Project Manager Health
Resume:
Barry Brauth
Washington, DC 20002
*******@*****.***
Opening Statement
I have spent over thirty years in health care financing. I understand how
private insurance operates, the Medicaid rules and regulations, and the
incentives that providers and state and local governments respond to. I am
an analyst that understands data and knows how to turn it into meaningful
information that addresses key policy concerns. I can lead staff and
connect with people who hold widely different perspectives. I am looking
for a leadership position with the Federal government that will allow me to
contribute to creating a more cost effective and accountable health care
system.
Key competencies
. Strategic thinker: I am creative and able to think outside the box to
invent novel solutions to complex problems. I engage problems
proactively, bring data to the decision making process, recognize the
good ideas of others, and think through the unanticipated consequences
inherent to any intervention.
. Leader: Nothing of real value can be done by a single person. Rather it
is the interplay of different perspectives and cognitive styles which
lead to success. I have a positive, optimistic attitude, am a self-
starter, proactive thinker, and value and appreciate the contributions of
everyone involved in the process. I am able to instill others with a
vision of how things can be done better and how they will benefit from
their participation in it.
. Powerful analyst: Numbers speak to me. I have the ability to put
numbers into context and apply them to policy questions. I am an adept
analyst who can manipulate data, distill its significance, and recognize
its implications. I understand how data informs decision-making and have
been responsible for constructing data warehouses that inform both day-to-
day operations and strategic objectives. Building data warehouses takes
time and I have been able to anticipate needs, build consensus, and
construct information infrastructures.
. Highly knowledgeable: I understand behavioral health and general health
care issues and trends. I am expert at all aspects of Medicaid and
Medicare financing including fee-for-service, managed care, and
rehabilitation. I understand insurance principles including adverse
selection, regression to the mean, moral hazard, and actuarial soundness.
I know the role that health expenditures play in the economy as well as
the trends, issues, and forces driving health care expenditures over the
last forty years. Finally, I have a deep conviction that how you pay
affects what you get and have always tried to use financial incentives to
shape systems behavior.
. Effective communicator: I'm a good speaker, writer, and presenter. I
have the ability to take complex material and present it in a concise,
organized, and understandable manner. I can listen critically and openly
to others, am able to draw them out, and lead them to consensus.
Professional Experience
Health Payment Alternatives - August 2009 to present - Founding Consultant
After more than thirty years developing financing strategies for health and
behavioral health programs, I am now providing consultation and expertise
to states, national associations, insurance companies, and providers on how
to use pay for performance approaches to achieve more cost effective
programs. Consulting on health care reform, assistance to state behavioral
health authorities on Medicaid and service system transformation, Medicaid
maximization, and outcome based reimbursement methodologies. Current
billing rate $1000 per day.
National Association of State Mental Health Program Directors - October
2008 to August 2009 - Director of Knowledge Development.
Director of Knowledge Development for the trade association of state mental
health commissioners, I was the organization's representative to the SAMHSA
funded Center of Excellence for Behavioral Health Financing. I was a
liaison between the state behavioral health commissioners, the various
provider and recipient stakeholder associations, and the Federal government
on parity, health care reform, and behavioral health restructuring. As co-
chair of the Medicaid Financing Division I provided consultation and
assistance to states on health care reform and strategies on program
reconfiguration. Salary $137,000
NYS Office of Mental Health - January 1987 to October 2008 except for one
year at Value Behavioral Health during 1996-1997 - Director of Strategic
Financial Directions. My bureau, comprised of twelve full time
professionals and five full time consultants, had three main
responsibilities all related to its core mission of policy and program
development.
. Data processing and information services: Twenty years ago, before data
warehousing had a name we developed analytical databases to support the
development of an alternative to psychiatric DRG's. With the increased
sophistication of systems and interest in management information these
early efforts blossomed into integrated data bases that crossed facility
cost and budget data with utilization claims data, and client clinical
data. It has been used to model client groupings, identify utilization
patterns, create provider report cards, and track case-mix adjusted
outcomes for use in pay for performance rate adjustments. This database
became an essential tool for all segments of the agency in licensing,
utilization review, financial oversight, and planning.
