Humanism in Healthcare Technology

Harmonizing payer-provider data flow so that the healthcare workforce can spend more time on care provision and less time on manual data processing.

2019 Healthcare Executive Engagement Committee; American College of Healthcare Executives (ACHE), SoCal chapter.

The hub of healthcare innovation. Our goal at ScaleLA is to serve 1M patients and drive $1B in cumulative revenue through the ScaleLA ecosystem by 2025 (specifically targeting those in underserved communities in Los Angeles).

Leading role in negotiating various types of contracts (hospital, risk based, provider groups, etc) for Humana's commercial and Medicare Advantage products. Accountable for Medicare Advantage (MA) network adequacy, accuracy, compliance, and network management.

Highlights:
• Satisfied CMS network adequacy regulations by closing several key network-gaps.
• Global-risk contracts; operationalizing contractually delegated functions.
• Reduced provider directory inaccuracy rates with Medicare Advantage networks by 37.1%.
• Implemented network monitoring methods to assess and address network competitive position.
• Developed and coached team to thrive within in a highly matrix organization.

Medicare Bundled Payment Care Initiative (BPCI) Pilot Program
• 14 Hospitals
• 50+ Post-acute care providers (SNFs, LTCs, HHAs, etc.)
• 48 DRGs at-risk (upside/downside)
• 90-day episodes

Outcomes
• $1.1M in distributed shared savings.
• Engagement strategy demonstrated operational efficiency & care efficacy metric improvements.
•In partnership with each hospital leadership team, we operationalized network strategy.
• Data analytics used to provide market insight and decision support to hospitals.
• Utilized analytics for real-time feedback loop between hospital stakeholders & post-acutes.

Head of contracting and payor operations for 28 clinics throughout CA and TX. Inspired, motivated, and enabled teams to succeed. We marked successes from programmatic (HEDIS/RAF campaigns, enrollments, etc.) to structural outcomes during my time with ECSC/AHS.

•Led a dedicated team of 5 direct reports.
•Improved cash flow nearly $1 million (net) and reduced inventory costs 9% (or $2.1 million) by developing & implementing a common method of controlling the various facilities.
•Raised managed Medicare market share by 380%; IPA contracting strategy.
•Designed and implemented financial audits to identify variances to contracted rates.
•Saved over $2M in lost revenue by integrating compliance & risk-management systems.
•Coaching of 450 staff on managed care matters using enterprise communication skills.
•Increased average patient encounters from 1.4 per year to 2.9 for over 5,000 members.
•Devised and implemented telemedicine programs expanding access to healthcare.
•Improved HEDIS scores above baseline on 50% of metrics with approx 13,000 patients; triggering P4P payouts