markmerlis.com

   home    about me    fiction   health policy    links   contact me

MARK MERLIS 

EMPLOYMENT

INDEPENDENT HEALTH POLICY CONSULTANT, New Hope, PA        2001--

For a review of current and recent projects, click here.

Institute for Health Policy Solutions, Washington, DC             1996—2001

  Senior Fellow

 Senior researcher at independent not-for-profit organization that studies health care access, cost, quality, and financing issues.

·        Conducted several studies of Medicare restructuring issues, including an examination of the FEHBP model, a review of the potential effects of the Breaux/Thomas plan, a report on administrative issues under a premium support system, and a study of the potential for reducing risk selection by improving consumer information.

·        Under contract to the Health Care Financing Administration, drafted the Quality Improvement System for Managed Care (QISMC), uniform standards and reviewer guidelines for the evaluation of Medicare and Medicaid managed care contractors.

·        Completed a number of studies of long-term care financing, including an evaluation of the potential efficacy of private insurance and a social insurance program, a cross-national comparison of long-term care systems, and a review of efforts to link Medicare and Medicaid data on dually eligible individuals.

·        Developed options for states wishing to use Federal Child Health Insurance Program (CHIP) funds to assist low-income workers with employee contributions for family coverage.

The Commonwealth Fund, New York, NY                    1995—1996

  Senior Program Officer for the Elderly

  Grantmaker for national foundation supporting independent research on health and social issues.

  ·        Revamped foundation’s programs for the elderly, shifting from service demonstrations to funding of timely and policy-relevant work on access, financing, and quality issues.

·        Developed new projects for presentation to the Fund’s Board; worked with researchers to define project goals, monitor progress, and disseminate results.

·        Participated in development of Fund-sponsored surveys, contributing to methodology and survey instruments for studies in areas such as Medicare managed care.

Congressional Research Service, Library of Congress                     1987—1995

Specialist in Social Legislation

  Senior health policy analyst in an agency that provides nonpartisan analysis and research for members and committees in Congress.   Specialty areas included Medicare Part A, Medicaid, private health insurance reform, and health care cost containment, including managed care.

  ·        Provided technical assistance to key congressional staff at all stages of legislative development, from background research to bill drafting to writing committee reports.   Was closely involved in the development of most of the major health legislation in recent years, including nearly all the health care reform bills in the last three Congresses, Medicare and Medicaid reconciliation legislation, and Medicare managed care and Medicaid reform proposals.

            --          Was among the first to propose small group market reforms at the Federal level and was extensively involved in the development and drafting of the earliest proposals in this area, such as the Pepper Commission's plan and the several Bentsen bills;

            --          Devised the original grant allocation formulas for the Ryan White AIDS Care Act;

            --          Research on rural hospital issues helped lay the groundwork for the payment reforms in OBRA 89.

  ·        Provided reports and briefings for a broader congressional audience, making technical subjects such as hospital capital reimbursement or Medicare risk contracting accessible to members and staff less familiar with health issues.  Other typical subjects included: small group and individual market reform legislation; tax treatment of employer benefits; managed competition; and Medicaid funding allocations.

National Governors' Association, Washington, DC               1986—1987

  State Fellow

·        Wrote a handbook for state Medicaid administrators on managed care contracting.

·        Provided technical assistance to states on prepaid contracting issues and assisted in planning a series of NGA seminars on the subject.

Maryland Department of Health and Mental Hygiene,

Medical Care Programs, Baltimore MD

  Deputy Director

Office of Planning and Analysis                                                              1984--1987

  Deputy in the policy and planning unit for Maryland's Medicaid program, supervising a staff of 6 research analysts and also overseeing the 5-member unit that operated Maryland's Medicaid HMO contracting program. 

  ·        Served as project director for Maryland's demonstration program under the national Program for Prepaid Managed Health Care; negotiated the terms of Maryland's participation, wrote the Federal waiver application, and was responsible for project implementation and evaluation. 

·        Authored or oversaw studies in such areas as Medicaid coverage options for persons with AIDS and racial differences in Medicaid long-term care utilization. 

·        Key member of the team that implemented Maryland's Medicaid Management Information System.

HMO Coordinator                                                                        1980—1984

Administrative Specialist                                                              1977—1980

  ·        Line manager for the Maryland Medicaid HMO program, responsible for regulatory and policy development, contract negotiation and rate-setting, and general contract management and monitoring.

·        Entry level in Medicaid fraud and abuse unit.

EDUCATION

B.A., Wesleyan University, 1971 (English)

M.A., Brown University, 1976 (American Studies)