Medical Management

JACK L. AYALA

**** ** **** ***. **** Lauderdale, FL 33322-5666

*******@*******.*** Cell: 856-***-**** Office: 954-***-****

SUMMARY

An accomplished senior executive with an extensive and proven track record with both payers and providers; An individual

whose outstanding leadership and analytical skills have brought start-ups, growth-oriented and financially distressed

healthcare entities to a new level of success and unique ability to bring diverse groups together. A person that is called upon to

raise the bar when others have deemed the task as hopeless. Focused builder and manager of large physician networks and

new models to maximize opportunities under the New Affordable Care Act. Extensive hands on experience with turnaround,

product management and branding, facility management and large construction, IS/IT system and implementation of

EHR/PHR across large systems. Continual history of successful team building. These skills have been applied to teaching

hospitals, secular and for profit national hospital systems; managed care companies (MCCs), coordinate and implement

Telemedicine projects, Health Exchange (HIX) Operations, Accountable Care Organizations (ACO’s) and single/multi-

specialty large group practices. Extensive experience with the implementation and funding of Clinical Campus for Medical

Clerkships at UME level & Graduate Medical Education Programs expansion and funding for new residency slots.

PROFESSIONAL EXPERIENCE

Genesis Medicus, LLC 2009 - Present

CAO & Managing Partner responsible for Finance and Operations

• Management of companywide assignments at client level, Responsible for financial analysis and modeling, payer

contract negotiations, strategic and analytical analysis. Identifying opportunities for our managed care clients and

implement CMS STAR rating measures and implementation of care coordination models that minimize recidivism to

ensures that BCR (Benefit Costs Ratios) are aligned with measurable; outcomes, quality and above all access to care.

• Create, implement, and oversee execution of systems and operational business plan for HIX segment.

• Supervision of M&A activity at pre-acquisition and post-acquisition levels. Providing and directing turnaround

strategy, programmatic development and implementation to support and successfully manage day-to-day operations.

• Develops client’s Brand Equity Strategy priorities and sets direction for business segment applying knowledge of

business, competitive landscape and regulatory environment.

• Operational oversight over the faculty Practice and the proprietary teaching faculty network consisting of 1,850

Community based Specialist and Sub-Specialists.

• Establish a comprehensive compensation plan to align physician compensation with the organization's criteria that

meet quality objectives. Ensure plan is executed and monitored.

• Responsible for the creation of New Financial and Business Models to assist Teaching Hospitals, Community Health

Centers, FQHC, & Large Physicians Groups & Practice (primary care, specialists and subspecialists) practices and

establish linkage agreements to form ACO.

• Establish a comprehensive compensation plan to align physician faculty teaching stipends with the organization's

teaching objectives.

• Ensure plans are executed and monitored Identified and Implemented a the (GME) Graduate Medical Education level

and develop and implement all strategies for the (UME) Undergraduate Medical Education Clinical Campus for 3rd

& 4th Year Medical Students to complete all Required Core Clinical Clerkships in partnership with accredited (AOA

& ACGME) teaching sites, throughout the US.

• P & L Responsibility $86M

PS&GM Holdings Markets CEO (Five States) 2005 - 2009

Holding Company Accomplishments (this is a continuation of Palm Springs General Hospital)

● Oversight for 12 Ambulatory Surgical Centers (ASC) under management or wholly-owned and four (4) Imaging Centers with

over 85 Interventional Radiologists and 26 MSOs, including both Single and Multi-Specialty /Faculty Practices and a large

International referral base with over 2,500 physicians. All facility construction, expansion and management as well as

development and implementation of P&P for all capital expenditures and Financial reporting

● Responsible for all analytical and financial reporting, all providers contracting, develop compensation model and employment

agreements for all staff physician and

● Ensure the seamless integration between the various Physician Groups/Faculty Practices and hospitals for the full integration

of Epic EMR/PHR, responsible for the design and execution of all strategies.

● Develop and implements all financial guidelines

● Since my promotion to run the Holdings Company, we have grown from one operation in one state to 42 operations in five

states - FL, AL, LA, SC and NC. I oversee and manage all operations and expansion of al

LOB's within the Holding Company wholly-owned or managed under JV Agreements with our physicians-partners

as well as all M&A Activities. P&L responsibility: $380 million at the Holding Company level

Palm Springs General Hospital (220 Beds)

CEO and Executive Vice President

Hospital Accomplishments

● Increase Outpatient procedures (Endoscopies, Cardiology and Surgeries) by 32% ($22.5 million); focused on facility

construction and expansion

● Established metrics, criteria and initiatives to obtain national recognition in the “Top 100 Hospitals” in Health Grades for two

categories (General Surgery, MI and GI). Rated, “Up & Comer” in Mammography, Implementation of MAC in Pharmacy

● Rated top quartile within the best 200 hospital in class for Medical Record Coding

Catholic Health East / Mercy, (Trinity Health) 2002 – 2005

Senior VP and COO at a number of Mercy / CHE Affiliate.

