Payer / Provider Relations Manager, Pharma experience

Todd A. Kremers

Rockford, MI *****

616-***-**** (mobile)

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

Profile Summary .

Accomplished professional with more than 20 years of operations, sales, strategic-planning, contracting, integration and business expansion experience

Experience in management of clinical initiative implementation and value-based contract management within broad health system business models. (ACO, CIN, PHO, Employed)

• Experience working at both the health plan and delivery system sides of the health care system

• Confident relations manager with broad experience in medical practice and hospital settings, using a consultative sales approach to get a full understanding of operational needs.

• Skilled in understanding departmental needs and empowering team members to grow and expand career goals.

•

Areas of Expertise

Health Plan & Relations Manager Sales / Marketing Effective Govt. Contracting Project Management Financial Planning Communicator Negotiation & Contract Performance & Decision Making Data Analytics Management Utilization Mgt. Collaboration Team Building & Mentoring

Work History

OneOncology – Nashville, TN (National Management Services Organization supporting Community Oncology)

Sr. Manager Contract Management June 2023 -Present Responsible for managing a National team of Contract Managers to oversee negotiations of Payer Contracts between National and Regional Health Plans for the Community Oncology Practices that OneOncology has partnered with to perform their Managed Services. Direct team in assessing network adequacy within respective geographies as well as reviewing reimbursement analysis of surrounding Oncology Practices and Hospital systems to best position the practice for contractual payment increases to ensure annual budget targets are met.

Corewell Health (Spectrum Health/Beaumont Health)- (Top 15 Nationally recognized Health System)

Advisor: Business Development Jan. 2019 –June 2023 Responsible for assessing market data to develop and implement business growth and profitability strategies within Corewell Health’s service area. Proficient in utilizing data sources such as Epic EMR, Sg2 Market Analytics in identifying organizational opportunities to improve efficiency and enhance growth strategies. Adept in building and maintaining excellent relationships with providers within the employed providers as well as unaffiliated provider groups within (PO’s -Physician Organizations within our health systems service area.

Manager: Payer Relations April 2016- Jan. 2019

Manage Payer Relations team to help develop and negotiate contract terms, conditions and incentives with existing contracted health plans as well as explore opportunities with potential new payer partnerships. Work with internal stakeholders to ensure department requirements are met and contractual obligations are followed. Identify cost savings and utilization reduction potentials to align with value-based contracting. Supervise team to evaluate change and drive improvement in contract management and changing trends in payment models.

ACCOMPLISHMENTS

• Spectrum Health / Priority Health Value Based Contracting Oversight

• SH/PH- Integration Optimization Utilization Reduction Collaboration

• NFAM- North Flight/Aeromed Joint Venture Contract Management

• SMART Contract Steering Committee –(Implementing organizations new contract management software)

• System education strategy on key contracts & product mix Trinity Health- (Second largest National Catholic Health System) Sr. Payer Strategies & Contracting Manager: May 2012- April 2016 Manage and negotiate Physician/ Facility and PHO contracts for Trinity Health organizations throughout Michigan. Work closely with all partnered and potential future Health Plans to negotiate physician fee schedules facility reimbursement as well as quality incentive reimbursement and pilot opportunities. Lead regular JOC meetings between the high-volume Health Plans and the appropriate departments from Trinity PHO’s to collaborate on cost savings opportunities. Responsible for working with data analysts to uncover potential opportunities for financial growth within PHO's as well as working with Trinity Hospitals throughout Michigan to develop favorable contract language. ACCOMPLISHMENTS

• PHO Clinical Integration Committee Member

• PHO lead on Utilization reduction efforts

• PHO Finance Committee member

• Trinity Health Process Improvement Team

• Trinity Preferred Contract Language Manual

Priority Health / Spectrum Health (Leading Health Plan West Michigan)– Grand Rapids, MI

Sr. Provider Account Representative: April 2010- May2012 Coordinate and manage overall activities related to key health systems throughout west Michigan to help drive improvement in quality measures and a reduction in over-utilization. Analyze performance and develop strategies by working closely with physicians, quality managers, pharmacists and other staff within each Physician Hospital Organization (PHO). Oversee Priority Health’s PCP Incentive plan within each PHO to improve Quality Index Scores for the PHO. Deploy Cost Variation Reports to the regional health systems and develop work plans to reduce specialist overutilization. ACCOMPLISHMENTS

• Innovation Through Inclusion Committee Member

• Key role in Cave Consulting Group Utilization Reports to Providers to assess over utilization and cost reduction opportunities

• ER Reduction Workgroup

Glaxo Smith Kline Pharmaceuticals-( Top 3 International pharmaceutical leader) Senior Pharmaceutical Sales Representative: Jan. 2007- April 2010 Pharmaceutical sales experience with Cardiologists, Urologists, and OB/Gyn throughout the greater Grand Rapids area. Successfully launched new products throughout West Michigan; awarded 2nd place in the region in a product launch incentive. Effective in obtaining formulary status for newly launched products within the hospital setting. Responsible for managing a given budget and utilizing analytical, business planning, and marketing skills to move market share achieving optimum results. ACCOMPLISHMENTS

• Launch Incentive Winner. (Coreg CR) 2nd place out of 21

• Successfully impacted product formulary status for new products on hospital level and Michigan Medicaid level. (Coreg CR) & (Altabax)

• Varsity Club Winner for market share growth within region (Vesicare) Top 5% in Nation

• Regional pharmacy champion 2008

• District Product Trainer (conduct national training seminars at various locations around the country to enhance the selling skills of other sales reps)

• Platinum Award Winner. (Top 10% in Nation- Valtrex) Metropolitan Hospital- Grand Rapids, MI Aug. 2003- Aug. 2006 Physical Therapy Patient Educator / Grand Valley State University student: Collaborate with physical therapy staff and doctors to properly educate patients during post-operative stay in acute care settings at Metropolitan Hospital. Extensive patient interaction through education of proper body mechanics and disease processes. Direct interaction with doctors, nurses and therapists to ensure patient awareness of procedures involved in the post operative rehabilitation process. Co-operative employment opportunity to research patient recovery data for Physical Therapy program at Grand Valley State University.

Commercial Tool Group- Grand Rapids, MI April 1993-Aug.2003 Program Manager:

Project Management of robotic equipment, engineering services and tooling for the automotive, appliance and medical industries. Met sophisticated engineering needs for customers that included some of the world’s largest automotive companies. Negotiated high dollar contracts and coordinated implementation of awarded programs. Managed accounts and orchestrated post sale services. Created and executed presentations to engineering groups and buyers. Responsible for start up sales in foreign marketplace (Canada, Mexico) when company established satellite offices/manufacturing plants.

ACCOMPLISHMENTS

• 1998- Team Leadership Award for exemplary leadership and commitment to teamwork

• 2003- 10 years of outstanding service award with the company.

• 2003- Outstanding Achievements Award for contributions to the company for 3 consecutive years of high profit margin

• Successfully managed accounts in foreign markets (Canada, Mexico) Education-

Doctorate Physical Therapy 1year Grand Valley State University Bachelor of Science (Health Science) Grand Valley State University Industrial Technology / Manufacturing Grand Rapids Community College

Contact this candidate