Midstate Medical Center
The CEO of a Midstate Medical Center (formerly called Veterans Memorial Hospital), noted that the hospital was about to acquire a smaller local hospital however, his own departments were not delivering quality results and profits; acquiring a new hospital would exacerbate this issue as middle managers did not understand their role in process improvement.
The CEO and I needed to design and implement a change management process.
We reengineered processes and disrupted thinking while integrating the operations of the second hospital.
This resulted in a complete merger of the hospitals and their departments which led to generating over $5 million of implemented process improvements, in the first year.
Situation : The CEO of a Midstate Medical Center (formerly called Veterans Memorial Hospital), noted that the hospital was about to acquire a smaller local hospital however, his own departments were not delivering quality results and profits; acquiring a new hospital would exacerbate this issue as middle managers did not understand their role in process improvement.
Task : The Chief Medical Officer and Chief Operations Officer asked me to develop an approach to improve the health status of the patients.
Action : We selected and implemented a new care management system along with several provider incentives aimed at identifying care needs of patients. We installed the care management system, trained the staff on care management processes, integrated the health status findings into rules structure to identify people for care, and set up two medical clinics (hiring doctors and staff) to work with especially difficult patients to ensure correct treatment.
Result : The outcome of this work resulted in definitive improvements in health status for the patients as well as increased revenue (net of $8 million the first year) for Bravo to take care of the patients. Perhaps more importantly, as a direct result of this work, Bravo health plan was acquired by Wellspring for $545 million.
Situation : Mercy Health Center (a 425-bed community hospital), experienced significant competition from other hospitals and employees were not engaged in the strategic mission of the organization.
Task : The new CEO was tasked with improving operations and we met an agreed on Two goals for the new year: employee culture and medical staff acquisition.
Action : We developed the campaign for building and developing a process improvement culture throughout each department. We did videos, personal visits, monthly meetings with all employees to develop ideas that we implemented to improve operations.
Result : The result was one clear culture and a cost savings of $4.2 million the first year and over $5.5 million the second.
Situation : Universal American was faced with implementing a new Medicare Advantage product without the ability to immediately enroll the members and pay the brokers for their work.
Task : The enrollment process clearly needed to be reengineered while establishing a culture of continuous improvement. The process used by brokers, IT and enrollment processing were slow and mostly manual.
Action : We redesigned the enrollment process working with agencies and agents to get their commissions paid quickly, applications completed online with real time validations.
Result : The process to get a person enrolled went from 56 days to Branding Statement April 29, 2019 page 2 less than 5 days with the new system. Universal enrolled more members and agents got paid immediately.
Situation : Geisinger health Plan, a community health insurer serving 350,000 members, had a great reputation for taking care of its members depending on personal service and manual efforts. Geisinger was expanding and needed to move the stratification and care management of patients to be supported by automated systems.
Task : I was recruited to manage this program which identified and selected the vendors and then implemented the automated support for all medical management programs including Utilization Review, Wellness, Care Management, Pharmacy services.
Action : I led a team of over 120 people, SMEs, analysts, project managers, developers, and subcontractors to redesign/reengineer the process so that patients were stratified and cared for appropriately.
Result : This resulted in an integrated system that has been developed at Geisinger and is now available for purchase through a unrelated company, (Caradigm, a combination of Microsoft and GE).
Priority Health, a health insurer serving Michigan residents, had no way to allow physicians and other health providers to request utilization review in an automated way, although their competitors all had that capability.
The CIO asked me to manage the project after two previous failed attempts and millions spent with no return.
I took over the management of the project team and worked thru agile processes to ensure that Branding Statement April 29, 2019 page 3 the process was integrated and working, including the testing of the approach.
Managing a team of 50 SMEs, analyst, developers, within 4 months we had the process working and tested, spending $800K with a return estimated at $3.5 million per year.
Blue Cross of Michigan Medicare Advantage
Situation : Blue Cross Medicare Advantage program is the 6th largest program in the country with over 600,000 members. It is the largest program in the US supporting group retirement programs.
Task : The key accounts area was set up to manage the large group accounts, representing over 330,000 members with an annual revenue just over $3 billion. The challenge was to service the groups and members demonstrating higher health status outcome while lowering costs. The new CEO of Medicare Advantage developed a pivot strategy to stabilize and grow the membership.
Action : In managing these key account grouse, we implemented several innovative approaches to lower costs and increase the health status of members, including a stratification system of the populations served and the potential to integrate the Johns Hopkins Predictive Analytics into the plan along with methods to increase social determinants of health.
Result : We maintained these key accounts and improved the outcomes for them in the process, thus maintaining the annual revenues and profits from these groups.
Aligning Vision, Strategy, and Execution to Drive Growth
Directed $5.9M budget and team of 40 in design/development of system architecture and integration with three HIEs enabling physicians to exchange clinical information real time – created robust Population Management Platform for analytics/care management of chronically ill Medicare patients expected to decrease operating costs by estimated 5% and increase patient outcomes/longevity.
Led team of 40 in health affordability/utilization management project to integrate authorization for drugs (pharmacy, home, office and mail) with existing online claims processing systems and HIPAA-compliant transactions – implementation of medical management generated $2.2M savings.
Set up Project Management Office within Medicare Advantage to manage $25M project portfolio, implemented reporting and risk assessment and 90-day segmenting process to enhance delivery of previously stalled projects – in first quarter, delivered 12 of 12 project segments on time.
Community First Health Plan
Implemented a new care management system including developing and testing of all integrations, functionality, and configurations. Worked with the business as they redesigned their processes to be population management focused.
Symbiox Health Network
As interim president, developed network of 55 MDs and application to DHHS for Shared Savings Program and designed Care Coordination Process integrating evidence-based medicine guidelines – achieved $700K cost savings by designing support network and implementing robust care management process.
Hamilton County Behavioral Health Network
Unified accounting, medical records/billing systems and clinical processes of 16 organizations into one management services organization facilitating sharing of uniform medical records and support systems among 600 clinicians.
Loyola Medical School
Negotiated 65 additional resident positions, expanding number of residency specialties by negotiating with City of Chicago for reopening of closed hospital.
Yale-New Haven Hospital
Facilitated performance improvement through implementation of process and procedure changes involving 125 faculty/community surgeons – increased operating room utilization rate by 22%.
Fairview Hospitals and Health System
Facilitated realignment of 68 staff positions, process improvement, and reduced accounts receivable from 72 to 43 days.
Saint Joseph Health Center
Developed/implemented quality management program, involving all 1300 employees and physicians, realizing first-year savings of $3.0M+ and $3.5M+ in second year.