Responsibilities at Saint Agnes Medical Center (SAMC)

● Total oversight for restructuring the office of the Chief Medical Officer, Department Chairs, and Committee Members and top

tier medical staff, at the Hospital to meet new challenges and strategies.

● Complete Oversight for all Contract Negotiations at Hospital, Radiology & Imaging Department, and Joint Venturing the GI

Lab, Non-Invasive & Nuclear Cardiology, Oncology, ED, Outpatients Services & Specialty Clinics as well as the SPU all of

which increased utilization by 40% and doubled net revenues.

● Overall gross Patient Service Revenue increased by $19 million

● Oversight for the Family Practice Residency Program between PCOM (Philadelphia College of Osteopathic Medicine) and

SAMC

● Additional duties included developing new business strategies and programs for IT and patient information integration

Keystone Mercy Health Plan (KMHP) Sr VP

Responsibilities included:

● Development and identification of Keystone Mercy/CHE 3,750 providers network to lead the implementation of several

disease management initiatives designed to achieve: 1) targeted Benefit Cost Ratios (BCR) at the KMHP and Targeted

Utilization at the Medical Center. Goals were achieved across a diverse mix of organizations and in a highly matrix

environment

● Development and Implementation of necessary systems to enhance the operations of our PBM for existing targeted population

and ready ourselves to deal with Medicare Part D as prescribed under the new MMA guidelines. Scope: throughout all of the

Mercy/CHE system

● Developed strategies for the CMO and VP of Medical Affairs as alternatives for Contracting & network development with all

of the Mercy/CHE designated sites of excellence and individuals providers

Creative Healthcare Group (a Mercy Affiliate and the largest Pediatric network in the state of New Jersey)

● The operations consisted of 320 Pediatricians and CRNP professionals that covered the entire state.

● Negotiated 37 Payer Agreements with a 23.75% avg. rate increase

● Consisted of 48 individual practices, covering four hospital inpatient units, two hospital EDs, two NICUs and one PICU

● Established the State’s largest pediatric triage call center and patient clinical information database

● Increased gross revenues from $49 million to $119 million, and expanded operations to two additional states

AMERICHOICE, INC., Philadelphia, Pa. (A UnitedHealth Group Company) 1997 – 2002

Senior Vice President

● Provided complete oversight for Network Development & Contracting over the “Partner PCP” concept a network of over

1,960 Top Tier Providers in the Tri-State (NY/NJ/PA) area. Resulted in significant impact on physician retention and

outcomes

● Responsible for the Tri-State (NY/NJ/PA) region’s Partners PCP Network and large Health System providers with

membership panels of 300 members or more

● P$L responsibility: over $580 million

● Assumed a leadership role in creating the Women’s Health Division, (for Ob & Gyn) servicing three product lines

(SCHIP/Medicaid/Medicare). Since the inception of the Women’s Health Division, the company had achieved $15 million in

annual savings through the implementation of Care Management and Case Management programs, membership growth of

21% and $150 million growth in annual revenues.

● Responsible for the successful launching and growth in the Tri-State region of the KidsChoice™ (SCHIP) and The Medicare

Personal Care Plus™ products. Additional responsibilities encompassed company-wide efforts for Outreach and Prevention

Services for the entire membership base of 457,000 lives. Notable outcomes included:

Productivity/cost savings - established a department that combined sales, marketing and retention functions with provider

relations. This model allowed a higher level of creativity, motivated physicians to promote our products and significantly

reduced our expenses, by $62 million annually.

Quality - achieved NCQA meritorious award and honorable mentioned recipient for outcomes in Prenatal Care.

ST. JOHN HEALTH SYSTEMS, INC., Miami, FL. (A PHC Affiliate) 1992 – 1997

President and COO

Directed the divestiture of two of PHC hospitals and repositioned the company as a dominant integrated delivery system in

two major Southeast markets:

● Expanded services lines through strategic alliances, joint ventures and developed a plan which facilitated the company

acquiring the management contract for 12 Primary Care Sites that later led to the acquisitions, merger and the greater

expansion of the St John Health Systems Center of Excellence. As a result of these Primary Care Centers who served a 7,000

member Medicare/Medicaid HMO, the organization increased its pretax profit margin to 12%.

● Implemented a Disease Management program to effectively track and treat most at risk population

● Launched two new product lines, a Medicare Certified Home Health Agency and a Government Programs MCO positioning

the company as a multi-service organization that could secure outside contracts with organizations not offering these services.

This both increased revenues and saved dollars.

● Established a joint venture agreement between St. Johns & M.O.M.S. ®, a proprietary provider network

of 900+ OB-GYN physicians in four states, who provided state-of-the-art case management & medical care to women.

Meeting community needs, decreasing the number of bad outcome births and reducing the number of NICU admissions

from 17% to 11%.

