Brian Mcleod Email & Phone Number

Greater New York City Area

Greater New York City Area

New York, New York

New York, New York

• Recruited and developed a team of consultants responsible for implementation and management of national provider incentive programs
• Designed and produced the analytic package used for Network Optimization deep dives for each market in the enterprise
• Identified an average of 20 million in savings in each market by narrowing the primary care physician (PCP) network and moving the remaining members to PCP’s with optimal medical loss ratio (MLR) and quality performance
• Created the financial model used to identify PCP practices for participation in the Accountable Care Shared Savings (ACSS) incentive program using risk adjusted data based on retrospective episode risk group (ERG).
• Worked with executive leadership to develop the Basic Quality Model incentive program, which targets PCP practices based on historical healthcare effectiveness data and information set (HEDIS) performance
• Work with health plan leadership to establish incentive program performance targets for PCP practices during the incentive program measurement periods

New York, New York

• Produced a standard quarterly medical expense trend drill down package for each market in the southeast (SE) region and worked with health plan leadership to identify ways to remediate negative trends
• Analyzed PCP MLR performance reports to identify outliers for Medical Management and Network Management intervention
• Collaborated with Medical Management team to implement strategies to impact health care initiatives
• Priced and evaluated historical facility costs and utilization by product and place of service to create a comparison of proposed contract cost changes for Network Management

Gainesville, Florida

• Extracted claims data using SQL to prepare monthly and ad hoc reports
• Produced and analyzed PCP MLR performance reports to identify outliers for Medical Management and Network Management intervention
• Developed and implemented a standardized reporting process for each market in the SE region to report impact of affordability initiatives
• Tracked and reported progress of health care initiatives to corporate office

Sunrise, Florida

• Recommended facility contract changes of proposed contracts to reduce costs to Finance and Network Management
• Reserved expenses and monitored high dollar cases at high cost facilities
• Calculated and tracked success of health plan’s health care affordability initiatives
• Constructed automated database to produce state mandated member notification letters based off established benefit levels

Sunrise, Florida

• Validated and implemented MicroStrategy internal database reporting system for the COSMOS claims platform
• Performed root-cause analysis of high cost utilization of active members by provider, diagnosis, procedure and facility
• Identified cases for Health Services to manage the same types of service at lower cost facilities
• Analyzed inpatient, outpatient, physician and pharmacy utilization and cost variances for monthly Senior Management reports

Boca Raton, Florida

• Shadowed asset manager for Quartz hedge fund
• Recorded daily stock transactions
• Tracked firm’s NASDAQ futures gains/losses for the time period

Mba, Finance, Business Management, Economics

Bachelor Of Science, Business Finance