RAINIER HEALTHCARE CONSULTING, LLC DEBRA HAGEMANN, PRINCIPAL

Size: px
Start display at page:

Download "RAINIER HEALTHCARE CONSULTING, LLC DEBRA HAGEMANN, PRINCIPAL 253.302.2618 www.rainierhealthcareconsulting.com"

Transcription

1 RAINIER HEALTHCARE CONSULTING, LLC DEBRA HAGEMANN, PRINCIPAL Senior health care managed care leadership experience includes multi-state commercial and Medicaid medical management program leadership including integrated utilization, care management, wellness, and quality programs. Extensive clinical program and product development leadership experience in both US and International settings responsible for all phases of the product lifecycle from discovery, design, construct, through deployment and maintenance. My passion is meeting business and financial goals through effective leadership to retain high performing staff, implement best practices with a simplified design focusing on key clinical interventions to meet outcomes. I have a proven ability to work independently, quickly gain trust through transparent communication and collaboration; and motivate staff to excel while working in a fast-paced, ever changing industry. AREAS OF EXPERTISE Clinical and Operational Management of UM, CM and QM departments Clinical Program Strategies and Software Design Organizational Design, Systems Improvements, and Clinical Department Management Predictive Modeling, Operational Dashboards, UM/CM Quality/Cost Reporting Provider Consulting on Risk Arrangements Payor and Provider Partnerships with Community Agencies Home Health Models Organizational Change Management Leadership PROFESSIONAL EXPERIENCE RAINIER HEALTHCARE CONSULTING, LLC November present Principal/Owner A sole proprietorship offering strategic program and product development consulting services on ACO implementations, integrated healthcare programs, operational excellence of UM/CM/Quality departments, and clinical software design/ and implementations. Target customers include payors, hospitals, provider groups, software vendors, and community agencies. All locations within US and Europe are within scope. Interim clinical management positions considered. COORDINATED CARE, TACOMA, WASHINGTON Centene Corporation April 2012 September 2014 Vice President, Medical Management Successfully led start up of new Medicaid managed care health plan medical management departments from 32,000 to 200,000 members in 2 years. Responsible for Quality Management, Referral/Prior Authorization, Concurrent Inpatient Review, Case Management, Clinical Training, and Community Health Worker Departments

2 DEBRA HAGEMANN RESUME PAGE 2 Reported to CEO of Coordinated Care as part of the Senior Management Team of Coordinated Care Reviewed analyses of all medical management quality, budget, productivity, forecasting, and outcome data on an ongoing basis to inform of department progress toward cost and quality goals. Revised interventions accordingly to meet business goals and budget. Oversaw programs and results from vendors for behavioral health, disease management, 24x7 nurse line, vision, radiology, and pharmacy specialty companies. Successfully implemented managed care processes for the WA Health Home initiative, a new Medicaid Expansion product and a new commercial Exchange product in January Met with provider groups to discuss cost/quality initiatives, risk arrangements, and contracting. Worked with community agencies to develop pilot programs to improve member s health. Examples include implementing a case management program in a homeless shelter, non-urgent 911 calls being referred to CM fire departments, collaborating with Tacoma s Clean Air for Kids program, partnering with FQHCs to host baby showers for members providing pre-natal care information. Implemented Patient Activation Measure by Insignia for all case managers. Awarded accreditation by National Committee on Quality Assurance (NCQA) in May 2014 after less than two years in operation with only a.4-point deduction. HEALTHWAYS, INC., NASHVILLE, TENNESSEE Senior Director, International Clinical Solutions (September, 2008 April, 2012) Lead for new and enhanced clinical product development for international division of Healthways. The international version of the Embrace software was customized to customer s needs in Germany, Brazil, Australia, and France to support a full continuum of programs from online wellness and chronic disease programs for members to online content to support chronic and high risk telephonic case management interventions in the customer s call centers. Successfully designed and launched a new award-winning integrated patient/provider/nurse call center portal in Australia named My Health Guardian. Role was as dedicated onsite account management for 6 months to implement the software design and installation of wellness, chronic, high risk telephonic, Telehealth, and self-management programs as well as lead the opening of a new call center in Sydney, Australia. Provided 1.5 years of onsite clinical product development leadership in Paris, France for the French government (CNAMTS) healthcare contract with Healthways. Senior Vice President, Domestic Product Development (2006 September, 2008) Accountable for staff of 90 clinical & IT colleagues designing new clinical programs and enhancing existing programs in Popworks software application used by 13 Healthways call centers in the US. Led 3 teams of clinical & IT staff through the following processes: Discovery, Business Requirements, Technical Requirements, Configuration, Quality Assurance, User Acceptance Testing, User Training, Go-Live Implementation, and 6 week Warranty phases. Scope included creation of 5 new clinical programs and ongoing enhancements to 8 clinical products (COPD, CHF, Asthma, etc.) Successfully re-engineered department structure, roles, and culture to decrease staff turnover from 40% to 2% and improve culture and colleague satisfaction within first 6 months in role.

