RAINIER HEALTHCARE CONSULTING, LLC DEBRA HAGEMANN, PRINCIPAL
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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
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