Experience

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  Honest Medical Group

  • Nashville, Tennessee, United States

  • Medical Director of Clinical Quality

    • Apr 2024 - Present
    • Nashville, Tennessee, United States

    Cross-functional leader responsible for medical leadership of Honest’s (1) accurate diagnosis and documentation programs for both Medicare ACO Reach and Medicare Advantage (MA) patient populations and (2) STARS MA program

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  Self-employed

  • Public Health Advisor

    • Sep 2023 - Present

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  Carelon Health

  • United States
  • Hospitals and Health Care
  • 700 & Above Employee

  • National Medical Officer - Special Needs Plans

    • Jan 2023 - Dec 2023

  • Staff Vice President of Case Management and Pharmacy (Interim)

    • 2023 - 2023

    Major Responsibilities:I have been overseeing all aspects of clinical, operational, and compliance outcomes associated with transitions of care, health risk assessments, individualized care plans, and complex case management for special needs plan products and general enrollment. I have been formulating a provider accountability forum to propel heightened Stars medication adherence, extended-day supply utilization, and mail-order penetration.Key Deliverables:• Initiated a robust acute and chronic case management process for high-cost and "pre-outlier" claimants with a focus on delivering tangible cost-of-care savings in inaugural quarter of implementation.• Achieved a notable 15% increase in extended-day supply/mail-order use within a single quarter.

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  Sanford Health

  • Sioux Falls, South Dakota, United States

  • Chief Medical Officer (Evangelical Good Samartian Society)

    • 2020 - 2022
    • Sioux Falls, South Dakota, United States

    Major Responsibilities:I have overseen quality and safety initiatives for 300 facilities within the scope of CMS 5 Star ratings, value-based purchasing, readmissions, and survey outcomes, including the development of action plans to address sub-optimal results. I have spearheaded organizational change and education efforts related to government mandates, policies, and provisions for skilled nursing facilities (SNF), home health, and hospice throughout the COVID pandemic. I have overseen 3-4 ongoing surveys, resulting in the successful navigation of 600+ inspections with 22 state governments. I have secured an HRSA grant, collaborated with a consultant, trained leaders, transitioned to a new event reporting software, and formulated a phased rollout plan for HRO integration.Key Deliverables:• Navigated challenges posed by COVID-19 pandemic and spearheaded organizational change to implement 200+ revisions in safety and infectious disease policies across 22 states.• Revamped safety, quality, and regulatory infrastructure, introducing a new accountability structure, and dashboard/report card system, and implementing comprehensive policies and procedures.• Optimized value-based revenue opportunities for skilled facilities in 12 states by implementing policies, procedures, training initiatives, scorecards, and accountability measures.• Increased revenue by 25% in first year, rising to $9M by the second year, a significant enhancement from previously passive collection of $3M annually out of a potential $15M in state-directed value-based revenue.• Introduced and adapted high-reliability science (HRO) principles from hospital/ambulatory settings, including daily safety huddles, safety culture initiatives, root-cause analysis, and event reporting.• Facilitated a cultural shift by flattening hierarchies and gaining buy-in from corporate leadership and the board.

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  Sanford Health Plan

  • Sioux Falls, South Dakota, United States

  • Medical Director of Medicare Advantage (I-SNP) and Post-Acute Care

    • 2019 - 2020
    • Sioux Falls, South Dakota, United States

    Major Responsibilities:I have established and spearheaded accountability forums for employed and contracted providers, overseeing HCC coding performance, admission rates, ED utilization rates, and HEDIS/STAR ratings. I have analyzed, identified opportunities, and implemented solutions for contract-level performance on PMPM spend/MLR, aggregate risk score, model-of-care (MOC) metrics, Part D spending, and HEDIS/STARs metrics. I have collaborated with health plan operations to launch plans in new counties/facilities or with new practice providers, conducting local education sessions for staff, providers, and hospital partners. I have cultivated and nurtured cordial relationships with over 50 providers, orchestrating a seamless transition to the Epic electronic medical record system. I have adapted Epic workflows and data collection to align with health plan requirements, enhancing efficiency and outcomes. I have created a nursing home specialist group across seven markets, fostering genuine integration between health plan and provider groups.Key Deliverables:• Alleviated provider burden and ensured optimal documentation of HCC diagnoses, HEDIS, and STARs metrics while teaming up with provider practices and informatics and formulating streamlined workflows.• Onboarded and educated new providers in HCC coding, ISNP workflows, and regulations, emphasizing model-of-care requirements such as health risk assessment (HRA).• Achieved a 25% decrease in ADK, maintaining a 5-Star status across all three states• Integrated efforts during a pivotal merger, addressing unique challenges posed by independent Nurse Practitioners (NPs) utilizing an outdated insurance documentation platform.• Incorporated these NPs into medical practices within owned medical group, integrating them into Sanford Health network.• Enhanced average RAF by 0.25 within one year.

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  UnityPoint Health

  • United States
  • Hospitals and Health Care
  • 700 & Above Employee

  • Executive Medical Director of Care Transformation and Value-based Care

    • 2012 - 2019

    I have spearheaded the analysis of quality and utilization data for Next Gen ACO, bundled payment, and self-insured health plans, formulating innovative care management and system enhancements to rectify performance gaps. I have orchestrated collaborative efforts with inpatient and post-acute providers, leveraging Milliman Care Guidelines (MCG) to reduce clinical variation in transitions, level of care selection, disease-specific care pathways, and projected SNF length of stay. I have overseen the performance of ambulatory and post-acute providers, focusing on core primary care metrics, readmission rates, and internal referral rates. I have formulated a compelling business case and secured executive approval for the initiation of SNFist and community-based care practice. I have collaborated on developing a targeted risk segmentation methodology, implementing specific clinical programs for rising-risk navigators, disease-specific navigators, house calls, and pharmacist consultations. I have overseen hospital outpatient departments, managed ambulatory triage functions, and supervised call center operations. I have directed and monitored medical directorships to ensure optimal performance and compliance• Achieved a notable 7-day reduction in average length of stay (ALOS) across an 80K-member ACO within a 4-year timeframe, simultaneously boosting in-network post-acute utilization to 65%.• Expanded practice's coverage to include 20+ facilities and 1,700 beds, managed by team of 3 physicians and 15 mid-level providers delivering comprehensive post-acute care, rehab services, care management, and house calls.• Launched SNF-based palliative care program seamlessly integrated into a comprehensive spectrum of palliative care services, fostering collaboration with in-network hospice services.• Established and managed a post-acute network, overseeing member facilities' performance on key metrics such as STARs rating, average length of stay, and time-to-first provider visit

  • Attending Physician - Geriatrics, Post-Acute, Inpatient Rehab, Palliative Care/Hospice, Homebound

    • 2007 - 2019

  • Home-base Primary Care and Home Health Medical Director

    • 2014 - 2016

  • Medical Director of Care Coordination and Post-Acute Services

    • 2012 - 2015

  • Hospice Medical Director

    • 2012 - 2014

  • Medical Director of Growth and Innovation

    • 2010 - 2012