3 DEBRA HAGEMANN RESUME PAGE 3 Director, Domestic Product Development ( ) Accountable as the Portfolio Business Leader of seven disease management products. Responsibilities include leading a team for researching, designing, and enhancing new and existing products for delivery into the marketplace. ANTHEM BLUE CROSS AND BLUE SHIELD, SOUTH PORTLAND, MAINE ANTHEM EAST Maine, New Hampshire, Connecticut ( ) Regional Director of Medical Management Member of the Anthem East Medical Management Team, accountable for the operations, budget, and regionalization of medical call centers, utilization-, disease-, case-, and quality-management departments of over 190 associates in 12 departments over 3 states managing 7 million lives. Successfully completed centralizing of member intervention activities from 4 regional departments while improving associate satisfaction as measured by the Great Place to Work Institute. Re-engineered programs from an individual state to regional focus including a new weight management program, a focused utilization management program, new HEDIS collection tools, and an NCQA documentation database. ANTHEM BCBS Maine ( ) Regional Director of Case Management and Medical Management in Maine Managed successful transition staff, facility, customers, and business name from a separate for-profit company (Katahdin Care Management) to an Anthem department resulting in organizational efficiencies, complete retention of customer accounts, and implementation of new strategic priorities. Successful integration of 3 separate state-based case management departments into 1 regional operating unit. Redesigned care management program to implement a vendor solution while concurrently restructuring internal catastrophic care management program to utilize motivational interviewing skills, resulting in combined 18,000 engaged members that impacted the overall medical loss ratio by 1%. KATAHDIN CARE MANAGEMENT ( ) Owned wholly by BCBSME Director of Medical Management Accountable for financial performance, business development, and ongoing operations of $3.2 million budget and 1.5 million lives. Expanded business to 3 significant new customer accounts that resulted in staff expansion from 55 to 72 full-time associates. Successfully managed budget process to become the successful for-profit subsidiary of BCBS Maine. Redesigned product delivery for all departments to improve efficiencies and provide more flexible programs to exceed customer expectations, including new performance measures, training programs, and new program development. Awarded Best in Blues Award in 1996 for Diabetes Disease Management Program for innovative disease registry design and outcomes measurement.

4 DEBRA HAGEMANN RESUME PAGE 4 HRS MAINE Owned by both BCBS Maine and BCBS Western Pennsylvania ( ) Manager of Medical Management Accountable for all daily operations and business development of medical management activities supporting over 1 million lives. Obtained first URAC accreditation for HRS, Maine while leading Utilization Management/Quality Management NCQA activities for BCBS Maine to 'excellent' accreditation. Completed business restructuring to add new member call center, referral management department, quality management department, growing staff from 20 to 55 associates. Lead systems conversion to new documentation platform maintaining excellent customer service during conversion. Awarded BCBS Maine Presidents Award for Quality Programs. Lead systems conversion to MEDecisions clinical management platform maintaining excellent customer service for all BCBSME members during conversion. As Manager of Medical Management, reported to non-clinical BCBSME VP of Quality. Role in MEDecision team was as Lead for all Medical Management for BCBSME Was part of BCBSME senior team to review & interview vendor RFPs and select winning vendor. Represented all medical management departments on MEDecision implementation team working daily with BCBSME IT & MEDecision implementation leads throughout the implementation process lasting several months. Was accountable within BCBSME for facilitating successful and timely implementation of system Was lead on creating business requirements, working with BCBS IT and MEDecision to design custom system enhancements to meet business needs. Created a users group to provide input on system enhancements. Was resource for MEDecision IT architects as system was configured and throughout entire implementation lifecycle through QA and warranty period. Led user acceptance testing process & go-no go decision with BCBS Senior Team Worked closely with MEDecision to approve colleague training information Led management of change process with UM & CM colleagues and customers HEALTHSOURCE MAINE/CIGNA, FREEPORT, MAINE Managed Care Consultant As a start-up HMO, later purchased by Cigna, Collaborated with provider organizations to establish medical management oversight processes leading to improved clinical outcomes. Developed first preventative health reminder mailings, designed first UM/CM policy manual, and created the first case management program. Provided onsite UM review and in-home catastrophic case management services and later became a dedicated consultant to top 3 major employers in Maine to review healthcare trends, recommend solutions, and advise on new programs to improve the health of their employees. CLINICAL NURSING EXPERIENCE HIGHLIGHTS Arcadia Home Health Agency, Brunswick, Maine ( ) Director, Downeast Home Health Care, Belfast, Maine ( ) Maine Medical Center, Portland, Maine Burn Nurse ( ) Temple University, Philadelphia, Pennsylvania Campus Health Clinic Nurse ( ) Direct patient care in acute care settings on both medical and surgical units ( )

5 DEBRA HAGEMANN RESUME PAGE 5 EDUCATION AND PROFESSIONAL AFFILIATIONS Harrisburg Area Community College, Harrisburg, Pennsylvania A.D.N., 1977 Temple University, Philadelphia, Pennsylvania Undergraduate studies, Dale Carnegie Training & Lifelong Member 2003 RHR International, Leadership Training 2004 PDI Leadership Training 2007 Currently licensed as RN in Maine (Compact State) and Washington State Board Member, Tacoma Area Coalition of Individuals with Disabilities (TACID) 2014 present Member, Case Management Society of America Certified Case Manager (CCM) ; currently pursuing recertification for CCM

Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Summit Health Plan of Florida

Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Summit Health Plan of Florida Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Summit Health Plan of Florida Medicare Quality Management Program Overview Quality Improvement (QI) Overview At Coventry, we

More information

Maureen Mangotich, MD, MPH Medical Director

Maureen Mangotich, MD, MPH Medical Director Maureen Mangotich, MD, MPH Medical Director Prepared for the National Governors Association Healthy America: State Policy Leaders Meeting, December 2005 Delivering value from the center of healthcare Pharmaceutical

More information

Proven Innovations in Primary Care Practice

Proven Innovations in Primary Care Practice Proven Innovations in Primary Care Practice October 14, 2014 The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA. 2014 Society for Healthcare

More information

Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Coventry Health and Life Insurance Company Commercial Lines of Business

Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Coventry Health and Life Insurance Company Commercial Lines of Business Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Coventry Health and Life Insurance Company Commercial Lines of Business Quality Management Program 2012 Overview Quality Improvement

