Episode 115: What are D-SNPs?  And Why Should You Care?

Dual Eligible Special Needs Plans - D-SNPs are specifically for individuals who are "dually eligible" for both Medicare and Medicaid.

This episode of The CarePayments Pod breaks down Dual Eligible Special Needs Plans (D-SNPs), explaining why this essential form of Medicare Advantage is a critical trend for integrated care. D-SNPs are designed for "dual eligibles"—individuals who qualify for both Medicare and Medicaid—by providing a single, coordinated door for all their services, which simplifies processes and improves care access for vulnerable consumers. The discussion covers the plan's structure, its significant growth (over 5.2 million enrollees), and the crucial concept of alignment that makes D-SNPs an effective tool in managing complex health needs.

Welcome to The CarePayments Podcast - A quick-hitting informative discussion about healthcare payment models and how they affect MCOs, Providers, Payers, and Care Recipients with your host Fady Sahhar of XtraGlobex. Dual-eligible programs serve a critical role in the healthcare system, providing integrated care for millions of individuals who qualify for both Medicare and Medicaid. 

You can find more information on Dual-Eligibles at www.dualeligiblehq.com

The Value-Based Payments Blog is available for free at www.vbpblog.com

Created by xtraglobex.com

NEW EBOOK FROM The VBP Blog - Eight Years of Advocacy, Policy Impact, and Action in Value-Based Payment brings together nearly a decade of insights from XtraGlobex’s advocacy-first approach to healthcare reform. 

Download Your FREE Copy of the New VBP EBook HERE: https://www.thevbpblog.com/the-vbp-book/

Guided by lead researcher and editor Cathryn Hilliard, this book explores how value-based payment (VBP) is reshaping Medicaid, long-term services and supports (LTSS), and managed care. Drawing from rigorous research, policy analysis, and frontline advocacy, it examines whether VBP truly delivers on its promises of equity, sustainability, and better outcomes. More than a policy guide, this book is a roadmap for advocates, providers, and policymakers seeking to ensure that healthcare transformation is both meaningful and just.

“This book isn’t just analysis — it’s a roadmap for the next decade of value-based transformation.”  - Fady Sahhar

https://www.thevbpblog.com/the-vbp-book/

You can find more information on Dual-Eligibles at www.dualeligiblehq.com

The Value-Based Payments Blog is available for free at www.vbpblog.com

Created by xtraglobex.com

Episode 114: Innovation, Strategy, and Advocacy Combining To Increase Community-Based Services with Dyann Roth, CEO of Inglis

This episode delves into the necessary coordination between policy innovation, organizational strategy, and advocacy to successfully expand community-based care services. The discussion, which features Dyann Roth, CEO, explores how to leverage integrated, outcome-focused approaches to transition individuals from institutional care to community-based supports. This strategy is presented as essential for enhancing the quality of life for consumers while simultaneously driving greater cost-efficiency and achieving successful metrics within value-based payment models.

Welcome to The CarePayments Podcast - A quick-hitting informative discussion about healthcare payment models and how they affect MCOs, Providers, Payers, and Care Recipients with your host Fady Sahhar of XtraGlobex. Dual-eligible programs serve a critical role in the healthcare system, providing integrated care for millions of individuals who qualify for both Medicare and Medicaid. 

Dyann Mowatt Roth is the President & CEO of Inglis, bringing over 35 years of nonprofit leadership with a focus on human services, healthcare, and accessible housing. Passionate about empowering people with disabilities, Dyann oversees Inglis’ long-term care, affordable housing, and community-based services, all designed to promote independence, inclusion, and whole-person wellness. 

Since joining Inglis in 2017, Dyann has significantly expanded the organization’s community-based services, championed assistive technology initiatives, strengthened the sustainability of Inglis’ long-term care facility, and increased accessible housing options. Through her expertise in aligning mission-driven goals with innovative, solution-focused strategies, Dyann has reinforced Inglis' position as a leader in disability services across the Commonwealth of Pennsylvania. 

Before joining Inglis, Dyann was the CEO of Resources for Human Development (RHD), a Philadelphia-based nonprofit with over 160 diversified human service programs across 15 states, and prior to that, served as the Communications Director for the United Way of Southeast Delaware County.   She holds a Bachelor of Arts from Penn State University and a Masters of Science from the University of Pennsylvania. 

Dyann currently serves on the Board of Directors of the Rehabilitation and Community Providers Association (RCPA).  She is also a member of the Forum of Executive Women and the International Coaching Federation, and is an avid hiker, cookbook collector and Philadelphia Eagles fan.

