Brian Cotter Email & Phone Number

Value-Based Analytics Can Be Easy!!! We Help Clients Breakdown Barriers to Critical Insights.1️⃣ Break Down Barriers:We transform healthcare data into actionable intelligence, enabling clients to realize their vision through clarity and precision.2️⃣ Speed and Trust:We find opportunities to significantly accelerate your current approach, fostering trust in your data and delivering timely insights. The impact is typically more than a 10x improvement in turn-around times.3️⃣ Simplify and Evolve:We focus on simplifying and automating processes, and evolving your in-house resources to consistently provide impactful insights.4️⃣ Deep Expertise:With unparalleled mastery in Traditional Healthcare data, Benchmark datasets, and Transparency datasets, we provide comprehensive solutions.5️⃣ Integration for Potent Insights:Our integration of various datasets unlocks valuable insights, driving value to clients and aiding decision-makers.

Dallas, Texas, Us

• Spearheads the strategic roadmap for integrating business, technical, and analytic resources in developing the essential infrastructure for commercial episodes of care analytics (based on Prometheus definitions). Responsibilities include creating a raw claims data intake process, developing a data warehouse, establishing a library of methodologies, designing a suite of client analytic deliverables, and ensuring a comprehensive QC/UAT process.• Designs client-facing analytics to assess cost, quality, and care variations across procedural, maternity, and chronic episodes. This enables clients to identify savings, quality improvements, and patient safety opportunities within their claims data experience.• Coordinates the methodology development for commercial client analytic deliverables through collaborative efforts with clinical, business, and analytic resources. This entails prototyping new analytics, refining them based on feedback, and conducting thorough QC/UAT to secure approval from key partners.• Manages a team of 12 analytic and development professionals who primarily utilize Python, R, SQL, Tableau, and MS Excel to create efficient data processes and deliver insightful analytics.

Woonsocket, Ri, Us

• Leads newly established department to meet analytic and reporting requirements of client savings programs under the medical benefit. Over 5 years, the department grew to 40 staff members to support rapid growth in new program development and client implementations. Team supports the analytic and reporting needs for the management programs under Novologix, Coram Home Infusion, and Accordant.• Provides executive and client insights through development of dashboards (tableau) and reporting (SSIS) that source EPIC (EHR), Medical/Pharmacy Claims, and department level databases. This work captures key trends, drivers of trend, and performance outliers key business metrics.• Directs market leading process for capturing savings insights for clients from external medical claims data and rapidly delivering results for RFP and sales prospects. Team manages full analytics process from collecting raw data to delivering presentations to clients. • Produces analytic proof points presented by executive leadership to wall street analysts, to national sales team, and to clients on the value of the specialty management programs.• Heads ongoing innovative development of new clinical analytics. This included a value-base oncology initiative. Which require building grouper to capture chemo admins across medical and pharmacy data into cycles, assign NCCN regimen, and evaluate treatment gaps.• Executes book of business strategy to aggregate client claims data for use in performance benchmarks and program savings models.• Institutes business logic repositories allowing business and clinical resources transparency into data logic and allowing them to make refinements as necessary. These repositories capture the data logic to simulate the impact of programs like prior authorization and dosing edits.• Client facing ‘subject matter expert’ for medical claims data and medical specialty management program analytics.

Woonsocket, Ri, Us

Responsible for designing and leading the execution of the various analyses required in support of emerging programs in the area of medical benefit management at CVS Caremark.• Developed analytic process to simulate the impact of specialty management programs under medical and pharmacy benefits. This the impact of these interventions are calculated at the level of the claim, script, and prior authorization.

Direct and assist the business intelligence team and business resources across the enterprise to deliver analytic capabilities through PCHI’s healthcare claims data warehouse.• Implemented Milliman’s Healthcare Cost Grouper and integrated the HCG classifications into a medical claims data mart. This allowed meaningful performance/cost comparisons to be made to benchmark populations. • Led the effort to source industry standard definitions to produce logical hierarchies for provider specialties, CPT/ICD9 procedure codes, and ICD9 diagnosis codes. • Participated on the teams charged with assessing the feasibility of implementing Episode Treatment Groups (ETGs) and Prometheus Payment Bundles. • Produced measure specific concurrent risk factors for Inpatient, High Cost Radiology, and Pharmacy PMPM pay for performance measures using models developed in conjunction with BCBSMA and DxCG.• Currently coordinating the transition with Boston area health plans to DxCG version 4.0 to support the new medical trend contracts.Manage the process and business logic to integrate claims data from commercial health plans and CMS to PCHI’s claims data warehouse for analysis and reporting.Primary liaison between PCHI and payers for all data and analytic issues. This role requires attending weekly meetings with the payers, corresponding daily on the progress of issues, and escalating critical concerns to senior management.Chair the Data Definitions group that is composed of senior analytic resources from across the organization. This group meets twice a month to work on projects focused on enhancing PCHI’s data warehouse.

London, Gb

Worked with national corporate clients to develop and implement their national health benefits strategies. • Received recognition for developing flex pricing model for a national client (35,000+ employees) to calculate employee contribution and employer cost scenarios using inputs for plan premiums and 10 credit variables. • Provide data expertise on client teams to support the development of benefits strategies.• Led full RFP cycle for clients in selection of health plans.

New York, Us

Reported and forecasted financial performance of self-insured and fully-insured business lines.• Created monthly profit/loss reports for all lines of business.• Forecasted Risk Based Capital requirements for D.O.I..• Mined data and collected information for NY and NJ State regulatory reports.

Bachelor'S Degree, Biology, General

Master'S Of Public Administration, Health Systems Finance