David Brady Email and Phone Number

•Provide consultative thought leadership and execution planning to executive level staff on a broad range of health care related business initiatives including, but not limited to: – Provider Network Management and Operations – Product and sales strategy – Vendor contract review, negotiation and management – Project management and execution leadership •Serve as project owner involving the coordination of cross-functional teams to ensure the successful implementation of a vender-hosted provider directory, cost transparency with quality indicators and rewards program. •Engaged in a system wide provider data accuracy initiative to ensure all directory relevant information complies with federal and state mandated requirements. •Proficient in establishing trust and lasting relationships through the use of open communication and the creation of respectful, collaborative work groups. •Provide organization-wide assistance with strategic business ventures upon request.

•Provided executive leadership for all health plan business functions with a primary focus on providing high quality, cost effective managed health care solutions to the community members of central Virginia. •Overall accountability for the attainment of membership, revenue and profit objectives. •Set strategic direction and associated financial forecast for short/long-range planning, reporting, and budgeting purposes. – Continually analyzed budget performance throughout the fiscal year and made adjustments as necessary. •Substantial focus on Medicare Advantage growth and profitability through: – Implementation of an enhanced Hierarchical Conditions Coding revenue maximization strategy, which resulted in top-line increases of more than 6% in the first year. – Quality improvement program focusing on STARS rating via HEDIS, CAHPS, HOS, and Part D measures. – Bid maximization through strategic partnership with expert level Actuarial services provider. – Establish cost containment processes and protocols for enhanced Medical and Utilization Management. •Shortened the length of hospital admissions by an average of 3 days and implemented re-admissions policies aligned with clinical quality indicators.•Successfully launched an Exchange-based HMO product resulting in a greater than 200% increase in business unit enrollment over the preceding year while reducing per member health plan expense by more than 14%.•Increased market credibility through regular engagement with key physician/specialty practices, members of the Broker community as well as core market employers. •Engaged in value-based contracting with provider practices and specialty centers that successfully attained applicable accreditation status and proven high quality outcomes through the use of evidence-based protocols.•Served as health plan Board President and successfully garnered support when setting expectations on progress indicators.

Serve as Program Manager and Business Development lead responsible for the strategic and tactical planning of Health Care Reform and Commercial business. Responsible for providing constant innovative thought leadership and direction to the design, implementation, positioning, and analysis for all lines of Commercial business. Selected Accomplishments/Responsibilities: •Successfully launched a web-based Private-label Health Care Reform Insurance Exchange as well as connectivity to the Federally Facilitated Marketplace (FFM). –Private Exchange fully functional by the federally imposed deadline of October 1, 2013.–Exceeded projected sales by more than 54% •Lead the implementation and integration of a member-based billing solution for Health Care Reform line of business•Serve as subject matter expert on Health Care Reform and the Affordable Care Act–Review, interpret and communicate legislative releases –Collaborate with legal and actuarial departments to ensure compliance with federal regulation–Conduct both internal and external training and education seminars–Participate in national speaking engagements–Conduct regional and national multi-media interviews •Lead vendor negotiations including the incorporation of complex financial contract terms and performance measures resulting in material and quantifiable savings. •Focus on the development of innovative commercial products to exceed growth expectations and achieve operational effectiveness •Assist in the development of high performing networks and new network contracting strategies including negotiation support, market analysis, financial forecasting, steerage and pay for performance arrangements

•Lead Project Manager responsible for Coventry’s High Performance Network (HPN) and/or Patient Centered Medical Home (PCMH) initiative in both Virginia and West Virginia. Project involves:–Surveying the market and identifying strategic hospital and provider systems with which to partner.–Meeting with hospital Executives to present the Integrated Delivery System concept, Coventry’s value proposition, the fundamentals of gain-share, physician care coordination program with pay-for-performance, physician/patient management reporting packages and fee schedule expectations.–Reviewing current reimbursement agreements and assessing competitive position.–Creating and delivering financial models that forecast the revenue cycle under a HPN/PCMH arrangement resulting in positive cash flows and net income specific to a Health System. –Negotiation of HPN/PCMH contract terms. –Designing products specific to the market/system that incorporates Coventry’s core HPN/PCMH concepts while maximizing patient compliance with evidence based protocols. •Successfully developed and filed an individual health insurance product which, due to its nature, creates economies of scale given its cross-state marketability. –Developed all product offerings, designed new business pricing/rating models and engineered an on-line quoting and application tool used by direct consumers and individual producers. Functionality includes back-end operational design to ensure accuracy and ease-of use by both internal and external end-users.–Increased sales more than 85% after assuming broker relations, recruitment and training responsibility.•Authored numerous white papers covering a wide variety of topics and products including, but not limited to: Coventry’s DM program, a Hybrid Minimum Premium product and Accountable Care Organizations with Value Based Benefits. Each included a concept proposal, implementation plan, reporting packages, financial models and market presentations.

• Responsible and accountable for effectively serving the needs of large national employers (up to 75,000 employees) as well as medium sized regional businesses (up to 5,000 employees) individually and as part of a team.• Lead prospective client proposal process, ensuring effective communication of Mercer’s value proposition emphasizing the breadth of products, depth of resources, and measurable investment returns. • Created interactive financial forecasting models, that incorporated statistical analysis, which were used to set employee benefit budgets and achieve long term strategic goals.• Presented technical and complicated financial analyses in simple yet precise formats incorporating visual aids and executive summaries to client executive team members including Chief Executive and Chief Financial Officers.• Designed and successfully implemented strategic financial solutions that yielded savings ranging from 5% to 10% on healthcare budgets of $30-$40 million.

•Presented findings and made recommendations at financial reviews with executive management as they related to the expansion and retention of core business.•Developed creative analyses incorporating fundamental statistics to determine and establish market trends. •Successfully retooled processes and enhanced the underwriting Excel based financial rating model, resulting in measurable increased workflow efficiencies and forecasting accuracy.•Assisted the Sales team in the delivery of client specific financial information and conducted presentations of underwriting risk analysis methodology. •Conducted annual performance appraisals as a means of identifying each individual’s strengths and weaknesses with the objective of establishing measurable goals and pinpointing opportunities for development. •Conducted information and training workshops for both the Underwriting and Sales teams involving effective communication of industry trends, changes in state and federally regulated policies, and the various funding alternatives available to clients.

•Developed client specific pricing analyses and financial models, based on raw health care cost data, which were used for budgeting cost reserves by clients. •Managed a client book with the average employer offering coverage to 6,000 employees and an average monthly medical budget of $4.9MM. •Participated in the delivery and explanation of pricing models, claims estimates, and product offerings. •Coordinated bidding projects for assigned accounts, which included completion of specifications, analysis of proposals, and delivery of analyses to the client. •Acted as a liaison between the insurance carrier, internal departments, and clients to resolve issues related to plan design, explaining estimates of paid claims, incurred but not reported claims, and total benefit plan cost.