Cathy Harvey Email & Phone Number

Dunedin, Fl, Us

Accountable for developing strategies and tactical execution to drive market share growth and financial performance in the Wisconsin and Michigan markets. Includes product design, provider network management, clinical model development, consumer satisfaction and driving quality results. • Led a $50M margin improvement in the first 8 months. Consistently outperformed margin expectations• Maintained market leader position in Wisconsin. Established leader position in Green Bay. 39% market share in WI and over 70% in Milwaukee• Ensured all membership in 4+STAR rating plans • Developed effective clinical interventions including flu vaccination best practices calendar (resulting in 10% admission reductions), super utilizer engagement (30% reduction in ED visits), and readmission strategies (5% reduction). Achieved lowest utilization in the region across all key categories of care• Improved provider engagement by transitioning 5 of 6 Accountable Care Organizations (ACOs) to shared risk arrangements and meeting quarterly with key C-Suite leaders. Over 90% of members under value-based reimbursement• Initiated first annual ACO Population Summit to facilitate joint problem-solving among peer organizations. Led workgroups of all key health systems to jointly develop strategies for palliative care/hospice, pharmacy integration and readmission reduction

Long Beach, California, Us

Responsible for daily operations, P&L and growth of a start-up Medicaid health plan. Products include Managed Medicaid for Aged, Blind and Disableds (ABD), Temporary Assistance for Needy Families (TANF), Accountable Care Act (ACA) expansion, and the Medicare-Medicaid Plan (MMP) for dual eligibles. Develop and execute business plans, medical cost strategies and annual operating plans focusing on growing membership, improving costs, meeting quality metrics and satisfying compliance requirements. Responsible for local functions, which include network management, medical management, pharmacy, quality, member and provider service, finance, human resources, compliance and government affairs.• Grew membership from 4,000 in one product, to over 100,000 in three products in my first 10 months. Achieved YTD profitability in 7 months• Led the acquisition and implementation of 3 Accountable Care Organization (ACO) owned entities, growing the membership to over 220,000 members and gaining entry into the Cook County service area. Included extensive network expansion, as well as the development of integrated care management models and risk-sharing strategies• Hired key leadership and stabilized the team. Grew from 80 to over 500 employees, while reducing turnover from 23% to 4%• Provided leadership on behalf of the industry by being elected to the Executive Board of the Illinois Association of Medicaid Health Plans, first as Vice President (2014-2016), later as President (2016-current). Worked with regulators and legislators on shaping Medicaid policy.

London, Gb

Responsible for the development and growth of dual eligible products, including dual eligible Special Needs Plans (SNPs) and Capitated Financial Alignment Demonstration Plans (Medicare Medicaid Plans). Includes development of operational and implementation plans, integrated benefit and reimbursement strategy, care management approach, vendor selection and RFP content.

Chicago, Il, Us

Responsible for system-wide strategic direction and development of Blue programs to enhance the Blue brand. The Blue Cross and Blue Shield System provides healthcare coverage for 100 million people or one in three Americans. • Developed national interactive exchange, “AskBlue”, to provide consumers navigational and educational support to find the right healthcare coverage for them. AskBlue generates over 16,000 visits per month, with over 800,000 visits to date, providing member Plans with a pre exchange portal to reach consumers in a retail environment with an ROI of 4 to 1. Suite of tools expanded to include AskBlue Medicare and AskBlue for Reform.• Developed Brand extensions and innovations to prepare for post reform consumer segments, improve speed to market and extend the Brand to non-traditional services. • Developed strategy to reduce childhood obesity. Led the development of a physician toolkit to diagnose and treat childhood obesity in conjunction with the CDC, ADA and AAP. Established pilots in 5 markets with national rollout in fall of 2010 to over 15,000 pediatric practices, establishing the national standard for care.

Worldwide, Oo

Provide confidential strategic healthcare consulting services to National Payors, Health Plans and State Medicaid Agencies related to product and program design, growth and cost improvement strategies and M&A.• Led the provider network and medical management integration strategy for CIGNA’s acquisition of Great West Healthcare.• Developed a Medicaid transformation plan for a State Medicaid agency. Identified over $175 million in cost saving opportunities in program management, reimbursement, medical management, and organizational structure.

Responsible for daily operations, profitability and growth of a start-up Medicaid health plan. Local operations include finance, contracting, medical management, compliance, member and provider service.• Hired senior team and stabilized start-up operations to achieve superior service metrics. • Managed successful integration of acquisition one year after original “go live”, growing plan from 24,000 members to 62,000 members and $120 M in revenue. Included re-contracting entire network in 45 days, and hiring 30 new employees in 60 days.• Successfully lobbied legislature and Commission to Reform Medicaid to require statewide expansion of Managed Medicaid.

Developed medical expense strategy and standard reporting. Selected outsourced medical/disease management vendor for this consumer-driven health plan.

Led the development and implementation of new distribution and branding strategies to support the merger of UWSI and BCBSUW and the formation of a new, diversified publicly traded Blue plan. Accountable for Marketing, Product Development, Corporate Communications and the Internet Operations Group.•Developed and successfully implemented the e-commerce strategy during first nine months. Capabilities include business to business and business to consumer sales, online customer service, and print on demand provider directories. Managed 8 internal workteams and 6 vendors to on-time completion. Developed centralized Internet Operations Group to provide sales, underwriting and customer service support.•Developed marketing strategy to differentiate BCBSUW products in the market using flexibility, access, choice and technology as key messages. Achieved 29% unaided consumer recall as compared to 7% of the nearest competitor

Us

Led a multidisciplinary team in working with UnitedHealthcare’s 45 health plans to develop and implement contracting and medical management strategies to improve financial results. Worked with corporate senior management, finance, Medicare, and health services areas to support implementation of strategic and operational plans.• Played a key role in leading the $50 million turnaround of a multi-state health plan legal entity. This included working with health plan staff to develop contracting and medical management strategies, addressing operational issues (including decentralization of key functions), and providing leadership during a time of management turnover.• Initiated and led the UnitedHealthcare Medical Expense Team that developed multi-disciplinary strategies to reduce medical expense across all UnitedHealthcare plans. 1999 savings estimated at $266 million.

Mba, Health Care Management

Education record