● Effectively managed operations and change during a period of rapid growth. From 1992 until 1997, revenues increased from

$1.8 million to $65 million. The most significant impact to this revenue growth was a reduction in claims payments during

this period.

BELLFLOWER DOCTORS HOSPITAL, Bellflower, CA. (A PHC Company) 1990 – 1992

420-beds acute care

President and CEO

● Established the hospital as a Primary Care Center of Excellence within the community.

● Shifted the hospital’s principal service line from inpatient psychiatric care to inpatient and outpatient medical/surgical

services by recruiting 300 additional physicians to the medical staff

● Formed a PHO formulate and executed strategies with physicians to deal with emerging managed care issues such as

quality of care, outcomes management, diminishing reimbursement and alternative care protocols.

● Introduced M.O.M.S. ® as the prototype for providing access, comprehensive case management and delivery of care to

a socially diverse patient population. The M.O.M.S. ® model was adopted by the Los Angeles Department of Health

Services and today is known as the MediCal OB Access Program.

● Managed the major renovation of the hospital’s physical plant financed totally through internal cash flow.

CPC Fort Lauderdale HOSPITAL, Ft. Lauderdale, FL 1987 – 1990

CEO and Regional Corporate VP for Southeast Market (FL, LA, GA and PR)

● Developed and executed plans to insure the financial turnaround of CPC Fort Lauderdale Hospital.

● Oversight for twelve (12) Acute Psychiatric Hospitals $929M P & L

● Built CPC’s Fort Lauderdale provider network recruiting 120 new attending psychiatrists, clinical psychologists and MSW's

resulting in expanded utilization gains at the facility (from less than 30% to 90%) and $9.6 million pre-tax profit within 13

months.

● Introduced Legislative language at state level to pave way for expanding clinical role of psychologist to admit patients

and prescribe psychotropic medications in the state of Florida at accredited institutions.

● Engineered Glenbeigh Hospital’s Pre-Acquisition financial turnaround within 90 days by collecting $1.0 million Medicare

accounts receivable, installing electronic billing for major payers, recruiting 38 staff physicians and aggressively marketing

the hospital’s quality within the community.

● Other responsibilities included Interim Chief Operating Officer of Healthcare Management Alternatives, Inc. (“HMA”),

Philadelphia, PA and acting CEO of Glenbeigh Hospital in Miami, FL (Pre-Acquisition)

FIRST HOSPITAL PAN-AMERICANO, Cidra, Puerto Rico 1985-1987

CEO/Administrator 465 beds

● Full oversight for the construction of a state of the art Full Service Adolescent and Adult Outpatient and Inpatient Acute

Care Psych Hospital facility

● Responsible for developing and implementing Affiliated Outpatient sites abroad and the Development of key clinical sites

and practices in Mexico City, Dominican Republic, Central & South America as key Referral base which generated over

45% of all admisions

BETH ISRAEL MEDICAL CENTER, (Continuum Health Partners), New York, NY 1981-1985

Vice President for Operations

● Established state of the art invasive and non-invasive cardiology programs

● Direct responsibility for the growth and expansion of all Peds services including: 150 bed inpatient unit; 30 bed PICU;

and, a full-service Pediatric Trauma ED

● Full oversight over the Graduate Medical Education and Training Program between Mt Sinai and BIMC for both

Residency and Medical Students. Also established an affiliation agreement covering other teaching sites and outside

community physicians

NEW YORK CITY HEALTH & HOSPITALS CORPORATION, New York, NY 1976-1981

Associate Director

● Lincoln Medical & Mental Health Center – South Bronx

● Elmhurst Medical Center – Queens, NY

● Woodhull Medical Center – Brooklyn, NY

● Responsible for oversight of decommissioning Green Point and Cumberland Hospitals

EDUCATION

Post Graduate Courses: Wharton, Harvard, Chapel Hill & Drexel

Undergraduate, Fordham University, New York, NY (BA Sept. 1976)

Public Health Administration Residency at Misericordia Medical Center, Bronx, NY

PROFESSIONAL AFFILIATIONS (Past & Present)

Editorial Board Latino Medical Journal

American Association of Mental Health Administrators (AAMHA)

Hispanic Association of Health Service Executives (HAHSE)

American Hospital Association (AHA)

Metropolitan Healthcare Administrators Association (MHAA)

Society for Healthcare Planning and Marketing (SHPM)

President of Association of Hispanics Healthcare Executives Pennsylvania (AHHE) (Past)

COMMUNITY SERVICES & VOLUNTEER ACTIVITIES

Board Member Samaritan Pharmaceuticals, Inc.

Board Member SAMC Foundation (Past)

Board Member Chamber Orchestra of Philadelphia (Past)

Board Member, Broward County Performing Arts Center (Past)

Board Member Mental Health Association Broward and Los Angeles Counties (Past)

Co-Chairman, Philadelphia Public Schools, Kensington Cluster (Past)

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