Todd Thoma Email & Phone Number

Responsible for all risk and modified fee for service contracting activities for The Polyclinic, it's subsidiaries, and its joint venture with Swedish Medical Center for the largest free standing ASC in Washington State. Work includes development and implementation of contract negotiation and contract modeling activities including risk and incentive programs under ACO and other ACA related activities.• Negotiated and managed value-based, capitated and non-capitated agreements with major… Show more Responsible for all risk and modified fee for service contracting activities for The Polyclinic, it's subsidiaries, and its joint venture with Swedish Medical Center for the largest free standing ASC in Washington State. Work includes development and implementation of contract negotiation and contract modeling activities including risk and incentive programs under ACO and other ACA related activities.• Negotiated and managed value-based, capitated and non-capitated agreements with major payers in support of the organization's ACO strategy for Medicare and commercial business.• Developed and implemented complex negotiation and contracting strategies to assure success in the organization's financial operations related to reimbursement and payer relations.• Implemented and managed the organization's structure for communication and participation of key stakeholders in contracting goals, objectives and outcomes. Show less

Kirkland, Washington

Responsible for the effective and profitable management of the organization's relationships with external payer, provider and business partners, providing direct support to a staff size between one hundred and two hundred medical, professional, technical and support personnel including planning, finance and business development functions.• Responsible for all contracting functions with payers in the market accounting for more than 40% of the organization's activity.• Managed Business… Show more Responsible for the effective and profitable management of the organization's relationships with external payer, provider and business partners, providing direct support to a staff size between one hundred and two hundred medical, professional, technical and support personnel including planning, finance and business development functions.• Responsible for all contracting functions with payers in the market accounting for more than 40% of the organization's activity.• Managed Business Development Team responsible for building and maintaining key referral relationships with various government, provider and payer organizations in the community.• Developed and implemented strategic partnerships with key provider systems in the community using both risk and fee-for-service reimbursement mechanisms.• Represented organization in a variety of regulatory and public policy forums regarding behavioral health issues affecting the organization. Show less

Provided leadership in plan’s management and oversight of relationships with over 800 external providers and provider organizations, with particular emphasis on hospital, professional and ancillary services, and financial analysis and reporting. Lead negotiator for contracts with key strategic partners of the organization. Responsible for development and implementation of effective contracting and negotiation strategies to achieve organizational objectives related to contracting… Show more Provided leadership in plan’s management and oversight of relationships with over 800 external providers and provider organizations, with particular emphasis on hospital, professional and ancillary services, and financial analysis and reporting. Lead negotiator for contracts with key strategic partners of the organization. Responsible for development and implementation of effective contracting and negotiation strategies to achieve organizational objectives related to contracting activities.• Managed contracting team responsible for all provider agreements in the Puget Sound region, and select statewide provider and payer contracts for the full range of healthcare services including hospital, professional, SNF, hospice and home health, medical transport and organ and tissue transplantation.• Responsible for development, implementation and maintenance of complex service delivery plans to assure cost-effective provision of health services to more than 350,000 plan members.• Directed provider network development activities for self-insured and fully insured commercial, Medicare and Medicaid products in accordance with all market and federal and state regulatory requirements.• Developed and applied strategies for successful management of a complementary contracting model to augment services provided by the plan’s internal delivery system at 22 sites throughout western Washington.• Developed, implemented and managed decision support unit providing analytical and reporting support for contracting activities with all types of provider and payer organizations. • Successfully developed a contracting strategy and implemented agreements with major hospital partners to use Medicare Outpatient Prospective Payment System payment methodology (APCs) for all lines of business. Show less

Responsible for all provider, healthplan and MSO service contracting and business development functions of a two hundred physician multi-specialty IPA with enrollment of more than 35,000 capitated lives. Identified threats and opportunities in the marketplace affecting the IPA’s business activities, and developed and implemented effective strategies for response. Managed the organization’s business relationships with the major risk sharing plans in the Puget Sound region, preserving and… Show more Responsible for all provider, healthplan and MSO service contracting and business development functions of a two hundred physician multi-specialty IPA with enrollment of more than 35,000 capitated lives. Identified threats and opportunities in the marketplace affecting the IPA’s business activities, and developed and implemented effective strategies for response. Managed the organization’s business relationships with the major risk sharing plans in the Puget Sound region, preserving and expanding the IPA’s position in the marketplace.• Responsible for administration of eight capitation-based risk contracts covering more than 35,000 enrollees.• Oversaw the organization’s risk profiling, impacting risk-sharing with the healthplans and IPA’s redistribution of risk with its providers and reinsurers.• Managed the oversight of all facility risk pools covering both inpatient and outpatient hospital services. • Managed risk pool settlement process, maximizing recoveries from all full risk and shared risk pools. Show less

Greater Seattle Area

SENIOR POLICY ANALYSTResponsible for analysis of and response to federal and state legislative and regulatory issues with financial and operational implications for the competitive viability of the company.• Developed strategic responses to legislative and regulatory issues impacting operations.• Represented the company in public and quasi-public forums related to health policy.

San Francisco Bay Area

MANAGERResponsible for administration of more than one hundred service contracts with managed care organizations generating more than $200 million per year. •Supported the development of managed care related policies and goals for the university's three hospitals and its medical group, and was responsible for development and implementation of contracting approaches to assure that goals and objectives were met.•Developed/implemented integrated strategies to achieve increased patient… Show more MANAGERResponsible for administration of more than one hundred service contracts with managed care organizations generating more than $200 million per year. •Supported the development of managed care related policies and goals for the university's three hospitals and its medical group, and was responsible for development and implementation of contracting approaches to assure that goals and objectives were met.•Developed/implemented integrated strategies to achieve increased patient activity and predictable revenue stream in a deteriorating health care market.CONTRACT NEGOTIATORPrepared comprehensive proposals and represented the Medical Center in complex negotiations with insurers, managed care payers, and government agencies for the provision of services.•Worked collaboratively with faculty and senior management to develop service packages, performing complex financial and operational analyses, including data retrieval, to determine effective pricing structures for contract proposals. •Developed and maintained a computerized reporting system to assure timely reporting to Medical Center and Medical Group management of all third party contracting activity and support appropriate management decision-making.CONTRACT ANALYSTProvided analytical support for marketing of clinical services to third party payers. •Analyzed the hospital's share of current markets, including monitoring of population changes, shifts in payer mix, development of managed health care systems, and service changes at other health care facilities. •Reviewed current and historical utilization and cost data for third party payers, making recommendations for price proposals for hospital products, and evaluated the competitiveness of UCSF's pricing through ongoing analysis of competitors. •Monitored the use of services and produced financial reports for senior hospital management and faculty, merging revenue and expense information to assure profitability of contract related business. Show less

Mhsa, Finance, General

Masters level study in health economics and healthcare finance.

Bachelor Of Arts (B.A.), Economics

Undergraduate study in economics