Overview of Kip Piper’s Expertise:
Kip Piper’s extensive expertise in Medicare, Medicaid, and health reform includes:
- Federal and state laws, regulations, policies, and waivers.
- Financing of health care programs by federal and state governments, including funding and budgeting.
- Legislative and budget proposals.
- Political environment, market dynamics, and competitive environment.
- Coverage, benefit designs, coverage decision making, and comparative effectiveness research.
- Affordable Care Act (ACA), including health insurance exchanges, Medicaid coverage expansion, federal subsidies, individual mandate, employer mandate, payment reductions in Medicare and Medicaid, and market regulation.
- Managed care and fee-for-services delivery systems and care delivery reform models.
- Reimbursement of hospitals, physicians, pharmacies, post-acute providers, and long-term services and supports.
- Access, coverage, and reimbursement of life sciences products, including pharmaceuticals, biologics, medical devices, medical diagnostics, imaging, and durable medical equipment and supplies.
- Managed care procurement, contracting, capitation, and oversight – Medicaid managed care, Medicare Advantage, Medicare Part D prescription drug plans, Medicare Advantage Special Needs Plans, qualified health plans, integrated Medicare-Medicaid plans for dual eligibles, and Medicaid managed long-term care.
- Innovations and demonstrations, including payment reform, accountable care organizations, medical homes, value-based purchasing, quality improvement, and performance reporting.
- Health insurance market regulation.
- Decision makers and influencers at the federal and state levels.
- Program management and operations in health agencies, including Centers for Medicare and Medicaid Services (CMS) and state Medicaid agencies.
An experienced health care executive, Kip Piper’s expertise includes:
- Leadership of large-scale health care organizations.
- Management of multi-billion dollar budgets.
- Strategy, tactics, and execution – policy, financial, operations.
- High-stakes decision making and problem solving – political, managerial, financial, and operational.
- Direction of complex, national projects and grants.
- Administration of large, multifaceted contracts.
- Design and implementation of innovations and reforms.
- Direction of multi-disciplinary teams and mentoring of managers and professional staff.
- Negotiation of complex legislative, regulatory, budget, and contractual issues.
- Crisis management and emergency management.
Specific Areas of Expertise:
Kip Piper’s specific areas of expertise in health policy, finance, business, marketing, and communications include:
- Medicaid policy and finance, including federal and state legislation, regulations, waivers, and budgets.
- Medicaid eligibility and eligibility expansion issues.
- Medicaid coverage and coverage decision making.
- Medicaid provider reimbursement, payment reform, and supplemental payments.
- Medicaid prescription drug benefits, including coverage, preferred drug lists, and Medicaid best price and rebates.
- Medicaid managed care, including Medicaid health plan markets, procurement, proposal development, capitation, and contracting.
- Federal section 1115 demonstrations, including waiver applications, federal-state negotiations, terms and conditions, and budget neutrality.
- Integrated health plans for Medicare-Medicaid dual eligibles.
- Medicaid long-term services and supports, including Medicaid managed long-term care.
- Medicaid cost containment and program integrity.
- Medicaid communications and marketing.
- Medicaid market intelligence, competitive intelligence, and B2G business development.
- State Medicaid administration and operations.
- Medicare Part A provider reimbursement, including inpatient hospitals and post-acute providers (e.g., skilled nursing facilities, home health agencies).
- Medicare Part B provider reimbursement, including payment of physicians, outpatient hospitals, biologics and other physician-administered drugs, durable medical equipment, and dialysis facilities.
- Medicare Advantage plans and Medicare Advantage Special Needs Plans (MA-SNPs).
- Medicare Part D prescription drug benefit, including coverage, benefit designs, stand-alone prescription drug plans (PDPs), and Medicare Advantage drug plans (MAPDs).
- Medicare coverage policy and coverage decision making.
- Medicare payment reform, including shared savings, value-based purchasing, and bundled payment.
- Medicare accountable care organizations (ACOs).
- Integrated health plans for Medicare-Medicaid dual eligibles.
- Center for Medicare and Medicaid Services (CMS) functions and operations.
Health Reform / Affordable Care Act / Obamacare:
- Affordable Care Act (ACA) policy, including federal statutes, rules, and guidance.
- Health insurance exchanges, including federal marketplace and state-based exchanges.
- Federal health insurance coverage expansion, including federal premium subsidies and cost sharing subsidies.
- Medicaid eligibility expansion through ACA State Plan option and section 1115 waivers.
- Qualified health plans (QHPs), including QHP market dynamics, risk adjustment, reinsurance, and risk corridors.
- Health insurance market regulations, including essential health benefits, adjusted community rating, minimum medical loss ratios, guarantee issue, and other consumer protections.
- Individual mandate and employer mandate.
Health Insurance Industry and Health Plans:
- Medicaid managed care, including market strategy, federal and state requirements, state procurement, proposal development, payment, plan contracting, state relations, best practices, competitive intelligence, due diligence, and special populations.
- Integrated health plans for Medicare-Medicaid dual eligibles, including associated demonstrations.
- Medicaid managed long-term care.
- Qualified health plans, including benefit designs, federal premium subsidies, federal cost sharing subsidies, marketing strategy, product development, and federal and state regulations.
- Medicare Advantage (Medicare Part C), including market strategy, payment, federal rules and CMS requirements, and Medicare Advantage Special Needs Plans for dual eligibles.
- Medicare Part D prescription drug plans, including payment, benefit designs, formularies, and federal regulations.
- Health insurance exchanges, including federal marketplace, state-based exchanges, Medicaid interaction, operational issues, and Affordable Care Act regulations.
- Marketing strategy and marketing communications.
- Strategic communications, public relations, thought leadership, advocacy, and government relations.
- Health insurance market regulation, including essential health benefits, adjusted community rating, individual mandate, employer mandate, preventive services coverage, and consumer protections.
- Health insurance payment and financing, including risk adjustment, reinsurance, and risk corridors.
Pharmaceuticals, Biotechnology, and Medical Technology:
- Access, coverage, and reimbursement of prescription drugs and biologics in Medicare Part B, Medicare Part D prescription drug benefit, and state Medicaid programs.
- Access, coverage, and reimbursement of medical devices, imaging, and other medical diagnostics in Medicare Part B and Medicaid.
- Benefit design and cost sharing practices in Medicaid health plans, Medicare Advantage plans, Medicare prescription drug plans, and qualified health plans.
- Federal legislative and budget proposals affecting access, coverage, payment, and industry regulation.
- Coverage policy and coverage decision making by Centers for Medicare and Medicaid Services (CMS), state Medicaid agencies, and health plans.
- Federal comparative effectiveness research.
- Program integrity and utilization management practices.
- Strategic communications, public relations, advocacy, public affairs, and thought leadership for companies and products.
- Market and product strategy and tactics.
- Affordable Care Act impacts, including health insurance exchanges, federally subsidized coverage, Medicaid coverage expansion, essential health benefits, payment cuts, preventive services coverage, and market regulation.
- Impact of policy and market change, including payment reform, accountable care organizations, medical homes, health information technology, value-based purchasing, value-based benefit designs, and health plan and provider consolidation.
- Medicaid best price, including federal rebates, state supplemental rebates, and preferred drug lists.
Health Care Communications and Public Relations:
- Strategic communications.
- Market access and product launches.
- Messaging on coverage, reimbursement, access, legislation, regulations, and budgets.
- Marketing communications.
- Public affairs, including policy advocacy and government relations.
- Influencer communications and stakeholder engagement
- Thought leadership.
- Social media, including Twitter, LinkedIn, blogging, and podcasts
- Coalition and alliance development.
- Crisis management.