If you’re involved with Medicaid at any level, whether you’re a provider, a supplier of equipment or a client, chances are you’ll be hearing more in the future about Dr. William Brendle Glomb.
Dr. William Brendle Glomb
Recently, Glomb was named as Medicaid medical director by Dr. Mark Chassay, HHSC’s deputy executive commissioner for health policy and clinical services.
Glomb has been with HHSC since 2008. He previously served as associate medical director for Medicaid/CHIP and head of initiatives relating to the Frew lawsuit over ensuring access to preventive medical and dental services for children with Medicaid.
Some major improvements have come from the Frew initiatives. One that Glomb cites as a signature achievement is Project Support, which co-locates mental health counselors and licensed clinical social workers with primary care physicians to serve patients with issues that prove to be mostly or entirely mental health-related. Glomb also has played a key role in helping HHSC respond to a legislative mandate to expand telemedicine, telehealth and telemonitoring services.
Glomb came to HHSC from private practice. That real-world experience, he believes, is a key asset during a period of rapid transformation within Medicaid, including managed care expansion, technological change and evolving policy at the state and federal levels.
His list of priorities and responsibilities is long, but he views communication with the Medicaid provider base and stakeholder community as especially crucial. By communicating more — and in more depth — with both, and by using their input to improve policies, HHSC can help improve services for clients within available resources.
Here’s what Glomb had to say about this and his other plans as he steps into this new role.
Q: Looking specifically at the provider community, what are their major concerns and what messages are we trying to communicate right now?
A: Well, recently we’ve seen some of the biggest changes in the history of the [Texas] Medicaid program, whether it’s the expansion of managed care statewide — particularly into the Valley — or the carve-in of pharmaceuticals into the managed care contracts or the addition of the dental HMOs. All three are changes being viewed cautiously by providers.
Providers’ concerns predominantly revolve around reimbursement rates. We absolutely understand that, and we appreciate our current providers for operating within the financial parameters required by a public program like Medicaid.
Their other concern is more procedural. It’s often a new way of doing things. They’re having to retool or, in more cases, rethink the way that they deal with Medicaid. That’s particularly true if they previously didn’t have managed care in their areas.
But the reality is, it’s not any different than dealing with any commercial insurance company. I practiced for 25-plus years, and dealing with Medicaid was often no more difficult than dealing with a commercial insurance company.
Q: What basic understanding would you like to see among providers in terms of why the state is expanding managed care?
A: Our Legislature has directed us to establish managed care throughout the state because of the potential savings. Since we’re not reducing benefits, those savings obviously come from more appropriate utilization of resources and benefits. So it’s the added scrutiny that goes into the managed care environment that helps the state save money.
For example, if a test is duplicative or is not going to directly influence treatment, then the state shouldn’t be paying for it. We actually have a legislatively mandated new committee that is going to look at the use and abuse of existing benefits.
Q: What approaches are we using to improve communication with providers?
A: There are several, but one noteworthy example is IMPROVE (Interactive Medicaid Provider Voice), which started as a Frew initiative. It’s our online method of communicating with the Office of the Medical Director. It’s designed to look at systematic issues within the Medicaid program that are problematic for the provider community and their patients. It’s now part of the Medicaid process helping to directly address system-wide issues.
Q: Are there other changes or new initiatives you’d like readers to know about?
A: One of what we’re hoping will be our most successful changes of policies has to do with non-medically necessary inductions of labor or C-sections in pregnancies of less than 39 weeks. We worked hand in hand with the Texas Healthy Babies expert panel, the Texas Academy of Obstetrics and Gynecology and the state representatives to the national ACOG [American College of Obstetrics and Gynecology] to write our policy in such a way that it wouldn’t be viewed by providers as telling them how to practice medicine.
There’s good synergy going on between HHSC and DSHS, and it’s important for the public to know that’s going on not only to advance good public health policy but good Medicaid medical policy and fiscal responsibility.
Q: One reason for hiring a physician for a job like this is your ability to communicate with your peers about all things Medicaid-related. What are your thoughts on this subject?
I think the biggest thing we need is bilateral communication with our provider bases. We want to make sure they have our ear in the Office of the Medical Director. If there are concerns regarding the type, quality and appropriateness — or perhaps even the state of the art of our benefits regarding medical practice — those are things we want to hear about.
Providers also need to make themselves available to us, either through their professional organizations or individually, so that when we are considering policy, they can feed their opinions and expertise back to us while we’re still in the planning stages and there’s still opportunity to make improvements.
Q: Can you cite some examples?
A: The pre-39-week policy is a classic example of what we’d like to do. The Texas Medical Association helped us to get a big group of obstetricians around the table on this. We even had the president of TAOG directly involved in crafting the policy, and he himself has written an educational module on the policy for DSHS to put up on its website.
We also have a Texas Health Steps advisory panel, predominantly made up of pediatric and family practice providers who perform Texas Health Steps exams and services. They meet with us on a quarterly basis to revise, tweak, upgrade and update Texas Health Steps services for children.
Another example is that we’ve convened two subspecialty advisory panels to help with Medicaid policy direction. We do this in conjunction with TMHP. One is a pediatric pulmonary panel — a six-member panel that’s met with us two times so far. We put before them pulmonary and technology policies that are currently up for review.
The other committee is our Pediatric Endocrinology Medicaid Advisory Panel, which is looking at everything from diabetes to utilization of growth hormone to obesity and lipid screenings and therapies. It’s very exciting stuff. Medicaid has never done this before in such an organized fashion.
Q: Do you have any other thoughts you’d like to pass along?
A: Medicaid and the Office of the Medical Director are making a specific and concerted effort to make sure that medical policy writing and revision are in direct alignment with what’s going on in the real world of real medicine and medical necessity for our beneficiaries. I believe that the provider community has the exact same goals in mind.