John McCarthy has more than 20 years of health care consulting and government leadership experience. He served as Medicaid Director in Ohio and the District of Columbia. John provides strategy and advisory services to clients to help them navigate the rapidly changing healthcare markets in the public and private sectors at both the federal and state levels. He is a nationally recognized expert in Medicaid reforms, value based purchasing, delivery system design, system implementation, and reimbursement policy. Most recently, he was CEO of Upshur Street Consulting, LLC.
From its inception in 2011 until December 2016, John served under Governor John R. Kasich, as the Director of the Ohio Department of Medicaid (ODM), Ohio’s first cabinet-level Medicaid agency. ODM is a cornerstone of the Governor’s Office of Health Transformation. Through its network of more than 75,000 active providers, ODM made coordinated, person-centered care available to residents across Ohio. John implemented a series of innovative policy initiatives that modernized ODM by improving the quality of health services at a substantial value to Ohio’s taxpayers.
Under John’s leadership, Ohio taxpayers saved over $6 billion in fiscal years 2012 and 2016. In the three years prior to the Kasich Administration, Medicaid spending grew an average of 8.9 percent annually, by 2013, this was reduced to 3.3 percent. He also implemented a new managed care program that provided choice to 1.6 million managed care beneficiaries. In 2012, he signed a pioneering, managed care based, agreement with the Centers for Medicare & Medicaid Services (CMS) for the integration and coordination of care for individuals enrolled in both Medicaid and Medicare. John’s modernization efforts also included the: implementation of Ohio Benefits, the state’s integrated eligibility system a state-of-the-art online portal; amendment of the State Plan to extend eligibility; and launch of the Medicaid Information Technology System (MITS), a sophisticated claims processing system to boost efficiency and communicate with providers.
Prior to overseeing Ohio Medicaid, McCarthy served as Policy Director and ultimately Medicaid Director for the District of Columbia. As Medicaid Director, John was part of the executive team that transitioned and reorganized Medicaid to be the largest freestanding agency in the District. He developed and procured new managed care contracts, increased oversight of the managed care plans and created a pay-for-performance quality bonus. Prior to government service, John spent 10 years at EP&P Consulting, serving as Corporate Manager. At EP&P, he led Medicaid transformation engagements for multiple states. John holds a master’s degree in public affairs from Indiana University‘s School of Public and Environmental Affairs and a bachelor’s degree in chemistry from Indiana University.