Medical Management

Steven L. Arnold, MD, MS, MBA, CPE, FHIMSS

**** ******* *** #**

Miami Beach, FL 33140

Cell: 646-***-****

***********.**@*****.***

Objective

I am seeking a long-term leadership position in which, more than twenty years of my experience in healthcare management, IT and medical informatics, can help an organization achieve, and maintain, high levels of quality and profitability in a rapidly transforming healthcare market.

Summary of Qualifications

Certified physician executive with an in-depth knowledge of the managed care market including Medicaid, Medicare, Commercial Insurance, Hospital Administration and IPA Management with:

Extensive knowledge of Data and Analytics and Medical Economics.

Demonstrated success in Disease Management, Population Health and Risk Analysis.

Expertise in Physician Network Development and relationship-building, Contracting, Utilization and Quality improvement and Strategic Planning

Expertise in NCQA accreditation and HEDIS. National recognition in financing, implementation and certification of inpatient and ambulatory Electronic Health Records with high level national positions on the Board of Commissioners of CCHIT and the Board of Directors of HIMSS.

Extensive knowledge and practice in Accountable Care Organizations, Managed Long-Term Care, Surgical and Implant Benefits Management, DME, Full Risk and Shared Risk Capitation, and Medical Home.

PROFESSIONAL EXPERIENCE:

Consulting Experience:

Founder and CEO

HGA – Healthcare Global Advisors

New York, NY 2005-present

Innovative global consultancy firm focusing on Health Information Technology, Managed Care Operations, Contracting, Disease Management, and Medical Informatics. Clients have included:

Magellan Complete Care

Chief Medical Officer 2015 – 2018

Magellan’s first complex care management health plan; 50,000 members with SMI (severe mental illness)

Participated in successful NCQA accreditation

Improved HEDIS performance through innovative outreach programs including closing HEDIS gaps among inpatient members; resulted in significant improvements in 27 of 30 HEDIS and Childhood Checkup measures.

Restructured UM Department

Restructured Case Management Department

Reduced both Medical/Surgical and Behavioral Health readmissions per thousand by 20%

Established first Behavioral Health Hospitalist program leading to a reduction in average length of stay, and a three fold improvement in 7 day follow up after hospitalization.

In first 12 months MLR was reduced from 94% to 72%, resulting in turning a financial loss into a significant profit with a $60 million swing.

CenterLight Health System (Managed Long Term Care), New York, NY

Consulting Medical Director 2014-2017

MLTC in New York with more than 7,000 members

Developed templates for UAS guidance and UM denial rationales that resulted in a reduction of unnecessary PCW (personal care worker) hours by more than 20,000 hours per month with 2 – 3% appeals rate

Established protocols, policies, quality and training for care managers

Healthfirst, New York, NY

Consulting Medical Director 2015 - 2017

Utilization management for Managed Long Term Care Product

CSW North America - International

Healthcare Information Technology Company based in the UK, working with the

National Institute of Health (NIH)

Global Advisor 2005-2006

Designed and assisted in development of a state-of-the art, CCHIT compliant, ambulatory and inpatient enterprise-wide electronic health system

Provided advice and strategies to hospitals regarding IT strategic planning, clinical systems implementation, operations systems integration, culture change, physician adoption, and return on investment

Provided design and strategic planning to ambulatory clients on staff and physician IT adoption, clinical decision support, and quality improvement

Care to Care – New York and Regional US

Radiology Benefits Management Company

Interim CEO 2011

Acted in consulting capacity of interim CEO to refocus the leadership team, establish marketing and public relations initiatives, identify potential clients in the Payer sector of healthcare and grow the company’s business.

Within four months, the marketing campaign was focused and improved, the leadership team began to work as a cohesive unit, one new client was established, the company became a Preferred Provider for ACAP (Association of Community Affiliated Health Plans) and six more clients were placed into the pipeline.

CareData, New York, NY

Turn-around company with CCHIT-certified Ambulatory EHR, PHR and Patient Tracking.

President and Chief Medical Officer 2007-2009

Advised in revision of software design to accommodate Payer needs and Pay for Performance documentation.

Touchstone Health Plan – New York, NY

Chief Medical Officer/Consultant 2007-2008

Turn-around situation, taking an 11,000 member Medicare Advantage Plan from 94% medical loss ratio to 78% medical loss ratio within one year.

