| The Client |
The Assignment |
The Outcome |
| A large Medicaid center sponsored start-up MSO |
Recruit PCPs in five counties represented by MSO for
full-risk arrangement. Identify potential physician group partners for MSO. |
One hundred physicians filed applications that were approved and credentialed. Interfaced with MSO management in discussing
strategies to attract individual and group physicians to the MSO. |
| A 200-bed hospital |
Assist this financially distressed, "red-lined" hospital
re-establish itself with commercial payers (indemnity, TPAs, PPOs, HMOs) and
radically change the payer mix of 71% government programs/8% indemnity/21%
managed care. |
Completed within eight months. Assumed the post of VP of
Managed Care, staffed the CEO with reorganization and integration of local
IPA. Negotiated favorable payer contracts, changing payer mix to +28%
managed care. The hospital was removed from the "watch list" and
has recorded both bed and revenue gains. |
| A national PPO organization operating in 42 states |
Develop a state-wide PPO organization for workers'
compensation and group health as an entrance into the New York market.
Contract with hospitals, physicians and specialty groups. Comply
with New York State Regulatory Requirements. |
Recruited 100 hospitals and 15,000 providers, including specialty and sub-specialty groups.
Client received certification in urban
counties throughout the state. Expanded network efforts into New Jersey at
request of client. |
| A regional Pennsylvania PPO |
Assist in reorganizing provider relations department. Revise
PCP capitation to incent low cost, high quality provider. Negotiate risk
contracts or revised payment methodologies with six major hospital systems. |
Developed infrastructure in provider department and trained
personnel. Developed and implemented PCP capitation program. Contracted with
two hospital risk arrangements which have resulted in savings of 20%. |
