Barbara Bourne Email and Phone Number

•Currently work with Quality Spectrum Insight, Catalyst Technologies/MedAssurant’s in house NCQA certified HEDIS system and Quality Spectrum Hybrid Reporter, their in house medical record management system to produce HEDIS reports for two commercial plans and one Medicaid health plan. •Responsible for accuracy of programming and validity and reliability of data for all three plans.•Analyzes results for possible data problems/errors and determines source of errors and recommends corrective procedures.•Programs and produces reports to send to provider groups showing their results for the various measures compared to common benchmarks.•Programs and produces reports for providers based on prospective data showing members who have not had various HEDIS services.•Works with HEDIS auditor to insure accuracy of data and systems to produce unbiased HEDIS results.•Prepared the Health Organization Questionnaire (HOQ) for three health plans for submission to NCQA.•Prepared and submitted the IDSS for health plans reporting HEDIS results to NCQA.•Serves as plan representative for the NCQA HEDIS Users Group.•Selected by NCQA to serve on special committee for development of the Relative Resource Use measure in HEDIS.•Managed two commercial and one Medicaid health plan to successful completion of HEDIS Audits for HEDIS 2007, HEDIS 2008, HEDIS 2009 and HEDIS 2010

•Developed new and unique strategies to identify potential fraud in Medicare data in 15 state region and Medicare/Medicaid data in State of Washington.•Presented results to senior staff and explained rationale behind conclusions and methodology.•Using SAS and Crystal Reports, developed computer programs using strategies to identify specific providers who are outside the norm and wrote reports that clearly and concisely illustrate data analysis findings. •Using the SAS/Crystal Reports combination, developed a system that saved analyst hours by summarizing data pertinent to providers identified as operating outside the norm. Before the process, it took analysts 8 – 10 hours per provider; now reports for multiple providers can be produced in 30 to 60 minutes thus freeing the analyst for other duties. This system has been selected by Delmarva as one of two “innovative methods” required to meet company requirements for Strategic Standard Milestones.