Nancy has a comprehensive portfolio of experience that includes both large and small scale public health program operations, policy development, implementation, fiscal analysis and strategic positioning. As a Consultant at Sellers Dorsey, Nancy works on state policy initiatives for the Commonwealth of Pennsylvania. Nancy is an expert in state and federal health policy issues and played a key role in the implementation and operational aspects of the Statewide Quality Care Assessment for the Pennsylvania (PA) Department of Human Services (DHS).
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How did you get started in healthcare management? Did you always want to be in healthcare management?
Yes, I have always wanted to work in the healthcare management field. I enjoy the diversity that a career in healthcare management provides. I have always had a sense of social mission and believe that healthcare management organizations have the ability to positively impact the health and well-being of the populations that they serve. I have found that work exists in many areas, such as health insurance companies, management consulting, professional societies and state and Federal agencies. I can attest to the fact that the core set of skills that are developed in healthcare management can readily be transferred across a variety of settings. Not to mention that healthcare career opportunities continue to be one of the areas that provides for faster job growth than any other job segment.
What are some of the biggest changes that have been made to health policy since you started your career?
The passage of the Affordable Care Act (ACA) in 2010 is the most significant change in the healthcare industry that I have witnessed over the course of my career. In order to leverage the opportunities and incentives contained in the ACA, the healthcare industry is moving towards rewards for value and quality of care, rather than paying for the volume of services. As the healthcare industry continues to evolve under the ACA by streamlining and improving patient care, integrating information and moving from a fee-for-service to a fee-for-outcome payment model the individual insurance market is more accessible, millions more Americans have acquired health insurance, and the population that is uninsured has plummeted.
What health care issues do you think are going to be big in 2016?
Some states are beginning to transform their healthcare system to an “All Payer Model,” from one that rewards fee-for-service, to one that rewards quality-based care that focuses on keeping patients healthy. The All Payer Model seeks to change the way Medicaid, Medicare and private insurance pay hospitals and physicians differently than they do today. Instead of paying for each test or procedure, physicians will receive a set payment for each patient they serve, shifting the financial responsibility from ordering tests and procedures to keeping patients healthy.
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What are your hopes for the future of Medicaid?
My hopes for the future of Medicaid would be that it meets the needs of the populations served to result in better health outcomes. This includes reducing the prevalence and improving the management of chronic diseases and addressing the substance abuse epidemic.
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What brought you to Sellers Dorsey?
I worked with the Sellers Dorsey team on the implementation, execution and reauthorization of the Statewide Quality Care Assessment. I enjoyed working with some of the firm’s decision makers. I found their knowledge of the legislative and regulatory processes, current health policies and the firm’s understanding of how government agencies work instrumental in developing innovative revenue maximization solutions.
Could you give everyone some insights on what you do here at Sellers Dorsey?
In my current role at Sellers Dorsey, I am involved in several of the firm’s initiatives. I work with the Sellers Dorsey team to assimilate project needs into project plans that meet several of the firm’s goals. Currently, I am involved in state initiatives for the PA DHS. I primarily collaborate with the DHS staff to coordinate various technical, policy and operational components of the Statewide Quality Care Assessment.
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What experiences, professional or personal, have best prepared you for this position?
Prior to taking a position at Sellers Dorsey I was a Senior Healthcare Analyst for the PA DHS. In this role, I worked on the implementation of the Statewide Quality Care Assessment. Over the last few years this initiative has provided millions of dollars in revenue for the PA DHS and allowed for modernization of the Medicaid hospital payment program. I believe that my personal integrity, organizational skills, professionalism, attention to detail and commitment to quality have driven my professional success.
What do you think your biggest accomplishment has been to date?
Overall, I would have to say that my greatest accomplishment is continuing to find ways to learn, grow and not be content with the status quo. Over the course of my career, I have been very fortunate to provide leadership for some significant program implementations. Working at KePRO, I oversaw numerous projects including contract proposals and start-ups, as well as day-to-day management functions. One project that I found to be particularly rewarding was the position as National Quality Program Director for the TRICARE Quality Management Program. This was a new opportunity for KePRO in which I provided leadership and management to a high performing team responsible for the oversite of the quality of care provided to TRICARE beneficiaries across the nation.
Personally, my greatest accomplishment would be the joy of watching my two children grow up to become successful and happy adults.
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What is something people may be surprised to know about you?
When I’m not at the office in the spring, summer and fall chances are you will find me at the beach. I love spending time at the beach with my husband and “Shihdoodle,” Ollie. I also enjoy decorating, gardening (both flower and water) and dreaming of grandchildren, which I hope to be fortunate enough to enjoy some day!
To learn more about Nancy Kohler, click here to view her bio.
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