New Interventions and Care Delivery Models to Promote Value for Older Adult Beneficiaries
4:30 PM – 5:15 PM
As the population ages, there is a growing need for care delivery models that can provide high quality and lower-cost health care to America’s older adults. There have been innovative projects put forth by CMMI that seek to achieve these duel objectives, including demonstration projects such as the Medicare Coordinated Care Demonstration project and the Value-Based Insurance Design (VBID) model for Medicare Advantage (MA). As the health care industry’s focus shifts to population health, barriers such as transportation, food, and housing insecurity are entering the equation of what it means to be and remain healthy, independent, and mobile. New allowances by MA plan providers offer targeted supplemental benefits, such as transportation and meal delivery, that will enable older adult beneficiaries with chronic conditions to remain at home. This panel brought together HHS, Administration for Community Living, and care design thought leaders to explore how to incorporate the preferences and needs of older adults into care delivery; what these new programs can learn from the aging network which has been working for decades to help older adults remain in their homes and communities; and public policy solutions to lower out-of-pocket health care spending for older adults.
James G. Scott, President & CEO of Applied Policy, founded the company to apply his in-depth knowledge of federal health policy to help healthcare providers and companies succeed. As a respected member of the Washington, D.C. health policy community, he has gained valuable experience and relationships throughout government and private industry.
Immediately prior to founding Applied Policy, Mr. Scott was responsible for obtaining optimal Medicare coding, coverage and payment for all pharmaceutical products manufactured by Hoffmann-La Roche, Inc. While at Roche, he also worked to resolve Medicare and Medicaid reimbursement issues at the federal level and served as the company’s principal point of contact with the Centers for Medicare & Medicaid Services (CMS).
Mr. Scott served as the Senior Legislative Advisor at CMS, advising the CMS Administrator on congressional intent in implementing the Medicare Modernization Act of 2003 and engaging Members of Congress in the implementation of the Act. Mr. Scott received agency-wide awards in 2005 for his work with Congress on the successful implementation of the new Medicare prescription drug benefit and for his work with congressional appropriators on the Fiscal Year 2006 President’s Budget request.
Prior to his service with CMS, Mr. Scott was an Assistant Counsel with the Office of the Legislative Counsel of the U.S. Senate, where he was a principal drafter of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 and other Medicare legislation. Mr. Scott and his work were recognized through the unanimous passage of a Senate Resolution and in numerous statements by Senators and Representatives printed in the Congressional Record.
Mr. Scott received a Bachelor of Science in Political Science from James Madison University in Harrisonburg, Virginia and received his Juris Doctor, Magna Cum Laude, from the Catholic University of America, Columbus School of Law, in Washington, D.C.
Mr. Scott serves on the Board of Directors of the Alliance for Aging Research, founded the Northern Virginia Health Policy Forum and is a member of the Steering Committee of the Partnership for a Healthier Alexandria.
Rhonda L. Randall, D.O., is the Chief Medical Officer of UnitedHealthcare Employer & Individual, the nation’s largest business serving the health coverage and well-being needs of nearly 28 million Americans. Dr. Randall collaborates with U.S. employers who are looking for quality, cost-effective, long-term solutions to health benefits for their employees and retirees. She also leads the clinical strategy development for these businesses to improve quality outcomes, ensure affordability and improve health and well-being. Additionally, Dr. Randall supports the clinical strategy for UnitedHealth Group through her work in the corporate office of Medical Affairs and as a senior medical advisor to the UnitedHealth Foundation.
Since 2003, she has held clinical leadership roles in many of the enterprises businesses including: care delivery, Medicaid Long-Term Care, Medicare Special Needs Plans and Medicare Supplement. Following the 2003 passage of the Medicare Modernization Act that created the Part D prescription drug program, Dr. Randall was instrumental in developing UnitedHealthcare’s first Part D plans. In 2008, Dr. Randall transitioned to UnitedHealthcare Medicare & Retirement, serving first as regional chief medical officer for the Northeast, later concurrently as vice president and national medical director of medical management as well as the deputy chief medical officer of Evercare Hospice and Palliative Care. From 2010 to 2013 she served as Chief Medical Officer for Medicare & Retirement and then as chief Medical Officer for UHC’s Retiree Solutions and National Accounts. Dr. Randall’s leadership enabled the business to deliver unmatched clinical quality, facilitating market leadership in Group Medicare Advantage and achieving impressive 4.5 Star ratings for the businesses National PPO plans.
