Experience

TPA Network Research Consortium

• United States
• Research
• 1 - 100 Employee

• Founder

  • Feb 2019 - Present

  New medical technologies account for as much as 30% of the increase in healthcare costs over time...yet little research is conducted to help payors evaluate and assess these emerging health innovations and treatments. The Research Consortium seeks to accelerate the adoption of worthy new medical technologies and cut the time it takes to bring new health innovations from the bench to widespread clinical use...something that now takes 15+ years on average. We do this by conducting research of value to payors that focuses on cost-effectiveness, return-on-investment, value (vs. the standard of care), medical outcomes, patient/payor satisfaction...and other metrics that aren't addressed by scientific research intended to prove efficacy This type of research is of critical value to payors to provide empirical support for the adoption and inclusion of new and emerging innovations by their health plan; ones that have been properly vetted. As a byproduct of this work, we help Plan Participants access cutting-edge medical treatments and provide Medical Researchers with valuable medical data and clinical research study participants. Funding generated from these latter activities provide a source of long-term sustainability that will enable us to provide our research at no cost to Plan Sponsors or Plan Participants. See www.ResearchConsortium.org to learn more about how your organization can join this exciting industry-wide initiative that benefits Plan Participants, Plan Sponsors and Medical Researchers. Show less



TPA Network, Inc.

• United States
• Insurance
• 1 - 100 Employee

• Partner

  • Jan 1985 - Present

  Consultants to TPAs and product / service providers to the TPA market; valuations, mergers and acquisitions; creators of the TPA Network Research Consortium, an independent research facility focused on assessing emerging medical technologies and health innovations on behalf of the ERISA-regulated community. Consultants to TPAs and product / service providers to the TPA market; valuations, mergers and acquisitions; creators of the TPA Network Research Consortium, an independent research facility focused on assessing emerging medical technologies and health innovations on behalf of the ERISA-regulated community.



Transborder Resources de Mexico

• La Jolla, CA and Mexico City

• Founder Owner

  • 1999 - 2005

  Pioneers in cross-border healthcare, medical tourism, international managed care and BPO operations in support of US payors. TBR brought managed care to Mexico and operate the largest provider network in the Republic. Largely considered the most advanced organization of its type operating in Mexico, we were close advisors to the federal government and FUNSALUD, the Mexican Foundation on Health. Installing computers throughout the Republic back in 2000, all claims were electronically submitted...something that would not be accomplished in the US for many years. Our systems were leased to one of the five largest health insurers in the US for its Latin American plans. Show less



FHP International Corporation

• Hospitals and Health Care

• Executive

  • 1992 - 1996

  Chief Consultant...and various executive-level positions in the TPA and National HMO Network (UltraLink) operating units. FHP was one of the very first HMOs. It was the second Medicare Advantage Plan (and became the nation's largest) and it grew to more than $2 billion in revenues by 1990 (which made it one of the nation's largest MCOs at the time). Chief Consultant...and various executive-level positions in the TPA and National HMO Network (UltraLink) operating units. FHP was one of the very first HMOs. It was the second Medicare Advantage Plan (and became the nation's largest) and it grew to more than $2 billion in revenues by 1990 (which made it one of the nation's largest MCOs at the time).



Compliance Technologies

• La Jolla, California

• Founder Owner

  • 1988 - 1990

  Government regulatory compliance re ERISA; represented more than 200 TPAs at hearings before the United States Congress, House of Representatives, Committee on Ways & Means Government regulatory compliance re ERISA; represented more than 200 TPAs at hearings before the United States Congress, House of Representatives, Committee on Ways & Means



ALTA Health Strategies Inc

• United States
• Insurance

• Senior Vice President

  • 1986 - 1988

  Acquired GAS in 1986; at the time, Alta was the largest third party administrator in the United States; operated the largest centralized health claims processing facility in the US, and was among the top ten payors in the country...including health insurors and BCBS organizations! Acquired GAS in 1986; at the time, Alta was the largest third party administrator in the United States; operated the largest centralized health claims processing facility in the US, and was among the top ten payors in the country...including health insurors and BCBS organizations!



Group Administration Services

• Baltimore, Maryland

• President

  • 1978 - 1986

  A pioneering TPA. GAS was one of the first TPAs to use computers in the administration of health plans; one of the first to administer fully-insured plans on behalf of health insurers; one of the first to have an underwriter's pen; and one of the first to install remote terminals in its clients' offices. GAS was the first TPA to be audited by the US Dept. of Labor...at its request. In 1982, it introduced "utilization review" to the TPA industry at the annual SPBA meeting; later, it developed products and services for TPAs including COBRA risk transfer products. Evidencing its unique value, in 1986 GAS was purchased by the nation's largest TPA, and the venerable private equity firm Warburg Pincus, for a EBITDA price multiple that has never since been duplicated in the TPA industry. Show less