Responsible for driving expansion of value-based primary care offering within the Medicare Advantage segment.-Design and execute strategy to establish value-based partnerships with Medicare Advantage plans.

Led the New England Network team and oversee network and operational infrastructure for the New England market aligned to cost levers and ensure market network(s) meet cost metrics, adequacy standards, network compliance regulations, and profitability goals. • Set New England network strategy and budget for market contracting across all provider types and product segments, pushing innovation across traditional and non-traditional models for all lines of business, coordinating expansion activities, and driving toward local market and national goals. • Owned New England’s specific cost discount position, Value-Based strategy cost savings initiatives, and unit cost targets and management for Commercial and Medicare Advantage segments.• Managed all New England provider relations and direct implementation and operations of Value-Based Contracting.• Evaluated Market “bottom line”, manage medical costs in close partnership with Clinical Functions and drove change to improve cost structure partnership.• Represented Aetna to the legislative, regulatory and community partners, improved public relations, and managed regional public policy issues.• Coached, mentored, and managed performance of team members while driving talent development and actively building bench for key roles.• Established strong partnerships and collaborative model with customers and prospective customers, National Network, Product, Clinical, Finance, Marketing, Actuarial, and the Medical Economics Unit across Commercial and Medicare segments to achieve objectives.

Oversaw Disease, Care and Utilization Management, Vendor Management, Appeals and Grievances, and Utilization Management Compliance Operations.• Drove the strategy and execution for Health and Wellness Redesign for Population Health Management including identification and stratification, new care management structure and member engagement digital capabilities, utilization management effectiveness, and overall clinical programming outcomes.• Led the development of identification and stratification of members for care management interventions.• Represented Health and Wellness value proposition to existing and potential customers and brokers in partnership with the Sales organization.• Chaired the Health Services Cost Savings Initiatives Committee to manage medical expense trend.• Negotiated and implemented vendor management contracts for outsourced Utilization Management programs.• Contributed to 4+ Star rating for Medicare Advantage product.• Supported, enhanced and contributed to superior NCQA accreditation status.• Drove compliance with state and federal regulatory bodies (e.g., CMS, market conduct exams).

Led and executed Aetna’s second joint venture in the country with Texas Health Resources forming a new health plan for the Dallas-Fort Worth marketplace-Texas Health/Aetna.• Developed and launched the JV strategy which includes design of joint venture’s organizational model, go-to-market strategy, and next generation member/patient experience.• Collaborated with Aetna’s market leadership and senior executives to generate leads, develop deal strategies including financial modeling, and gain internal approvals.• Owned end-to-end negotiation of complex joint venture health plan deals involving hundreds of thousands members and billions of dollars in contract value, requiring significant investment from Aetna and counterparty.• Led the team that develops and executes Aetna's provider joint venture strategy.• Developed local market strategies to launch provider-run health plans focused on delivering a superior consumer experience at a lower cost.• Managed the joint venture governance process to ensure the process is transparent to internal constituents and aligned with existing enterprise and local growth strategies.

Led and managed the Division’s Project Management (PMO) Office, Reporting and Analytics, Market Response, Training and Communications teams in support of the Division’s strategic initiatives.• Reporting to the Chief Medical Officer, developed and managed a Divisional business plan and $45M operating budget to achieve annual targets and support the needs of the organization.• Represented the Chief Physician Executive both internally and externally. • Maintained direct operational responsibility for coordinating the account management lifecycle, including Request for Proposals, Sales support, Care Management and Quality Performance Guarantees.• Led the strategic and functional integration of departments within the Division.• Implemented strategies and initiatives that contribute to affordability of health care for members and accounts.• Oversaw performance measurement/productivity and management reporting for the Division.• Partnered with Sales to manage client expectations and marketplace requirements related to care management and utilization management trends and what BCBSMA is doing to address them and improve the health and productivity of their workforce.• Served as Chairperson of the Utilization Management Redesign Leadership Team and oversaw multiple work streams to deliver administrative savings.• Managed development of several enterprise-wide initiatives including genetic testing, opioid/pain management, infant formula, Medical Policy/Pharmacy Medical Policy integration, and expanding coverage for colonoscopy screenings. All initiatives have produced annual savings, improved quality and increased access to care.

Developed and supported BCBSMA activities to promote payment reform with national and statewide entities.Collaborated with key business leaders to coordinate with other Massachusetts health plans to develop common payment models.Partnered with key federal and state constituents around Medicare and Medicaid payment reform.Led and facilitated cross-functional work teams in support of payment reform goals.Represented BCBSMA in state-wide payment reform pilots, including the state patient centered medical home initiative.

Developed strategy, criteria, policies and procedures for Personal Spending Account (PSA) vendors to support current and future Consumer Directed Health Plan (CDH) business needs. Achieved over 30% membership growth in PSA offerings and CDH products. Negotiated and managed PSA Vendor relationships.

Developed strategy, criteria, and policies necessary to lead and facilitate the selection, development, negotiations, and maintenance of existing or new provider networks to meet current and future business needs. Responsible for Value-based and fee for service contracting for the Boston Metro and North regions with Hospitals and physicians. Also responsible for the development, support and implementation of strategic provider performance based methodologies and programs within Health Care Contract Management. Led the development of the new Medicare Advantage strategy, including the expansion of the HMO and new PPO product launch, including the development and communication of innovative provider contracting arrangements and reimbursement methodologies required to attract and retain key providers. In addition, led the development of the BCBSMA contracting strategy for Retail Clinics within Massachusetts. Successfully negotiated significant discounts with Retail Clinic providers.