Stephen Tonguis, Mba, Mhs, Cssbb, Safe, Cphq Email & Phone Number

Little Rock, Ar, Us

Little Rock Metropolitan Area

I support the development of a new CCWIS Child Welfare system for Arkansas DHS. As part of the Independent Verification and Validation (IV&V) team, I oversee the roles, responsibilities, tasks, and outputs of those responsible for developing the new CCWIS system requirements. This includes providing oversight of the State's PMO in this role. As a lead analyst and writer, I produce a comprehensive monthly assessment report on system integrator activities across various domains. My work involves analyzing and evaluating system security, OCM and training, maintenance and operations, quality assurance, go-live preparedness, change management, project management, risk and issues, requirements management, design and development, architecture and environments, interfaces, reporting, data management, system integration testing, user acceptance testing, and non-functional testing. I ensure that my assessments comply with I-EEE standards and provide actionable insights to help improve the organization's overall performance. The output from my work improves project outcomes, and the audience is the Arkansas Department of Human Services and the Federal Administration of Children and Families.

Little Rock Metropolitan Area

During the beginning of the COVID-19 outbreak, I was tasked with creating thorough business models that considered geography and socio-economic factors. The objective was to determine the most effective and equitable strategy for distributing vaccines throughout the state when they became available. This involved analyzing factors such as population density, healthcare infrastructure, and demographic data to ensure the vaccines were allocated to the communities and individuals most in need. It was a challenging but essential task, and I am proud to have played a part in the effort to combat the pandemic. I reported directly to the Head of Epidemiology for the Control of Infectious Disease Outbreaks.

3107 Oak Creek Drive | Suite 200 | Austin, Tx 78727-3107

As a CPC+ Regional Cluster Lead, I oversaw the deployment of regional learning activities for primary care practices in the TMF network. These practices served in CMS Quality Payment Programs and as Health IT Liaisons for the Regional Learning Network. I innovated and delivered a curriculum compliant with CMS standards across the AR, OK, KC, TN, and LA markets. I provided technical/educational support, one-on-one training, and WebEx/conference-style seminars to 500 practices, 3,000 medical providers, and participants of Medicare CPC+ to ensure operational success. I also engaged private pay stakeholders (insurance companies) to partner with Medicare and providers to improve patient outcomes. I provided practices that adhered to care delivery requirements, employed BI tools to analyze regional performance trends, and conducted 500 assessments to identify and report on substandard practices.I supported Population Health by coordinating with medical practices to improve primary care healthcare delivery processes by focusing on chronic disease prevention, resulting in better patient outcomes, lower healthcare costs, and elevated patient engagement. I addressed systemic knowledge gaps and service training needs to increase patient satisfaction. As a program manager, I developed a project management tool to calculate labor hours per task, streamlining contractor practices and reducing overall labor costs. I implemented countless process improvements that overhauled subpar vendor performance to improve skills over two years and secure CMS contract renewal. In addition, I played the role of Client Manager, which included designing an Excel tool to track the completion of CMS quarterly learning/training requirements. This tool was successfully adopted by peers and used to enhance the curriculum.

Little Rock, Arkansas Area

As PCMH Program Manager, I guided and motivated cross-functional team of 15 Project Managers, System Engineers, Research Analysts, and Helpdesk Technicians of $25.3B international IT company. Ran complex algorithms to analyze thousands of healthcare claims in preparation of monthly quality/cost-of-care reports and presentations for Arkansas Medicaid Payment Improvement Initiative (APII) part of the Department of Human Services (DHS)-sponsored Patient-Centered Medical Home (PCMH) program. Stewarded accounts to improve statewide quality outcomes and reduce medical costs across 192 practices and 400 providers for 350K beneficiaries. Spearheaded claims analysis, beneficiary attribution, empanelment, risk stratification, provider incentives, provider payment administration, HEDIS and eCQM coaching/evaluation, and predictive modeling. Employed SAS/BI tools to monitor project performance and conduct quality assurance. Program Administration: Partnered with Medicaid Program Administrator and Medical Director to implement PCMH requirements avoiding $54.4M in anticipated healthcare costs.Claims Processing: Overhauled Arkansas Medicaid 30-year legacy mainframe claims management system and transitioned to premiere claims processing platform with provider portal.Provider Education: Created special, cost-of-care training to explain complex calculation behind AR Medicaid algorithm.