Dr. Randall is a fellowship-trained geriatrician and is board certified in family practice. Her background includes years of practice in hospice and palliative medicine. Dr. Randall earned a bachelor’s degree in biology from Saint Vincent College in Latrobe, PA, and was honored in 2011 as one of the college’s Alumni of Distinction. She earned her medical degree from the Philadelphia College of Osteopathic Medicine. Dr. Randall completed her internship, residency, chief residency and fellowship at Florida Hospital in Orlando. She has served as volunteer clinical faculty in geriatrics for Florida Hospital’s Residency program and Florida State University College of Medicine. Dr. Randall has published papers on stroke, Alzheimer’s disease, polypharmacy and normal pressure hydrocephalus. Dr. Randall has served on the First Coast Carrier Advisory Committee for Medicare Local Coverage Determinations. She is a two-time recipient of UnitedHealthcare’s innovation awards, some of the business’ highest honors, first in 2005 for her leadership in disaster planning and again in 2006 for her contribution to a clinical workgroup that developed new a model of care for people with advanced illness and end-of-life needs. She has been a champion for Florida’s frail elders in the public policy arena, working with policymakers to expand long-term care home and community-based services. She has also collaborated with state agencies to update regulations so seniors who are eligible for both Medicare and Medicaid can receive hospice services from the comfort of their homes instead of a nursing home. She is a member of the Florida coalition on Physicians Orders for Life-Sustaining Treatment as well as the national Coalition to Transform Advanced Care.
Dr. Randall currently serves as President of the Florida Medical Directors Association and a member of the house of delegate as well as the nominating committee for the American Medical Director’s Association. She also serves as the Chair of the Board for St. Charles Borromeo Catholic School in Orlando, FL.
Lance Robertson was appointed to serve as Assistant Secretary for Aging and ACL’s Administrator on August 11, 2017.
His vision for ACL focuses on five pillars: supporting families and caregivers, protecting rights and preventing abuse, connecting people to resources, expanding employment opportunities, and strengthening the aging and disability networks.
His leadership in the fields of aging and disability began in Oklahoma, where he served for 10 years as the Director of Aging Services within the state’s Department of Human Services. Prior to that, he spent 12 years at Oklahoma State University, where he co-founded the Gerontology Institute and served as the executive director of the nation’s largest regional gerontology association.
Asst. Sec. Robertson earned his undergraduate degree from Oklahoma State University and a master of public administration degree from the University of Central Oklahoma, and he is a veteran of the United States Army.
Allyson Y. Schwartz, a former member of the U.S. House of Representatives from Pennsylvania who served from 2005-2015, is a nationally recognized leader on health care issues. Throughout her professional life she has worked on issues such as affordability, primary care, coordinated care, and increased access to coverage.
Having worked as a health service executive, Schwartz was elected to the Pennsylvania State Senate in 1990, serving 14 years until her election to Congress. In the state Senate, Schwartz was the driving force behind Pennsylvania’s CHIP program, which was a model for the federal CHIP program five years later.
In Congress, Schwartz was appointed to the powerful Ways and Means committee in her second term and served as a senior member of the Budget Committee. In both capacities, Schwartz was a strong advocate for Medicare. She was the leader in Congress on physician payment reform to encourage value over volume, supported research, innovation, and use of technology to improve quality, efficiency, and contain costs.
Schwartz was instrumental in the passage of landmark health reform legislation, authoring key provisions such as the ban on pre-existing condition exclusions for children and increased access to primary care.
Schwartz serves on the Executive Advisory Board of the Leonard Davis Institute of Health Economics of the University of Pennsylvania, as well as being a member of the Advisory Board, University of Pennsylvania Wharton School “Penn Wharton Budget Model”. Schwartz is a member of the National Hospice and Palliative Care Advisory Board, participates in an advisory group to Avalere Health’s Patient-Perspective Value Framework and serves as a member of RAND’s Technical Expert Panel on the Medicare Advantage Stars Rating System, She is on the Board of Trustees, Einstein Health, Philadelphia and served as Co-Chair of the Health and Housing for Seniors Task Force of the Bipartisan Policy Center, where she also frequently participates in roundtable discussions on the future of Medicare..
Schwartz earned a B.A. from Simmons College, and a Master of Social Service from Bryn Mawr College. She is married, has two grown sons, two daughters-in-law, and a 6-year-old granddaughter.