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Michael Baxley, MS, MD, MPH has over 45 years of experience in a wide variety of corporate, health industry, military and government program settings, as well as residency training with board certification in Occupational and Environmental Medicine, certification in medical coding and Master's Degrees in Biology (Teratology) and Public Health. His chief interests and individualized goals throughout his career have been tailored specifically to the evolutions, industries or situations in which he was involved. However at the core of these endeavors has been finding and taking lead on the best solutions for maintaining the productivity, the quality and statistical quantification of delivery of promise, product and process, as well as the health, wellness, and well being of their constituencies. Additionally, he has focused on ensuring the development and edification of the owners, leaders, intermediaries and purveyors of such in business, provider groups and health care plans. Dr. Baxley has authored, managed, provided training and fostered programs addressing the numerous changes, challenges and issues faced by employers, employees, the health care industry and physicians and ancillary providers.Experiences/Specialties: Occupational and Environmental Health, Medicare Risk Adjustment, Medical Coding, Health Analytics, Clinical Informatics, Population Health assessment and maintenance, Preventive Medicine, Military Medicine, and Increasing Health and Productivity, while minimizing disability and unnecessary and avoidable health care costs.Consultative Competencies: Providing informatics, compliance, risk adjustment, utilization management, medical coding expertise and innovative services and process solutions for health plans, medical service organizations, physician practices, and health care entities.
Value Based Md Solutions
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Healthcare ConsultantValue Based Md Solutions Nov 2021 - PresentProviding informatics, compliance, risk adjustment, coding expertise and innovative services and process solutions for health plans, medical service organizations, physician practices, and health care entities.
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Medical Director | MedicareHumana Oct 2019 - Dec 2021Louisville, Kentucky, UsHumana Inc., headquartered in Louisville, Ky., is committed to helping their millions of medical and specialty members achieve their best health. Their successful history in care delivery and health plan administration is helping create a new kind of integrated care with the power to improve health and well-being and lower costs. Humana’s efforts are leading to a better quality of life for people with Medicare, families, individuals, military service personnel, and communities at large.To accomplish that, Humana supports physicians and other health care professionals as they work to deliver the right care in the right place for their patients, the Humana members. With a range of clinical capabilities, resources and tools – such as in-home care, behavioral health, pharmacy services, data analytics and wellness solutions – combines to produce a simplified experience that makes health care easier to navigate and more effective. -
Healthcare Consultant And AuthorMichael Baxley, Consultant Jun 2019 - Oct 2019Dr. Baxley is a consultant, author, instructor, publisher and coach These services were originally established to provide consultative solutions for maintaining the health, productivity, and wellness for the individual, their life, the environment and even business management in the workplace. Due to the unique broad areas of our work lives and interaction with the environment the occupational and environmental discipline requires, it allows both individual and population based approaches to both care and prevention. In fact, this field of medicine was the original population health and pervasive approach to medical management, now gaining favor and traction in managed care of the non-occupational Medicare, Medicaid and commercial medical lives. By nature, every intervention in this approach can be unique and tailored to individual or corporate needs, yet always promotes the health, well-being, safety and productivity of the population, the workplaces and its leaders and its people. Dr. Baxley now by choice and avocation promotes himself as a writer, self-publisher and a self-designated intermediary and interpreter between the science and rigors of a discipline or concept, the influences of the surroundings and its effect on those in its domain.
