Proven Experience
Results underscore the breadth of MMHS principal and consultant, David Kern's, experience negotiating Managed care contracts on behalf of payers, physicians, and provider institutions beginning in 1988.
Payers
Responsible for market assessment, development, and provider contracts for 77 hospitals, 6,385 physicians and 92 ancillary providers in mid western market.
Controlled aggregate cost trend to 4% with a 6% target in a market average of 8% as Principal negotiator in 13 facility service agreement with an annual claims run rate of $39 million.
Held Physician unit cost significantly* below trend of Medicare base rate as Principal negotiator in a mid western market MSA of 1.5 million with prevailing rates at 110% of Medicare.
Eliminated Inpatient authorization conflicts and stabilized cost with implementation of facility case rate methodology in mid size mid western market.
Reduced ED utilization and increased patient satisfaction scores with implementation of physician financial incentives that provided extended hours access in a large mid western market.
Expanded network to accommodate membership increase of 125,000 to 300,000 members with lead provider contract responsibility in three state region.
Reduced facility and professional cost by $3.87 and $4.00 pmpm respectively as principal negotiator in a small southern market program with 30,000 HMO members.
Responsible for HMO provider network development and contracting for 250 physicians and 3 hospitals in a small southern market.
Physicians
Lead advisory, market evaluation and contract responsibility for 163 physicians, 77 practice sites, $300 million in annual revenues, in six western states.
Substantially* increased average compensation under multiyear no opt out service agreements with the second and third largest payers, as principal negotiator for a 53 physician multi- specialty group involving a large and mid size western markets.
Recovered six figure offsets related underpayments, market appropriate interest, and re-crafted service agreements to avoid reoccurrences with multiple payers in several western markets.
Developed and implemented model contracts standardizing reciprocity, steerage, compliance penalties, liability windows, multiyear terms, adequate payer reserves, stable risk structure, and predicable compensation design, in five western markets.
Developed payer contract evaluation and implementation committees which encompassed a large and mid size western market.
Developed market assessment, strategic/tactical development plans and metrics used in six western markets.
Consolidated, third party payer contracting, management and operations staffing for 3 small group practices into multi-specialty practice in a small southern market.
Institutions
Significantly Exceeded med/surge, and ICU and out patient trend in large suburban market in the southeast.
Local development lead and responsible for operations in first physician IPA/hospital joint venture in a midsize southern market.
Lead development and implementation of surgical supply standardization process in a mid size southern market.
Developed and implemented acuity adjusted physician specific information system utilized by a 500 physician IPA/hospital system joint venture in based in a large mid southern market.
Assessed and negotiated cardiovascular surgical support services for a 617 bed tertiary referral center in a large mid southern market.