Raghu S. Email & Phone Number

Detroit, Mi, Us

Purchase, Ny, Us

- Developed VBC roadmap (infrastructure, data, EMR, product, and performance management) that is being implemented; Have seen improvement in prod development and customer value story!- Introduced new pricing framework that has helped improve margin for USGH products- Improved RCM function including ability to recapture HCCs and net new HCCs; Improve value story to Health Plans- Improved Chronic Care attainment by pushing for more integrated care and segmenting population to maximize outcomes- Improved overall data governance to ensure integrity of data as part of pathway to risk- Improved Clinical/Quality Measures via focus on closing gaps and introducing new product/clinical features; Also helped with redesign of clinical workflows to act on data capture from HIEs.- Improved VBC Contracting by introducing more data/analytics into the process; Created playbook for pathway to risk----------------------------------------------------------------------------------------------------- In charge of Overall Pricing (Gen Med, P360, CCM, BetterSleep, and MH)- In charge of VBC/Population Health, Strategy/Roadmap, Analytics, VBC Contracting, and Performance- In charge of VBC Contracting and Guidelines across the products including Virtual First Health Plan offerings, Chronic Care offerings, and Mental Health offerings.- In Charge of Risk Adjustment and Quality Gap Closure Strategy- Collaborate with COO, CMO, CFO, CPO, and other key stakeholders to develop new VBC/Population Health offerings/products including whole-person care offerings that provide clinical and financial outcomes- Define the "Value" of different Teladoc Programs including clinical outcomes and cost savings/ROI- Push for VBC components in various efforts (EMR/Clinical Ops, Prod dev, RCM, Clinical Strategy/Model, Data Engineering, and AI)

Detroit, Mi, Us

Board Member

Woburn, Massachusetts, Us

• Consulting for Payors, Providers, MSOs, and Tech organizations to push VBC and Population Health (Eternal Health, North Carolina Community Health Center Association, Harvard MedTec, Toney Healthcare, and many others) • Market Analysis, Financial Analysis, Financial Modeling, CFO Function • Financial Analytics, Clinical Analytics; Program Evaluation and ROI • Path to Risk & VBC Consulting • Care & Practice Transformation and Program Development. • Population Health Consulting • Care Variation Consulting • EMR, Care Workflow, RCM

Seattle, Wa, Us

Client Board Member

New Orleans, Louisiana, Us

-- In charge of Value-Based Care Program Analytics, Medical Economics, Financial Performance, Quality Performance Analytics, Cost of Care & Utilization Analytics, Population Health Analytics, and Advanced Analytics with health system/network/Clinically Integrated Network. This includes all Value-Based Initiatives & Payments Bundled Payments and the performance of all Risk-Based Contracts. This includes any actuarial work needed for Value-Based Care and Pop health-- The team supported all Population Health initiatives and program evaluations. The team developed ML/AI models externally for EMR integration and evaluated the ones that are embedded within the EMR.-- In charge of the Medical Action Planning team that worked with the Chief Population Health Officer and other clinical leaders to find savings opportunities and manage total cost of care trends and performance across risk contracts. -- Worked with CFO to optimize risk scores and improve revenue/margin on MA or MSSP Contracts; Analyze and Look at Financial and overall performance of risk contracts-- Involved and pushed forward the integration of EMRs (Cerner, EPIC) and other data to support value-based care/population health-- VBC Contracting-- Attribution Management-- EMR, Care Workflow, and Care Integration-- RCM, Claims Billing, and HCC Coding

Detroit, Michigan, Us

Sr Healthcare Financial Executive focused on providing actuarial, healthcare/medical economics, financial, and analytics support to Middle Small Group, Large Group, Jumbo group, ASO group, Individual Business Segment, and Senior Markets. The group consisted of accountant/financial analysts, actuarial associates, healthcare/medical economics associates, analytics associates, data scientists, clinicians, and others. Reported under Chief Actuary; Some of the work included the following:* Population Health & Value-Based Care* Healthcare and Medical Economics* Program Eval and Performance * Segment Financials & Performance * Financial Transformation & Governance* Actuarial/Pricing, Renewals & Risk Analytics* Provider Reimbursements* Stop Loss Analytics* Clinical Analysis* Risk Adjustment and Optimization* Trend Mitigation* Advanced Analytics & Data Science

Worked with many clients (Health Integrated, Humana, PSIMedica, Consumer Health Advisors, Toney Healthcare Consulting, Pure Health Back, LifeCare, Ochsner Health System, Scott & White, and many others) on Population Health and Value-Based Care, Market Finance, CFO Function, Financial Analytics, Segment Financials & Performance Finance Analytics, Financial Transformation & Governance, Actuarial/Pricing & Risk Analytics,Healthcare and Medical Economics, Cost of Care Analytics, Provider Reimbursements, Hospital Contracting & Provider Network, Stop Loss Analytics, Clinical Analysis, Risk Adjustment D&A (Risk Optimization), Trend Mitigation, and Data Mining/ Data Analytics/Data Science

Louisville, Kentucky, Us

Sr. Healthcare Executive focused on finance, actuarial, and clinical support to corporate as well as markets. Reported dotted line to CFO & Chief Actuary; Areas of focus included:* Trend Mitigation, Financial Performance across products/segments* Healthcare & Medical Economics* Program Eval and Performance* Actuarial and Underwriting* Care Management, Disease Management, & Population Health* MA Pricing, Risk Optimization* Hospital Contracting and Network Development* Marketing Research and Analytics

Sr Healthcare/Finance Executive focused on supporting informatics, analytics, and financial performance to the enterprise; In Charge of all analytics to support Clinical and Financial Performance; Reported to CFO* Pricing, IBNR, and other actuarial functions* Underwriting, Renewals, and Sales Analytics * Hospital Contracting & Provider Networks* Cost & Utilization (Trend Mitigation)* Care Management, Disease Management* Program Eval and Performance* Fraud & Abuse* HEDIS/Quality Metrics * New Product Development/Pricing

Healthcare/Finance Executive focused on helping healthcare clients with financial, managed care, and other value-added services; Worked with BJC Healthcare, SSM Health, HSHS Health System, & Anthem/HealthlinkQuality Management and Patient Safety - AHRA Grant, focusing on Quality Metrics and SurveillanceFinancial Performance Management - Managed Care Contracts and PerformanceMarket Analysis - Market studies on Clinics, Lab, and other venturesFinancial Reporting and AnalyticsFinance and Medical EconomicsAnalytics/Data Science -Statistical Analysis and Predicting ER visits and IP admits (Care management)Provider and Member Engagement

Masters In Health Administration, Finance, Econonomics, And Epidemiology

Masters In Business Administration, Finance, Economics, And Mis

Bachelors, Chemistry, And Mathematics

High School, Mathematics, Chemistry

Paws Certificate, Anatomy And Physiology

Education record