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.