Paul Joseph Scalisi

***** *** ******* ****

Nashville, TN 37211

615-***-****

ac0gcv@r.postjobfree.com

SUMMARY: Strategic and Operational Managed Care Contracting Executive with record of growth, expert negotiating skills, and margin expansion across multiple States and Markets. Team oriented contracting, compliance, legal, operations, and leadership experience with Health Plan, Hospital, Provider Organizations, Employers, and Physician partnerships. Sales and Service experience with Self Insured and Fully Insured Groups on a National basis. Ability to create custom Provider and Benefits Networks for Employers. Executed payment models on percent of premium, capitation, risk sharing, and shared savings as well as traditional fee for service reimbursement. Created Clinically Integrated Networks and Value Based Payment mechanisms, ACA expertise and experience. Profit and Loss responsibility across multiple markets and States including ongoing and greenfield operations. Ability to bring together diverse groups of Health Care Operators to form high performing teams.

EDUCATION: 1988 University of Missouri, Executive Managed Program

1983 Master of Hospital Administration

University of Minnesota, Concentration Finance

1981 Bachelor of Arts, Boston College

Major, Economics, with Honors

EXPERIENCE:

6/2016- Reference Health, Partner, Managed Care and Healthcare Operations Consulting

Developed Clinically Integrated Networks for Physicians and Hospitals. Created Growth and Development Plans for start-up Venture Capital Health Care Companies, negotiated Managed Care Agreements on behalf of Specialty and Hospital Based Physicians including Emergency Room Physicians and Urgent Care Centers and Hospitals with Large National Insurers.

9/99-5/2016 Vice President of Managed Care, LifePoint

Health, Inc. (70 Hospital System, 2500 employed Physicians Nationwide)

Directly responsible, with Staff for all HMO/PPO Commercial, Medicare Advantage, CHAMPUS/VA Programs, and Managed Medicaid Contracting and Analytics. 2.3 Billion in Net Managed Care Revenue. Accomplishments include recontracting and ongoing contracting all Hospital contracts, yielding significant net revenue increases, resulting in rapid expansion and Industry leading EBDITA. Many of the Hospitals had Urgent Care Centers and contracted as Free Standing entities and as Departments of the Hospital, In addition to traditional fee for service reimbursement, work with Plans on shared savings and incentive based reimbursement. Implemented contracts management and modeling software. Led organization’s efforts for Health Care Reform (ACA) and Health Exchange initiatives. Developed custom networks for local Employers.

12/96-4/99 Regional Vice President, Phycor (50 Multispeciality Group

Practices)

Responsible for Physician Managed Care Operations in Northeast and Midwest United States. Payment model was capitated Percent of Premium for Hospital, Ancillary, and Physician services on a full risk basis from Health Plans. Organized Physicians into risk bearing PODs for Medicare and Commercial lives. Largest site had 90,000 fully capitated lives. Met profit and revenue targets for Phycor as well as partner Physicians and IPA’s and PHO’s.

Accomplishments include achieving profit targets, significant operational improvements with the 90,000 lives IPA, developing two new green field sites, and turning around the financial operations of a Phycor owned HMO.

Directly contracted with self-insured Employers

1/95-12/96 Executive Director, United Healthcare of Massachusetts and Tennessee. (transferred from TN to MA)

Responsible for the day to day and strategic Sales and Provider operations of the Plans for Self Insured and Fully insured clients. Accomplishments include recontracting the Hospital, Physician, and Ancillary networks, Building Sales and Service functions, fee schedule creation, and moving Small Group business to a profitable position. Both operations were green fields and built operational staff.

7/92-1/95 Director of Operations, PruCare, 45,000 lives, Nashville, TN

Responsible for Provider Contracting, Service, Provider Recruiting, and the Medicare Product. Reinvented Plan by moving from a fee for service model to age/sex capitation for Hospital, Ancillary, and PCP, Specialty, and Hospital Based Physician Services. Moved Plan from loss to significant surplus, filed and operationalized the Medicare Risk Product. Expanded PCP base including from 40 to 225. Contracted for Hospital Based Physicians Anesthesiology. Developed partner IPA/PHO relationships for the Plan. Actively involved in Marketing, particularly to Large Groups.

7/90-7/92 Director, Provider Relations, HealthPlus

225,000 Member HMO, D.C., and Baltimore.

Responsible for Hospital, Ancillary, and Physician Contracting, in

addition to Provider Service and Recruiting. 48 Hospitals, 5,000

Physicians. Staff of 14.

Accomplishments include service area expansion, fixed cost contracting with Hospitals and Ancillary providers leading to profit growth, and Richmond, VA Service Area Expansion.

11/88-7/90 Regional Manager, Kaiser Permanente, 250,000 lives, Washington, D.C.

Responsible for all Hospital, Ancillary, and Physician Contracting. Accomplishments include moving the Plan from a significant loss to large surplus in the span of a year by recontracting the Hospital Network and building capitated Radiology, Mental Health, Physical Therapy, and Lab networks. Contracted for subspecialty Physician Services including Anesthesiology.

2/86-11/88 Regional Director, MedCenters Health Plan, 250,000

lives, Minneapolis, MN

Responsible across State of Minnesota for Hospital, Ancillary, and Physician contracting and two joint ventures with large Multi-specialty Groups (150 and 45 Physicians).

Restructured Hospital and Ancillary contracts to improve Plan

profits by 8 Million dollars. Met profit and Member targets in the joint ventures. Staff of 3.

5/82-2/86 Assistant Vice President, United Hospitals, Saint Paul,

Minnesota. (572 Beds and 117 Bed Children’s Hospital)

Responsible for 13 Hospital Clinical and Support Departments, Physical and Occupational Therapy, two Primary Care Clinics, two Urgent Care Centers and Work Comp.

Accomplishments include reducing staff from over 400 F.T.E.’s to 250 while expanding the workload. Recruited multiple PCP’s and SCP’s to Medical Staff.

OTHER: Board Member, CommonWell, an Alternative Medicine Company

Volunteer tutor for troubled youths, Youth Hockey Coach

PERSONAL: Enjoy competitive sailing, running, and American History.

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