. Medicaid management: As new clinical programs were developed they
required administration. Policy makers in the governor's office, budget
division, and legislature had to be won over. Fiscal regulations needed
to be drafted, rates calculated, and payment system specifications and
edits detailed for the MMIS vendor. Stakeholders needed to be consulted,
providers trained on how to bill, and technical assistance provided. We
filled that gap and over time matured into an ongoing provider relations
function and liaison role with other state agencies. Since Federal
Medicaid and Medicare rules change unexpectedly, we tracked important
changes that posed threats or created opportunities, drafted comments,
mobilized agency attention, and recommended necessary action. Rates and
reimbursement methodologies were used for inpatient services, clinics,
case management, rehabilitation, housing support, assertive community
treatment, Medicare prospective payment, and Medicaid home and community
based waivers.
. The final area of the responsibility was really the main reason for
having the other two: to support a think tank and program development
capability that could respond both to the ubiquitous crises of the day as
well as develop long term solutions to chronic problems. The latest
example was spearheading a mental health restructuring project that is
now being implemented and is designed to promote and fund evidence based,
recovery oriented, integrated treatment and rehabilitation services
throughout the ambulatory care system. This project was conducted as a
collaborative effort with other state agencies, trade associations,
providers, hospitals, local governments, and consumers.
I was responsible for supervising the work of the bureau, serving on
various agency task forces and interagency task forces, developing
solutions to complex problems, and representing the agency's fiscal and
reimbursement positions throughout state government, the federal
government, and other key stakeholders including providers, their
associations, local governments, and consumers.
Managed care experience: Value Behavioral Health - 1996 to 1997 - Director
of Utilization and Data Analysis. I worked briefly for the Troy office
when the State employees account was up for rebid. I introduced
sophisticated data modeling techniques that could take advantage of five
years of utilization data to case-mix adjust and then profile practitioners
on their multi-year outcomes. This data was used to put together a
preferred provider network that identified high quality practitioners with
low inpatient profiles who were put together into a preferred provider
network that allowed VBH to underbid and retain its state employees
account.
Consulting experience: JBS International - 1995 to 2005 - Consultant -
While working full time I served as a part time consultant in alcoholism
and substance abuse as a member of teams that conducted technical reviews
of state substance abuse systems for CSAT. I was the key fiscal consultant
on the Access to Recovery grant program focusing on helping states
understand how to transition to voucher based, outcome oriented payment
containing financial incentives which couple payment to outcomes.
Insurance industry experience: Empire Blue Cross Blue Shield - 1982 to 1986
- Senior Policy Advisor to the President. At a time of profound change in
the health care system I was at ground zero for helping convert Blue Cross
Blue Shield from an indemnity insurer to one that could put together and
market a less expensive managed care insurance package. I was responsible
for developing data analysis tools to used to profile utilization patterns
and alternative insurance approaches including capitation and prudent buyer
arrangements that helped to transform Blue Cross from a largely inpatient
insurer into a comprehensive managed care company.
Hospital experience: NYS Office of Mental Health - 1974 to 1982 - I held
positions culminating in Project Manager. I first worked at ground zero of
the mental health system serving at Bronx Psychiatric Center as a Patient
Resource Agent. I worked with consumers and developed Social Security
disability benefits, and Medicare and Medicaid benefits that the state was
then able to bill against. After completing my Masters degree at NYU I was
promoted to our Central Office as a reimbursement strategist in the Federal
Programs Coordination Unit. I researched all the relevant statutes,
regulations, and policy memoranda issued regarding the Medicare and
Medicaid programs to maximize rates and exploit billing opportunities. My
work played an integral role in more than doubling Medicaid and Medicare
payment to the Center to over $400 million.
Education
. Martin Van Buren High School, Queens, NY, June 1967
. SUNY Binghamton (Harpur College), Sept 1967 - May 1971, BA Psychology -
128 credits
. New York University, Sept 1977- May 1979, Masters of Public
Administration specializing in Health Policy, Planning, and
Administration - 56 credits
Awards
. Special Recognition Award - NYS Office of Mental Health - 2001
. NYS Psychiatric Association - Special Achievement Award - 2004
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