Managing Principal Consultant with executive level expertise leading business development, start-up operations, turnaround opportunities within the healthcare industry. This role allows me to provide strategic and operational expertise within the managed care and hospital/provider sectors.Collaboration with key investors of a healthcare organization on business development and go-to-market strategies. Key investors for this group include the owner of Yeti and Schwinn Bike, NBAs Chris Paul of the Phoenix Suns and Kevin Love of the Miami Heat.Accountable for [all] start-up operations for a medical practice - Head-to-Toe Pediatric Therapy - in the Dallas, TX market. These activities include, real estate, marketing/brand development, proforma, finance, investor relations, public relations and credentialing/payer contracting.Designing strategy solutions for a scholarship foundation to achieve maximum donations/gifts from individual to corporate sponsors to support underprivileged students.Working jointly on business development opportunities with a former Dallas Cowboy during the Tom Landry and Roger Staubach era in the Healthcare Information Technology space.Delivered a keynote address for a payer-provider conference in Chicago, IL to communicate the importance of value-based/alternative payment models (APM), the Institute of Healthcare (IHI) Triple Aim (quintuplet) and CMS requirements for Accountable Care Relationships by 2030.Guiding a Behavioral Health and Substance Use Disorder digital platform organization to improve community tenure and compliance with business development, market presence, product development and legislative strategies.Adjunct Faculty at Graceland University for their Masters of Public Health to educate students on business management, marketing, reimbursement/payment models and legislative strategies.

Direct oversight for the health plans $1.2B P&L and ~248,000 member lives. Commitments to the Board of Directors and Parent Organization:Lead a business operating model and cultural transformation.Ensure viability and sustainability for long-term success.Serve more of the community (Medicare, ACA, and Commercial products).To be the plan of choice for our members, providers, community stakeholders, and legislators.Developed the framework and culture for the organization – vision/mission statements, core values, branding/re-branding, organizational structure, alternative payment models (APMs)/pay-for-performance (P4P), and business operating platform.Provided overall leadership and consultation to the healthcare delivery system, governance, and political environment (US and State legislators, to include Congress, Senate & House) about industry trends and overall community benefit – based on product offerings.Building unique organizational structures, both internal and external, to support financial needs, community investment, and legislative protection.Achieved strategic alignment, profitability, and sustainable membership & revenue growth. We accomplished the following:Prior to my arrival, the organization experienced $68M in losses (2015-2019); our first three years the organization netted more than $101M in profits.Net Position/Net Worth increased by 141% ($61M to $163.4M).Net Revenue increased by 43% ($640M to $1.2B).Membership increased by 33% (161K to 248K).Increased Market Share by 6.4%.Investment into the Community – $ 4.1M.Recognized for these accomplished in 2022 in this article: The 10 Most Inspiring People in Healthcare Industry, 2022.

Oversight of the organization's business and market development for new and existing markets. This included but was not limited to Medicaid and Medicare Advantage opportunities. Responsible for successfully growing the organization's business footprint geographically by expanding into new states and organically into new regions or products. Developed a three-prong approach for business development opportunities: Expansion of our geographic footprint identified and evaluated/analyzed for appropriate fit with the organization’s growth and profitability goals. Leveraging processes, care approaches, and staff skills to serve additional populations. Identify internal core capabilities that can be packaged as products or services (i.e., Community Care Management, Risk Stratification/analytics) that the organization can market to other health plans via a vendor arrangement. Accountable for overseeing the business development teams’ activities for market opportunities in KY, OH, ND, MI, AL, FL, and VA and existing markets in PA, DE, and WV. Developed a strong working relationship with key market leadership, including, but not limited to, the governor’s staff, policymakers, legislators, DHHS, provider trade associations, coalitions, providers, and community-based organizations. Worked collaboratively with our contract lobbyist to develop healthcare policies to position the organization for future business opportunities. Identify potential strategic partnerships, joint ventures, and potential acquisitions to support growth opportunities.

