Special Report | Channel leaders: Relationships are the Rx for healthy systems

Kevin Lee, vice president and senior program director, Health Management Systems Inc.

The leaders

» Mark Blevins

Perot Government Systems

Vice president of civilian services

» Jerold Clark Jr.

Anteon International Corp.

Senior group manager of operational intelligence

» Douglas Gilbert

Verizon Federal Network Systems

Director, Energy Dept. operations

» Bhaskaran Jayaraman

Avineon Inc.

IT director

» Kevin Lee

Health Management Systems Inc.

Vice president and senior program director

» Eric Olson

InfoReliance Corp.

Director of Marine programs

» Greg Pellegrino

Deloitte Touche Tohmatsu

Public sector global managing director

» Tim Schilbach

Apogen Technologies Inc.

Project manager

» William Smithson

SI International Inc

Vice president of financial systems applications development

» Heinz Wimmer

Analex Corp.

Vice president of central operations

How we found our leaders

The Washington Technology Channel Leaders were picked from nominations submitted by our readers. The editorial staff read the nominations and judged them on the following:

» How the person helped a federal, state or local government agency fulfill its mission

» How the person helped his or her company meet growth, positioning and profitability goals

» How the person showed creativity, leadership and good partnership in the delivery of products or services to a government customer.

Nominations of chief executive officers, division presidents and executive vice presidents were not accepted. Instead, we wanted to recognize the people in the trenches: program and project managers and sales and business development executives. These are the people who touch and interact with government customers daily.

In times of tight budgets and financial constraints, states often are forced to get creative when looking for ways to cut costs. New Jersey is no exception.

The state was looking for ways to run its Medicaid program more efficiently, and Kevin Lee, vice president and senior program director with cost-recovery company Health Management Systems Inc., believed he had the answer.

Lee led a team that worked with the New Jersey Human Services Department to come up with a way to submit Medicaid claims over the same network that pharmacies use to submit insurance claims, and make the process faster and more efficient. On Lee's watch, the state has recovered $500 million, according to the department.

"In virtually all Medicaid programs, pharmacy is probably the No. 2 cost center behind skilled nursing-facility care," Lee said. One of his career goals, he said, is to have a positive impact on health care delivery by improving funding and financial aspects of the system, specifically in the government sector.

"Focusing on where the money is spent in pharmacy is certainly a topic that continues to demand attention and creative thinking," Lee said.

The program that Health Management Systems developed for the state, COBManager, can increase pharmacy-cost recovery by 4 percent or more, amounting to millions of dollars a year. Other states are looking at doing something similar, according to Lee.

"Kevin's had excellent relationships" with everyone involved in the project, said Chuck Anderson, vice president of eligibility services with Health Management Systems. Lee was instrumental in getting the pharmacy community's approval of the company's plan, he said.

"We attacked the program strategically," Lee said. "What we endeavored to do was put Medicaid on more of an equal footing with more of the dominant practices for pharmacy management for adjudication and process." Putting Medicaid in this "real-time setting" ensures that the government pays no more than it owes, he said.

Because transactions occur in real time, the possibility of overpaying as a result of less than timely coordination with insurance carriers or other systems is reduced.

At Health Management Systems, Lee works with states that want to set up new databases and systems, and helps them determine which processes or technologies likely would work best. Getting large-scale systems under control can be challenging, he said. "The systems are unique," he said. "One state Medicaid program may look very different from another state's Medicaid program."

Some across-the-board industry standards have been developed, but "we're still on the leading edge of that," he said. "As we move toward more open standards, some of that will, I think, be easier, but in some ways, it's incredibly challenging, because [as technology improves,] the rate of change continues to increase," Lee said.

Even after 16 years with the company, the job remains exciting, said Lee, who works in Trenton with the New Jersey team. "Every day is different," he said.

Health care information management is a dynamic industry, he said. "Technology's changing. Software's changing. You've got standards that are evolving and converging. Every day's an opportunity to try to do better."

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