Created a DRG Cost Containment department responsible for saving more than $1.5 M in first year of operation for a plan size of only 11,000 members.

Oversight of 38 employees in Utilization, Quality, Case and Disease Management.

Consistently beat budget expectations and restructured health services department to significantly reduce administrative expenditures.

New Parkway Hospital and Integrated Delivery System – New York, NY

Senior Vice President Managed Care 2007-2008

Analyzed, Modeled and Renegotiated Contracts (including full and partial risk capitation) for a 251 Bed Community Hospital and Integrated Delivery System resulting in improved bottom line financial performance.

Refocused the hospital in a managed care direction, establish new and more lucrative contracts, blend the disparate entities (hospital, lab, surgicenter and physician clinics) into a cohesive, well-functioning entity that was able to set up both the hospital and clinics under full and partial risk capitation contracts.

Established Pay for Performance programs for inpatient and ambulatory practices.

Designed and initiated electronic health record implementation for both hospital and physician practices.

Provided medical management for quality, length of stay and inpatient utilization of admissions.

Created Analysis Templates for contracts against payment methodologies to ensure correct and maximum reimbursements from Payers.

Care South/Physician Alliances, LLC, Nashville, TN

Consultant and Acting VP Medical Affairs & Strategic Planning 1997-1998

Consultant to multi-million dollar IPA management company with 1000 participating providers

Developed PSN model including Business and Marketing Plans, Cost/Benefit Analysis and Strategic Implementation

Established new PSN in West Tennessee consisting of more than 100 providers.

Assisted IPA’s with internal management and contracting

Assisted in development of community-based Private Label Healthplan.

Developed multiple value-added services for PSN including prescription analysis, group purchasing, initiation of electronic medical record-keeping, billing & collections, and provider profiling.

Full Time Positions:

Access MediQuip, Lake Mary, FL/Houston, TX

Nation’s first, and largest, surgical and implant benefits management company with annual revenue of $100 M. (Access MediQuip closed in May 2015)

Chief Medical Officer 2011-2015

Reporting to CEO with 25 direct/indirect reports and an operating budget of $750 K

Helped reduce debt service from $50 M in 2011 to $15 M in 2015

Part of executive team responsible for 25% revenue increase year-over-year.

Developed patient risk stratification software for identifying risk costs from surgical intervention

Developed Pay 4 Performance system for surgery involving implants

Helped to develop a national surgical Network; URAC Accredited within 6 months

Achieved URAC provisional accreditation for utilization management

Developed Clinical Guidelines for Surgical Implants

Created a National Board of Physician Advisors

Developed first of its kind Clinical Decision Support Tool; software for pre-auth processes – including Spine Surgery, Neurostimulation, Joint Surgery, Pacemakers and Implantable Defibrillators

Created Device and Therapeutics Committees with two large national health plans

Virginia Premier Health Plan – Richmond, Virginia

(Wholly owned subsidiary of Virginia Commonwealth University Health System)

Chief Medical Officer 2009-2011

Turn-around situation, taking a half billion dollar revenue company with 153,000 Medicaid members from a $33 M loss over two years to profitability within the first six months. At the end of the first year, converted the $33 M loss into a $15 M net profit and, at the end of the second year, close to a $40 M gain, the most profitable in the Plan’s history

Reduced Medical Loss Ratio from 92% to 85% through sound utilization practices, reduction in claims leakage and innovative contracting.

Continued to lead and improve Quality management resulting in a consistent first place position for Medicaid plans in the State of Virginia (four consecutive years) and 26th in the nation for the current HEDIS reporting year.

Participated in presentations to academic center’s board of directors

Participated in academic center’s executive board for health plan

Participated in academic center’s operations committee

Directed and managed Utilization Management, Quality Management, Disease and Case Management with oversight of four medical directors and staff of more than 100 employees.

Initiated effective Change Management to realign healthcare vision with the business mission and successfully change behavior.

Improved network relations through collaborative initiatives

Participated in joint operating committee with Carillion Health System in Roanoke, VA, an integrated delivery system and academic medical center with medical school

QLIMG (Queens-Long Island Medical Group)

One of the largest PC Medical Groups in the Country with over 300 physicians, 21 multi-specialty centers and 200,000 patients.

Hospitalist Medical Director 2006-2007

Created infrastructure for inpatient hospitalist program, disease management.

