Led the transformation of the Federal Employee Program healthcare systems and business processes.
Directed the transformation of the program’s claims and customer self-service systems and processes. This was a multi-year, multi-release program. The transformed system is used by and integrated with more than 50 health plans around the country. The transformation enabled the program to enhance their customer and health plan services, reduce administrative costs, and improve the company’s ability to develop and implement new products. The program was designed to provide business value throughout the implementation releases, ensuring quality delivery in each release, and understanding and minimizing the risks to the business throughout the program.
Led the development of a pilot High Deductible Healthcare Plan (HDHP) product strategy and implementation roadmap for a national payer.
Led the development of new and modified business functions and processes required to support the new HDHP product. The product leveraged the client’s current product strengths and current system environment, and it provided greater value and decision-making capabilities for their customers.
Developed the strategy for a Health Information Exchange (HIE) solution.
Included development of a go-to market HIE solution design, delivery approach and plan, business case, and vendor partner alliance agreements.
Led the development of a strategic plan to expand a regional payer’s health savings and spending product offerings.
The project included analyzing the market, competitive, and regulatory demands; identifying strategic options available; completing a due diligence and cost/revenue analysis; recommending the options most suited to the client’s needs. Upon the decision to move forward, assisted the client and client legal counsel to prepare and negotiate the necessary contracts. The final step included working with the client to develop the implementation plan.
Assisted a national healthcare bank in the evaluation and evolution of its HSA, HRA, and FSA product and service offerings.
The project included a marketplace evaluation of services and vendors; development of a vendor integration strategy; an operational readiness assessment of the client’s operating model, governance, and business processes; and the design of the operational processes and touch points between all internal and external stakeholders.
Developed a business model for a Regional Health Information Organization (RHIO).
The goal of the organization was to provide a network for the exchange of health information across its regional area. The organization needed to ensure it had a viable and sustainable business model prior to moving into the implementation phase.
Led the design, development, implementation and business migration of a new corporate membership and billing system for a regional payer.
Project included a phased migration of the groups and members onto the new platform, in order to manage the level of change and risk to the business.
Led the design, development, implementation and migration of a new provider information management system for a regional payer.
The new system became the single source of provider demographic and contract information for all professional and facility providers. The project included integration with the claims and capitation systems.
Led the configuration, integration, testing, implementation, and business migration of the Medicare business onto the EDS claims system for a regional payer.