Barbara Bourne, Ph.D.

Barbara Bourne, Ph.D. Email and Phone Number

Experienced Consultant in HEDIS, Stars and Healthcare Informatics/Research @ BJB HEDIS/Quality Consulting
Barbara Bourne, Ph.D.'s Location
Pasadena, Maryland, United States, United States
Barbara Bourne, Ph.D.'s Contact Details

Barbara Bourne, Ph.D. work email

Barbara Bourne, Ph.D. personal email

About Barbara Bourne, Ph.D.

I am passionate researching data for answers like the mongoose whose motto is "go and find out". My background in research and measurement in my doctoral program along with my experiences in teaching research at places such as the University of Texas Medical Center in Dallas, TX, have prepared me with the skills to be used in medical reporting as well as measurement tools such as HEDIS. My graduate coursework including Beginning and Advanced Statistics, Multivariate Analysis of Variance, and Factor Analysis gave me the processes to arrange data to answer specific questions and to arrange the information garnered in a clear and unified manner. The last 20 years of my professional positions have dealt with some aspect of medical data/reporting including HEDIS, fraud and abuse, and managed care data such as cost and utilization. Of the seven areas for which I took doctoral qualifying exams, my favorites were research, measurement and consultation. I’ve used this knowledge to build the ability to program using files at the health plan level for traditional, Medicaid, and Medicare plans as well as mega-level ones such as traditional Medicare files for 16 western states. My programming experiences have made me familiar with the various units of medical data such as ICD9 (moving to ICD10), CPT/HCPCS, POS, revenue codes, etc. I’ve also developed and programmed reports that compare the providers in medical groups at a health plan on HEDIS measures to other groups and to NCQA rates as well that shows that I recognize the value of using both internal and external benchmarks. I have also taken three levels of classes of HIPAA and have taught classes in this area at a community college and employer levels. I’ve used SAS for many of my positions as well as such PC programs as Crystal Reports, Access and Excel and Power Point for presentations.I feel that my interest in counseling led to my interest in furthering my knowledge to improve the lives of others through medicine.

