Atlanta, Georgia, United States
Dustin has more than 15 years of consulting experience working with government healthcare agencies to transform their operations and implement strategies and recommendations to fulfill their missions. Dustin has worked with over 30 different state health agencies across the country. Who I Help: • State Health and Medicaid Agencies • State Units on Aging • State Disability Agencies • Adult Protective Service Agencies Areas of Expertise: • Program Design and Implementation: Designs and implements state healthcare reform initiatives – which involves performing a variety of activities, including contract development, creating / updating waiver applications, crafting new policies and procedures, and leading strategy design sessions. • Performance Improvement and Operational Assessments: Conducts operational and performance improvement assessments to improve efficiencies, reduce costs, enhance staff alignment, and improve quality of care. • Stakeholder Engagement and Workgroup Facilitation: Expert at facilitating challenging conversations and developing communication materials for a variety of purposes and audiences, including public stakeholder engagement sessions and town halls, and regulatory agencies (e.g., CMS). • Analytics, Evaluation, and Research: Supports clients on all projects to use data and best practice research to drive their decision-making.
Select experience: • Performance Improvement: Performed over five different operational assessments for state Medicaid agencies and LTSS agencies to improve efficiencies, reduce costs, enhance staff alignment, and improve performance. Activities include: quantifying the number of staff needed to support new activities, developing new organizational structures, developing and providing staff training, performing staff interviews, developing a report that identifies performance deficiencies and provides recommendations for improvement, and developing new processes to improve performance. • Project Management: Led 30+ different projects ranging from size and scope including a $31 million contract with a state Medicaid agency to provide strategic support and guidance as it implemented managed care. • Data Analytics: Regularly performs data analytics to better inform leadership decision making. • Stakeholder Engagement: Regularly support stakeholder engagement sessions with consumers, direct service providers, and advocacy groups. • Program Design: o Successfully designed and implemented a Person-Centered Options Counseling (PCOC) network to assist consumers who are entering into or inquiring about the State’s system of publicly and privately financed LTSS. o Successfully created a new division to streamline a State’s provider licensure, certification, and monitoring functions across five existing state agencies. • Medicaid Performance Audit: On behalf of the State Legislature, conducted and led an audit of a state’s managed care program and provided more than forty audit findings and recommendations. • Quality Improvement: Led several executive steering committees to identify performance measures to improve their programs. • Program Monitoring and Oversight: Supported multiple states improve and design their compliance strategies to oversee MCO performance or their home and community-based services (HCBS) programs.
Select experience: • Medicaid Compliance and Regulation: Managed a team of consultants on a high-profile healthcare fraud investigation case. Led the team through the entire litigation process from the initial investigations stage, through discovery, to trial. Prepared over 50 written reports for legal counsel regarding a variety of complex healthcare issues including compliance with medical loss ratio reporting and payer regulatory filings and compliance. Recalculated the health plan’s State medical loss ratio rebate calculations over a 5-year period and concluded the health plan overpaid the State by $3 million. • Physician Reimbursement Rates: Engaged to determine whether an MCO’s low reimbursement rates to physicians led to poorer quality of care. Analyzed physician financial statements to determine whether physicians were receiving adequate compensation to provide quality services. Assisted in preparing an expert report for senior management and legal counsel. • Internal Audit: Evaluated a company’s internal operating controls as part of an SEC investigation. Analyzed the company’s segregation of controls and duties at three manufacturing facilities, all of which contained different accounting systems and internal controls. Identified deficiencies and implemented new measures to improve the company’s internal controls. • Audit Committee Investigation: Investigated a Nutraceutical company’s revenue recognition principles on behalf of an audit committee. Concluded the company was not in compliance with GAAP and consequently the company restated its financials. • Business Valuation: Performed several economic calculations related to business valuation, damage claims, and lost profits in litigation matters.