Reduced UM – inpatient bed days per thousand:

o17% reduction in Medicare members

o6% reduction for Commercial members

o3% reduction for Medicaid members

AmeriChoice, a United Health Group Company, New York, NY

Senior Regional Medical Director, Northeast (NY, FL, Rhode Island) 2001 - 2005

Executive Management responsibilities for one of the largest national Medicaid managed care organizations with oversight of both Medicaid and Medicare in New York, Rhode Island and Florida, consisting of more than 300,000 covered lives.

Contributed 25% of the profitability for all United Medicaid plans in US

Ran a 73% medical loss ratio

Innovative, nationally recognized approach to Asthma Disease Management resulting in establishment of Specialty and PCP Centers of Excellence, improvement in quality scores and reduction in overall cost and utilization for asthmatic members

Maintained less than 5% turnover in personnel over a 5 year period

Created and consistently met, or improved on, budgetary financial targets within health services department.

Direct reporting of four Medical Directors and staff positions in Credentialing and Quality Management.

Direct oversight of Disease Management, Utilization Management and Credentialing

Successful Utilization turn-around resulting in an MLR of 74% in Medicaid and 68% in Medicare over multiple years.

Oversight of Quality Management resulting in one of the best records in the northeast for Medicaid HEDIS measures.

Innovative creation of Cross-Functional Interdisciplinary Team to address both the macro and micro management of inpatient utilization and Disease Management focused on Asthma, Diabetes and CHF.

Initiation of Electronic Health Record Demonstration Project for Diabetes.

Successful adoption and deployment of ambulatory EHR in physicians’ offices.

Close alignment with Provider Relations and Marketing for successful membership growth and member retention in a highly competitive market.

Participated in joint operating committees including New York Presbyterian (chaired by Mr. Dov Schwartzben)

Taconic IPA (TIPA), Fishkill, NY

VP Medical Affairs 2000

Executive Management of one of the largest IPA’s in Northeast with 3,000 physicians and 135,000 covered lives

Direct supervision of 2 associate medical directors

Maintained profitable medical loss ratio in Commercial sector below 74%

Coventry Healthcare – Virginia and West Virginia

(Joint venture between Health America and Academic Institution Alleghany Health Alliance)

Senior Medical Director, Health Assurance/Southern Health Services 1998-2000

Health Plans of 129,000 Commercial members (59,000 members (WV & Ohio) and 70,000 (VA)

Turned a $1.4 M per month loss into a profitable balance sheet within six months through:

Oversight of QI and UM Departments

Implemented infrastructure that resulted in Reduced Bed Days/1000 in WV and Ohio by 39% in 180 days to under 200/1000 with ALOS of 3.2 days

Reduced unnecessary Diagnostic Imaging by 12% and Colonoscopies by 10%

Established Cross-Functional team to lower medical loss ratio

Implemented Strategic Management Implementation

Improved provider relations with Company

Established Fraud and Abuse guidelines

Established Cost/Benefit Analyses for UM, Fraud and Abuse, Medical Loss Ratio

Established Budget and Guidelines for Medical Management Dept.

Daily interaction with Appeals procedures and Grievance Committee

Helped guide Health Plans through full accreditation processes (NCQA and URAC)

Worked on Legislative Committee to interpret and implement State and Federal guidelines, including Medicare.

PRIVATE PRACTICE:

Practicing Physician – Los Angeles 1979-1993

Established and developed a successful family practice in the highly competitive Southern California area.

Created Corporate Health Services, one of the first PPOs in the country and was a founding member of the Beverly Hills Westside IPA.

Served as a consultant on managed care for several major insurance underwriters, including AIG, Transamerica, Chubb and CNA.

Leadership roles in professional, business and civic organizations.

In addition to the private practice of family and sports medicine, also built a family practice network that established contracts with major Hollywood studios.

Founded National Emergency Care Month in the US

Founded and ran two global companies; Entertainment Medical Specialists and World of Health Travel. Both companies contracted with major motion picture studios to provide travel medicine and urgent care on-site in the US and abroad. (Sold both companies in 1993).

Family Practice and Urgent Care Medicine – Virginia 1995-1997

MILITARY

US Air Force

Lt Colonel, Medical Officer, Langley AFB, VA 1993-1995

In addition to primary care medicine, provided investigative services in the area of healthcare fraud by civilian providers.

Uncovered $ 2.4 M dollars in overcharges resulting in a favorable settlement of $750,000.