Barbara Bourne, Ph.D.'s Current Company Details
BJB HEDIS/Quality Consulting

Bjb Hedis/Quality Consulting

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Experienced Consultant in HEDIS, Stars and Healthcare Informatics/Research
Website:
bjbsecurity.com
Employees:
3
Barbara Bourne, Ph.D. Work Experience Details
  • Bjb Hedis/Quality Consulting
    Consultant
    Bjb Hedis/Quality Consulting Feb 2013 - Present
    Annapolis, Md
    •Serves as consultant to health plans to improve HEDIS scores.•Reporting/analysis of claims/member data to identify provider groups with low scores on measures after submission to NCQA•Reporting/analysis of claims/member data to identify provider groups with low scores on measures before submission to NCQA•Serves as consultant to improve Medicare Stars results•Analysis of CAHPS data•Serves as consultant to health care quality committees on research design, appropriate statistical techniques, and areas to research.•Works with health plans seeking NCQA Accreditation•Serves as Gerson Lehrman (GLG) Council Member Consultant.•Available as instructor on beginning and intermediate statistics.
  • Edaptive Systems Llc
    Hedis Project Manager – Medicare Advantage Star Program,
    Edaptive Systems Llc Oct 2011 - Feb 2013
    Owings Mills, Md
    •Upon the award of the HEDIS project to Edaptive by CMS, Edaptive offered the position of manager to Dr. Bourne.•Managed the overall implementation of tasks associated with the Centers for Medicare & Medicaid Services (CMS) contract to collect Medicare Advantage HEDIS files for analysis. This included the development of the STARS ratings that are used by CMS for identifying quality health plans and for reimbursement of health plans for the quality of care furnished their members.•Ensured that contract deliverables are met on time and monitors contract and subcontract budgets and consultant agreements. •Provided staff and resource management administrative support to mid-level managers, web developers, data analysts, researchers, and consultants.•Served as the primary contact with CMS concerning project.•After assuming her position as manager of the project, used her knowledge of HEDIS and the HEDIS process to involve the HEDIS auditors and vendors in the Patient Level data submission process. This led to a major increase in the reliability of the data submitted.•Dr. Bourne created a series of reports that showed the progress of plan file submissions and identified those plans that were late to contact their representative to request submission of files.•Dr. Bourne created a series of reports that matched the Patient Level Data by plan by measures to the summary data and identified those plans whose PLD files were within requirements and those that were not.
  • Hcd International
    Hedis Project Manager
    Hcd International Sep 2010 - Oct 2012
    • Oversee the overall implementation of tasks associated with the Centers for Medicare & Medicaid Services (CMS) HEDIS contract• Ensure that contract deliverables are met on time and monitor contract and subcontract budgets and consultant agreements. • Provide staff and resource management for administrative support, mid-level managers, web developers, data analysts, researchers, and consultants.• Maintain a solid understanding of the Software Development Life Cycle.• Serve as the primary contact with CMS concerning project.• Responsible for project budget
  • Johns Hopkins Healthcare Llc
    Hedis Program Manager
    Johns Hopkins Healthcare Llc Jan 2007 - Aug 2010
    • Worked 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.• Analyzed results for possible data problems/errors and determines source of errors and recommended corrective procedures.• Programmed and produced reports to send to provider groups showing their results for the various measures compared to common benchmarks.• Programmed and produced reports reports for providers based on prospective data showing members who have not had various HEDIS services.• Worked 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.• Served 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 and HEDIS 2009.
  • Delmarva Foundation
    Lead Health Analyst And Research Scientist
    Delmarva Foundation Aug 2004 - Dec 2006
    •Developed new and unique strategies to identify potential fraud in Medicare data in a15 state region and Medicare/Medicaid data in State of Washington.•Using SAS and Crystal Reports, developed computer programs using strategies to identify specific providers who were outside the norm and wrote reports that clearly and concisely illustrated data analysis findings. •Developed reports to present results of analysis to senior staff. •Supervised junior analysts in identifying methods to find potential fraud.•Worked as Senior Statistician on project to blend Medicare and Medicaid data for the State of Washington to look for fraud across both systems.
  • Austin Community College
    Instructor In Advanced Medical Billing And Legal; Ethical Principles In Medicine Including Hipaa
    Austin Community College Jan 2001 - Aug 2004
    I taught medical office billing including sections on diagnosis and procedures codes. I taught a course devoted to the legal aspects of medical information with much of the time focused on the legal aspects of HIPAA.
  • Austin Community College
    Instructor In Advanced Medical Billing;Legal Ethical Principles/Hipaa
    Austin Community College Jan 2001 - Aug 2004
    Taught classes in medical billing including areas of diagnoses, procedures, place of service, fee schedules and a special section on HIPAA.
  • Seton Health Plan
    Reporting Coordinator
    Seton Health Plan Dec 2000 - Mar 2004
    Anything and everything connected with a Medicaid Health Plan. This included the traditional areas such as HEDIS, budget reports, analyses of claims data. Because Seton Health Plan was part of a hospital system, I also did special reports on hospital data.
  • Texas Health Quality Alliance - Texas Eqro
    Research Scientist
    Texas Health Quality Alliance - Texas Eqro Jun 1999 - Nov 2000
    Recruited by THQA at suggestion of Health and Human Services Commission for knowledge of Medicaid system in Texas.Supervised collection of data for development and production of physical health and behavioral health research studies to support State of Texas Medicaid program. Additionally, worked with State employees to plan research studies.Served as lead in the development of a reporting database for use by the State of Texas to facilitate reporting for Medicaid program that integrated healthcare claims and membership information for 13 health plans and for similar data for traditional Medicaid members. This included developing and carrying out project plan for requesting and processing data. This system is still used by the new Medicaid quality monitor.Developed courses to train State and THQA employees on new system. Served as primary trainer.

Barbara Bourne, Ph.D. Skills

Hipaa Medicaid Data Analysis Medicare Healthcare Healthcare Information Technology Health Policy Sas Analysis Hedis Healthcare Consulting Managed Care Statistics Sql Ehr Emr Hospitals Medical Billing Informatics Healthcare Management Healthcare Industry Quality Improvement Spss Qualitative Research Project Management Management Research Databases Healthcare Information Systems Medicine Public Health Performance Improvement Accreditation Revenue Cycle Process Improvement Physicians Training Medicare Stars

Barbara Bourne, Ph.D. Education Details

Frequently Asked Questions about Barbara Bourne, Ph.D.

What company does Barbara Bourne, Ph.D. work for?

Barbara Bourne, Ph.D. works for Bjb Hedis/quality Consulting

What is Barbara Bourne, Ph.D.'s role at the current company?

Barbara Bourne, Ph.D.'s current role is Experienced Consultant in HEDIS, Stars and Healthcare Informatics/Research.

What is Barbara Bourne, Ph.D.'s email address?

Barbara Bourne, Ph.D.'s email address is bb****@****hhc.com

What schools did Barbara Bourne, Ph.D. attend?

Barbara Bourne, Ph.D. attended University Of Florida, University Of Colorado Colorado Springs.

What are some of Barbara Bourne, Ph.D.'s interests?

Barbara Bourne, Ph.D. has interest in Aikido.

What skills is Barbara Bourne, Ph.D. known for?

Barbara Bourne, Ph.D. has skills like Hipaa, Medicaid, Data Analysis, Medicare, Healthcare, Healthcare Information Technology, Health Policy, Sas, Analysis, Hedis, Healthcare Consulting, Managed Care.

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