More information

Quality Oversight in the Health Care Marketplace, Spring 2010 Tufts Health Care Institute

Quality Oversight in the Health Care Marketplace, Spring 2010 Tufts Health Care Institute Quality Oversight in the Health Care Marketplace, Spring 2010 Tufts Health Care Institute Session 16: C.1. Performance Reports National Reports Some reports present information on a category of providers

More information

Quality and Performance Improvement Program Description 2016

Quality and Performance Improvement Program Description 2016 Quality and Performance Improvement Program Description 2016 Introduction and Purpose Contra Costa Health Plan (CCHP) is a federally qualified, state licensed, county sponsored Health Maintenance Organization

More information

URAC PATIENT CENTERED HEALTH CARE HOME PROGRAMS

URAC PATIENT CENTERED HEALTH CARE HOME PROGRAMS URAC PATIENT CENTERED HEALTH CARE HOME PROGRAMS Today s Speaker Christine G. Leyden, RN, MSN SVP & GM Client Services, Chief Accreditation Officer 7/27/2011 2011 URAC 2 Learning Objectives for Today s

More information

TABLE OF CONTENTS. Medical Management. BCBSIL Provider Manual Rev 10/13 1

TABLE OF CONTENTS. Medical Management. BCBSIL Provider Manual Rev 10/13 1 TABLE OF CONTENTS Medical Management... 2 Benefit Pre-certification... 2 Benefit Pre-certification for Inpatient and Ancillary Medical Services... 2 Benefit Pre-certification for Outpatient Medical/Surgical

More information

Pamela Tropiano, RN, CCM, BSN, MPA. CareSource

Pamela Tropiano, RN, CCM, BSN, MPA. CareSource Annual Education Conference September 30 October 3, 2012 Orlando, FL 1.7 Creative Case Management Pamela Tropiano, RN, CCM, BSN, MPA Senior Vice President, Health hservices CareSource Mission: The CareSource

More information

Care Coordination: Case managers connect the dots in new delivery models

Care Coordination: Case managers connect the dots in new delivery models The Pathway to Certfication is CCMC IssueBrief VOLUME 1, ISSUE 2 Care Coordination: Case managers connect the dots in new delivery models Well before health reform was signed into law, new models for health

More information

Connect4 Patients CCCM Primary Care Community. Presented By: Veronica Mansfield, DNP, APRN, AE-C, CCM Kit McKinnon, MBA, BSN, RN, CDE, CCM

Connect4 Patients CCCM Primary Care Community. Presented By: Veronica Mansfield, DNP, APRN, AE-C, CCM Kit McKinnon, MBA, BSN, RN, CDE, CCM Connect4 Patients CCCM Primary Care Community Presented By: Veronica Mansfield, DNP, APRN, AE-C, CCM Kit McKinnon, MBA, BSN, RN, CDE, CCM September 17, 2015 Objectives: Describe innovative care management

More information

Midwest ESOP Conference. September 11, 2015

Midwest ESOP Conference. September 11, 2015 Midwest ESOP Conference September 11, 2015 Why are you here today? I want to fix my company s healthcare problem Rising healthcare costs are: Negatively affecting my bottom line, EBITDA, stock price, etc

More information

Health Plan Quality Monitoring

Health Plan Quality Monitoring Health Plan Quality Monitoring Andrew L. Naugle, MBA Patty Jones, RN MBA BACKGROUND Section 1311(b) of the Patient Protection and Affordable Care Act of 2010 (ACA) detailed the intent of the federal government

More information

Solutions. Quality Service Plan Choice Value-Added Programs. for small business.

Solutions. Quality Service Plan Choice Value-Added Programs. for small business. Solutions Quality Service Plan Choice Value-Added Programs for small business. How does a small business attract and keep talented workers? One of the most important and attractive employee benefits an

More information

V. Utilization Management (UM) Program

V. Utilization Management (UM) Program V. Utilization Management (UM) Program Overview Better Health Network s Utilization Management (UM) Program is designed to provide quality, cost-effective and medically necessary services while meeting

More information

Call-A-Nurse Location

Call-A-Nurse Location Call-A-Nurse A 24-hour medical call center, specializing in registered nurse telephone triage, answering service, physician and service referral, and class registration. Call-A-Nurse Location Call-A-Nurse

More information

The Value Quadrant of Healthcare Reform. 2008 Pharos Innovations, LLC. All Rights Reserved.

The Value Quadrant of Healthcare Reform. 2008 Pharos Innovations, LLC. All Rights Reserved. The Value Quadrant of Healthcare Reform ACOs in PPACA Provider Organizations or networked groups Accountable for quality, cost and overall care of defined population of Medicare FFS benes Key metrics to

More information

RAYMOND J. FABIUS, MD, FAAP, FACPE

RAYMOND J. FABIUS, MD, FAAP, FACPE RAYMOND J. FABIUS, MD, FAAP, FACPE 8 Frog Hollow Drive (Cell) 610-322-2565 Newtown Square, PA 19073 (Work) 610-639-7002 www.rayfabiusmd.com ray.fabius@ab3health.com PROFILE PHYSICIAN EXECUTIVE WITH LEADERSHIP

More information

Evolving with the System: The Changing Role of Medical Assistants in the Delivery of Team-Based Care

Evolving with the System: The Changing Role of Medical Assistants in the Delivery of Team-Based Care Evolving with the System: The Changing Role of Medical Assistants in the Delivery of Team-Based Care Background Geneia brings innovation to health care by helping hospitals, physicians and all types of

More information

POLICIES AND PROCEDURES

POLICIES AND PROCEDURES POLICIES AND PROCEDURES Policy Number: QM 07 Originator: Quality and Utilization Management Department Original Issue Date: 2/99 Subject: Provider Appointment Access / Access Standards Revision Date: 11/01,

