Bob Mcdaniel Email & Phone Number

Responsible for market growth of $500M revenue orthopedic physician company specifically contract negotiations, financial analysis, modeling, and achieve best in class growth market reimbursement rates across unique reimbursement models (Risk, VBC, ACO, CIN, RBRVS). Focus on benchmarking analysis, develop payer value proposition and clinical performance. Oversight to credentialing, RCM, and payer dispute resolution. Key leader within integration, migration, and JV ASC Partnership efforts to develop payer and member value across markets. Develop and track clinical performance, quality and outcomes for value creation and ROI. Monitor federal changes in CMS RBRVS reimbursement rates. Key leader working closely with legal, business development, marketing, and operations to represent our sponsors, board, and physician clinical governance advisory committees.

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Responsible for market growth oversight across 5 regions and $5B medical spend across large hospital and health systems including large multi-specialty physician groups. Accountable for provider payer partnership unique arrangements, performance analytics and outcomes to establish high performers, achieving better outcomes and incentive opportunities.

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Responsible for market growth oversight across 4 regions and over 150 staff focused on market growth efforts across Commercial Employer & Individual, Medicare and Medicaid lines of business. Directly oversee multi-state region of provider network staff, direct clients, leased networks, integration strategies and tactics to develop best practices, reduce administrative burden and improve operational process efficiencies. Additional responsibility to national HCA, Tenet, ASCs, and other large health system client management. Collaborate with cross-functional partners across healthcare economics, claims, operations, clinical, finance and legal to drive issue resolution, incentive programs and provider payer contracts to support national client sales efforts.

Saint Louis, Mo, Us

Responsible for market growth of $50M network optimization healthcare initiatives, contracting, value-based rate negotiations and performance outcomes for hospital health systems including large multi-specialty physician groups. Achieved $10M in cost of care savings programs with unique value-based contracts and financial models to establish reductions with lowered reimbursement and upside quality-based performance incentives. Oversight of NCQA network guidelines, HEDIS, Quality P4P and P4O requirements. Served on Utilization Management, Payment Integrity and Fraud and Abuse Committees. Created and designed unique benefit structures while managing medical, behavioral, and dental networks to close gaps in care and drive better quality outcomes. Developed new benefit structure product lines, cost analysis, and grew market share. Led external vendor partnerships, associations, and board representation.

Indianapolis, Indiana, Us

Responsible for market growth of $30M in network optimization healthcare initiatives, contracting, value-based rate negotiations and performance outcomes for hospital health systems including large multi-specialty physician groups. Achieved $10M in cost of care savings programs, unique value-based contracts, ACO risk arrangements and financial performance models to establish reductions with lowered reimbursement and upside quality-based performance incentives. Achieved market growth expansion of $50M in provider payer partnerships and physician advisory board committees. Implemented new clinical care model and increased better quality scores with focused marketing campaigns to drive awareness and member compliance.

Indianapolis, Indiana, Us

Responsible for market growth of $20M financial profitability and 500,000 member lives overseeing internal operations and external field teams (network, claims, marketing, clinical and quality). Led and managed Cost of Care team to improve increase in quality scores and closure in gaps in care. Improved quality outcomes with hospital systems, ASC and large multi-specialty physician groups to expand provider incentive-based programs focusing on preventative measures, utilization, and readmissions.

Solna, Stockholm County, Se

Responsible for advocacy, shaping policy, reimbursement and legislative focus at the federal and state levels including oversight to outsourced lobbying firms and healthcare legislative tracking. Direct responsibility to lobbying efforts, trade associations, speaking engagements at National Governors Association, AHIP, MHPA and various political events RGA/DGA/NCSL. Key responsibility to market growth of $30M new business development and national provider payer partnerships across government Medicare and Medicaid lines of business. Managed Top 20 State national accounts and new product implementation. Led and coordinated new product line roll-out across sales and marketing teams. Established Federal and State Government market share for new business with sales and marketing teams. Established Top 20 State business proposals, pricing, and reimbursement strategies. Led and coordinated product launches and marketing campaigns. Established International and U.S. market share contractual partnership arrangements. Developed contract pricing methodologies, pricing analysis, RFP proposal bids, incentives, and tiered volume level discount structures.

Dentistry

Biochemistry/Histology

Bs, Life Science