Our Projects
Aligning Vision
Strategy
Execution to Drive Growth
Blue Cross of Michigan Medicare Advantage
Situation :-
Blue Cross Medicare Advantage program is the 6th most powerful program in the country, with over 600,000 members. It is the most extensive program in the US, supporting group retirement programs.
The key accounts area was set up to manage the large group accounts, representing over 330,000 members with annual revenue of just over $3 billion. The challenge was to serve the groups and members, demonstrating higher health status outcomes while lowering costs. The new CEO of Medicare Advantage developed a pivot strategy to stabilize and grow the membership.
In managing these key accounts, we implemented several innovative approaches to lower costs and increase members’ health status, 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.
We maintained these key accounts and improved their patient outcomes, thus keeping these groups’ annual revenues and profits.
Priority Health
Situation :-
Priority Health, a health insurer serving Michigan residents, had no way to allow physicians and other health providers to request utilization reviews 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 the process was integrated and working, including the testing of the approach.
Managing a team of 50 SMEs, analysts, and developers, within four months, we had the process working and tested, spending $800K with a return estimated at $3.5 million per year.
Geisinger
Situation :-
Geisinger Health Plan, a community health insurer serving 350,000 members, had an excellent reputation for taking care of its members depending on personal service and manual efforts. Geisinger was expanding and needed to move patients' stratification and care management to be supported by automated systems.
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, and Pharmacy services.
I led a team of over 120 people, SMEs, analysts, project managers, developers, and subcontractors to redesign/re-engineer the process so that patients were stratified and cared for appropriately.
This resulted in an integrated system developed at Geisinger and now available for purchase through an unrelated company (Caradigm, a combination of Microsoft and GE). In addition, we reduced inpatient admissions by 3% among all health plan members and 44% of readmissions. These resulted in $10+ million per year.
Universal American
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.
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.
We redesigned the enrollment process working with agencies and agents to get their commissions paid quickly, applications completed online with real time validations.
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.
Bravo Health
Situation :-
Bravo Health, a special needs Medicare Advantage program serving Baltimore and Philadelphia, knew that the health status of its members were not advancing as they
should,
The Chief Medical Officer and Chief Operations Officer asked me to develop an approach to improve the health status of the patients.
We selected and implemented a new care management system along with several provider incentives to identify patients’ care needs. We installed the care management system, trained the staff on care management processes, integrated the health status findings into the rules structure to identify people for care, and set up two medical clinics (hiring doctors and staff) to work with complicated patients to ensure correct treatment.
The outcome of this work resulted in definitive improvements in the health status of the patients as well as increased revenue (net of $8 million in 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.
Midstate Medical Center
Situation :-
The CEO of Midstate Medical Center (formerly called Veterans Memorial Hospital) noted that the hospital was about to acquire a smaller local hospital; however, his 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, leading to over $5 million of implemented process improvements in the first year.
Mercy Health
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.
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.
We reengineered processes and disrupted thinking while integrating the operations of the second hospital.
The result was one clear culture and a cost savings of $4.2 million the first year and over $5.5 million the second.