More information

Recognizing Physician Excellence SM Program

Recognizing Physician Excellence SM Program Recognizing Physician Excellence SM Program Guide to Physician Tools and Resources 66335-1007 SU Recognizing Physician Excellence (RPE) Program Guide to Physician Tools and Resources Table of Contents

More information

Integrating Patient Safety in Care Management Programs

Integrating Patient Safety in Care Management Programs Integrating Patient Safety in Care Management Programs Annette Watson, RN, CCM, MBA Chief Accreditation Officer 6 th Annual Quality Colloquium- Cambridge, MA About URAC Nonprofit, independent organization

More information

Game Changer at the Primary Care Practice Embedded Care Management. Ruth Clark, RN, BSN, MPA Integrated Health Partners October 30, 2012

Game Changer at the Primary Care Practice Embedded Care Management. Ruth Clark, RN, BSN, MPA Integrated Health Partners October 30, 2012 Game Changer at the Primary Care Practice Embedded Care Management Ruth Clark, RN, BSN, MPA Integrated Health Partners October 30, 2012 Objectives To describe the recent evolution of care management at

More information

Purchasers Efforts to Promote Better Information Technology

Purchasers Efforts to Promote Better Information Technology Purchasers Efforts to Promote Better Information Technology Peter V. Lee Pacific Business Group on Health The Health Information Technology Summit West March 7, 2005 Measuring Provider Quality and Cost-Efficiency

More information

Case management certification desired [and paid for] by more employers

Case management certification desired [and paid for] by more employers The Pathway to Certfication is CCMC IssueBrief VOLUME 1, ISSUE 1 Growing Trend: Case management certification desired [and paid for] by more employers For more than a century, case management has meant

More information

Healthy Solutions for Life

Healthy Solutions for Life Healthy Solutions for Life 2015 Presentation Overview About Healthy Solutions for Life Disease Management Health Coaching Model DM Programs TeleCare Monitoring 2013 Nurtur Health, Inc. All Rights Reserved.

More information

Conifer Health Solutions Tenet Investor Webinar

Conifer Health Solutions Tenet Investor Webinar Conifer Health Solutions Tenet Investor Webinar May 16, 2012 Stephen Mooney President, Conifer Health Solutions 1 2012 Conifer Health Solutions, LLC. All Rights Reserved. Forward Looking Statements Certain

More information

Cost Trends & Care Management 2002 Market Survey Highlights. The Impact of Disease Management Intervention on Healthcare Costs

Cost Trends & Care Management 2002 Market Survey Highlights. The Impact of Disease Management Intervention on Healthcare Costs Med Vantage, Inc Cost Trends & Care Management 2002 Market Survey Highlights The Impact of Disease Management Intervention on Healthcare Costs December 2 13, 2002 Geof Baker, President Med-Vantage, Inc.

More information

Five Myths Surrounding the Business of Population Health Management

Five Myths Surrounding the Business of Population Health Management Five Myths Surrounding the Business of Population Health Management Joan Moss, RN, MSN Robert Sehring Chief Nursing Officer and Chief Ministry Services Officer, Senior Vice President, Sg2 OSF HealthCare

More information

Opportunities in Private Healthcare in the GCC Presented by: Ralph Foster II

Opportunities in Private Healthcare in the GCC Presented by: Ralph Foster II Opportunities in Private Healthcare in the GCC Presented by: Ralph Foster II AHMC PROFILE AHMC is a private US company headquartered in Washington D.C. focused on the development and management of world-class

More information

Disease Management Identifications and Stratification Health Risk Assessment Level 1: Level 2: Level 3: Stratification

Disease Management Identifications and Stratification Health Risk Assessment Level 1: Level 2: Level 3: Stratification Disease Management UnitedHealthcare Disease Management (DM) programs are part of our innovative Care Management Program. Our Disease Management (DM) program is guided by the principles of the UnitedHealthcare

More information

Making Better Healthcare Happen in the San Francisco Bay Area

Making Better Healthcare Happen in the San Francisco Bay Area Making Better Healthcare Happen in the San Francisco Bay Area Brown & Toland s strength lies in the dynamic points of connection between our network physicians, our patients and our wider Bay Area community.

More information

Blue Shield of California Wellness Programs and Services

Blue Shield of California Wellness Programs and Services Blue Shield of California Wellness Programs and Services Helping you and your family on the way to better health The support you need for a healthier life Blue Shield s wellness programs and resources

More information

Montefiore s Population Health Management Services. October 23, 2015

Montefiore s Population Health Management Services. October 23, 2015 Montefiore s Population Health Management Services October 23, 2015 Integrated Delivery System Our Locations 3,092 Acute Beds Across 10 Hospitals Including 132 beds at the Children s Hospital at Montefiore

More information

For more information, please visit anthem.com/ca.

For more information, please visit anthem.com/ca. For more information, please visit anthem.com/ca. SpecialOffers is provided by Anthem Blue Cross as a service to our members. These services do not constitute benefits under Anthem Blue Cross plans and

More information

CIGNA Small Group Business

CIGNA Small Group Business HEALTH BENEFIT SOLUTIONS 806774 11/06 CIGNA HEALTHCARE. PROTECTING THE HEALTH OF SMALL GROUPS IN A BIG WAY. Business owners with 50 or fewer employees face a big decision. How can they provide their employees

More information

27. Will the plan pay for radiology done in the provider s office?... 10 28. How do providers request assistance with care management issues?...

