Michael Lutz Email & Phone Number

Delaware City, De, Us

Washington, Dc, Us

Washington, Dc, Us

Washington, Dc, Us

Supported multiple health plans with their corporate strategy to develop new products, geographical service areas, and internal processes in support of sustained membership growth across all lines of business including Medicare, Medicaid, and commercial, including pharmacy benefits programs.Provided technical consulting to Medicare Advantage plans’ Encounter Data Submission (EDS) processes to identify areas improved efficiency and accurate as well as compliance with federal requirements. One plan client indicated that the project directly resulted in an annual increase in revenue of $90M.Provided federal and state health policy analysis to health insurers as well as state and local governments for all Medicare and Medicaid products, including long-term care, pharmacy, and dual-eligible programs. Helped clients formulate their positions and draft comments back to federal and state agencies soliciting input on proposed regulations.Provided guidance to health plans on how new regulations will impact operational business units and provide advice on how best to modify current operations to meet new regulatory demands.Responsible for all Medicare Advantage and Medicaid Managed Care subject matter expertise for the firm’s clients in all business units: health plans, life sciences including pharmacy benefit management relationships, providers, financial services. Provided strategy, contracting, and operational design expertise to plans launching Medicaid Managed Long-Term Supports and Services programs in several states including Pennsylvania and Virginia.Provided network adequacy and optimization expertise across a range of health care programs. Example projects have included assessments of network adequacy requirements across the Medicaid, Medicare Advantage, and health exchanges , pharmaceutical manufactures, and the Blue Cross Blue Shield Association.Served as the firm’s press representative for Medicare Advantage and Medicaid interview requests.

Mclean, Va, Us

• Provide research and policy recommendations to leadership staff at the Centers for Medicare and Medicaid Services (CMS).• Develop policy briefings for the Administrator, her Deputy Administrator/Chief of Staff, and Directors of the Center for Medicare (CM) and the Center for Consumer Information and Insurance Oversight (CCIIO) around current marketplace issues for consideration of future policy priorities.

• Provide consulting support to private health insurers, state and local governments for Medicare and Medicaid products.• Assisting a state agency with planning and design features to restructure their state-wide Medicaid program.• Assessing the dual eligible individual population and providing program design recommendations to a state Medicaid program.• Providing product design and implementation guidance to a Blue Cross Blue Shield plan looking to expand its Medicare Advantage product portfolio through a partnership with a major medical delivery system in its market.

• Responsible for all Health Services operational and strategy projects across six states for multiple Medicare health plans focused on the dual-eligible population.• Provided clinical quality improvement reporting directly to the Boards of Directors for two plans.• Led all activities for multiple projects including specialist referral implementation and readmission reduction strategies (net savings to company projected at $14 million in 2012).• Managed a diverse staff of all levels including a Director, Managers, and line-level staff. Activities under my direct responsibility cover the entire East Region and include: o Clinical Quality Improvement, NCQA accreditation, and SNP Model of Care oversight o Project Management o Health Services Analytics o Health Services Training • Led all Health Services efforts in the launch of a new Medicaid plan in Texas, generating $115 million per year in revenue. Responsibilities include working with external providers and regulators for Texas’ Health and Human Services Commission as well as all internal departments. Directly responsible to the corporate officers and CEO of the company for all activities around the program launch. Responsible for negotiating contracts with vendors and ASO partners.• Led activities associated with the company’s behavioral health insourcing initiative.

Falls Church, Virginia, Us

• Provided consulting support to private health insurers, state and local governments, and industry associations on a wide array of coverage issues from product development, operational efficiency and improvement, and development of programs for uninsured individuals.• Projects for which I served as project manager included assisting: o The Centers for Medicare and Medicaid (CMS) with developing and implementing Medicare Advantage application network criteria requirements, SNP access criteria, and Medicare Advantage application reviews. o A Blues plan with conducting an assessment of efficiency and accuracy of their Medicare Part D PDE process in coordination with their Pharmacy Benefits Manager. o A Pharmacy Benefits Management company’s efforts to develop Medicare Part D functionality. o The turn-around of a major health plan, which was experiencing operational deficiencies that threatened the viability of its state operating license. o The development of a market strategy for a Midwest Medicare plan. o Conducting a feasibility assessment for a plan looking to enter the long-term care insurance market. o An Arizona plan prepare for the state’s upcoming Medicaid procurement including a full gap analysis of the plan’s operational divisions.• Oversaw project management, project design, staffing, and deliverables for projects ranging from $50,000 to $2.25 million.• Conducted frequent business development meetings with existing and potential client executive staffs highlighting the firm’s abilities to bring innovative, value-added approaches to business problems. • Source of Medicare industry and products knowledge for a firm of over 140 consultants. Provided training sessions for all new staff on Medicare and the insurance industry including how each market has developed, how the markets function, and how to structure programs to profitably and efficiently operate.

Philadelphia, Pa, Us

• Assisted with the development of the business case and outlined the operational dependencies for senior executives regarding the launch of a Private Fee for Services product.• Participated as a core team member in a corporate project mapping the product and marketing strategies for the Medicare lines of business for the next 3 to 5 years. This project scope included in-depth market analysis, current and prospective product analysis, and competitor evaluation focusing on return on investment and profitability/operational ability considerations.• Participated in the creation and development of a new business area to implement the launch of Medicare Part D products.• Developed processes and procedures to insure ongoing compliance with Medicare reporting requirements.• Developed and maintained reporting procedures for Government Programs marketing and retention for senior management.

Philadelphia, Pa, Us

• Provided oversight to continuous quality improvement initiatives across the operations division.• Established internal consulting type of organization to review and solve quality, productivity, and efficiency issues. • Oversaw special projects including: process mapping/improvements to call centers; researching a variety of processing issues and fixes; process mapping claims activity from initial submission through adjudication; and associate level improvement plans.• Developed and piloted nine timings studies for claims operations.• Directed the creation and implementation of reports to identify quality and compliance trends and issues.• Contributed to regular meetings with senior management to identify issues and present resolution.

Mba, Risk Management And Insurance

Ba, Economics

Diploma, Advanced Academic