AREAS OF EXPERTISE

Hospital, health care, managed care, physician organization and health insurance. Experienced health care executive in developmental, contractual, regulatory and operational areas.

EMPLOYMENT HISTORY


EW #13651 is one of three forming partners for a leading hospital, health care litigation consulting firm. Have served as consultant and/or expert witness in actions on a national basis testifying as to HMO, hospital and healthcare industry standards in areas including contracting, reimbursement, member services, claims, medical management, credentialing and all areas of physician and health plan administration and functioning.

President, Mercy Health System Physician Hospital Organization, Inc., Toledo, OH 2000-2002

The Mercy Health System PHO was based in a 3 urban hospital organization and provided care for over 50,000 covered lives under contracts with two HMOs utilizing 600+ physicians and a 4 hospital integrated delivery system as its provider base. Products included Medicare, Medicaid and commercial risk and non-risk programs. The PHO was at risk for over $90M of premium revenue

Executive Director, CEO - Susquehanna Regional Physician Hospital Organization/United Community Health Plan, Inc., Binghamton, NY 1994 -2000

United Health Services, Inc., a 4 hospital system in upstate New York, was the focus for developing an integrated delivery system managed care product involving a network of physicians and a multi county service area. The effort focused on creating a joint venture with a managed care partner, and with this partner, establishing a strong managed care presence in a developing market. The first year of operations resulted in over 300 physicians contracting for the delivering of care to commercial, Medicaid and Medicare risk markets generating a gross profit approaching $1M. Market leadership was achieved in three years. The 1999 total revenue was $50M.

Executive Director - Methodist Delivery System, Inc., Indianapolis, IN

My responsibility was to take a joint physician/administration work group from theory to reality. Specifically, I organized and led the fast track development of an at-risk Physician Hospital Organization that served as the single point of entry into the fourth largest private hospital in the country. I developed and implemented a unique full risk PHO model for Methodist Hospital of Indiana and its medical staff of 1,200 that was the focus of national interest
.

President, Chief Executive Officer - CCS, Inc., Nashville,Tenn.

Developed and managed a computer software/consulting company on an entrepreneurial basis as a private market investment activity.

Executive Director, Vice President - Travelers Health Network of Illinois, Inc. Chicago,

Travelers needed an alternative product developed for their largest market, Chicago. Headed product development. I established and managed a 3 county PPO working with all area hospitals.

Vice President, Executive Director - Maxicare Health Plans, Inc., Chicago

Assumed operational leadership of 115,000 member HMO. Managed a staff of 125 with responsibility for all areas including systems, UR/QA, marketing and provider relations. Increased membership by 30,000 in 18 months. Implemented Medicare risk contract. Promoted to Vice President with national HMO development responsibilities. This involved planning and managing projects, hiring other consultants as required and coordinating the elements needed to deliver a consulting product to the client.

Worked with a number of developing and operational managed care programs on a national basis providing consulting in all areas of HMO development and operation.

Overall HMO development, design and implementation including marketing, systems, claims, UR/QA premium development/actuarial evaluation and underwriting issues.

Consultant to Federal office of HMOs. In this capacity I evaluated over 40 programs on a national basis.


Executive Director, Roosevelt Health Plan (now, Chicago HMO)

Began as a consultant to Roosevelt Memorial Hospital (Chicago) to develop a feasibility study for a Medicaid HMO and was then hired to implement the HMO and obtain state licensure and Medicaid contract.

Started up Medicaid HMO, the first HMO licensed in Illinois.

Wrote and submitted application for state qualification.

Teaching and Research

Assistant Professor, School of Medicine, University of Illinois School of Medicine (Chicago).

Senior Director, Research and Development, Blue Cross Association (Chicago).



EDUCATION

DEGREE UNIVERSITY FIELD YEAR
B.A. Syracuse University Sociology
M.A. University of Chicago Social Psychology
Ph.D. University of Chicago Medical Sociology

RECENT PRESENTATIONS


American Conference Institute, Baltimore, MD
Co-chair, The Legal Forum for Healthcare Attorneys and Corporate Counsel in Health Care Organizations


The New HealthCare Marketplace Conference, Syracuse, NY
Quality and Performance Measures


CAPCON Conference, Orlando, Fl
Medicare Risk Contracting in a Joint Venture Hospital Model

RECENT TEACHING
Binghamton University, Adjunct Assistant Professor teaching Marketing and Public Opinion course to Executive MBA in Health care students,
SUNY Upstate Health Science Center, Binghamton Clinical Campus. Two presentations on Health Economics to 3rd year Medical Students,

SELECTED PUBLICATIONS
Health Care Litigation, to be published in the LNC Resource
Capitation and Litigation, published in the Capitation Management Report