You can find more information on Dual-Eligibles at www.dualeligiblehq.com

The Value-Based Payments Blog is available for free at www.vbpblog.com

Created by xtraglobex.com

Episode 113: Aligning Waiver Programs with Advocacy with Dr. Janet Williams of Minds Matter LLC

Fady sits down for a discussion with and Dr. Janet Williams, the founder of Minds Matter LLC and a national advocate for people with brain injuries. Dr. Williams shares her journey, which began in the 1980s, and discusses the success of the brain injury waiver program in Kansas, which she helped develop. The program is based on the principle of "nothing for me without me" and provides all services in the person's own home and community, with no waiting list. She highlights that this model is cost-effective and focuses on empowering individuals to be as independent as possible.

Welcome to The CarePayments Podcast - A quick-hitting informative discussion about healthcare payment models and how they affect MCOs, Providers, Payers, and Care Recipients with your host Fady Sahhar of XtraGlobex.    Dual-eligible programs serve a critical role in the healthcare system, providing integrated care for millions of individuals who qualify for both Medicare and Medicaid. 

Dr. Janet Williams has been a leading advocate and provider of brain injury services for more than three decades. She began her work in 1982 as a social worker in a longterm rehabilitation facility. She became an advocate through her work at with the Brain Injury Association of America with Marilyn Spivack in 1985, and for the past 33 years has dedicated her career to advancing home and community-based supports. As the founder and leader of Minds Matter, LLC, Dr. Williams has supported over 10,000 individuals with brain injuries, emphasizing independence, dignity, and recovery in the community rather than institutions. Her work focuses on aligning policy, insurance, and healthcare systems to ensure that people receive the right environment, modifications, and supports to live, work and play where they want.

You can find more information on Dual-Eligibles at www.dualeligiblehq.com

The Value-Based Payments Blog is available for free at www.vbpblog.com

Created by xtraglobex.com

Episode 112: Real Innovations In Value-Based Payments in the Home Health Arena with Dr. Michael P. Johnson of BAYADA Home Health Care

Dr. Michael P. Johnson from Bayada Home Healthcare joins Fady Sahhar for a discussion about innovations in value-based payments within the home healthcare sector. He emphasizes the need for "emotional alignment" with clinicians, shares a successful case study called "Directly Home," and discusses the challenge of transitioning to longitudinal care management. Dr. Johnson concludes by highlighting the importance of using a framework of structure, process, and outcomes to improve patient care.

Welcome to The CarePayments Podcast - A quick-hitting informative discussion about healthcare payment models and how they affect MCOs, Providers, Payers, and Care Recipients with your host Fady Sahhar of XtraGlobex.    Dual-eligible programs serve a critical role in the healthcare system, providing integrated care for millions of individuals who qualify for both Medicare and Medicaid. 

Michael P. Johnson, PhD, PT is Chief Researcher, Home Care Innovation at BAYADA
Home Health Care in Moorestown, NJ. This is a new role where Dr. Johnson is
responsible for building an infrastructure that will support collaborative research efforts across eight (8) specialty practices at BAYADA, partnering with academic researchers, industry leaders, as well as payors and policy makers, to advance the quality and accessibility of care in the home.

Prior to his role as Chief Researcher, Dr. Johnson spent nearly 10 years as President of the Home Health Practice which is comprised of over 120 offices in 22 states that provide care to nearly 29,000 clients weekly through a multidisciplinary team approach delivered by over 3,500 clinicians and staff. The practice focuses primarily on geriatric home care services under the Medicare Program. He also served, concurrently as President of the Hospice Practice for 3 years, which is comprised of over 20 offices in 8 states that provide end of life care to nearly 1,400 clients daily.

Dr. Johnson has served as a member of the National Advisory Council for the Agency for Healthcare Research and Quality (AHRQ), a Steering Group member for the AQA Alliance, and as a consultant on the development and testing of quality measurements for use in the Physician Quality Reporting System (PQRS). He has also served in multiple elected and appointed roles within the American Physical Therapy Association (APTA) over the past 30 years, including as a member of the Scientific Advisory Panel (SAP) for the Center on Health Services Training and Research (CoHSTAR).

He lives just outside of Philadelphia, PA with his family - spouse of 33 years – Beth and three adult children – Lucas, Madeline, and Paige. He holds a BS in Physical Therapy from Northeastern University (Boston), an MS in Orthopedic Physical Therapy from MCP Hahnemann University (Philadelphia) and a PhD in Health Policy from the University of the Sciences (Philadelphia).

