Rolling out the Affordable Care Act in the field


David Sayen, a regional administrator of CMS, is pictured center. (Courtesy of Centers for Medicare and Medicaid Services)
April 8, 2013

As the new features of the Affordable Care Act roll out between now and 2014, the Centers for Medicare & Medicaid Services (CMS) are developing new programs and tools to help healthcare providers deliver better care to the American public — and much of the work takes place outside the Beltway. Tom Fox spoke with a leader in the field about leading from the field. David Sayen is the CMS regional administrator for Arizona, California, Hawaii, Nevada and the Pacific territories. He has more than 30 years of federal service and experience in health and human services programs. Fox is a guest writer for On Leadership and vice president for leadership and innovation at the nonprofit Partnership for Public Service. He also heads up their Center for Government Leadership.

How is working in a field office different than working at headquarters?

Our job in the field is to make sure people are communicating. On the Medicare customer service side, a lot of issues come directly to us either through congressional inquiries or from people who can’t get what they need from their Prescription Drug or Medicare Advantage plan. We use that information to improve service; and in the field, we get to see that change and bring it back to the policy level to improve the next time around.

I also think it’s my role to advocate for the people that live in these states and in the Pacific territories, and to make sure that when decisions are made, their particular challenges are properly heard. So we do a lot of work with congressional offices and other elected officials in the region.

What are the top priorities for your region?

CMS has a long list of priorities. Expanding coverage under the Affordable Care Act is front and center. It’s our job to make sure the program works and that people understand and take advantage of the benefits. The proliferation of health information technology, and our incentives for doctors and hospitals to get electronic records, is another priority where we have a tiger by the tail. This has tremendous potential for patient safety and for savings, and it’s something that I’m really concerned about.

The transformation for delivery of care is also a priority. We are moving steadily into a value-based purchasing approach, where we attenuate how we pay for things based on the results.

What role will your region play with the implementation of the Affordable Care Act?

A big piece of the Affordable Care Act is Medicaid expansion and working aggressively with states to develop the enhancements needed for their enrollment systems. With respect to the new healthcare insurance marketplaces, we will be supporting the states and working with stakeholders and partners to educate people about the opportunity for coverage. We will do a lot of outreach through ethnic media, particularly radio, which is important for reaching monolingual households. We will also be working with faith-based organizations.

How is the sequester affecting your employees’ ability to accomplish this work?

We are making adjustments and using our creativity to find more efficient ways to work. For example we are conducting webinars and teleconferences to educate partners instead of travelling in some cases.

What are your biggest day-to-day management challenges and how are you overcoming them?

We are a large organization with a lot of parts. The challenge for an agency dispersed like ours is that what people experience of the program doesn’t always tie back to my office. If you’re in Arizona and you belong to a health plan that provides your Medicare benefits, the issues are probably with that plan and not with us. When you are spread out like that, it can be difficult to get a good consistent product to your customers and understand your customer’s experience.

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