Designs and launches successful new businesses, including business startups, new subsidiary launches, and merger and acquisition due diligence and integration
Co-created the Connected Health Coalition (CHC), an Optimity Advisors service offering that partners with a Silicon Valley firm with our corporate clients to access, understand and leverage technology from around the globe and across industry verticals. Our innovation platform leverages use-case workshops, learning sprints, startup and technology challenges, and rapid prototyping to rapidly explore disruptive technology and early stage product adoption. The CHC’s objective is to identify early-stage innovations that can be applied and scaled for our clients to differentiate and take our clients to new market leading positions.
Worked with the largest senior association to develop digital innovation strategies for caregiving and healthy living. Worked across all divisions to develop a new digital business model for caregiving platform and enterprise product and content creation to drive disruptive product designs for aging in home and caregiving connections.
Pioneered application and adoption of digital interactive shopping for multi-segment insurer in 2003 prior to advent of exchanges, connectors, and insurance marketplaces. Transitioned individual and family, employer, and self-insured to on-line digital shopping platforms that were custom designed for each segment. Empowered brokers and consultants. Over a 4-year period, moved over 1.7MM lives from traditional sales process to fully digitized quote-to-bill platforms while reducing administrative cost, improving retention, and expanding ancillary products and services sold.
Provided senior advisory services for the design and launch of a care management system as part of an integrated health management NewCo launch focusing on behavioral and medical for chronic condition management such as severe mental illness. The program integrated care management teams such as providers, social workers, nurse care managers, and family members. The system supported the hierarchy and roles to enable a holistic participation, review, and update of the member’s health data, and coordinate the appropriate level of care.
Led the business operations and technology development of a member owned and operated health plan. Plan successfully grew to $1B in revenue and 200K+ members. Led consumer engagement strategy and culture initiative for a regional, member-driven health plan. Developed roadmap to implement culture, process, organization, technology, and measures to improve overall consumer experience across all health plan functions. Created a unique consumer engagement platform that included one push button, on demand service, telehealth, retail walk-ins, digital shopping with specialized sales support centers. Worked with the Board of Directors and CEO to address pre-launch capitalization and solvency risks which occurred due to low rate setting, government default on risk corridor payments, and high reimbursement lease network rates.
NEW PRODUCT LAUNCH
Led a greenfield digital member experience strategy facilitation for a 5.6M member Federal Employees Health Benefit Program (FEHBP) administrator. Advised on roadmap development, sourcing, and implementation that resulted in a successful launch of new immersive digital member experience including innovative health and wellness services and tools, mobilized platform capabilities, and integrated member experiences based on unified data asset management and API and network distribution strategies.
Facilitated Medicare Part D Launch strategy and launch for a national health management services firm with a PBM. Strategy included developing administrative sourcing partnerships, identifying clinical program priorities, product development and market segmentation, and distribution strategy.
Managed multiple strategic vendor relationships from procurement through implementation and ongoing managed services including ecommerce, medical specialty services (radiology, oncology, lab, vision, behavioral), pharmacy benefit management (PBM), care management technology and business process sourcing, core claims, enrollment, and billing platforms, and government program business process outsourcing services.
Led greenfield operations and technology strategy for a regional managed care organization transforming for marketplace changes and new government program product launches. Successfully designed and deployed a new private marketplace platform with integrated enrollment, billing, and service components.
Drove benefits process reengineering for coordination of benefits for Medicare Advantage and Part D for a large national government program administrator.
Conducted a people, process, and technology operational assessment for a subsidiary of a large behavioral health company. Targeted 25% administrative cost savings costs while maintaining high customer satisfaction and expected clinical yield results. Gained organizational and executive agreement on organizational restructuring, information technology capital investments, and process changes to drive faster, better, cheaper performance.
Facilitated health systems business process and systems consolidation strategy that gained Board approval for a two- year $100 million investment and $157 million ROI.
BUSINESS P/L PERFORMANCE
Drives improved revenue, profit, and service satisfaction improvements.
Assumed P/L executive leadership role over a newly launched consumer driven health product segment, mitigating pricing, adoption, and claims administration and service issues. Managed business operations scalability to accommodate 400,000 member growth over two-year period, reducing customer issues by 80% over a 12-month period and improving medical loss ratio by 5%, and shifted financials from loss position to profitability position.
Drove overall operational performance and efficiency strategy for service, claims, and enrollment for large regional payer through sourcing, organizational realignment, and LEAN/Six Sigma re-engineering. During Kenneth's tenure PMPM operational costs reduced by 12%; claims automation increased by 7%; service handle times reduced by 10% while maintaining first call resolution and customer service satisfaction survey measures; and membership retention topped 93% (from low 80's prior) for the 12 month period following operational strategy implementation.
Facilitated sales and operations transformation of paper to online benefits portal and automated processing of quoting, medical underwriting, account installation, enrollment, and billing workflows. Electronic installation and renewal increased by 300% while retention rates held at 95%.
Assessed performance and efficiency of a large Blue Cross Blue Shield administrator on behalf of a State Health Plan. Reviewed operational processes, metrics, and costs relative to benchmarks and industry best practices. Provided findings and recommendations to the State Health Plan, as well as a presentation to the State legislature.
BUSINESS OPERATIONS CHANGE MANAGEMENT
Identifies, analyzes, and resolves diverse operational issues while maintaining optimal productivity, administrative expense, and customer service satisfaction.
Provided technology planning and risk advisory services for a 2 million member state Medicaid disease and case management outsource vendor implementation - a program that successfully transitioned in less than 12 months. Kenneth continued to work with vendors to reduce data management and performance guarantee issues by 50% over a 6 month period post transition. With his direction and facilitation, the client implemented health systems business process and systems consolidation strategies that gained Board approval for a two- year $100 million investment and $157 million ROI.
NEW MODELS OF CARE AND ENGAGEMENT
Innovates revenue generation, administrative cost reducing initiatives that support new customer engagement and improved model of care strategies
Led consumer engagement strategy and culture initiative for a regional, member-driven health plan. Developed roadmap to implement culture, process, organization, technology, and measures to improve overall consumer experience across all health plan functions.
Assessed business and clinical competencies of a large hospital and physicians network seeking to transition to an ACO operating model. As part of the assessment, conducted a feasibility study of partnering, buying, or building an insurance subsidiary. Presented organizational, financial, and operational process opportunities for the hospital and physician system required to evolve into a quality and cost-based revenue and delivery model. In first three years of launch, the ACO was third top performing ACO in the U.S.
Conducted a people, process, and technology clinical operational assessment for a subsidiary of a large behavioral health company. Targeted significant administrative cost savings while maintaining high customer satisfaction and expected clinical yield results. Gained organizational and executive agreement on organizational restructuring, information technology investments, and process changes to drive a higher performing and more cost efficient and intensive clinical utilization management operations.