Eugene Hyatt Email & Phone Number

Chester, Va, Us

Richmond, Virginia, United States

Report to the Sr. Vice President, Product to develop care model analytics, provide financial modeling and recommendations for chronic condition initiatives, and identify value-based care cost trends in the markets impacting Medicaid and Medicare populations.Built and analyzed Medicaid chronic condition, medication adherence, and emergency room frequency models, demonstrating both average savings and per-member-per-month (PMPM) savings for members under well-managed care. The analysis informed initiative selection and prioritization, with projected savings in the multi-million dollar range once fully implemented.Led Medicaid maternity cost analysis across Arizona and Texas, identifying areas to reduce neonatal ICU stays and recommended inpatient conditions suitable for outpatient care transition. The findings emphasized material cost reductions without compromising quality of care.Performed a comprehensive analysis of high-cost Medicaid membership for health plan partners, identifying specific population segments for increased focus. Uncovered pharmaceutical cost drivers, proposing cost-effective alternatives through equivalent drug and lower cost transitioning strategies, contributing to overall cost management.

Greater Atlanta Area

Richmond, Virginia, United States

Reported to the Sr. Director, Rx Pricing and Profitability to build-out the pricing team, establish price guidelines, build a comprehensive pricing and cost repository, and function as the Rx pricing subject matter expert for Pricing and Finance teams.Collaborated with the Rx Department and the national field sales team to identify and target high Rx sales opportunity customer leads, resulting in a revenue increase of $4 million through strategic pricing adjustments.Revamped the pricing model, enabling expedited deal reviews by reducing turnaround time from 2 days to 2 hours while also conducting comprehensive “What-if” scenario analyses for optimal pricing strategies.Built and managed an Rx pricing strategy “Deal Desk” to evaluate profitability of deals using competitive intelligence, quality controls, and market analysis to enhance deal profitability while simultaneously securing new business.

Richmond, Virginia, United States

Reported to the Vice President of Pricing Strategy and Value Capture to lead Health Systems team to complete complex renewal financial reviews, set competitive pricing while increasing margin, and identify areas for margin improvement.Conducted comprehensive price elasticity analysis, delving into year-over-year price change drivers (volume, mix, and cost factors). Provided strategic insights to enhance pricing strategies and improve financial performance.Spearheaded innovative initiatives for margin review, identifying key customers. Implemented strategies that resulted in over $1 million in incremental revenue.Led a high-performing team, doubling the number of health system RFP renewals year over year. Maintained a 90% Health Systems Renewal Rate through strategic implementation of competitive pricing while effectively preserving margins.

Greater Pittsburgh Area

Directed the Creating Customer Value (C2V) Analytics Team of 5 analysts and consultants in building comprehensive cost savings identification models to size the opportunities for use in pricing and clinical ROI development.Partnered with business unit partners to accelerate Highmark’s achievement of a $200 million dollar cost savings target in seven months, more than 40% faster than the prior year. Using SAS and Teradata, developed and presented market expense deep-dive results to regional market leaders, identifying their highest cost expense drivers by medical service line (Inpatient, Outpatient, Behavioral Health, ER, and Pharmacy) and engaging functional areas to develop actions to mitigate costs while improving quality.Helped expand the overall Medical Economics department from 7 FTEs to 17 FTEs in 18 months and provided training, coaching, and performance evaluation for new team members.Spearheaded a successful “rapid-analytics” review of ten large medical payment policies, compressing a 3-month review process into 2 weeks by effectively coaching and directing the team.

Greater Atlanta Area

Presented diabetic test analytics (HBA1C) to the CEO and physician board of a major multispecialty medical group account, resulting in a change in their medical policy to increase diabetic screening (HBA1C) testing with LabCorp, worth $208K/month or $2.5 million dollars annually once fully implemented.Developed episodes of care laboratory test analytics for a large OB account using zip code-based and state-based peer comparisons, revealing peer group influenced cost drivers and age/sex stratifications that were negatively impacting their healthcare cost trends. Provided reporting and analytics to demonstrate LabCorp’s data capabilities to the CEO of a major OBGYN physician group, facilitating a successful collaboration with LabCorp sales staff and the CEO to bring additional business to LabCorp worth $200k/month or $2.4 million dollars annually.Partnered with the Clinical Quality Board of a large multi-specialty FQHC client to develop analytics to stratify patients based on HBA1c results into four categories, focusing on the “pre-diabetic” category to identify and engage population health management tools to avert higher “diabetic” category costs.Identified system-wide gender-based and age-based population health issues for a regional ACO account using laboratory test volume analysis and age/sex bracketing compared to state and local peers.Provided analytical leadership and vision by designing and presenting Chronic Kidney Disease and Diabetes lab result analytics that included peer comparisons customizable by zip code, state, and specialty, which were utilized by LabCorp clients to improve patient care.Designed divisional Patient Service Center (PSC) Ideal Site Selection model, projecting potential revenue and ideal street-level PSC site placement based on competitor and hospital locations, consumer spending patterns, traffic/interstate routing, and census demographics.