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Chief Clinical Informatics Officer | Associate Chief Medical OfficerConviva Care Solutions Apr 2018 - Jun 2019Miami, Florida, UsDuring the critical first year of a new model delivery system, Dr. Baxley's adoption of a broader, systemically impactful role of Chief Clinical Informatics Officer allowed him creativity and scope within the information systems, while providing ongoing and ad hoc informatics assistance to utilization management, compliance, pharmacy, population health, data integrity, communications and physician group processes. He navigated the clinical integration of three electronic medical records in multiple configurations, with access to all platforms and instances, utilizing direct organizational skills, and clinical and informatics contributions in key enterprise initiatives in multiple areas - compliance, operational, clinical and pharmacy, physician group and operational committees. As new administrative positions, processes, and focus groups established with these efforts, Dr. Baxley, shifted energies into clinical information support for them, supporting Conviva's value proposition. Accomplishments during this rapid growth tenure included but were not limited to:Development of CME educational program, audit oversight, newsletter articles and resources for Opioid statutes compliance Clinical informatics configuration and SME for first transitioning EMR in ConvivaPoint of Contact and collaboration for Conviva process configurations with legacy EMR’s programmersFacilitating health plan co-located pharmacy EMR access by clinical pharmacistsClinical Informatics support for Population Health, Chronic Conditions, preventative vaccinations with development of EMR templates and work flows Collaboration, clinical leadership and EMR improvement activities in data integrity processes effecting all EMR platformsEMR Configurations and informatics, deployment, and on-site educational provider support for initial point of care program and chronic condition – focusing on physician led clinical integration, follow up and outcome integrity -
Chief Medical And Compliance OfficerOne Homecare Solutions Oct 2014 - Apr 2018Miramar, Fl, UsIn addition to formal medical director and regulatory oversight roles for this integrated home health, DME, and Pharmacy/Infusion delivery model, Dr. Baxley's varied proficiencies and leadership in the inaugural phases and since produced de novo accomplishments and sustained legacy practices, processes and capabilities which include but are not limited to: Policy and Procedure (P &P) development in credentialing evolutions, health and safety, privacy, information technology security, disaster planning and business continuity, and customer service/call center; A clinical integrity team providing QA, informatics tracking, a successful managed care delegation, second level review processes, a comprehensive written approval notification process and health plans liaison activity; a corporate compliance and privacy office with efficient prompt risk management response, Medicare, Medicaid, and regulatory training oversight, and a secure and detail rich medical records/legal query information management process and response with electronic warehouse security; Development of and maintenance of a comprehensive SharePoint reference database with P & P, Request for Proposal information, utilization management, compliance and training resources; Informatics tools many of which have been incorporated into the proprietary OneCare order management system, and also into various sustained analytical databases germane to the delegation and/or operational processes; and process flow guides/programs and templates/documents for routine and unique or critical client engagement opportunities as such as specialized programs, Hospice, Transitions of Care, and Health Plan mediated process/outcome expectations. Finally, Dr. Baxley provided creative consultation/support to all the levels and departments of the enterprise vis-à-vis utilization management, medico-legal, occupational health, ergonomics, workers compensation, OSHA, infection control and risk management issues. -
Healthcare ConsultantMichael Baxley, Consultant Oct 2014 - Dec 2014Occupational, Environmental, Health and Innovative Work Solutions for Enterprise and its employees
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Chief Of Quality Medical InitiativesMcci Group Holdings, Llc Jun 2012 - Oct 2014MCCI provides & coordinates accountable medical care for over 105,000 patients in multiple markets across 3 states through more than 50 wholly owned centers nearly 200 provider employees, and in excess of 115 affiliated practices. Its core business of Medicare has delivered superior patient centered services for over 27 years in the South Florida market. Moreover, this high touch model of care utilizing innovative programs, integrated care coordination and Primary Care driven, team approach ensures proven capabilities across a wide range of platforms and emerging opportunities
