Hugh Larson Email & Phone Number

San Diego

Greater San Diego Area

I lead a team of experts that helps provider organizations (i.e., physician organizations, health systems, and hospitals) succeed under alternative payment models. This includes guiding organizations in the transition from a fee-for-service environment to a value-based environment.My team brings a broad range of skills to our consulting engagements including strategic planning, opportunity assessments, resource allocation, actuarial analyses and financial forecasting. In our client engagements, we are working with Medicare Shared Savings Program participants, Next Generation ACOs, health systems directly contracting with employers and other alternative payment contracts. We are helping these clients effectively evaluate their opportunities and pitfalls under MACRA, whether to pursue MIPS or APMs as well as other changing federal regulations. In addition, we.assist ACOs evaluating their performance under risk-based contracts, develop forecasts of future benchmarks, expenditures and savings/losses as well as analyze detailed medical claims data.

As a principal and co-owner of Optimized Health Care Decisions, LLC, I worked on a broad range of projects for healthcare provider organizations. Some of my representative projects are:• Assisted a specialty hospital in evaluating a bundled payment contract proposed by a regional insurer• Helped a multi-site hospital system evaluate the feasibility of implementing Medicare Shared Savings Programs (MSSP) in multiple geographic regions• Developed an MSSP “tutorial” presentation for a hospital's senior management• Reviewed the Bundled Payment for Care Improvement models 1 through 4• Developed logic and model for utilizing state and municipal employers’ health care cost, plan design and enrollment data collected by a large actuarial consulting firm• Provided actuarial review of projected future health care costs under a Multiple Employer Welfare Arrangement (MEWA)• Estimated the cost increases to employers’ with Health Reimbursement Arrangements (HRAs) resulting from certain aspects of the Patient Protection and Affordable Care Act (PPACA) on behalf of a third party administrator (TPA) seeking a waiver from the Center for Medicare and Medicaid Services (CMS)• Developed a white paper outlining the impact of insurance exchanges and subsidies on early retirees with employer provided health care coverage for an insurance broker

I provided consulting services to employers, hospitals and insurers. I was a lead negotiator representing AT&T, Lucent Technologies and several other employers in purchasing health care services from United Health Care, Aetna, Cigna, New Jersey Blue Cross and Blue Shield and Empire Blue Cross Blue Shield (as well as many others) through POS plans, PPO plans, EPO plans, HMOs, etc.These contracts varied in duration and value with some extending for three years and covering over $1 billion in health care spending for 100,000 lives. Some other projects were:• Assisted employers in developing RFPs, analyzing supplier’s proposals and recommending suppliers for medical plans, dental plans, vision plans and prescription drug plans• Represented an employer coalition of Fortune 500 companies in negotiating a comprehensive prescription drug contract• Analyzed hospital and physician cost and quality data to assist clients in selecting hospitals and physicians for a proposed provider network • Assisted employers in analyzing claim utilization patterns to develop effective utilization management protocols• Developed, implemented and evaluated health care vendor performance standards addressing the broad services provided by vendors including claim processing, provider network, customer service and customer satisfaction• Analyzed pharmaceutical claims discounts off average wholesale prices (AWP) for employers selecting pharmacy benefit managers (PBM)• Evaluated the adequacy of PBMs’ pharmacy networks• Evaluated mental health and chemical dependency vendors’ costs and utilization by CPT code to assess their networks’ cost efficiency• Analyzed high-cost claimants’ medical claims and utilization to evaluate the benefit of stop loss re-insurance

Consultant and actuarial student. Provided health and welfare benefits/actuarial consulting services to large employers.