Physician executive, 10+ years clinical experience.Seeking to use medical management, technology assessment, financial, and physician consensus building talents. Established an evidence based research department,designed and managed transplant case management department,designed internet based medical management functions, patient support and empowerment tools.
2001- Present Medical Education and Quality Consultant
I was recruited to my present position by a colleague to join a start up Medical Quality Institute and e-business providing online interactive medical education and medical quality management services for healthcare providers. My responsibilities include curriculum design, CME credit application, provider and professional society relations, and e-business development. I recruit, schedule and train expert speakers for online CME courses. I created our marketing strategy for reaching medical organizations.
1999- 2001 Senior Medical Director of Medical Policy
BlueCross BlueShield of Tennessee
My promotion to senior medical director gave me new responsibilities in
addition to my existing medical policy responsibilities listed in the job description below. These included rebuilding of the transplant case management area, member contract redesign, internet medical management development, coding, and vendor selection. With a budget of approximately $800,000 I managed a total of 15 employees including a PhD and 6 masters level nurses. We developed a coding area to support provider contracting and reimbursement methodologies. I re-wrote the medical coverage sections of the HMO, PPO, and ASO contracts to maximize health outcomes and improve patient understanding of their benefits. I redesigned the transplant case management processes in conjunction with organ transplant facilities in the Southeast. I worked with these facilities to develop shared evidence based patient selection protocols and work flow processes. I refocused the efforts of the nurse case managers on patient support and continuity of care issues. This resulted in average response times of one working day, denials dropping to near zero, and improved internal and external satisfaction.
1997- 1999 Medical Director for Medical Policy
BlueCross BlueShield of Tennessee
As Director of Medical Policy I established an evidence based research process to support all areas of medical management which ultimately evaluated over 200 new and existing technologies per year. The policies resulting from this evaluation process were published on the internet in a searchable format for clinicians, patients, and other technology assessment departments to use. These policies, and the process to develop them, changed the way the company made coverage decisions to a process based on health improvements associated with a medical service. The process was recognized by a joint study of best ethical processes by Harvard University and the NIH. I was asked to speak at their conference in Washington DC. This led to my serving on the AMA’s ethics project, E-Force. I was also responsible for the creation of an online library for medical staff, which included technology assessments, articles, and links to additional information. I developed a computer based inter-reviewer reliability tool to help educate physician reviewers and reduce variability between reviewers. I added medical and public policy to the legislative bill review process and reviewed all proposed federal and state legislation.
1997- 1997 Health Policy Fellow
Senator Edward Kennedy’s Office
In this self-funded position my primary responsibility was to do research for Senator Kennedy to support the passage of the CHIPS legislation. This involved researching existing legislation and health improvements associated with insuring children. I studied HIPAA portability and also participated in discussions involving the emerging Patient Bill of Rights legislation. I researched and advised Senator Kennedy on Tennessee’s TennCare program. BlueCross BlueShield of Tennessee recruited me while I was in this position.
1994-1996 Associate Medical Director
SecureCare of Central Iowa
Des Moines, IA
This provider sponsored health plan was started as a partnership between Mercy Medical Center and its medical staff. As Associate Medical Director I was on the senior management team, participated in provider relations, and learned the UM process. I also shared responsibility for running the Quality Committee, which involved a consensus process to balance cost and quality of care, and make coverage decisions. A desire to improve my knowledge and skills in these areas led me to pursue a MHA.
1994-1996 Physician Lobbyist
Iowa Academy of Family Practice
Des Moines, IA
To participate in healthcare system change I became the Academy’s physician lobbyist. I lobbied the state legislature on health system reform issues and successfully convinced the Iowa Chapter to adopt a stop smoking campaign as their clinical issue.
1986-1997 Primary Care Physician
Mercy Clinics Inc.
Des Moines, IA
Working for MCI I practiced in rural, suburban and urban clinics surrounding Des Moines. My practice included the full scope of family medicine. As the system grew from a handful of physicians to a multi-specialty organization of more than 100 physicians I became progressively more involved in the evolution and management of the clinic system. I implemented and designed a physician knowledge and attitude survey to support strategic planning and provider education. I became involved in the development of a PSO with Mercy Clinics Inc. and its parent hospital Mercy Medical Center.
1994 to 1996 MHA, University of Colorado, Denver, Colorado
1993 Harvard Short Course in Medical Management
1983 to 1986 FAAFP, Family Practice Residency, University of Kansas Medical Center, Kansas City, Kansas
1979 to 1983 DO, Des Moines University, College of Osteopathic Medicine and Surgery, Des Moines, IA
1974 to 1978 BS, Iowa State University, Ames, IA
American Board of Family Practice 1986 Re-certified 1992, 1998
American Academy of Family Practice
American College of Physician Executives
Medical Ethics Instructor - University of Tennessee Physician Executive MBA program (PEMBA)
Active Medical License Tennessee
Inactive Medical Licenses Iowa, Kansas, Missouri