27. Will the plan pay for radiology done in the provider s office?... 10 28. How do providers request assistance with care management issues?... Provider Q&A Contents 1. Who is Florida True Health?... 3 2. What is the new product name?... 3 3. Does the plan have a website?... 3 4. How will physicians be paid? (FFS or capitation)... 3 5. What clearing

More information

Program Description and FAQ s 2016 Medicare Shared Savings Program Year

Program Description and FAQ s 2016 Medicare Shared Savings Program Year and FAQ s 2016 Medicare Shared Savings Program Year Who is the National Rural ACO? The National Rural ACO was formed in 2013 to pool knowledge, patients, and resources so that independent community health

More information

Benefit Design and ACOs: How Will Private Employers and Health Plans Proceed?

Benefit Design and ACOs: How Will Private Employers and Health Plans Proceed? Benefit Design and ACOs: How Will Private Employers and Health Plans Proceed? Accountable Care Organizations: Implications for Consumers October 14, 2010 Washington, DC Sam Nussbaum, M.D. Executive Vice

More information

MODULE 11: Developing Care Management Support

MODULE 11: Developing Care Management Support MODULE 11: Developing Care Management Support In this module, we will describe the essential role local care managers play in health care delivery improvement programs and review some of the tools and

More information

UnitedHealthcare. Confirmed Complaints: 44. Quality Overview. How Often Do Members Complain About This Company? Accreditation Exchange Product

UnitedHealthcare. Confirmed Complaints: 44. Quality Overview. How Often Do Members Complain About This Company? Accreditation Exchange Product Quality Overview United Accreditation Exchange Product Accrediting Organization: NCQA Health Plan Accreditation (Marketplace ) Accreditation Status: Interim (Expires 1/215) Accreditation Commercial Product

More information

Population Health Management: Advancing Your Position in the Journey to Value-Based Care

Population Health Management: Advancing Your Position in the Journey to Value-Based Care Population Health Management: Advancing Your Position in the Journey to Value-Based Care Webcast Session One: An Integrated Approach to Population Health Management 11 August 2015 Welcome & Introductions

More information

ACO CASE STUDY METRO HEALTH: GRAND RAPIDS, MICHIGAN

ACO CASE STUDY METRO HEALTH: GRAND RAPIDS, MICHIGAN ACO CASE STUDY METRO HEALTH: GRAND RAPIDS, MICHIGAN January 2011 ACO CASE STUDY METRO HEALTH: GRAND RAPIDS, MICHIGAN Prepared by: Keith D. Moore / kmoore@mcmanisconsulting.com & Dean C. Coddington / dcoddington@mcmanisconsulting.com

More information

Client Spotlight: The PinnacleHealth Spine Institute of Harrisburg, PA

Client Spotlight: The PinnacleHealth Spine Institute of Harrisburg, PA Client Spotlight: The PinnacleHealth Spine Institute of Harrisburg, PA Introduction Priority Consult, LLC, is a healthcare solutions company that has developed highly specialized software applications

More information

How To Manage Health Care Needs

How To Manage Health Care Needs HEALTH MANAGEMENT CUP recognizes the importance of promoting effective health management and preventive care for conditions that are relevant to our populations, thereby improving health care outcomes.

More information

How To Help Your Health System With The National Rural Accountable Care Consortium

How To Help Your Health System With The National Rural Accountable Care Consortium and FAQ s 2016 Medicare Shared Savings Program Year Who is the National Rural Accountable Care Consortium? The National Rural Accountable Care Consortium was formed in 2013 to pool knowledge, patients,

More information

The ACO Model/Capabilities Framework and Collaborative. Wes Champion Senior Vice President Premier Healthcare Alliance

The ACO Model/Capabilities Framework and Collaborative. Wes Champion Senior Vice President Premier Healthcare Alliance The ACO Model/Capabilities Framework and Collaborative Wes Champion Senior Vice President Premier Healthcare Alliance Roadmaps to Serve as a Bridge from FFS to ACO Current FFS System What are the underpinning

More information

MEDICAL QUALITY MANAGEMENT: THEORY AND PRACTICE Previously titled: Core Curriculum for Medical Quality Management

MEDICAL QUALITY MANAGEMENT: THEORY AND PRACTICE Previously titled: Core Curriculum for Medical Quality Management MEDICAL QUALITY MANAGEMENT: THEORY AND PRACTICE Previously titled: Core Curriculum for Medical Quality Management CHAPTER OUTLINES Note: All chapters open with an introduction, learning objectives and

More information

Wellness on the Run. Care When Members Need it Most Innovations in Care Management

Wellness on the Run. Care When Members Need it Most Innovations in Care Management Wellness on the Run Care When Members Need it Most Innovations in Care Management Welcome Today s presentation will begin shortly. In order to hear the audio for this presentation, please turn up your

More information

Developing the Future of. Healthcare Management and Leadership in Abu Dhabi. Cleveland Clinic Abu Dhabi Administrative Fellowship

Developing the Future of. Healthcare Management and Leadership in Abu Dhabi. Cleveland Clinic Abu Dhabi Administrative Fellowship Developing the Future of Healthcare Management and Leadership in Abu Dhabi 1-2 Creating Abu Dhabi s Future Healthcare Managers and Leaders The position is a highly selective and rigorous, 12-month postgraduate

More information

Las Vegas Chamber of Commerce Group Health Benefits Program LVCC

Las Vegas Chamber of Commerce Group Health Benefits Program LVCC Las Vegas Chamber of Commerce Group Health Benefits Program LVCC The LVCC Group Health Benefits Program Adds Value to Chamber Membership Providing quality and affordable health insurance has never been

More information

Aetna Better Health Aetna Better Health Kids. Quality Management Utilization Management. 2013 Program Evaluation