Little Rock, Arkansas Area

In my previous role, I managed a team of consultants focusing on supporting the Arkansas Medicaid PCMH initiative. Our goal was to improve population health outcomes while reducing healthcare costs. As an Account Manager and a PCMH Coach, I assisted healthcare providers and staff in transforming their practices into Patient-Centered Medical Homes (PCMH). I designed and implemented quality improvement (QI) interventions, curricula, and processes to achieve this innovative model for improving primary care. I monitored the deployment of these interventions to ensure their effectiveness. As a manager, I oversaw a team of six Clinical and Healthcare Policy Consultants to support the State of Arkansas' Medicaid cost-reduction/quality improvement initiative across 150 primary care practices. I directly managed operations at 28 medical practices with over 84K beneficiaries and $3M in annual revenues. I designed training materials, hosted monthly webinars, conducted quarterly on-site support visits, and held monthly conference calls. Additionally, I drafted monthly/yearly progress reports to summarize P&L and detail performance highlights. I established and measured key performance indicators (KPI) to generate meaningful business insights as the foundation for strategic decisions. In this role, I coordinated a $2.2M budget that achieved a 15.1% positive margin and more than $9.6M in cost savings for Arkansas Medicaid in 2016. I taught healthcare providers to become patient-centered medical homes and led the development of assessment tools for practices better to understand process improvement opportunities across eight quality domains. I aligned protocols for providers to identify high-risk patients and create value-added care plans. I started and trained numerous care management teams composed of RNs, LPNs, social workers, and other support roles to proactively maintain the health of high-risk patients, reducing emergency room visits and hospital readmissions.

Little Rock, Arkansas Area

This role kicked off my primary care transformation career by converting primary care clinic into patient-centered medical homes (PCMH) and administered Medicare Comprehensive Primary Care Classic (CPC) and Arkansas Medicaid Payment Improvement Initiatives (APII) for nation’s second-largest faith-based health system with 105 hospitals, $21.8B in assets, and $13.9B in annual revenues across 18 states. Coached six primary care practices and provided support as Negotiator, SME, Analyst, and Project Manager. Integrated behavioral health into clinic workflows by instituting procedures to screen patients for depression.Identified gaps of care by introducing point-of-care reminders within eClinicalWorks EMR. Instituted CQM for prevention and chronic disease to evaluate population health.Improved patient access by simplifying provider schedules.

Little Rock, Arkansas Area

Established strategic initiatives, authored internal/external communications, and coordinated monthly operations reporting processes to track metrics for interstate Blue Cross of Florida and Arkansas supplemental health insurance startup. Handpicked leadership team in partnership with executive recruiting firms including screening and onboarding candidates and new hires. Monitored customization and implementation of enterprise-wide software systems. Reported directly to the CEO to establish a joint venture offering ancillary health insurance products to Blue Plans nationwide including life, dental, disability, and worker compensation.Leveraged 10-year employment at Florida Blue to design marketing tools measuring market capture by segment, product, and channel resulting in $1.5B sales improvement.Aligned business care, due diligence, transaction documents, and operations integration to reduce dental operating costs by $12M annually.Increased corporate valuation by expanding customer base, cross-selling products, and retaining clients yielding annual sales increase of 10%.

Jacksonville, Florida Area

Managed process improvement initiatives to achieve operational efficiencies. Mentored 9 Green Belts on DMAIC (five-stage problem solving) tools and techniques. Managed cross-functional project teams. Reported to VP Operations.Admittedly, this role was the most challenging yet rewarding work of my career. One project, I prevented $1.2M claim submissions and reduced duplicate claims 50% by implementing real-time notification to providers of failed electronic submissions.

Jacksonville, Florida Area

Ensured profitable growth of (51+) large group business segment. Developed strategies and integrated business plans. Monitored product growth, profitability, and competitive landscape; developed corrective action plans as needed. Reported to CMO and VP, Large Group Segment.

Miami/Fort Lauderdale Area

Gainesville, Florida Area

Master Of Business Administration (Mba), Master Of Health Science (Mhs)

Ba, English

Activities and Societies: Delta Tau Delta