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A former health plan President & CEO in a Fortune 500 environment, Mike has more than 20 years’ experience in the highly complex Massachusetts healthcare system.Having held Senior Management positions at CeltiCare Healthplan of Massachusetts, Partners Healthcare System, Blue Cross Blue Shield of Massachusetts, and Healthsource, Inc., Mike has seen the inner workings of the healthcare system from a variety of different views, including both the Payer and Provider perspectives.Services• Healthplan and Provider Organization strategic planning and business development • Network development design, negotiation and strategy• Implementation of Accountable Care Organizations • Revenue cycle management• Experienced with payment reform and varied reimbursement models, capitation, risk sharing, bundled payments, fee for service • Dispute resolution
Kirby Healthcare Consultants Llc
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Principal At Kirby Healthcare Consultants, LlcKirby Healthcare Consultants Llc Jan 2022 - PresentMassachusetts, United States
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Chief Network OfficerBeacon Health Options Jul 2020 - Nov 2022Boston, Massachusetts, United States -
Vice President Of Managed CareUniversity Of Chicago Medical Center Jan 2019 - Jul 2020Chicago, IlResponsible for all Managed Care activities for the University of Chicago Medicine ("UCM"). UCM is comprised of both the University of Chicago Medical Center ("UCMC") and the Faculty Practice of the Biological Sciences Division ("BSD"). Responsibilities also include accountability for Managed Care activities for the University of Chicago Medical Center Care Network Affiliated Physicians ("UCMCCNAP").
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PrincipalKirby & Associates Healthcare Consultants, Llc Mar 2014 - Dec 2018Greater Boston AreaProvided healthcare consulting services for a variety of healthcare clients on both the Provider and Payer sides. Significant engagements included serving as Executive Director of the Boston Medical Center Accountable Care Organization ("BACO"). In that capacity had managerial responsibility for all Managed Care functions of the enterprise including Contracting and Care Management activities. Other significant clients included providing strategic Contracting services for Harvard Pilgrim Healthcare ("HPHC"), a leading New England based Managed Care organization as well as various Contracting related services for Steward Health Care system ("Steward"), a Boston based Healthcare organization.
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Chief Executive Officer And Plan PresidentCelticare Health Plan 2011 - 2013Boston MaResponsible for all aspects of the management and operations of the health plan. Full accountability for establishing strategic growth plan, including planned expansions into new market segments and products in a highly competitive and established marketplace. Full accountability for plan financial performance including revenue, medical and administrative expense. Responsible for managing in a matrix environment where certain functions are managed on a centralized corporate basis with the resulting corporate dependencies. Primary plan liaison with both regulatory authorities and legislators.
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Corporate DirectorPartners Healthcare 2005 - 2011Boston MaResponsible for the provision of timely and accurate financial reporting and analysis in support of the revenue budgeting and payer contracting processes for the largest integrated delivery system in New England; including two academic medical centers, six community hospitals, numerous sub acute providers and over 5,000 physicians in both academic and community settings.• Designed and implemented service line pricing changes in all major insurance contracts across consolidated healthcare delivery system. Changes re-allocated over $40 million in annual revenue from higher margin services to lower margin services. Resulting changes significantly reduced system level product mix risk exposure.• Serve as primary financial resource with respect to rate and payer mix information • Development and implementation of detailed hospital pricing model
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Director Provider Financial ManagementBlue Cross Blue Shield Of Massachusetts 1997 - 2004
Mike Kirby Skills
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Frequently Asked Questions about Mike Kirby
What company does Mike Kirby work for?
Mike Kirby works for Kirby Healthcare Consultants Llc
What is Mike Kirby's role at the current company?
Mike Kirby's current role is Principal at Kirby Healthcare Consultants, LLC.
What is Mike Kirby's email address?
Mike Kirby's email address is mi****@****als.edu
What is Mike Kirby's direct phone number?
Mike Kirby's direct phone number is +197877*****
What schools did Mike Kirby attend?
Mike Kirby attended University Of Vermont.
What are some of Mike Kirby's interests?
Mike Kirby has interest in Football, Collecting Antiques, Exercise, Home Improvement, Shooting, Reading, Gourmet Cooking, Sports, Watching Basketball, The Arts.
What skills is Mike Kirby known for?
Mike Kirby has skills like Healthcare, Management, Strategic Planning, Hospitals, Business Development, Budgets, Executive Management, Revenue Cycle, Finance, Negotiation, Physicians, Pricing.
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Mike Kirby
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Mike Kirby
Technology Leader | It Transformations | Results-Driven | Team Empowerment | Financial Services | Contact Center Technology | Risk Technology | Program Management | PmpPhoenix, Az1unionbank.com -
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