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Expert has implemented a wide variety of value-based care models at more than 600 hospitals and health plans. He is recognized as an expert in Population Health, Bundled Payments for Care Improvement (BPCI), Comprehensive Care for Joint Replacement (CJR), MACRA, Merit-Based Incentive Payment System (MIPS), Alternative Payment Models (APM), ACOs, ACO Medicare Shared Savings Program (MSSP), Next-Generation ACO, Hospital Value-Based Purchasing (VBP), Core Measures, Comprehensive Primary Care Plus (CPC+), Hospital-Acquired Condition Reduction Program, Oncology Care Model (OCM), Joint Commission, NHSN, CDC, Reportable Diseases, HAIs, CMS, Epidemiology, Nosocomial Infections, Antimicrobial Stewardship, Post Acute Care Transition, Risk Sharing, Capitation, Network Contracting, Payer Provider Collaboration, Home Health, STARs, HEDIS, Medicare Administrator (MAC), Fee for Service Medicaid, Medicare Advantage, Managed Medicaid, Medi-Cal, and other areas.

Expert has defined go-to market and sales strategies for start-up and Fortune 100 companies alike. He is an expert in developing comprehensive healthcare solutions that leverage market opportunities and generate rapid revenue growth. His specialties include joint ventures, strategic partnerships, channel sales strategies, mergers and acquisitions, private equity, venture capital. Challenger Sale, Conceptual Sale, SPIN Sale, Account-Based Sale, SNAP Sale, Solution Sale, Miller Heiman, sales strategy, sales enablement, market segmentation, value proposition, and sales closing.

He is a P&L turnaround expert whose specialties include pricing models, contracting, negotiation, and other areas.

Expert has supported more than 80 health plans in North America to implement comprehensive payment integrity initiatives. His specialties include claims adjudication, fraud waste abuse, claims editing, subrogation, coordination of benefits, fee for service claims, dental, vision, pharmacy, medical claims.

Expert is highly knowledgeable in pre-adjudication EDI editing, concurrent claims editing, and retrospective data mining claims recovery. His expertise also includes medical cost management, network affordability, clinical decision support, claims platform, medical loss, disease management, care coordination, post acute care, actuarial analysis, gaps in care, HEDIS, STARS, commercial risk adjustment, provider network, Medicare Advantage risk adjustment, private and commercial exchanges, utilization review, provider credentialing, member enrollment, denial management, provider payer collaboration initiatives, Medicare, Medicaid, and Commercial claims editing, claims workflow analysis.

As a consultant, Expert has:
1) Worked with hospital systems to create health plans
2) Developed payer provider collaboration strategies to lower medical loss and administrative expenses
3) Designed go to market and sales strategies for disruptive new healthcare technologies
4) Defined flexible pricing models to maximize sales growth
5) Assessed new technologies to determine value potential
6) Designed STARs and HEDIS operational turnaround programs
7) Created financial risk sharing models for providers and payers - capitation, partial capitation, etc.
8) Improved ROI model to improve analytics software value
9) Designed new marketing and sales strategies to revitalize stalled revenues
10) Lowered network medical losses for health plans through disease management, care coordination, post acute care, and case management
11) Defined claims editing and FWA plan for health plans (fee for service)
12) Identified additional value-add services for claims clearinghouses (dental, medical, workers compensation, etc.)
13) Partnered with TPAs to conduct financial turnaround of operations
14) Maximized CMS reimbursements through value-based care models and population health initiatives
15) Improved clinical quality at hospitals through workflow redesign, analytics, and evidence based practices
16) Improved revenue cycle management for providers and IPAs
17) Created clinically integrated networks to improve outcomes and maximize revenue