Frank R Mata Email & Phone Number

Support/enable business to operate cost effectively and at peak performance. Key member of the enterprise acting as a critical advisor to Senior Leadership team in their development of strategies to manage healthcare costs, support provider engagement/contracting activities and achieve other key corporate goals. • Provided insights and analysis to support clinical care management activities and identify healthcare cost containment opportunities. Analyzed proposed medical management programs to project the cost and savings from such initiatives.• Improved risk stratification and predictive analytic methodologies to better identify appropriate members for Care Management programs. • Assessed vendor performance, including evaluating ROI and quantifying potential performance-based incentive payments.• Analyzed health care data to identify trends, explain plan results and uncover/investigate opportunities for plan improvement.o Led team to improved processes to allow for more detailed drilldowns and better insight into emerging costs and new opportunities for health care cost savings initiatives. • Responsible for supporting the Reimbursement Policy Committee with quantification of the impacts of proposed changes to provider reimbursement policies. Attend regularly scheduled meetings to support and participate in data review to identify impact of any changes.• Participate in the process of vetting, testing, and implementing enterprise reporting and analysis tools• Responsible for two additional teams on top of the three teams already managingo Trend Analytics & Affordability: Responsible for the creation of detailed analytics which provide leadership with a sound understanding of actual results and the main drivers of such performance.o Population Health & Clinical Informatics: Responsible for the deployment and maintenance of analytical/statistical models that enhance clinical strategy, operational efficiency and consumer experience.

Manage team of Medical Analytic Managers and Informatics Specialists to drive to best in class access to cost and provider data to support contract negotiation and provider reporting. Develop innovative value based contracting initiatives. Create medical cost reporting to support ACO agreements. Develop tools to evaluate network providers on cost efficiency and quality outcomes. Design scorecards to help educate providers on performance against peers.• In collaboration with ACOs, identified necessary action plans to ensure success on meeting HEDIS/STARs Quality Metrics, Medical Cost Targets and revenue optimization. Met on a quarterly basis to review the ACOs progress with key stakeholders. Provided consultative expertise on the mechanisms available to enhance performance. • In collaboration with VP of Network Contracting, developed innovative value based provider contract agreements (ACO, Steerage Models, Bundled Payments, Risk/Gain Share Models, Narrow & Tiered Network Designs, etc.) that resulted in improvements in both medical costs, and quality outcomes. o Created narrow PCP network called “Passage” which resulted in 10% lower Risk Adjusted PMPMs on both Commercial and Medicare products. • Owner of company-wide member attribution logic, which assigned a PCP to members based on internal algorithms. o Routinely met with ACOs to discuss ways to improve accuracy.• Responsible for the recruitment, retention, development and management of staff across 3 teams. o Contract Analytics: Develop financial reimbursement models for our fee for service network physicians and facilities. o Provider/Network Analytics: Develop/maintain reporting for all value based contracting. Provide analysis to ensure adequate networks across all products. o Data Management: Ensure Analytics staff has access to accurate and timely data through development of various data marts and tools.

Responsible for creating the information that will empower both internal and provider partners to identify areas of opportunity to make meaningful changes to the cost and quality of health care being delivered to members. Provide consultation and analysis for all Value Based Provider Contracting and overall network strategy.- Support the initiatives of Medical and Network Operations by providing applicable data and guidance on measurement for Provider Collaboration groups.- Maintain quarterly financial and quality reconciliations according to Provider Collaboration contracts. Share results with each group and provide recommendations on opportunities to lower medical costs. This includes tracking of estimated liabilities for internal accounting. - Provide guidance and analysis to determine best construct of narrow and high performance networks.- Research, analyze and provide recommendations for new provider reimbursement models that will be used as alternatives to Fee for Service contracting. Implemented numerous steerage incentive contracts as well as bundled payments for hips/knee replacements. Tracked performance to ensure we saw expected levels of performance.- Continue to provide innovative and best in class analytics/tools to provider collaboration groups. Revised Gaps in Care reporting for better provider engagement. Created new tools for Pharmacy prescribing patterns to enable providers to prescribe the appropriate medications at the lowest cost. Revised readmission reporting according to HEDIS specifications, allowing providers to make actionable decisions on their Care Transitions process. - Manage team of analysts who are responsible for standard and adhoc data warehouse reporting; developing and maintaining department applications; and analyzing the performance of health care expenses. Responsible for recruitment and retention of Medical Analytics staff.- Identify deficiencies in data quality and work cross-functionally to resolve.

