Susan Mathieu Email & Phone Number

Greater Denver Area

Greater Denver Area

Denver, Co

Denver, Colorado

Write responses and review managed care company proposals in response to Request for Proposals (RFPs) for Medicaid managed care programs.Write RFP for municipality seeking new vendor for medical services provided to inmates.For a CMS State Innovation Model Design Awardee developing ACOs: - Served as project manager for all firm activities; - Developed a communications plan and supporting stakeholder meetings; - Researched and drafted white papers to support model design; - Wrote SHIP; - Facilitated stakeholder workgroups and developed recommendations for the state; - Drafted ACO contract for enrollment of Medicaid expansion population.For state client assessing feasibility of managed care models: served as project manager, supported colleagues with analytic assumptions, conducted stakeholder work, researched care coordination activities and managed care programs in other states, analyzed current initiatives, and wrote recommendations report.Researched and wrote legislatively required report recommending approaches to improve efficiency of contract management activities for state client.Researched and wrote documents on the impact of the ACA on health care programs to support a health foundation in developing funding strategies.

Denver, Colorado

Designed and implemented Adults without Dependent Children (AwDC) Medicaid expansion to provide health care to 10,000 uninsured Coloradans. Activities included:o Strategizing with colleagues to determine approach (state plan or 1115 Demonstration waiver); o Producing and presenting analysis, recommendations and risk mitigation strategies to leadership;o Selecting external stakeholders for Advisory Committee to ensure strategic collaboration; planning and running monthly meetings;o Presenting at outreach sessions, stakeholder forums and public meetings;o Working with RCCOs to ensure preparedness to provide coordinated care for expansion clients and writing readiness plan for submission to CMS; o Writing concept paper, 1115 Demonstration Waiver proposal, and negotiating with CMS to obtain federal approval; o Developing system specifications, in collaboration with eligibility and claims payment teams, to ensure program policies and objectives would be operationalized;o Working with contractors on cost/benefit model, identifying data, developing assumptions; working with budget team to model projected enrollment and estimated program costs; o Writing outreach materials to ensure client, stakeholder and provider awareness of program; ando Managing work of external contractors to ensure submission of timely, high-quality deliverables. Monitored and resolved post-implementation issues and challenges. Specifically:o Developing solutions to eligibility system and claims system operations challenges; ando Meeting with stakeholders to ensure Department awareness of experience with new program; worked to resolve issues related to eligibility requirements and determinations and assignments to RCCOs

Denver, Colorado

(Temporary assignment)Analyzed the ACA to ensure awareness of opportunities and understanding of new requirements.Wrote grant proposal to obtain financial support for evaluation of the Accountable Care Collaborative.

Washington, Dc

Provided technical assistance and consultation services to multiple states to ensure Medicaid and CHIP programs meet policy objectives with respect to better coordination and quality of care, improved access to health care services and the alignment of financial incentives. Activities included:o Advising clients on program design issues and Medicaid best practices, writing policy and decision memos, participating in internal and external stakeholder program design meetings, and preparing talking points and presentations for Cabinet members, Medicaid directors and program directors; o Writing Medicaid State Plan Amendments (SPAs) and negotiating with CMS to obtain approval;o Writing Medicaid managed care contracts and Requests for Proposals (RFPs) and applying state and federal laws and regulations to ensure program compliance; o Preparing RFP evaluation guides, conducting RFP evaluator training and facilitating RFP evaluation consensus meetings for Medicaid managed care procurements;o Prior to service provision, evaluating managed care organization policies, participating in on-site readiness reviews, assessing readiness and developing recommendations for process improvements; o Developing managed care organization performance improvement programs for state monitoring of health care provided; ando Writing provider agreements and developing fee schedules.Developed evaluation questions, analyzed utilization data, oversaw data programming and wrote CMS-required evaluations for 1115 Medicaid waivers.Prepared RFP for state employee health benefit wellness program.Prepared RFP submissions and letters of engagement to solicit future work for the firm.Summarized Medicaid and state uninsured program activities and design features for state policy-makers. Managed multiple projects to ensure high-quality deliverable submissions both on-time and within budget. Mentored and oversaw work of junior staff and interns.

• Evaluated the impact PBM changes had on enrollees to inform Medicare Payment Advisory Commission (MedPAC) policy recommendations prior to implementation of the Medicare Part D program. • Researched, analyzed data and wrote reports, data profiles, and fact sheets on aging, long-term care and chronic and disabling conditions for use by state and federal health policy-makers. • Evaluated the impact of changes in the Medicare payment system on home health agencies and identified activities that enhanced agencies’ ability to adapt to the new prospective payment system.

• Researched and wrote chapters of the District of Columbia State Health Plan, a comprehensive document assessing the supply and demand of health care services in the District of Columbia. • Oversaw work of contractors.• Collaborated with members of the State Health Coordinating Committee on Health Plan content.

• Served as liaison between the District of Columbia Public Schools and Department of Health in a cooperative effort to increase federal Medicaid funding for mandated special education services.• Worked with agency directors and financial officers to identify savings opportunities for multi-million dollar savings initiative. Served as contact for federal and internal audit of initiative.

Mpp, Public Policy - Health

B.A, History

Education record