Hiliary Critchley

Experience

Healthcare Policy

  • Published analyses to inform decision makers on the future of health reform legislation (which eventually became the Accountable Care Act) in publications such as the Health Affairs, which were used to brief and influence Congressional staff.
  • Covered topics that initially focused on broad analyses of American opinion on an increased role of the US government in healthcare; as bills were introduced, topics covered became more specific and included American opinion on topics such as insurance mandates, the effect of changing Medicare and Medicaid reimbursement rates, the rationale behind insurance exchange programs, etc.
  • Presented findings at the National Press Club alongside former Directors of Federal Agencies, health policy analysts, and leading healthcare economists.
  • Provided Executive advisory to a health plan regarding the complexity of organizational planning necessary to address the impact of the Affordable Care Act while maintaining business as usual, which included expansion initiatives, pilot programs, system upgrades, and adapting to other changing state regulations.
  • Facilitated conferences with representatives from the Department of Defense, the State Department, USAID, and Congress on the potential for collaboration across agencies and private organizations.

Healthcare Operations

For a California county public (Medi-Cal) payer, Ms. Critchley serves as an ICD-10 project manager on a multi-year engagement who:

  • Maintains oversight of ongoing initiatives, including:
    • Progressive elaboration and refinement of business requirements
    • Test strategy development, which includes user acceptance and end to end testing
    • Change management strategy development and execution
    • ICD code crosswalk development
    • Financial neutrality strategy and recommendations development
  • Maintains stakeholder engagement by preparing for and facilitating regular Governance Committee meetings, Steering Committee meetings and Board of Directors briefings.
  • Builds partnerships and coalitions
    • Develops provider and health network focus group collaboration by developed concepts and presentation (coordinated forum)
    • Manages the development and facilitation of ICD-10 focused training (for internal employees and the organization’s provider community)
    • Monitors vendor, health network, and provider remediation plans and progress through regular survey development and analysis

For a leading Medicare Part D Business Process Outsourcing company, Ms. Critchley served as a Project Manager who:

  • Led initiatives with IT Systems Analysts, Developers, and Production Implementation Analysts to identify automation opportunities in Enrollment processing systems by prioritizing top manual work types. After operational buy-in was obtained, she documented business and technical requirements and planned the implementation of these improvements by facilitating IT department and Operational production teams. This led to first pass rate improvements of over >25% for two systems, a Board-level goal.
  • Co-facilitated a workshop to improve the process by which the client assesses their Medicare beneficiaries a Late Enrollment Penalty (LEP). Maintaining a focus on regulatory requirements, this workshop led to recommendations for a redesigned process that reduces handoffs, improves transparency, decreases state and federal-level compliance risk, and increases the likelihood of consistently meeting service level agreements (SLAs.)
  • Performed an in-depth analysis of the methodology and technical systems (Facets, ADP EZ Labor and Payroll, ProClaim, Customer Service, Enrollment, and other custom-built workflow management systems), employed to compensate both employees. Ran workshops, reviewed compensation processes, reviewed reported data, analyzed the extent to which the compensation process is standardized and controlled, and proposed a technical automated solution the company’s IT Director agreed to implement.
  • Led an initiative to accurately report and validate work completed through systemic reports that can be integrated into the payroll system to reduce manual data entry and incorporate appropriate compensation control points. Working with the business, wrote the technical business requirements for Enrollment and Claims divisions to implement these improvements. Oversaw the IT review of these capabilities, which will create employee accountability and increase Management transparency, leading to the ancillary benefit of improvements in productivity. Microsoft Project was used.
  • Led a re-organization of 300 people within Enrollment, Billing, Quality Assurance, and Business Analytics, maintaining a desk-level tracker of all employees, writing new Department Charters and job descriptions, producing executive communication, and modeled impact to financial projections.
  • Assisted in the development of an Enrollment Operations Scorecard to establish performance scorecard metrics and algorithms, create tracking mechanisms, and rapidly operationalize the process throughout the organization.
  • Led an initiative with the Enrollment Quality Assurance Department to expand processes, implement statistical sampling methodologies, and increase quality assurance standards.
  • Provided project management oversight on an Appeals and Grievances project that prioritized data-driven recommendations leading to a 50% reduction in average handle time and annual savings of up to 400,000.
  • Provided project management oversight to a Coordination of Benefits project that developed business requirements to save $450,000 in administrative cost savings annual. This project also developed recommendation for a Part C MSP validation process that would save clients $19M in the first year, $6M each year after.

Healthcare Strategy

  • Assessed emerging technologies and methodologies used in the home health market, which have great potential for application in Veterans’ Administration, Medicare and Medicaid services.
    • Presented insights at annual conferences such as the American Telemedicine Association and the mHealth Summit.
  • Assessed the future of a line of fertility products of an international research-based biotech company by researching the company’s current products, the opportunity for future growth in related areas, and potential strategies to capture this growth.
  • Supported a high-level entry strategy project in the molecular diagnostics / in vitro diagnostics space. The final deliverable was a recommendation of whether or not an in-vitro diagnostics presence was necessary in order to be a top competitor in the molecular diagnostics space.
  • Led an effort that performed primary market research in order to investigate new ways that healthcare companies could revitalize their sales model in order to better serve the unmet needs of patients and physicians in key therapeutic areas, which included Metabolic Syndrome, Breast Cancer, and Sexual Dysfunction.
  • Analyzed the potential of the pharmaceutical division of a worldwide consumer products company, assessing the options of internal development or divestment.
  • Conducted a business assessment on the treatment of cardiac arrhythmias with pacemakers and ICD devices. Reviewed the companies in this sector, researched Medicare and Medicaid policies affecting the devices’ future, and projected future growth.
  • Interviewed product procurement agents for a company making cardiac drug-eluding stents and other interventional cardiology (IC) products to gain an understanding of whether offering a wide suite of IC products was beneficial.