Direct oversight for the plan's $600M P&L and ~265,000 member lives. The cost of care strategies and APMs incorporated had the plan consistently operating with a medical loss ratio (MLR) of 75 – 78% and value-based provider contracts greater than 40% (based on total healthcare spend). Responsible for turning around a $10-$15M annual plan net loss (MLR of 104%) into a $22M net profit during our first year. Accountable for leading the growth and development of the health plan as the State of Nebraska moved to an integrated healthcare delivery model (physical, behavioral, pharmacy).  Developed and maintained vital partnerships with state government offices, provider communities, community-based organizations, and other relevant business enterprises. Facilitated statewide collaboratives and supported key stakeholders for policy reform/legislative bills, lobbying, value-based purchasing, telehealth, and population health. Developed marketing and branding strategies to engage the public, create a forum for healthcare discussion with identified community leaders, and community outreach and support. Collaborated with a six (6) station radio house to develop a bi-weekly 8–10-minute talk show as well as on-air sponsorship/advertisement spots; Collaboration w/Yahoo Sports Radio & Pandora Radio; Collaboration with the University of Nebraska, Creighton University, and Nebraska Wesleyan University to establish programs to benefit the student learning experiences.

Developed the foundation and infrastructure for a provider-owned managed care organization. The short-term objective was to be a viable Medicare Advantage and Medicaid managed care organization, with long-term objectives to participate in Commercial, Third-Party Administrator (TPA) and participation in the Exchange. Developed the framework and culture for the organization – vision/mission statements, core values, branding, organizational structure, alternative payment models (APMs)/pay-for-performance (P4P), and business operating platform. Transformed the care delivery payment model to include, but not limited to, gain share/pay-for-performance, and an accountable care delivery model. Under Governor Kasich’s Department of Health Transformation and Department of Health, I served on the Ohio Patient Center Medical Home Collaborative.

Accountable for the overall operations of the organization, including, but not limited to, operational efficiencies, P&L, network development, provider relations, credentialing, member services, claims, configuration, provider data management, grievance & appeals, and regulatory compliance. Accountable for all phases of “new” business development (i.e., adding new service lines), expansion planning (“new” regions), and business integration. Designed appropriate operational systems/controls to identify and mitigate the principal business, financial, compliance, and other risks facing the managed care organization.  Worked collaboratively with key hospitals, health systems, physician groups, and ancillary providers in contract negotiations in existing and new markets.

Provided leadership, direction, and guidance to the organization's physician-owned and multi-specialty practices and the system-wide performance improvement programs. This included more than 650 employed physicians and 100 healthcare delivery entities (including 32 acute care hospitals). This position had accountability – on behalf of the health system – for developing and implementing APMs/P4P contracts w/payers, improving productivity standards, and creating an environment of enhanced quality and patient safety outcomes.As part of this role, I had the opportunity to serve on faculties and present numerous papers (nationally and abroad), including (but not limited to) the Institute for Healthcare Improvement (IHI), British Medical Journal (BMJ), National Association for Healthcare Quality (NAHQ) and American Hospital Quality Association (AHQA). This provided the opportunity to collaborate with numerous organizations (including the Ministry of Health – Singapore, the National Institute of Public Health of the Czech Republic, Johns Hopkins Hospital System, and Dana-Farber Cancer Institute) to improve quality using technology.

Responsible for leading our analytics and consulting team pertaining to all tracking, trending and reporting for our clients (i.e. PepsiCo Bottling, Nestle, Cintas) cost and utilization for their employee sponsored benefit programs. From the information presented, we would advise our clients on premium rate setting, benefit design, and health/wellness programs.

Director, Cost of Care (1994-1996)Developed and implemented the first Cost of Care system for the medical center. These strategies reduced overall cost and utilization of services. The program reduced total expenditures (by 22% annually).Surgical Technician (1987-1994)Accountable to provide surgical assistance for all inpatient and outpatient surgical procedures. These surgical procedures include the following sub-specialties: general surgery, urology, OB/GYN, plastics, eyes, orthopedics, neurology, thoracic, transplants and traumas.

Accountable as the first or second assistant for all inpatient and outpatient surgical procedures. These surgical procedures include the following sub-specialties: general, urology, OB/GYN, and plastics. This position also allowed me to serve as the department’s analytical lead.