You can find more information on Dual-Eligibles at www.dualeligiblehq.com

The Value-Based Payments Blog is available for free at www.vbpblog.com

Created by xtraglobex.com

The CarePayments Pod 111: The Future of Care at Home and Medicare Opportunity Is Now! with Bob Roth of Cypress Homecare Solutions

Fady sits down with Bob Roth, the managing partner and co-founder of Cypress Home Care Solutions. He discusses his personal journey into the home care industry after his mother's heart attack and the founding of his company. He highlights industry challenges, such as a changing population demographic and the high cost of care, and explains how his company uses technology and machine learning to improve efficiency and monitor clients' safety at home. Roth also emphasizes the importance of advocacy and leadership in the local market and concludes by stating that caring for the aging population is one of the biggest problems of our generation. 

Welcome to The CarePayments Podcast - A quick-hitting informative discussion about healthcare payment models and how they affect MCOs, Providers, Payers, and Care Recipients with your host Fady Sahhar of XtraGlobex. Dual-eligible programs serve a critical role in the healthcare system, providing integrated care for millions of individuals who qualify for both Medicare and Medicaid. 

Bob Roth is the Managing Partner and co-founder of Cypress HomeCare Solutions, a family-owned and operated home care agency launched in 1994 after Bob, his father, and brothers cared for his mother, Joan. That deeply personal caregiving journey inspired a lifelong mission: to provide compassionate, high-quality home care for others navigating similar paths.

With more than 40 years of experience spanning consumer products, healthcare, and technology, Bob brings strategic vision and operational excellence to the home care industry. Under his leadership, Cypress has been recognized with some of the industry's highest honors.

Since 2013, Bob has hosted the weekly radio show/podcast "Health Futures – Taking Stock in You" on Money Radio. He also pens a monthly column, "Aging Today," for the Jewish News of Greater Phoenix and Lovin’ Life After 50, a role he’s held since 2009. In 2017, Bob was appointed by Governor Doug Ducey to the Arizona Governor’s Advisory Council on Aging, becoming the first home care agency owner to serve on the Council in its 40-year history.

You can find more information on Dual-Eligibles at www.dualeligiblehq.com

The Value-Based Payments Blog is available for free at www.vbpblog.com

Created by xtraglobex.com

Episode 110: What Are The Challenges of Consumers Enrolling in Medicaid? with Andrew Segal CEO of ANSEGA Health Solutions

Andrew Segal, CEO of ANSEGA Health Solutions, joins Fady Sahhar, President of XtraGlobex, for a discussion on the challenges consumers face with Medicaid enrollment. The episode highlights the complexities of the process, including confusing applications and documentation, and shares a personal story to emphasize the need for a more user-friendly system. Listeners will also learn about potential solutions for states, such as simplifying processes, using technology, and improving customer support to enhance access to care for vulnerable populations.

Welcome to The CarePayments Podcast - A quick-hitting informative discussion about healthcare payment models and how they affect MCOs, Providers, Payers, and Care Recipients with your host Fady Sahhar of XtraGlobex.    Dual-eligible programs serve a critical role in the healthcare system, providing integrated care for millions of individuals who qualify for both Medicare and Medicaid. 

Andrew is an experienced executive leader and leading subject matter expert in health policy and long-term care. He is currently serving as the Chief Innovator & CEO of ANSEGA Health Solutions, a health management consulting firm he founded in 2019 that combines deep industry knowledge, meaningful insights, and expertise for healthcare organizations. ANSEGA guides, payers, providers and health-tech startups to transform how they serve their customers while navigating complex state and federal regulatory landscapes.

Andrew formerly served as an appointee to Governor Andrew Cuomo as the Director of the Division of Long-Term Care for the New York State Department of Health, Office of Health Insurance Programs (OHIP). In that role, he led the strategic oversight and regulation of 58 Managed Long-Term Care (MLTC) plans for over 250,000 Medicaid managed-care beneficiaries throughout the State of New York. This included the oversight, planning, and implementation of the Partially-Capitated Plans, Fully Integrated Dual Advantage (FIDA) demonstration program, Medicaid Advantage Plus (MAP), and the Program of All-inclusive Care for the Elderly (PACE). In 2018, he was responsible for generating $350M in Long Term Care savings under the Medicaid Global Spending Cap for the $12.4B Long-Term Care program.

Prior to his tenure with the State, Andrew worked for the largest non-profit home and community-based organization in the country, the Visiting Nurse Service of New York (VNSNY), where he served as Vice President of External Affairs and Government Relations.  In that role, he oversaw the legislative and policy activities for the enterprise, including the Managed Long- Term Care plan, the Medicare Advantage plan, and the Certified Home Health Agency. Prior that, he served as Director of Product Management for VNSNY CHOICE Health Plans, the largest MLTC in State.

Andrew holds a Master of Public Health (MPH) focused in Health Policy & Management from Columbia University in the City of New York.

