Mission & Margin
Medicaid vendor strategy: Understanding your real buyer | Gary Jessee
Overview
Gary Jessee, Senior Vice President at Sellers Dorsey, leads the national consulting practice working across state Medicaid agencies, managed care organizations, vendors, and solution providers on readiness, policy implementation, and system transformation. In this episode, Trey Sutten and Gary walk through where vendors pitch to the wrong buyer in Medicaid, what state Medicaid directors are actually managing during HR 1 implementation, why states are pausing new vendor onboarding, and how to separate waste from fraud in program integrity.
Show Notes
Gary Jessee, Senior Vice President at Sellers Dorsey, leads the national consulting practice working across state Medicaid agencies, managed care organizations, vendors, and solution providers on readiness, policy implementation, and system transformation. In this episode, Trey Sutten and Gary walk through where vendors pitch to the wrong buyer in Medicaid, what state Medicaid directors are actually managing during HR 1 implementation, why states are pausing new vendor onboarding, and how to separate waste from fraud in program integrity.
Topics Discussed:
– Medicaid readiness and capacity under HR 1: redesignations, community engagement requirements, and what states are actually focused on
– Service delivery models matter: why pitching to a state Medicaid director doesn't work if your buyer is a managed care organization
– Why vendors miss the mark: understanding who pays for a solution before approaching a buyer
– Medicaid directors under pressure: the toughest job in state government, managing federal mandates, policy changes, and 22 new directors navigating the role
– Medical frailty definitions and policy advocacy: what constitutes medical frailty, how states define it, and where MCOs have leverage
– Vendor fatigue and consolidation: health plans with 17 vendors solving the same problem, pausing new vendor onboarding, and what solutions need to look different
– Carve-in and carve-out transitions: why unwinding benefits from managed care is complex, political pressure, and learning from pharmacy and other carved services
– Waste versus fraud in programs: distinguishing between bad actors, compliance failures, and system inefficiency; where analytics and AI change program integrity
– How work actually gets done in state government: procurement processes, demonstrating value, and why flying to meet a Medicaid director might be a waste of time
– Purpose and impact in healthcare: what motivates people to stay in Medicaid, the heart of the industry, and leaving your mark on systems of care
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