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Senior executive and licensed attorney with proven track record in managed care. Successful in creating, communicating and implementing strategies that delivered growth and profits while extending excellence in service to customers and communities. Collaborative and team-oriented leader.STRATEGIC THOUGHT LEADERSHIP• Population Health• Fee-for-Value Transformation• Quality | Cost PerformanceRELATIONSHIPS & PARTNERSHIPS• Team Leadership• Provider Networks & Alliances• Customer RelationshipsNEW PAYMENT & DELIVERY MODELS• PCMHs• High Performance Networks• Bundled Payment Models
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Market President - OhioDevoted Health May 2019 - PresentWaltham, Ma, Us -
PrincipalValue Health Consulting, Llc 2017 - May 2019Principal consultant advising and serving healthcare providers, payers, suppliers, and others in strategic and operational initiatives. Services include business development, growth planning, effective messaging, partnership alignment, and strategic planning and implementation. Representative clients include healthcare systems, post-acute care providers, wellness companies, data & analytics service providers, and physician groups. For more information, please contact me through LinkedIn or email at richard.waldron77@gmail.com.
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Senior Vice President, Provider Engagement DivisionMedical Mutual 2013 - 2017Cleveland, Ohio , UsCollaborated with CEO to develop strategy for companywide transformation from a transactional orientation toward value delivery and population health. Established and led a new division of 70 employees with responsibility for provider networks and new payment models. Drove strategic direction from fee-for-service model to fee-for-value including new contracting, analytic and metric frameworks, and data-sharing with provider partners.• Provided vision for new Provider Engagement Division, setting tone for transformation to Population Health and Fee-for-Value. Built, focused and energized team for success.• Member of State of Ohio’s State Innovation Model (SIM) core team that created a model for rapid expansion of the Patient Centered Medical Home (PCMH) concept and developed a set of care episodes along with associated reporting and potential reimbursement approaches. • Led network portion of re-entry into Medicare Advantage enrolling over 15,000 new Medicare Advantage members in the first year, exceeding goal by 50%. • Developed strategic partnership with a major health system that resulted in an acquisition of 100,000 new members for Medical Mutual. • Secured a long-term renewal with single largest customer by implementing a Catalyst for Payment Reform strategy leading to benefits, systems and program changes including a reference pricing approach to laboratory services. • Developed and implemented a “middle ground” telemedicine strategy focusing on existing network relationships vs. vendor driven platforms. The resulting strategy has achieved cost objectives, restrained over-utilization of services, and met customer demand. • Created and implemented narrow network strategy tied to HMO products for ACA business, now being expanded to additional market segments. -
Vice President, Network Management, South RegionMedical Mutual 2009 - 2013Cleveland, Ohio , UsPromoted to lead integration of First Medical Network into Medical Mutual. In 2010, assumed additional responsibility of the South Carolina (Carolina Care Plan) network. Led staff totaling 35.• Reversed annual losses exceeding $5 million, achieving profits in 2011 and 2012 (pretax profits of $2.8 million in 2012) through network-based strategies (narrow network HMO products, alliance with multi-provider organizations, strategic negotiations).• Grew discount by 58%, membership by 200%+ and revenues by 220%.• Integrated staff from 2 separate companies and created a high performing team for the South Region.
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Director, Network ManagementMedical Mutual 2006 - 2009Cleveland, Ohio , UsRegional responsibility for the network in company’s most profitable and largest markets (Cleveland and Akron), accounting for 70% of the company’s $2+ billion in reimbursement with a staff of 15.• Grew discount by 7% and consistently achieved objectives of competitive advantage and loss ratio success.• Directed the modernization of the company’s reimbursement processes including introduction of real-time claim adjudication and transparency tools.• Successfully led the network activities in the development of a Medicare Advantage product including representing Medical Mutual during the CMS site review.
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Director, Institutional & Ancillary ContractingMedical Mutual 2002 - 2006Cleveland, Ohio , UsDirected a provider facing team of up to 15 people responsible for contract negotiation and administration, relationship management, and financial objectives. Managed 1000+ providers across Ohio with over $1B in annual reimbursement.• Expanded use of fixed reimbursement contracts, particularly in the outpatient setting. • Hired and trained a new staff and managed the transition to a more nuanced contracting approach.• Developed innovative charge increase neutralization contract protections and audit functions that recovered $2M to $3M annually.• Developed vison for and implemented automated financial modeling to analyze contracts.
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Director Legal DepartmentMedical Mutual 1989 - 2002Cleveland, Ohio , Us• Played a key role in re-establishing the company as it left the Blue Cross & Blue Shield Association and became an independent mutual company. • Advised the institutional and professional provider contracting teams and served on committees such as credentialing and risk management. • Originally hired from a private law firm to come in-house, handling a variety of legal matters.
Richard Waldron Skills
Richard Waldron Education Details
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The Ohio State University Moritz College Of LawLaw -
Ohio UniversityOrganizational Communication
Frequently Asked Questions about Richard Waldron
What company does Richard Waldron work for?
Richard Waldron works for Devoted Health
What is Richard Waldron's role at the current company?
Richard Waldron's current role is Devoted Health - Ohio.
What is Richard Waldron's email address?
Richard Waldron's email address is ri****@****ual.com
What is Richard Waldron's direct phone number?
Richard Waldron's direct phone number is (216)-687*****
What schools did Richard Waldron attend?
Richard Waldron attended The Ohio State University Moritz College Of Law, Ohio University.
What skills is Richard Waldron known for?
Richard Waldron has skills like Health Insurance, Provider Relations, Managed Care, Medicare, Insurance, Hipaa, Hmo, Ppo, Network Development, Healthcare, Claim, Medicaid.
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