Aetna Better Health Aetna Better Health Kids. Quality Management Utilization Management. 2013 Program Evaluation Aetna Better Health Aetna Better Health Kids Quality Management Utilization Management 2013 Program Evaluation EXECUTIVE SUMMARY Introduction Aetna Better Health implemented its Medicaid Physical Health-Managed

More information

Performance Results for Health Insurance Plans

Performance Results for Health Insurance Plans WASHINGTON STATE COMMON MEASURE SET FOR HEALTH CARE QUALITY AND COST Performance Results for Health Insurance Plans DECEMBER 2015 Table of Contents Introduction... 3 About the Results... 4 How to Read

More information

ACO CASE STUDY CATHOLIC MEDICAL PARTNERS: BUFFALO, NEW YORK

ACO CASE STUDY CATHOLIC MEDICAL PARTNERS: BUFFALO, NEW YORK ACO CASE STUDY CATHOLIC MEDICAL PARTNERS: BUFFALO, NEW YORK January 2011 ACO CASE STUDY CATHOLIC MEDICAL PARTNERS: BUFFALO, NY Prepared by: Keith D. Moore / kmoore@mcmanisconsulting.com & Dean C. Coddington

More information

Making the Grade! A Closer Look at Health Plan Performance

Making the Grade! A Closer Look at Health Plan Performance Primary Care Update August 2011 Making the Grade! A Closer Look at Health Plan Performance HEDIS (Healthcare Effectiveness Data and Information Set) is a set of standardized measures designed to track

More information

ACO s as Private Label Insurance Products

ACO s as Private Label Insurance Products ACO s as Private Label Insurance Products Creating Value for Plan Sponsors Continuing Education: November 19, 2013 Clarence Williams Vice President Client Strategy Accountable Care Solutions Today s discussion

More information

HEALTH PLANS Authors: Scot McConkey, Jordan Battani

HEALTH PLANS Authors: Scot McConkey, Jordan Battani INTEGRATED HEALTH MANAGEMENT FOR HEALTH PLANS Authors: Scot McConkey, Jordan Battani Introduction The frustrations, delays and disagreements that have defined the United States debate on health care reform

More information

The Obama Administration s Record on Supporting the Nursing Workforce

The Obama Administration s Record on Supporting the Nursing Workforce The Obama Administration s Record on Supporting the Nursing Workforce Nurses are at the center of the American health system. There are more nurses in our country than any other type of health care provider.

More information

ST JOHN S LUTHERAN MINISTRIES. Kent Burgess President & CEO

ST JOHN S LUTHERAN MINISTRIES. Kent Burgess President & CEO ST JOHN S LUTHERAN MINISTRIES Kent Burgess President & CEO WHAT S CHANGING MAYBE? -The way we get paid (Reduce Cost) -The way we get measured (Better Care) -What will be required of us (More) -Partnerships/Affiliations

More information

T h e M A RY L A ND HEALTH CARE COMMISSION

T h e M A RY L A ND HEALTH CARE COMMISSION T h e MARYLAND HEALTH CARE COMMISSION Discussion Topics Overview Learning Objectives Electronic Health Records Health Information Exchange Telehealth 2 Overview - Maryland Health Care Commission Advancing

More information

Achieving Success through Innovative Partnerships

Achieving Success through Innovative Partnerships Achieving Success through Innovative Partnerships Rosanne DiStefano, Executive Director Joan Hatem-Roy, LICSW, Assistant Executive Director Jennifer Raymond, MBA, Hebrew Senior Life Common Goals for the

More information

A. IEHP Quality Management Program Description

A. IEHP Quality Management Program Description A. IEHP Quality Management Program Description A. Purpose: The purpose of the QM Program is to provide operational direction necessary to monitor and evaluate the quality and appropriateness of care, identify

More information

HEDIS/CAHPS 101. August 13, 2012 Minnesota Measurement and Reporting Workgroup

HEDIS/CAHPS 101. August 13, 2012 Minnesota Measurement and Reporting Workgroup HEDIS/CAHPS 101 Minnesota Measurement and Reporting Workgroup Objectives Provide introduction to NCQA Identify HEDIS/CAHPS basics Discuss various components related to HEDIS/CAHPS usage, including State

More information

Section 9: Medical Management and Quality Improvement and Accreditation

Section 9: Medical Management and Quality Improvement and Accreditation Section 9: Medical Management and Quality Improvement and Accreditation MEDICAL MANAGEMENT PLAN...171 Philosophy... 171 Mission... 171 Goals... 171 Authority... 172 Structure... 172 Scope... 178 QUALITY

More information

1115 Medicaid Waiver Programs Section1115 of the Social Security Act allows CMS the authority to approve state demonstration projects that improve care, increase efficiency, and reduce costs related to

More information

The chart below demonstrates Cenpatico s corporate structure and the reporting relationship of the Iowa Plan to our team.

The chart below demonstrates Cenpatico s corporate structure and the reporting relationship of the Iowa Plan to our team. 7A.4.1 Organizational Chart Submit an organizational chart which demonstrates: The Bidder s corporate structure The reporting relationship which staff assigned to the Iowa Plan would have with other parts

More information

Pay for Performance: Its Influence on the Use of IT in Physician Organizations

Pay for Performance: Its Influence on the Use of IT in Physician Organizations Pay for Performance: Its Influence on the Use of IT in Physician Organizations Thomas R. Williams, M.B.A., M.P.H.,* Kristiana Raube, Ph.D., Cheryl L. Damberg, Ph.D., and Russell E. Mardon, Ph.D.** T he