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Founder And Principal In Healthcare Consultation ServicesMichael Baxley, Consultant Apr 2011 - Jun 2012Occupational, Environmental, Health and Innovative Work Solutions for Enterprise and its employees. Areas of expertise and services provided include but are not limited to: * Training and Presentations on Health Care Legislation, Medicare Risk Advantage (MRA), Medical Record Integrity, Practice Efficiency and productivity enhancements* Development and deployment of Occupational Health Programs in non health care corporate environments, individual clinics or hospital based settings * Medical Record, Policy and Procedure, MRA/HCC processes reviews, recommendations and improvements* Development and deployment of ergonomics, health promotion and safety processes and programs * Review, insight and enhancement of reporting, analytics and subsequent management around health care, occupational and environmental and health related costs and issues* Customized interpretation, review, preparation and/or delivery of summaries, presentations, assessment instruments, written reports and media releases
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Physician Planner/Faculty AdvisorPrime Education, Inc. (Prime) 2004 - 2012New York, Ny, UsReview, planning, development, and presentation of CME programs and publications -
Vp Healthcare AnalyticsWellcare Health Plans, Inc. Aug 2010 - Apr 2011Tampa, Florida, Us* Medicare Risk Adjustment education, interpretation and promulgation * Prospective and Retrospective Medicare Risk Adjustment coding and clinical analytics* HealthCare Analytics development, monitoring, and utilization * Health Risk modeling and Predictive Analysis* Assessment, development, and promulgation of physician, ancillary and facility performance metrics* Vendor and Ancillary Contracting Health Cost/Benefit Analysis* Prior Authorization, Claims and HealthCare Delivery Models coding and utilization analysis -
Medical Director, FloridaWellcare Health Plans, Inc. Aug 2009 - Aug 2010Tampa, Florida, Us
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Senior Market Medical ExecutiveCigna Healthcare Apr 2007 - May 2009Bloomfield, Ct, UsMarketing, Network, and Medical Management -
Chief Medical Officer, Florida MedicaidUnitedhealthcare 2005 - 2007Us -
Regional Medical Director Midwest Region MedicaidUnitedhealthcare 2005 - 2006Us
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Managing Medical DirectorBlue Cross Blue Shield Of Florida 2000 - 2005Jacksonville, Florida, Us -
Medical Director Ne FloridaAetna 1999 - 2000Hartford, Connecticut, Us -
Medical Director Ne FlPrudential Healthcare 1998 - 2000Us -
Company Care Regional Medical DirectorHca 1995 - 1998Nashville, Tn, Us -
Medical Director Occupational Health ProgramsSharon Regional Health System 1993 - 1995
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LcdrUs Navy 1982 - 1993Washington, Dc, UsLeadership Positions: Naval Medical Clinics, Diving and Submarine Medicine; Occupational Medicine: Disaster, Hazardous Waste, NBC Operations; Congressional Inquiries; Navy Environmental Health Center
Michael Baxley Skills
Michael Baxley Education Details
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University Of PittsburghMph -
University Of PittsburghOccupational And Environmental Medicine
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University Of South AlabamaMedicine
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The University Of AlabamaBiology (Teratology)
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The University Of AlabamaEnglish
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Carroll College
Frequently Asked Questions about Michael Baxley
What company does Michael Baxley work for?
Michael Baxley works for Value Based Md Solutions
What is Michael Baxley's role at the current company?
Michael Baxley's current role is Healthcare Consultant.
What is Michael Baxley's email address?
Michael Baxley's email address is mb****@****mac.com
What is Michael Baxley's direct phone number?
Michael Baxley's direct phone number is +130579*****
What schools did Michael Baxley attend?
Michael Baxley attended University Of Pittsburgh, University Of Pittsburgh, University Of South Alabama, The University Of Alabama, The University Of Alabama, Carroll College.
What are some of Michael Baxley's interests?
Michael Baxley has interest in Occupational And Environmental Health, Children, Economic Empowerment, Performance Analytics, Environment, Ergonomics, Science And Technology, Risk Profiling, Human Rights, Predictive Modeling.
What skills is Michael Baxley known for?
Michael Baxley has skills like Healthcare, Medicare, Managed Care, Public Health, Hospitals, Healthcare Management, Medical Coding, Medicaid, Healthcare Industry, Health Policy, Medical Education, Healthcare Information Technology.
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