Atlanta, Georgia

Designed innovative market financial models that identified over $31 million dollars in savings per market and presented this analysis to BCBS market leads, providing insight for savings achievement.Mentored and provided developmental opportunities for the Medical Economics team to be consultants for key healthcare clients and their initiatives.Built strategic market models to predict and measure the return on investment for site of service initiatives, revealing both the ideal procedures and facilities to achieve the highest savings potential.Guided the development of a Facility Bundled Payment model that targets high revenue outpatient procedures while providing unique and substantial physician participation in savings based on quality and efficiency.Consulted as a plaintiff’s key Medical Economics expert witness during a US District Court case for contract procedure cost bundling and implantable device identification where the testimony was used by the jury to successfully rule in favor of the plaintiff.

Atlanta, Georgia

Integrated pricing scenarios for Medicare utilization in selected markets to determine best implantable device pricing strategies across multiple device types i.e., ortho, neuro, etc.Defined implantable device utilization best practices across peer groups for physicians and facilities using comparative statistics and national utilization pattern standards.Directed “deep dive” analyses of medical procedure data to identify aberrant practice patterns of implant utilization and cost while providing specific recommendations for improvements through utilization/practice management and manufacturer contracting adjustments.Presented results of complex informatics and statistical analyses to a broad variety of audiences with varying levels of data and statistics sophistication.Coordinated targeted market analysis of unbundling implants from claims at a CPT level for Healthplans to assist in contract modifications that carve-out the implant from the bundled fee.Directly supported clinical operations with information and analysis to identify opportunities to improve delivery of services and measure effectiveness of programs for Access MediQuip clients.Developed financial models to determine profitability of network facilities based on implantable device utilization, providing detailed analysis at the medical procedure, device manufacturer, and item class level.

Alpharetta, Georgia

Established an “industry first” actuarially validated savings methodology (patent pending) that drove a 200%+ increase in the revenue growth rate for IPG. The model identified savings by site of service and has verified savings of multiple millions of dollars for health plan implant management.Produced a methodology to reclassify missing and miscellaneous HCPCS codes (A4649, L8699, etc) into more appropriate codes based on an extensive cross-referencing tool. The reclassification process unveils additional savings that could accrue to health plans via more accurate coding and focused initiatives. Served as a health plan consultant, providing recommendations for effective implantable device management using industry leading data analysis and initiative implementation. Projects include network conversions from bundled to carve-out payments, site of service facility and procedure identification for implementation, and conversion from CPT/ICD-9 procedure to HCPCS based analytics.Developed an extensive online implant metric reporting package detailing cost and utilization with statistical comparisons to benchmarks. Report details include implant usage by health plan, facility, physician, procedure, HCPCS, and device with outlier analysis and monthly metrics for trending.

Researched and developed methodologies to measure hospital performance for both cost efficiency and quality outcomes (Centers of Excellence Program). Published results on Cigna’s national website to assist members in making informed medical decisions. Trained Medical Directors and contracting staff in the effective use of Centers of Excellence data in contract negotiations and quality discussions with hospitals and multi-specialty groups. Developed methodologies to identify outlier OB/GYNs based on their acuity and c-section rate and used results nationally to educate aberrant physicians.Conducted a study on the relationship between reproductive endocrinologists, the success of implantation, and the occurrence of multiple births.Provided effective analysis and recommendations to large employer groups, improving their disease management outcomes while decreasing their medical expenses.Led staff in national studies to test the difference in cost and average length of stay for data derived from All Payer states Vs Medpar states, incorporating the results into the Centers of Excellence methodology.Authored processes to select PCPs and Specialists for a Specialty Network based on disease outcomes and cost effectiveness, currently used by contracting to identify providers for network inclusion/exclusionPresented as a guest speaker at several national conferences regarding “The Whole is Greater than the Parts: Using Multiple Symmetry products for Optimal Results” (Phoenix, AZ) and “ETGs and Employer Reporting: Health Management ‘News You Can Use’ “ (Las Vegas, NV).Designed employer medical risk trending reports that display retrospective and prospective risk scores, predicting the future illness burden of employees.Achieved NCQA recognition for hospital and physician reporting for all Cigna sites across the nation. Managed a diverse staff of 7 remote and on-site employee.

Developed computer models to forecast regional healthcare utilization and pharmacy budgets for two consecutive years, directly resulting in budget surpluses for both yearsCompleted complex RFP/RFI medical and demographic responses for regional statesImproved HEDIS rates by increasing encounter data capture and establishing region-wide standards for quality and quantityDeveloped comprehensive HEDIS reports to track PCP and medical group data rates which were used to educate physicians Presented reports and analysis-based recommendations by benefit plan for a large employer client resulting in a significant decrease in pharmacy expense - $5.00 PMPM SavingsDevised innovative severity adjustment for a Fee Schedule Tiering Project, helping to generate a $1-$2 PMPM savingsDeveloped targeted medical condition analysis and recommendations for a major medical group, resulting in a $500,000 savings.

Master'S, Health Services Administration

Bachelor'S, Dietetics

High School Diploma