More information

Accountable Care Organizations 101. MultiCare Connected Care October 20 22, 2014

Accountable Care Organizations 101. MultiCare Connected Care October 20 22, 2014 Accountable Care Organizations 101 MultiCare Connected Care October 20 22, 2014 1 Objectives 1. Describe what an ACO is and why we believe developing an ACO is important 2. Describe examples of what integration

More information

ISSUEBRIEF. CONVERGING PATHWAYS A Journey Towards Quality Case Management

ISSUEBRIEF. CONVERGING PATHWAYS A Journey Towards Quality Case Management ISSUEBRIEF VOLUME 1, ISSUE 3 2005 CONVERGING PATHWAYS A Journey Towards Quality Case Management Development of case management as a profession surged in the latter part of the last century, due in large

More information

Colorado Choice Health Plans

Colorado Choice Health Plans Quality Overview Colorado Choice Health Plans Accreditation Exchange Product Accrediting Organization: Accreditation Status: URAC Health Plan Accreditation (Marketplace HMO) Provisional Accreditation Commercial

More information

Designing the Role of the Embedded Care Manager

Designing the Role of the Embedded Care Manager Designing the Role of the Embedded By Patricia Hines, Ph.D., RN and Marge Mercury, RN, MS, CMCE The Embedded The use of an Embedded ( ECM ) to coordinate within the complex delivery system is sharply increasing.

More information

Sunflower State Health Plan

Sunflower State Health Plan Sunflower State Health Plan 1 Comprehensive Provider Network Doctors & Clinics Sunflower State has a large and growing network of Providers throughout the State including: Hospitals, Health Clinics, Primary

More information

CPR-PBGH Toolkit for Purchasers on Accountable Care Organizations. June 26, 2014

CPR-PBGH Toolkit for Purchasers on Accountable Care Organizations. June 26, 2014 CPR-PBGH Toolkit for Purchasers on Accountable Care Organizations June 26, 2014 Overview Introductions The Current ACO Landscape ACO Options Available to Employers Today Features of the Ideal ACO CPR-PBGH

More information

Organizational Structure: Vision, Mission and Values: BCBSF COMPANY FACTS

Organizational Structure: Vision, Mission and Values: BCBSF COMPANY FACTS Headquarters: Jacksonville, Florida Founded: In 1944, the Florida Hospital Service Corporation, the forerunner of Blue Cross of Florida, began operations in Jacksonville with a staff of four. In 1946,

More information

Our Patient-Centered Medical Home a Process, not a Click

Our Patient-Centered Medical Home a Process, not a Click Our Patient-Centered Medical Home a Process, not a Click Richard Johnston, M.D. President, Medical Clinic of North Texas, P.A. Medical Clinic of North Texas, P.A. MCNT Physician Owned Primary Care Medical

More information

2015 Quality Improvement Program Description

2015 Quality Improvement Program Description Horizon Blue Cross Blue Shield of New Jersey Horizon Healthcare of New Jersey, Inc. Horizon Insurance Company 2015 Quality Improvement Program Description QIC approval 1/26/2015 Table of Contents I. INTRODUCTION

More information

North Shore Physicians Group Primary Care Redesign

North Shore Physicians Group Primary Care Redesign North Shore Physicians Group Primary Care Redesign Christine Sinsky, MD 12.23.11 The physician cannot do this work alone, notes Lindsay Gainer, Director of Clinical Services and Innovations at North Shore

More information

The Role of Technology in California s Dual Eligibles Coordinated Care Demonstration

The Role of Technology in California s Dual Eligibles Coordinated Care Demonstration The Role of Technology in California s Dual Eligibles Coordinated Care Demonstration Following the passage of SB 208 (Steinberg, 2010) and the receipt of federal planning funds to develop new models of

More information

Johns Hopkins HealthCare LLC: Care Management and Care Coordination for Chronic Diseases

Johns Hopkins HealthCare LLC: Care Management and Care Coordination for Chronic Diseases Johns Hopkins HealthCare LLC: Care Management and Care Coordination for Chronic Diseases Epidemiology Over 145 million people ( nearly half the population) - suffer from asthma, depression and other chronic

More information

Emerging g Trends in Home Care

Emerging g Trends in Home Care Emerging g Trends in Home Care Dana Sheer, ACNP, MSN Susan Beausoliel, BSN, MS, DNP 1 The Triple Aim Goals Quality Improve Patient Outcomes Goal Readmissions Cost Reduce costs/penalties associated w/ readmissions

More information

Guide to Population Health Management

Guide to Population Health Management Guide to Population Health Management presented by the Healthcare Intelligence Network Note: This is an authorized excerpt from the Guide to Population Health Management. To download the entire guide,

More information

Office of Health Professions Education

Office of Health Professions Education Office of Health Professions Education Business Plan Kelly J. Caverzagie, MD Vice-President for Education Nebraska Medicine 986430 Nebraska Medical Center Omaha, NE 68198-6430 Mobile: 402-350-2058 Email:

More information

2015 ASHP STRATEGIC PLAN

2015 ASHP STRATEGIC PLAN 2015 ASHP STRATEGIC PLAN ASHP Vision ASHP s vision is that medication use will be optimal, safe, and effective for all people all of the time. ASHP Mission The mission of pharmacists is to help people

More information

Opportunities for Home Care Providers in Working with Medical Homes October 2014. EMHS Vice President Continuum of Care Chief Advocacy Officer

Opportunities for Home Care Providers in Working with Medical Homes October 2014. EMHS Vice President Continuum of Care Chief Advocacy Officer How to Establish Partnerships and Opportunities for Home Care Providers in Working with Medical Homes October 2014 Lisa Harvey-McPherson, RN, MBA, MPPM EMHS Vice President Continuum of Care Chief Advocacy

