Syntax is an enterprise SaaS-based solution, which provides the analytics, infrastructure, and a collaborative virtual workspace to facilitate best-fit payment model design and promote transparency and consistency in contract negotiations. The solution was designed to create a frictionless experience for every payer, provider, and risk bearing entity that needs to engage and implement value-based care. Syntax simplifies and demystifies incentive design by allowing healthcare actuaries, network managers, analysts, and healthcare providers to operate at the top of their profession by helping them remain more organized and freeing them up from many of the redundant, manual processes during contracting. Actuaries, analysts, and network managers will be able to compare savings, quality metrics and trends in real-time, and work with providers to agree on terms in a fraction of the time it typically takes. Enabling payers and providers to save time during contracting, unburden their employees of work that is unnecessarily manual, and ensure the best-fit incentive designs for their company.

Responsible for leading a team of exemplary associates in the end to end execution of value based programs, providing operational deliverables, solutions enablement, and industry-leading analytic insights.

Lead value based purchasing program analytics and financial reconciliations including total cost of care, PCP-centric shared savings, procedural episode bundle payments, specialist incentive models, and global accountability organization integrated payment models. Additionally identify variation in care for procedural episodes and flag potential fraud, waste or abuse findings for additional review and investigation. Support analysts and managers reporting to me to provide direction, leadership and market insights to communicate drivers of payment results and encourage management of utilization and cost without sacrificing patient outcomes.

Lead and supervise Trends & Metrics analytics and reports for Geisinger Health Plans. Areas of responsibility include management of Medical Expense drill down analytics, Provider contracting support for facilities, vendors and physicians, and Patient Centered Medical Home shared savings model development, negotiation, implementation and execution. Operational reporting is also provided on scheduled release to senior leadership to identify actual trends of utilization and unit cost, PCMH performance management and contract monitoring and projected vs. actual results. Additional operational reporting supported through analytics teams to identify potential Claims processing errors, contract implementation errors and other payment integrity opportunities. Represent department in discussions with senior leadership across Geisinger Health System, providing analytic input and considerations for business opportunities and innovation efforts around payment redesign, process improvement and care delivery changes.Developed culture and tracking tool to monitor actual achieved savings initiated by Trends & Metrics team and realized for GHP. Regularly share this scorecard with team and senior leadership to highlight positive ROI from efforts of this analytic group and value provided to the organization. Through fiscal year 2014, Trends & Metrics’ ROI was more than 3 to 1, with over $9M in identified and realized savings.

Provide supervisory support to two analysts, developing data query skills and analytic approaches to root cause analysis. Support Geisinger Health System’s process improvement initiatives through metric development and monitoring. Participate in discussions with the Operations Research team in building predictive and simulation models that support executive leadership business decisions. Leverage newly acquired software to streamline existing data reporting processes. Facilitate discussions with workgroups in determining bed capacity planning and long range modeling of bed demand to Geisinger hospitals.

Responsible for accurate, timely ad-hoc and routine reporting from claims, membership and authorization systems, presenting findings to senior leadership of Geisinger Insurance Operations including suggestions for trend mitigation. Participate in all associated meetings and work groups to create appropriate initiatives that provide high quality care at lower costs. Provide leadership and guidance to team of six analysts, responsible for coordinating training and evaluating career development as well as assisting in steering drill down analytics and presentation points. Serve on multiple workgroups as representative for Actuarial Informatics, providing analytic view points to assist leadership in steering analytics to evaluate effectiveness of initiatives, vendors and programs. Includes return on investment reporting, trend reporting, episode payment creation, and payment settlement models.