what if scenarios. And then looking at what our overall strategic plan is and what our leadership has added as priorities is trying to align those.
So I think flexibility and frankly from my vantage point kind of still in a wait and see approach. Because it's nothing, as you know. I think we'll, we'll see. Maybe in the first budget and then have to kind of see how that trickles down.
Thomas Royal:Some solid advice.
Moving over to data, has CMS become more data focused in its expectations and what's changing and how they use data to guide and evaluate value-based care?
Jennifer Gasperini:So I think as Jennifer just mentioned, we're still learning that information, but I I have heard a couple of things. One, Kim Brandt, who spoke at the NAACOs Conference, did talk about how data would be a priority for Doctor Oz, the new CMS administrator, and we know also that Chris Klomp, who's the director of Medicare has a big focus and background in technology health IT and focus on data. So I think this is going to be an area of focus and excited to learn more because improving interoperability and data sharing really helps ACOs and really the movement to value.
Thomas Royal:Looking forward, how do you see data infrastructure evolving to support population health management?
Jennifer Houlihan:Well, I think. I mean, I think it has been evolving, but I mean a couple things. Just as as Jennifer said, that is we are hearing and given some of the backgrounds of the new CMS and and leadership, is is a much more tech enabled integration focus. So I think you know some of the important pieces that we know make a huge difference are real time data. So how we're leveraging real time clinical decision making and using that for care coordination? So I think that will continue and you know the idea again where if we're trying to reduce burden and create some alignment we need better sort of data exchange across providers, payers, other setting. So hopefully you know, I think we'll see that continue to evolve. And then, of course, AI, you know, there's a lot of potential there. I think we're still some guardrails and how that will be used, but would be remiss.
without mentioning how you know, that's certainly entering into the equation now, and probably even more so as we think about how we ingest all of data from multiple points and create these actionable insights that our various members of the care team. And I think one of the other things that we've heard can use is that, you know, how do we give data to patients to allow them to use information? So I think there's a lot of, you know, thought around that but advanced analytics, AI, you know how patient centered and help in patient decision making I think we'll all be things that will continue to evolve and I think we'll see a lot of advancement there. I think that is an area again, as Jennifer mentioned of both strong technical background and interest of this new administration and thinking about that in the context of improving efficiency. And so I think I think this is gonna be a big area of focus. It'll be interesting to see how that plays out.
Thomas Royal:What initiatives are you leaning into to incentivize patient engagement and how are you measuring any effectiveness?
Jennifer Houlihan:I feel like this is still a very evolving area. There's a lot of platforms, mobile apps of course, telehealth remote monitoring, those are pieces that we've used on patient engagement. I think we still need to see some better integration of those platforms.
But I I think that this is an area you know we've had use of AI chatbots and you know, working with partners that engage our patients in different ways. I've also seen obviously incentive models where you're incentivizing and providing some sort of benefit to patients if they do certain milestones or behaviors. So I think the tech enablement has been a big piece that we've probably tapped into most and then we've also partnered, you know with community based organizations on some of the other patient engagement pieces and supporting them in that ways. But I think there are still a lot of opportunity. I think one of the areas we saw in that role too was an RFI around thinking differently about new measures of well-being for patients. So I think that what really matters to patients and patient reported outcomes, still an area that we'll see more growth in.
I don't Jennifer anything to add.
Add to that.
Jennifer Gasperini:No, I I echo all of your comments and I think it's a big area of opportunity. You know, a lot of people are trying to really work on this and interested to see how this evolves.
Thomas Royal:That's great.
So we have an immense level of expertise in this interview right now. If you had a magic wand to improve one thing about how we track and report on outcomes, what would that be?
Jennifer Gasperini:That's a good question. I one thing that comes to mind for me is improving interoperability. I know there's just a lot of work arounds and Band-Aid solutions to overcome the lack of interoperability, and I think if we had true interoperability it would make a lot of this tracking and outcomes focused analysis a lot easier.
Jennifer Houlihan:Yeah, I agree with that. I think also. So a lot of the conversations I'm in is the kind of the need for better sort of better behavioral economic modeling. We we have a lot of interventions that we deploy in pop health but we don't always have the sophisticated evaluation to know which one worked or the sophistication to know which patient segment it worked best for. So I just think we continually need to have this ability to showcase the wonderful outcomes that we're achieving in the space and tying that to economic and financial. And of course we show the savings we generate. But there I think there's a lot of benefits that we're providing. But as we all know, you know we've got to show both that quality and cost or savings piece and just needing to sure we have strong evaluation models that can demonstrate that.
Thomas Royal:Well, if you look into your crystal ball, can you tell us what you see happening in healthcare at the federal and state level over the next 5-10 and 15 years?
Jennifer Gasperini:My instincts are telling me that it's hard to tell you what will happen in the next 5 minutes these days. I think the landscape is changing at a pace we have not seen before, and I have developed an eye twitch because things have moved at such a fast pace and it is really overwhelming. So I do think the next four years though will be very telling and it's going to be. A wild ride.
Jennifer Houlihan:Yeah, can could not agree more with that sentiment. I mean, I mean, I think. I really wanna see the strategic refresh come out for CMMI, especially when we kind of review the past. What 3/4 plus administrations? You know, you saw this clear progression of goals, of shifting Medicare beneficiaries into value with 100%.
So I would still say and believe that we're still in this journey of transitioning from volume to value and would love to see that become you know, more of the mainstay or the you know we've achieve a tipping point. And I think it'll be a really interesting as Jennifer said, next 1-2-3-4 years to understand and how Medicare Advantage evolves where we see CMMI take downside risk. And so that's kind of my hope is that we continue to see it evolve, but in a sustainable and that we can really see sustainment and our savings and not sort of have this year after year where we have to sort of beat ourselves in this game, but also see real momentum across all other areas, other segments and obviously Medicare as a lead. But we're we building this work and this chassis f or all all patients, all populations, and wanna see this deployed as widely as possible.
Thomas Royal:Well, thank you both for your time today and it has been a real pleasure. Jennifer Houlihan., Jennifer Gasperini, thank you for joining us today on the move to Value podcast.
Jennifer Houlihan:Thank you for having us.