You can find more information on Dual-Eligibles at www.dualeligiblehq.com

The Value-Based Payments Blog is available for free at www.vbpblog.com

Created by xtraglobex.com

The CarePayments Pod 109 - What are PACE Programs? and How Do They Support Dual-Eligibles?  w/ John Koehn, SVP of InnovAge

Welcome to The CarePayments Podcast - A quick-hitting informative discussion about healthcare payment models and how they affect MCOs, Providers, Payers, and Care Recipients with your host Fady Sahhar of XtraGlobex.    Dual-eligible programs serve a critical role in the healthcare system, providing integrated care for millions of individuals who qualify for both Medicare and Medicaid. 

John Koehn is the Senior Vice President of External Affairs of InnovAge.  Among other duties he oversees all government relations activity for the company.  InnovAge is the nation’s largest PACE provider by enrollment and operates in six states: California, Colorado, Florida, New Mexico, Pennsylvania and Virginia.  The PACE model unites a team of experts – primary care doctors, social workers, therapists, dietitians, dentists and more – to deliver comprehensive, high-quality, cost-effective care. By helping older adults maintain their quality of life, PACE empowers seniors to age independently in the communities they cherish, sustaining their connections to the places and people that mean the most to them.

Previously, John was the Market President at AmeriHealth Caritas, where he managed over 160,000 beneficiaries and oversaw critical programs to improve member satisfaction, clinical care quality, and profitability. Prior to his tenure at AmeriHealth, John served as the Health Plan President for Amerigroup New Jersey, where he was instrumental in obtaining state support for and ultimately implementing major initiatives such as Managed Long-Term Services and Supports. Under his leadership, the New Jersey health plan led the market in quality scores as well as cost-effectiveness ratings.

John graduated from the University of Connecticut with a bachelor’s degree in history and earned a master’s degree from the University of Michigan. He has been a board member for several organizations focused on healthcare, education, and community-based programs.

John remains a student at heart. He is always happy to hear of another good book, over-stuffed bookshelves notwithstanding. 

** We appreciate Mr. Koehn’s insights on InnovAge and PACE. Mr. Koehn left InnovAge at the end of May to pursue other opportunities and now serves as Massachusetts market president at CareSource, a nationally recognized nonprofit managed care organization.


You can find more information on Dual-Eligibles at www.dualeligiblehq.com 

The Value-Based Payments Blog is available for free at www.vbpblog.com

Created by xtraglobex.com

You can find more information on Dual-Eligibles at www.dualeligiblehq.com

The Value-Based Payments Blog is available for free at www.vbpblog.com

Created by xtraglobex.com

The CarePayments Pod #108 - As MLTSS Increases, So Do The Challenges of Implementing It

The CarePayments Podcast - A quick-hitting informative discussion about healthcare payment models and how they affect MCOs, Providers, Payers, and Care Recipients with your host Fady Sahhar of XtraGlobex.    Dual-eligible programs serve a critical role in the healthcare system, providing integrated care for millions of individuals who qualify for both Medicare and Medicaid. 


You can find more information on Dual-Eligibles at www.dualeligiblehq.com 

Created by www.xtraglobex.com

You can find more information on Dual-Eligibles at www.dualeligiblehq.com

The Value-Based Payments Blog is available for free at www.vbpblog.com

Created by xtraglobex.com

The CarePayments Pod Episode #107 - How Can Real-time data Improve Outcomes? with Stephen Vaccaro of HHAeXchange.

Welcome to The CarePayments Podcast - A quick-hitting informative discussion about healthcare payment models and how they affect MCOs, Providers, Payers, and Care Recipients with your host Fady Sahhar of XtraGlobex.    Dual-eligible programs serve a critical role in the healthcare system, providing integrated care for millions of individuals who qualify for both Medicare and Medicaid. 

Stephen Vaccaro serves as President at HHAeXchange, the leading provider of homecare management solutions for providers, managed care organizations, and state Medicaid agencies, where he leads the market strategy and national expansion of HHAeXchange’s State, Payer, Provider, and Self Direction purpose built technology solutions. With more than 30 years of leadership experience in the healthcare technology space, Stephen understands the business needs of all stakeholders in the homecare ecosystem. He has a proven track record of success in executive leadership, sales, implementation, service delivery, strategic planning, project management, product development, and acquisition integration.

You can find more information on Dual-Eligibles at www.dualeligiblehq.com 

The Value-Based Payments Blog is available for free at www.vbpblog.com

Created by xtraglobex.com

You can find more information on Dual-Eligibles at www.dualeligiblehq.com

The Value-Based Payments Blog is available for free at www.vbpblog.com

Created by xtraglobex.com