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Tuesday, December 8 • 4:00pm - 5:00pm
Track 5: Leveraging Machine Learning to Enhance MCO Provider Network Oversight

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Ensuring that Medicaid recipients have access to providers and services is a critical issue for states that administer Medicaid through managed care programs. Inadequate provider networks threaten the quality of care and can impede efforts to improve population health outcomes. Additionally, inaccurate data makes it difficult for organizations to understand gaps in coverage. Manual processes to validate provider networks both in terms of data accuracy and network adequacy are insufficient given the high volume of Medicaid providers. In recent years Pennsylvania, assisted by Deloitte, has successfully automated provider network validation processes. Machine learning, applied to provider network oversight, has enabled Pennsylvania to focus reviews on high-need specialties and to understand the true and actual networks of providers who are available to serve recipients.

avatar for Ramona Pereira-Chakka

Ramona Pereira-Chakka

Principal, Deloitte Consulting
Ramona has over a decade of experience helping government leaders transform their agencies through emerging and disruptive technologies, innovative business models, and retooled program operations resulting in improving quality outcomes for millions of recipients. Ramona particularly... Read More →
avatar for Matthew C. Mardorff

Matthew C. Mardorff

Specialist Leader, Deloitte Consulting
Matthew is a Specialist Leader at Deloitte with more than 15 years of experience in the field oftechnology implementations and analytics for Health and Human Services, focusing primarily onMedicaid programs. During his time with Deloitte, Matt has served as a trusted business advisor... Read More →
avatar for Barry Bowman

Barry Bowman

Managed Care Operations Chief & Director of Monitoring and Compliance, Pennsylvania Department of Human Services, Office of Medical Assistance Programs
Barry is the Managed Care Operations Chief and Director of Monitoring and Compliance for the HealthChoices Physical Health Program administered by the Pennsylvania Department of Human Services, Office of Medical Assistance Programs. Barry has 25 years of experience performing contract... Read More →

Tuesday December 8, 2020 4:00pm - 5:00pm PST