Akhil Shah

Akhil Shah

Experience:

Care Delivery and Models of Care Implementation

  • Supported the development of a not-for-profit subsidiary to support practice-based care management through a shared services model
  • Led a member segmentation and engagement strategy, including the product benefit design and implementation of two new plans, for the largest commercial health insurer in New York
  • Drove the development of integrated specialty care delivery programs to target member engagement, coordinated care delivery, and cost avoidance

Clinical Integration and Accountable Care Organizations

  • Collaborated with health system, hospital, physician organization, and health plan executives to complete demographic and environmental readiness assessments and develop strategic plans for accountable care organization development, mergers and acquisitions, and physician alignment opportunities for several clients: a large national Catholic health system, a large Michigan-based health system, and a community-based hospital in New York
  • Led the strategy development and operationalization of two large hospital-aligned IPAs that included governance, information technology, clinical operations, payer contracting, and ACO formation
  • Drove three year earnings of over $14 Million in value-based contracts through pay for performance incentives, health plan contract administrative fees, risk contract surpluses, and patient-centered medical home bonuses for a large hospital-aligned IPA
  • Managed the implementation, business process redesign and integration of a meaningful use qualified health information technology platform consisting of a modular electronic medical record, electronic prescribing system and a chronic disease registry for a three hospital health system and its affiliated independent physician association

Health Plan and Payer

  • Led the development and operationalization of claims, medical management, and provider network infrastructure for three start-up health plans. Also managed vendor integration of a claims and medical management vendor with a separate provider network vendor, pharmacy benefits management company, and billing and enrollment entity for the three plans
  • Managed the procurement, program development, and implementation of cost and revenue management opportunities surpassing $50 million over three year by targeting programs in three key areas: risk adjustment, radiology benefits management, and managed behavioral health capabilities
  • Redesigned and deployed the billing and premium collections process for a large NY-based commercial insurer, yielding over $30 million dollars in previously uncollected premium dollars
  • Supported the IT transition and business integration of a national specialty benefits vendor for the behavioral and physical health business units