Responsible for business development, delivery and organization strategy for Population Health and Quality solutions at the state and national level

Responsible for the design, development, and marketing of product and service solutions oriented around population health, public health, quality measure outcomes, and care referral market needs

Lead the strategy and development of Advanced Payment Models across Commercial, Individual ACA, Medicaid, and Medicare product lines. Responsible for provider reimbursement policy and a portfolio of initiatives, including pay for performance, bundled payments, shared savings, and total cost of care contracts. Oversee participation in CMS and Medicaid State APM models, including Comprehensive Primary Care Plus (CPC+).

Responsible for developing and implementing community-wide strategies relative to provider network performance and partnership initiatives: evaluating cost and quality performance of specific providers and health systems, identifying opportunities for improvement and supporting health system efforts to acheive the triple aim of improved health outcomes, lower per-capita cost, and a better patient experience.

Led health plan interdisciplinary team of network contracting, medical management, and advanced analytics experts to develop solutions to reduce variation in the cost, quality, and efficiency of care in collaboration with provider organizations.

Led the development of quality improvement and population health initiatives aimed at improving health and quality outcomes across the health plan network for Commercial, Medicare, and Medicaid populations. Responsible for quality team achievement of NCQA accreditation standards and maintaining compliance to CMS and State Medicaid standards and quality benchmarks, including Medicare 5 Star Ratings.

Oversaw preventive health and chronic disease management workgroups that developed initiatives to improve HEDIS quality scores with providers. Led the health plan effort to collect and submit HEDIS data to NCQA. Collaborated with marketing to develop member engagement initiatives for health education and gaps in care.

Developed physician incentive program quality measures and provided education to physician network on best practices to achieve outcomes. Collaborated with analytic team to enhance the online patient registry used by physician practices. Developed a health coaching program for members with metabolic syndrome that received national recognition for innovation by a National Alliance of Healthcare Purchasers (Evalue8).