More information

csc WORLD WORLD HEALTHCARE: A Performance Improvement Maturity Model for the Healthcare Industry at Virgin Money AN ARTICLE FROM

csc WORLD WORLD HEALTHCARE: A Performance Improvement Maturity Model for the Healthcare Industry at Virgin Money AN ARTICLE FROM csc AN ARTICLE FROM WORLD HEALTHCARE: A Performance Improvement Maturity Model for the Healthcare Industry The Green IT Issue WORLD Building a Better Business June 2008 at Virgin Money JUNE 2008 A Performance

More information

Population Health More that just a trending buzz-word! Kristi R. Stovall VP, Marketing & Brand Development Citra Health Solutions September 16, 2014

Population Health More that just a trending buzz-word! Kristi R. Stovall VP, Marketing & Brand Development Citra Health Solutions September 16, 2014 Population Health More that just a trending buzz-word! Kristi R. Stovall VP, Marketing & Brand Development Citra Health Solutions September 16, 2014 The Definition of Pop Health Population health is defined

More information

How Health Reform Will Help Children with Mental Health Needs

How Health Reform Will Help Children with Mental Health Needs How Health Reform Will Help Children with Mental Health Needs The new health care reform law, called the Affordable Care Act (or ACA), will give children who have mental health needs better access to the

More information

UTILIZATION MANAGEMENT PROGRAM Introduction Health Care Services

UTILIZATION MANAGEMENT PROGRAM Introduction Health Care Services UTILIZATION MANAGEMENT PROGRAM Introduction Health Care Services Call us: 1-888-898-7969, Option 1, then Option 4 Fax us: 1-800-594-7404 Business hours: Monday Friday (excluding holidays), 8:30 a.m. to

More information

Panel #2: Optimizing the Home Health Interdisciplinary Team

Panel #2: Optimizing the Home Health Interdisciplinary Team Panel #2: Optimizing the Home Health Interdisciplinary Team Panelists Kate Jones, RN, MSN, CCM, is the Chief Clinical Officer for Amedisys Home Health and Hospice. She is responsible for designing chronic

More information

Financial and Population Analytics for Accountable Care Organizations SEPTEMBER 20, 2012

Financial and Population Analytics for Accountable Care Organizations SEPTEMBER 20, 2012 Financial and Population Analytics for Accountable Care Organizations Valence Biographies Lori Fox Ward is Senior Vice President of Clinical Integration for Valence Health where her primary role involves

More information

2014 Quality Improvement and Utilization Management Evaluation Summary

2014 Quality Improvement and Utilization Management Evaluation Summary 2014 Quality Improvement and Utilization Management Evaluation Summary INTRODUCTION The Quality Improvement (QI) and Utilization Management (UM) Program Evaluation summarizes the completed and ongoing

More information

NCQA Patient-Centered Medical Home. Improving experiences for patients, providers and practice staff

NCQA Patient-Centered Medical Home. Improving experiences for patients, providers and practice staff NCQA Patient-Centered Medical Home Improving experiences for patients, providers and practice staff PCMH Recognition The patient-centered medical home is a model of care that emphasizes care coordination

More information

Annual Notice of Changes for 2015

Annual Notice of Changes for 2015 Cigna HealthSpring Preferred (HMO) offered by Cigna HealthSpring Annual Notice of Changes for 2015 You are currently enrolled as a member of Cigna HealthSpring Preferred (HMO). Next year, there will be

More information

Accountable Care Organizations New Healthcare Opportunities for Employers

Accountable Care Organizations New Healthcare Opportunities for Employers Accountable Care Organizations New Healthcare Opportunities for Employers The ACO and Employer Opportunities Since the passage of the Patient Protection and Affordable Care Act (PPACA) in 2009, the marketplace

More information

Annual Notice of Changes for 2015

Annual Notice of Changes for 2015 Cigna HealthSpring Premier (HMO POS) offered by Cigna HealthSpring Annual Notice of Changes for 2015 You are currently enrolled as a member of Cigna HealthSpring Premier (HMO POS). Next year, there will

More information

Co-management (Service Line Agreement 2007)

Co-management (Service Line Agreement 2007) Co-management (Service Line Agreement 2007) Orthopedics Neuroscience Cardiology Cardiovascular Surgery Collaboration on a different level Tactical method of increasing alignment and collaboration Agreement

More information

ANNUAL NOTICE OF CHANGES FOR 2016

ANNUAL NOTICE OF CHANGES FOR 2016 Cigna-HealthSpring Preferred (HMO) offered by Cigna-HealthSpring ANNUAL NOTICE OF CHANGES FOR 2016 You are currently enrolled as a member of Cigna-HealthSpring Preferred (HMO). Next year, there will be

More information

How To Understand And Understand The Health Care System In California

How To Understand And Understand The Health Care System In California Understanding Accountable Care Organizations (ACOs): What s Worked and What Hasn t in California s 30 Year ACO Experience ACOs are like unicorns mythical creatures. We know what they look like, but no

More information

SUMMARY: PROFESSIONAL EXPERIENCE

SUMMARY: PROFESSIONAL EXPERIENCE Michelle McFarlane, RN, MSN, MBA AddVal Inc. 1018 Street Road; Suite 102 Southampton, PA 18966 (215) 396-8972 mmcfarla@addvalinc.com SUMMARY: Known as the credentialing angel, Michelle McFarlane founded

More information

Self-Insured Schools of California: SISC PPO (HSA Eligible)

Self-Insured Schools of California: SISC PPO (HSA Eligible) Helping SISC III SELF-INSURED SCHOOLS OF CALIFORNIA Self-Insured of California: Helping SISC PPO (HSA Eligible) Administered by Blue Shield of California 2013/2014 Enrollment Guide Blue Shield of California

More information