I provide subject-matter expertise to the federal client, Medicare Quality Payment Program (QPP) Service Center representatives, and clinicians related to Merit-Based Incentive Payment System (MIPS) policy and implementation, specializing in the Cost Performance Category and Advanced Alternative Payment Models subject areas. Additionally, I develop widely-distributed deliverables such as fact sheets and supplemental policy guides used to educate eligible clinicians on complex topics such as MIPS payment adjustments, eligibility determination processes, implications of participation threshold calculations, available data submission methods, and measures assessing beneficiary per capita and episode-based resource use.Further, I contribute to executive leadership strategic planning efforts to ensure contract success and influence current and future direction of $34.8M QPP MIPS Customer & Program Support Services Task Order supporting CMS’s Office of Clinical Standards & Quality. Through working directly with federal partners and impacted providers, I consistently propose and execute innovative approaches to public-facing CMS education and outreach efforts based on human-centered design and rapid-cycle PDSA principles.

As co-lead, I managed the design, implementation, planning, and day-to-day operations of the Next Generation ACO Model, a nationwide alternate payment arrangement and delivery system reform initiative. The model tests whether strong financial incentives for ACOs; refined benchmarking methods rewarding quality performance and improvements in cost containment; and the use of tools to enhance beneficiary engagement can achieve goals of improved health outcomes and reduced expenditures for Medicare beneficiaries. In this role, I provided technical assistance and expertise to ACO leadership, participating providers and other stakeholders on a wide range of topics including model benchmarking and beneficiary alignment methodologies; provider network management; and interpretation of CMS-provided claims data and financial performance reports. I also delivered oral and written briefings to CMS leadership and oversaw work streams to ensure successful completion of model milestones while identifying potential risks and employing mitigation strategies.

I developed and monitored model operations policies and procedures impacting 83k providers and 1.3M Medicare beneficiaries. As operations lead, I translated complex model test requirements to stakeholders and authored hundreds of responses to inquiries through the creation of individualized written guidance, national webinars, and open- door forums. In addition, I oversaw the production, distribution, and education and outreach activities associated with providing data to ACOs for care coordination efforts, financial performance tracking, and population management. As model policy advisor and business owner for the ACO Operating System, I advised technical contract staff and developers on desired functionality; identified and analyzed downstream impacts of system changes, and translated model policy needs into additional system capabilities.

In close collaboration with contract staff, I developed the monitoring and compliance strategy to enhance compliance with the terms of the model participation agreement. Further, I finalized and oversaw the execution of compliance activities including initial readiness reviews, the development of an annual comprehensive audit guide and issuance of requests for corrective action plans on behalf of the agency in response to identified instances of non-compliance.

I served as a Project Officer with the State Innovation Models (SIM) Initiative, a $1 billion program testing the ability of state governments to utilize policy and regulatory levers to accelerate statewide health care transformation. I advised West Virginia, New Mexico, Iowa and Connecticut on the development and implementation of a State Health Care Innovation Plan and provided direct support to state health officials and staff.

Managed the release of the SIM Round 2 Funding Opportunity Announcement and organized subsequent negotiations with state applicants, resulting in the successful administration of over $622M to 11 Round Two Model Test Cooperative Agreements awardees.

As a paralegal specialist I developed written approval and denial decisions on claims filed under the Radiation Exposure Compensation Act (RECA). Ι managed a caseload of over 200 pending claims and adjudicated over 800 total claims for compensation. I also conducted tailored outreach to the Navajo Nation and Spokane Tribe of Indians and briefed program leadership on program status and outreach strategies.