Responsible for development of sophisticated models, reporting and analytics to drive change in the delivery of health care through collaborative agreements with health care providers. - Developed standard and adhoc reporting and analysis for provider collaboration agreements that drove to strong provider relationships, reduced medical costs, enhanced revenue and improved quality outcomes.- Participated in cross functional provider collaboration monthly meetings offering analytic expertise to assist clinical and provider networking teams as well as provider groups to focus on actions that lead to effective and efficient delivery of healthcare. - Shared information / thoughts with provider groups on how to lower spend while maintaining the same health outcomes for our members. Developed and provided tools to assist providers in steering to lower cost facilities for ambulatory surgery, advanced radiology and specialty drugs. Shared leakage reports on where members were seeking care outside a provide groups network of physicians and provided recommendations on how to increase domestic utilization.- Subject matter expert for the Optum Impact Intelligence tool which was utilized in provider profiling. Made recommendations for changes to the configuration settings which created more statistically valid output.- Managed analyst who was responsible for standard and ad hoc data warehouse reporting; developing and maintaining department applications; and analyzing the performance of health care expenses.

Responsible for statistical analysis to support Medical Operations, Network Operations, Actuarial and Underwriting decision-making. Designed and developed unique methods for information analysis which allowed senior management to draw conclusions about the relative performance of products, providers, networks, partners, etc. Presented cost of care trends to isolate opportunities and potential for improvement- Provided all analytics for the value based network initiative. Made recommendations on how to analyze providers as well as how to calculate the potential savings.- Created Risk Stratification models for Commercial, Medicare and State of CT HEP members. This was used to provide Care Management with a more accurate list of members to reach out to for various disease management programs.- Created analytical models for our new Exchange members. This provided an early look at utilization metrics compared to our other lines of business. It also provided Care management with a list of high utilizers that they could reach out to for management.- Provided analytics for the yearly Medicare bid. Some of these analytics included various looks at medical cost trends by county and cohort, pricing effects of benefit changes by plan, finding inaccuracies in the collection of member cost share, etc.- Assisted the Employer Group Reporting team with analytics on some of our large group accounts. Created reports with more in-depth analysis than the standard employer group reporting package. This included information on attributed membership, non-domestic spend, disease prevalence, high risk members, etc. These reports helped in retaining our key large accounts.- Created Preliminary trend models that allowed the medical economics team to quickly review emerging trends on a monthly basis.- Made revisions to the Cost of Care in-depth trend models to improve productivity and accuracy of reporting.

Responsible for sophisticated statistical analysis to support executive management, actuarial and underwriting decision-making. - Develop modeling that identifies causes for variation in medical costs, and develop reports that summarize this information in order for management to make actionable decisions.- Responsible for Northeast and Arizona Discount reporting to Hewitt, Mercer and Towers Perrin.- Helped create more accurate Bed Days Reporting by developing completion factor triangles using historical Bed Days data.- Assisted the Sales team with their Employer Group Requests for Pricing and Information.- Automated the monthly HCRA tax payment process.- Responsible for calculating a reserve estimate on medical claims as part of the early settlement of 2010 Montefiore unpaid claims. Provided completion factors to assist the Payment Operations team in calculating a settlement amount for any unpaid Vendor claims as well as HCRA tax payments.

- Assisted in the conversion of the Guardian Joint Venture claims to Health Net reporting. This included assistance with the final Reserve estimate agreed upon by the Guardian on the run out of remaining joint venture claims.- Developed and maintained the monthly claims triangles used for Reserve reporting. This included the monthly reconciliation of the claims triangles to the General Ledger.- Provided guidance and consultation to the Reserving Actuaries with any questions regarding the developing and reporting of the claims triangles.- Assisted with questions from internal and external auditors regarding the claims reserve triangles.

Responsible for the preparation and interpretation of claims expense and reserve analysis in determining pricing and IBNR reserve requirements.- Developed, calculated and analyzed reserves and other Health Care Costs.- Monitored level of trend and prepared Corporate Trend and Run-Rate reports.- Prepared monthly Day 3 reports, which assisted in calculating the Reserve levels.- Performed the conversion to month-end Reserve reporting. This included creating two new sets of claims triangles and testing the accuracy of the new reports.