Greater Chicago Area
An accomplished healthcare executive with extensive payer and provider industry experience known for building innovative partnerships among diverse organizations in the health system to achieve common goals. Possesses extensive payer and provider executive leadership experience in 1) innovative collaborations, 2) creative contracting, 3) shared risk arrangements, 4) medical management, 5) value-based contract strategy and fulfillment, 6) case-mix adjusted provider performance measurement, 7) advanced analytics, and 8) medical cost management Innovative Partnership: Direct to Employer Contracting; Bundle Contracts; CMS Program Partnerships; Episode of Care Models; Oncology Programs; Provider Partnerships & Collaborations Strategy and Business Development: Shared Risk & ACO Strategy, Development, and Execution; MSSP / MA Plan Development; Investment Justification; Value-Based / Managed Care Strategic Planning; Analytics-Driven Innovation; Customer Segmentation; Network Growth and Development; Population Health Organization (PHO) Strategy Additional Specialties: Clinically Integrated Network Executive Leadership, Enterprise Risk Management, Retail Analytics, Clinical Outcome Studies, Care Coordination Informatics, Medical Management Informatics, Targeting Analytics Patient Centric Medical Home Development Economic Analyses Pharmacy Outcomes and Economic Analyses Health Benefits Team Building Operations Management
Responsible for narrow network development & contracting, value-based care innovations, provider partnerships, VBC contracting and strategies for South Carolina’s largest health insurance company.
Owner and operator of consulting LLC. Clients include healthcare provider, national consulting firms, and health insurance companies and firms that render services to providers and / or health insurance companies. Examples of engagements include: • Consulting regarding business, development, analytical, and strategic solutions necessary to meet enterprise value based care objectives. • Evaluation and consulting regarding pre-existing business development plans for digital health and population health organizations. • Examination and critique of third party audits and quantitative consultant output. • Facilitate business development & growth strategic planning in various health delivery industries. • Evaluate and provide advisory services regarding shared-risk / Accountable Care Organization (ACO) contracts.
- Contracting and Network Development Divisions Chief from May 2020 to April 2021 - Interim President and Executive Director from November 2019 to May 2020 - Chief Analytics Officer from January 2017 to April 2021 - Consultant from Sept 2016 to December 2016 Responsible for the Rush Health Clinically Integrated Network contracting, network development, population health, care management, strategy, innovation, analytics, and related partnerships. Select areas of accomplishment: • Assumed the role of Rush Health President & Executive Director on an interim six-month basis and successfully stabilized the organization following significant executive level turnover • Teamed with national payer executives to lead a cross functional team to negotiate and execute a Medicare Advantage contract in record time, resulting in an 87% increase in access to Medicare Advantage patients. • Created an analytics capability that is now creating advanced predictive models, conducting complex contract analyses, identifying gaps in care and missing HCC codes, assessing performance (used to distribute approximately $25,000,000 in annual incentive funds), and facilitating the success of Rush Health value-based care arrangements. • Led the organization through initial stages of the Covid pandemic maintaining morale and productivity while securing accommodations and financial advances from commercial payers to ensure Rush Health could address community clinical needs. • Collaborated with plan sponsors, payers, and provider organizations to create innovative win / win agreements, including multiple innovative direct to employer efforts. • Reorganized and revamped the contracting and network development divisions of the organization • Served as the Rush Health executive lead of successful effort to create Value Based Care provider performance metrics and incentives. MSSP alone, as a matter of public record, earned highly material shared savings in the 2019 performance year.
Leader for Health Services and Outcomes Research resources for Walgreens. Responsible for research and advanced analytical activities that center on specialty drug, infusion, retail drug, health clinic, immunization, and digital health. Took my post in this progressive organization within weeks of the Boots Alliance / Walgreens merger. • Oversaw pharmacoeconomic studies showing the relationship between high touch infusion services and clinical outcomes. • Conducted studies that addressed the impact of Walgreens interventions on medication adherence metrics. • Materially impacted Walgreens innovative dispensing program delivery system. • Led team through cost cutting and down sizing activities as a result of the Walgreens Boots Alliance merger.
Built advanced analytical capabilities addressing pharmacy, marketing, consumer, predictive modeling, case-mix adjusted provider performance modeling, value-based care, program evaluation, medical cost, utilization, and risk issues. Oversaw program reporting, risk assessment, new product, and government programs analytics teams. Group consisted of more than 85 PhDs, actuaries, and analysts. • Created empirical predictive modeling capability for medical management, value-based care, and marketing applications. • Increased visibility of empirical and objective analytics throughout enterprise through active training of staff and executives. • Led analysis of pharmacy Maximum Allowable Cost pricing, resulting in savings of $80,000,000 per year. • Built case mix adjusted provider performance measurement system used in Accountable Care Organization (ACO) contracts. • Managed Accountable Care Act membership on-boarding and health risk assessment for early care activation and to maximize revenue. • Led creation of new cutting-edge clinical segmentation approach.