Developed proposals to Tri-Care for expense reduction and enhancement of service levels in the out-patient setting.

Established overseas health care protocols for a military unit.

EDUCATION:

BA, Pre Med, Psychology SUNY Stony Brook 1967-1971

MD University of Miami School of Medicine 1971 – 1976

MS, Clinical Psychology University of Miami 1978

MBA Warwick University, England 2006

RESIDENCY Internal Medicine, Cedars/Sinai, Los Angeles 1976-1977

Family Practice, Northridge Hospital, CA 1977-1979

Certification:

Board Certification

Family Practice 1975-1994

Urgent Care Medicine 2014

ACTIVE LICENSURE

New York expir May 2019

Florida expir Jan 2019

ASSOCIATIONS:

FAAFP American Academy of Family Physicians 1979-1994

CPE American Association for Physician Leadership (ACPE) 2005

FHIMSS Health Information Management Systems Society 2009

BOARD OF DIRECTORS/COMMITTEES:

HIMSS

Board of Directors, HIMSS 2010-2014

oHIMSS Mobile Health Committee 2015

oChairman, HIMSS Physicians’ Communities Committee 2009

oChairman, HIMSS Global EHR Task Force 2006-2009

oMember, HIMSS Practice Leadership Task Force 2006

oMember of Advisory Board, HIMSS Katrina-Phoenix Project 2005-2006

oChairman National EHR Implementation Committee, HIMSS 2004-2005

oMember, HIMSS National EHR Steering Committee 2004-2006

CCHIT

Commissioner, Board of Commissioners, CCHIT 2008–2009

Co-Chairman National EHR Certification Committee, CCHIT 2004-2006

Co-Chairman National EHR Cert Testing Committee, CCHIT 2004-2006

NY State Senate Committee for Preventive Healthcare Grants 2010 –present

Founding Board of Urgent Care Medicine 2008- present

Advisory Board, Formulary Magazine 2004 – 2010

Chairman, New York State - EHR Committee, NYHPA 2004-2005

Board of Directors, New York City Police Reserve Association 1993 – present

ABPS

Chairman of the Board, Urgent Care Medicine 2015

Board of Urgent Care Medicine 2012 - present

AWARDS and PUBLICATIONS:

White Paper, HIMSS,

National EHR Adoption in the Global Economy 2007, 2009

White Paper, HIMSS

National EHR Implementation: A Network Model 2006

Private Health Plans Perspectives: Electronic Personal Health Records and Electronic Prescribing, American Health and Drug Benefits 2009

Co-Author and Editor: Guide to the Electronic Medical Practice: Strategies to Succeed, Pitfalls to Avoid: HIMSS Publication 2006

Co-Author and Editor: No Strings Attached; A Guide to the Wireless Medical Practice, HIMSS Publication 2007

HIMSS Leader of the Year Award 2006

Spirit of HIMSS Award 2006, 2007

SPEAKING ENGAGEMENTS:

Managed Care and Pain Management, VCUHS Pain Management Symposium,

Virginia 2011

Navigating the Waters of Managed Care, Florida Health Plan Assoc

Orlando, FL 2011

CMO/CMIO Roundtable, Virginia HIMSS 2011

Moderator, Introduction to the Surgeon General of the USA

HIMSS Congress, Orlando 2010

Healthcare IT Updates, NY HIMSS, New York 2010

Healthcare IT Updates, VA HIMSS, VA 2010

Slipping through the System of Denials: How HMO’s Get the Upper Hand….

12th Annual Hospital Case Management 2008

Moderator – Global EHR Implementation, HIMMS Congress,

New Orleans 2007

Safe Harbors: Understanding Implications of Stark II, HIMSS Webinar 2007

Navigating Waters;: Managed Care, Formulary Conf, Phila 2006

Implementing EHR in the Payer Setting, HIMSS Congress, Dallas 2005

Implementing EHR in the Ambulatory Setting HIMSS Congress, Dallas 2005

Adopting EHR in the Medical Office, E-Forum, Albany NY 2005

Certifying EHR in the Ambulatory Market, E-Gov Institute, DC 2005

Professional Affiliations:

Health Information Management Systems Society 2006 – present

Association of Medical Directors of Information Systems – 2009-2010

Rotary International – member and past president 1983-1995

Freemason 2008 – present

References Upon Request

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