Greater Toronto Area, Canada
Nationally recognized leader in long term services and supports (LTSS), dual eligibles, older adults, social determinants of health (SDOH), and complex populations. Expert in Medicaid/Medicare with deep experience across health services at both payers and providers, for-profit and non-profit environments, as well as Fortune 50 and middle market companies. Proven, outcomes-driven leader with strong strategy, business development, sales, operations, people development, and entrepreneurial skills.
Altarum is a nonprofit organization focused on improving the health of individuals with fewer financial resources and populations disenfranchised by the health care system. We work primarily on behalf of federal, state, and local government entities in planning and implementing vital public health and health care service delivery programs. We combine our expertise in public health and health care delivery with technical assistance, practice transformation, training, quality improvement, applied research and analytics, health and science communications, data modernization and interoperability, and technology development and implementation. Led successful turnaround – Within 2.5 years, the company went from repeatedly losing money every year to breakeven, and within 3.5 years, to having a healthy margin. Strengthened the balance sheet – Increased net assets by 33%. Enhanced liquidity and made the balance sheet more accessible, increasing days cash on hand 112%. Effectively managed costs – Lowered corporate costs by 13% while improving service. Drove business development – Created new business development approach that drove growth with existing clients and enabled company to engage with new clients. Won 23 new contract vehicles. Launched successful new business – Conceived of, and launched, industry-leading business to reshape how states manage their dually eligible populations. Within 18 months, secured four state clients and achieved breakeven financial results. Led culture change – Transformed to a culture of high-performance. Recognized as “Best Place to Work” in multiple locations and lowered voluntary turnover rate by 21%. Raised profile – Significantly increased the profile of the organization, including receiving a significant unrestricted grant from MacKenzie Scott’s foundation
Social Health Bridge Trust is Centene's signature Social Determinants of Health (SDOH) initiative. Acting as a financial and interventional layer between healthcare companies and community organizations, Social Health Bridge enables both sectors to work towards improving people's lives. Social Health Bridge enables true value based arrangements focused on achieving the outcomes that matter to the healthcare industry by leveraging the infrastructure of the community organizations. Conceived of company, wrote business plan, and secured funding. Company is live in one market.
Responsible for national product management of Centene’s Medicaid and Complex Care product lines – TANF; CHIP; Foster Care; Medicaid Expansion; Aged Blind & Disabled (ABD); Managed Long Term Services & Supports (MLTSS); and Medicare-Medicaid Plans (CMS Financial Alignment Demonstration). These products operate across 30 states and collectively comprise more than 12.5 million members and more than $70 billion in revenue. Centene is #1 or #2 in national market share for these products. Additionally, responsible for Centene’s overall strategy for Social Determinants of Health (SDoH), and the Centene Center for Health Transformation, a collaboration with academic researchers. Accomplishments include: Business development – Responsible for $2.4 billion award of LTSS business in Pennsylvania – the largest win in company history. Played key role in re-procurements of contracts in Florida, Kansas, Illinois, and Indiana, as well as new procurements in New Mexico, North Carolina, and Iowa – these contracts combined are worth more $8 billion in revenue. National MLTSS Health Plan Association – Founded and served as Board Chair of MLTSS trade association. Identified need for association, developed mechanism to run organization, and recruited 7 additional health plans to join. Organization currently has 11 health plan members with more than $500K in revenue. CMS Health Equity Award – Led Provider Accessibility initiative, which won Centene the CMS 2019 Health Equity Award, and ranked the company #7 on Fortune’s 2019 “Change the World” list. Strategic Partnerships – Developed and manage ongoing strategic relationship with key partners, (e.g., SEIU, AHCA, LeadingAge, Lutheran Service of America, Easter Seals, Feeding America). Board seats – Identified need for Centene’s participation, obtained Board seats, and serve (or have served) on following Boards: Long Term Quality Alliance, Partnership for Medicaid Homecare, and Healthcare Career Advancement Program.
New product launch – Successfully launched four MMP plans in five months (OH, SC, TX, MI). Ensured key activities were completed effectively, including: contract reviews, readiness reviews, and operating model implementation. Advisory panels – Serve (or have served) on the following advisory panels: NCQA’s LTSS Advisory Board, the Medicaid Quality Review System Technical Expert Panel (TEP), Mathematica’s Home & Community Based Services Measures TEP, and NASUAD’s MLTSS Institute. Co-Chair NQF Measure Applications Partnership Dual Eligibles work group – Identified need for Centene’s participation, developed application, & served as Centene’s representative. Passive sensor pilot – Led effort to deploy passive sensors that identify changes in members’ conditions and prevent hospitalization & institutionalization, resulting in savings of $388 PMPM. LTSS KPI Dashboard – Led development and implementation of a set of key performance indicators for LTSS members that enables tracking and improvement of quality measures as well as Centene’s LTSS value-based purchasing infrastructure. Coordination of benefits/claim crossover – Drove effort that substantially reduced claim delays, increased auto adjudication rates by 70% in four months, and brought claim payments into compliance. Hospice flag – Led effort that generated $1 million in savings by ensuring appropriate billing for MMP members electing hospice.
Village Care, a New York City based non-profit integrated health system ($200 million in revenue), serving over 12,000 people annually. Its platform of services covers the entire post acute and long term care spectrum (managed long term care health plan, skilled nursing facilities, assisted living facility, homecare, health clinic, case management). Oversaw corporate strategy, human resources, and facilities management. Additionally, managed a $60 million P&L that included a 219 bed long term care facility focused on HIV/AIDS, 105 bed short term rehab facility, and a 95 bed assisted living facility. Supervised over 400 employees via six direct reports. Accomplishments include: Financial performance – Grew gross margin by more than 10%. Improvement was the result of revenue maximization and cost reduction efforts: Enhanced revenue – Achieved 14% improvement in Medicaid case mix index and 4% improvement in Medicare rates at rehabilitation facility by focusing on improved documentation. Increased census – Grew census at assisted living facility by more than 10%. Reduced overtime expense – Implemented a new staffing pattern and overtime policy that decreased overtime expense by more than 80%. Redesigned clinical model – Shifted long term care facility to a predominantly LPN model from an RN model leading to over $1 million in savings without impacting quality of care. Quality –Reduced 30 day rehospitalization rate by nearly 30% at sub-acute rehab facility. Achieved “Five Star” CMS rating for both nursing facilities. Customer satisfaction – Grew customer satisfaction scores by more than 10% versus prior year through the implementation of a customer satisfaction transformation initiative at sub-acute rehab facility.