All posts by James Waldinger

Mr. Waldinger, an Associate Manager at PCG, is an experienced Medicaid policy and reimbursement professional who focuses on healthcare operations, mental health and substance abuse policy and integration, and health care reform and its impact on Medicaid programs and providers. As the former Chief Financial Officer and Budget Director for the Massachusetts Medicaid Program, MassHealth, and CFO for the Massachusetts Behavioral Health Partnership (MBHP), Mr. Waldinger was responsible for understanding the fiscal impacts of all programmatic and policy changes, including the building, updating, and tracking of all provider reimbursement calculations, policies, and impacts. At MassHealth, Mr. Waldinger led all financial efforts related to multiple successful State Plan Amendments (SPAs) and 1115 Waiver submissions, including Massachusetts’ landmark health care reform waiver in 2005-6. At MBHP, Mr. Waldinger led efforts to implement a sophisticated inpatient psych hospital pay-for-performance initiative. Mr. Waldinger’s current role at PCG includes heavy involvement in claims processing and Medicaid reimbursement policy transformation. His experience speaks to multiple behavioral health engagements, from provider strategic planning, to statewide behavioral health services assessments, to the development of reimbursement methodologies that incentivize integration of community-based services. Mr. Waldinger’s in-depth understanding of provider costs, cost reporting, cost modeling, and cost settlement experience, provides clients with a unique understanding of the behavioral health system and potential impacts of policy changes.

Behavioral Health’s Move Toward Value-Based Purchasing

“Alternative payment models are not an option for behavioral health providers,” Arizona Medicaid Director Tom Betlach said, “They are your growth strategy.” Betlach’s point was very clear and it resonated with the more than 5,500 attendees at NatCon, where Payment Reform – be it alternative payment methodologies (APMs) or value-based purchasing (VBP) models like Delivery ...

CCBHC Is The Start of Something Good!

CCBHCs! That’s Certified Community Behavioral Health Centers, for those not familiar with the billion dollar investment that the Substance Abuse and Mental Health Services Administration (SAMHSA) will soon make to state behavioral health systems. In 2014, Congress passed the Protecting Access to Medicare Act (H.R. 4302), which included a demonstration program based on the Excellence in Mental ...

The Science of Addiction

Research presented by Dr. Nora Volkow, Director of the National Institute on Drug Abuse, at NatCon used brain imaging to dramatically illustrate how addiction changes brain function.  Dr. Volkow’s research demonstrates, for example, that the frontal cortex – or reward center – of the brain weakens as a result of alcohol and illicit drug use. ...

PCG’s top health trends to look for in 2016

Year end is a time of reflection, and a time to plan for what’s to come. Here at PCG, our Health team has much to be proud of in 2015: we helped more than 40 states develop and implement health care reform and Medicaid policy that will impact millions of Medicaid members nationwide. And so ...