Expert

Overview of Kip Piper’s Expertise:

Kip Piper’s extensive expertise in Medicare, Medicaid, and health reform includes:

  1. Federal and state laws, regulations, policies, and waivers.
  2. Financing of health care programs by federal and state governments, including funding and budgeting.
  3. Legislative and budget proposals.
  4. Political environment, market dynamics, and competitive environment.
  5. Coverage, benefit designs, coverage decision making, and comparative effectiveness research.
  6. 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.
  7. Managed care and fee-for-services delivery systems and care delivery reform models.
  8. Reimbursement of hospitals, physicians, pharmacies, post-acute providers, and long-term services and supports.
  9. Access, coverage, and reimbursement of life sciences products, including pharmaceuticals, biologics, medical devices, medical diagnostics, imaging, and durable medical equipment and supplies.
  10. 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.
  11. Innovations and demonstrations, including payment reform, accountable care organizations, medical homes, value-based purchasing, quality improvement, and performance reporting.
  12. Health insurance market regulation.
  13. Decision makers and influencers at the federal and state levels.
  14. 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:

  1. Leadership of large-scale health care organizations.
  2. Management of multi-billion dollar budgets.
  3. Strategy, tactics, and execution – policy, financial, operations.
  4. High-stakes decision making and problem solving – political, managerial, financial, and operational.
  5. Direction of complex, national projects and grants.
  6. Administration of large, multifaceted contracts.
  7. Design and implementation of innovations and reforms.
  8. Direction of multi-disciplinary teams and mentoring of managers and professional staff.
  9. Negotiation of complex legislative, regulatory, budget, and contractual issues.
  10. 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:

  • 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:

  • 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.