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Strategic Research and Planning: Research and white paper on the state of the art in disease and health population management for a major government agency. Interviewed major DM companies and identified key components of effective programs and conducted secondary research on chronic disease prevalence and the impact of DM programs. Recommended key attributes of a universal program for the state employee and retiree health plans. Recovery Audit Business Analytics: Consulting targeted improving identification, processing and tracking of improper payments and claims audits in a Medicare RAC pilot program. Through in-depth data mining and integration, uncovered missing recoveries and implemented reporting to better manage the adjustment process. Developed staffing and financial project models including audit identification/recovery rates and productivity estimates to optimize recoveries and priorities for a given auditor resource level. Health Information Data Mining and Strategic Data Analysis: Delivered data-driven strategic planning to start up company offering an office-based surgery network and accreditation program. Conducted primary analysis of large national claims database encompassing over four million covered lives to identify market potential and specific procedure focus. Delivered report covering the outpatient surgery characteristics (market sizing, site of service distribution by state, top surgical procedure rankings) and estimates of cost savings of moving surgeries from the hospital outpatient setting to an office based setting. Temporary SAS Programming / Analytic Staffing: Health care analytics, SAS programming, research design, database development. Quickly came up to speed to produce vital monthly reports for large group business unit. Provided forensic research to uncover SAS programs and databases used in previous renewals for large clients. Produced first round of key financial and utilization information for renewal. Delivered analyses on imaging utilization, physician services, and selection bias across plans. Expert Analysis for California 2005 Health Initiative: Provided an economic analysis of the impact of proposed legislation for a state mandated prescription drug discount card program. Analysis focused on employer health plans and employees covered under those plans and the possible financial impact on out of pocket payments and changes in insurance status. Identified range of cost impact on employers' insurance premiums. Results were used in op-ed articles, web site, and other campaign efforts. Expert Witness for PPO Lawsuit: Provided expert consultation on the nature of hospital network negotiations and market strategies for a law suit involving disagreements over validity and reasonableness of negotiated rates. Delivered written report of analysis of court documents, network contracts, and claims information. |
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