Clinical Data Science Executive
Resume:
Gerald F. DeMara
Riegelsville, Durham Township, Pennsylvania, 18077
610-***-**** ********@******.***
summary
A highly knowledgeable and forward-thinking informatics executive, researcher and statistical modeler specializing in the understanding of population behaviors and the influence of behavior on decision-making. Possesses deep understanding of data, program evaluation and the algorithmic measurement of clinical, biometric and financial outcomes. Demonstrates the ability to communicate complex findings in creative, intuitive ways to inform the guidance necessary for high quality, confident clinical and financial decisions. Extensive experience in advanced analytics, including fluency with statistical models and methodologies, data warehousing, sourcing, integration and mining of large complex healthcare databases and the development and implementation of complex clinical algorithms.
Clinical Research & Statistical Methodologies Predictive & Explanatory Modeling
Microsimulation Development Probabilistic Clinical Profiling Medical Case Episodic Care
Clinical Risk Determinant Identification Complex Clinical Algorithm Development
Behavioral Modeling (Frailty & Risk Assessment, Probable Paths to Future Events)
Biometric & Self-assessment Information Demographic and Cartographic Algorithms
Conceptualization and Implementation Care-delivery Impact on Clinical Outcomes
Financial and Economic Analyses Healthcare Provider Efficacy Evaluation
Professional Experience
George Institute for Global Health – Data for Impact / Clinical Data Science Head
June 2022 - Present
At GIGH Data for Impact (D4I) We are committed to undertaking research and identifying practical approaches towards better treatments, better care and healthier societies, specifically for the underserved as chronic and acute illness is a human condition complicated by socio-economic and other complicating health care delivery issues. D4I develop innovative, affordable and evidence-based solutions to the world’s biggest health problems by conducting large-scale clinical trials, epidemiological studies, health systems research, and population-based studies. We look beyond single diseases, across the life course, to identify patient-centered approaches to care that can be implemented at scale.
These holistic and bespoke analytical and modeling perspectives reflect both clinical and behavioral conditions as well as behavioral health crises manifesting as physical health symptoms.
Viewed through this lens, taken with all associated component and cumulative risks (both current and future), allow for accurate prioritization, messaging and outreach to optimize clinical outcomes, financial determinations and quality of life improvements.
Biometric Health – Founder, SVP Clinical Data Science, Chief Analytics Officer
January 2021 – May 2022
BMH understands that everyone’s health is at risk and that populations are comprised of diverse individuals with both common and unique character attributes. Such attributes include demographic, geographic, illness burden, risk, spend and care-seeking tendencies. While any of these may potentially influence member behavior, combinations of attributes have proven to be the most powerful predictors of future decision making.
An individual’s future, however, cannot be predicted in a vacuum. Using the ‘wisdom of the collective’, each individual’s future disease progression, care-seeking and spend behaviors can be anticipated with precision, providing proactive answers to patient health, risk, care-seeking and disease progression questions by answering diverse questions quickly and creatively with clinical and statistical quality and confidence.
Health Care Service Corporation
July 2014 – March 2020
Divisional Vice President, Clinical Data Science & Strategy
October 2016 – March 2020
As DVP of Health Care Management, my team and I contribute to strategic, financial and clinical decisions that directly affect our members. Working closely with advanced analytical, statistical and clinical resources, we develop predictive and explanatory models using robust methodologies (to include machine learning) to create data visualizations depicting utilization, standardized risk across populations and the identification of members prioritized for program outreach. Our multiple tools are applied to various legacies, tactical and future state analytic computing environments. Our analytics/models/tools are developed using large medical, pharmaceutical and social determinants of health databases to solve problems and deliver actionable insights in support of improved health outcomes and sustainable financial growth.
Executive Director, Enterprise Analytics
March 2015 – October 2016
As Executive Director of Enterprise Analytics 'Clinical Data Science & Health Intelligence', I lead a multi-disciplinary group responsible for the research and development of retrospective and predictive statistical modeling algorithms, microsimulations, opportunity discovery and forecasting tools employing the following disciplines: predictive and retrospective modeling, microsimulation & complex reporting tools, discovery and root cause identification tools.
Director of Enterprise Analytics
July 2014 – March 2015
As Director of Enterprise Analytics, I lead a multi-disciplinary group responsible for the research and development of retrospective and predictive statistical modeling algorithms and descriptive forecasting tools for the purposes of: clinical outcomes research, member risk assessment, benefit change simulation, program evaluation and business case justification.
Vettia, Vice President of Analytical Insight
December 2013 – June 20144
My role at Vettia is to research, design and develop statistical protocols that drive actionable insights through identifying influencers of population behaviors and understanding how behavior determines decision making. This knowledge is then leveraged to provide differentiated, client-centric, market-driven solution strategies while building new best practice competencies. In addition to my programming, modeling and research responsibilities, I also have charge of developing Vettia’s analytic frameworks, standards and practices.
Aetna U.S. Healthcare, Inc.
August 1992 – November 2011
Aetna Integrated Informatics – Informatics Head
Medical Informatics & Quality Metrics, Applied Informatics, Plan Sponsor Research
October 2005 – November 2011
In addition to my historical responsibilities with regards to study research, design and methodologies, my acceptance of an Informatics Head position further requires involvement with broader aspects of our organization to include:
Responsible for all Plan Sponsor Unique statistical analyses and full studies reflecting a vast and diverse array of subjects/hypotheses.
Developed a Customs Clinical Outcomes Repository (CCOR) comprised of HEDIS-standard and PG-contractual language custom definitions for use in clinical studies, PG resolution analyses and rapid RFP responses.
The conceptualization and development of large functional performance/clinical outcomes/patient risk modeling systems, for example:
oHealth Opportunity Score (HOPS) – multi-component risk determination models identifying members with behaviors supportive or not of continued or better health.
oHOPS Extrapolation Algorithm (HOP-EA) – completes HRA surveys for members by applying Book of Business determined ‘average’ responses by ‘member characteristics key’.
oPropensity for Change (PfC) - Identifies members who require change and with a 75% or greater willingness to change for focused outreach.
Operating Plan development.
Compensation & Budgetary responsibilities.
The development of an Applied Informatics Research, Programming & Documentation Standards & Practices document to include the installation of an Informatics Peer Review Panel and concise instructions for the documentation of all algorithms and study-relevant information.
Aetna U.S. Healthcare, Aetna Integrated Informatics - Senior Research Manager
Medical Informatics & Quality Metrics; Medical Informatics
September 2002 – September 2005
As Senior Research Manager I was responsible for leading the research, design and methodological development of key clinical, performance measurement and predictive modeling initiatives. These initiatives include, but are not limited to:
The conceptualization and development of the Characteristic Profile Matching Algorithm (CPMA), subsequently utilized on all Applied Informatics initiatives requiring a statistically derived, profile-matched control cohort.
The planning, design and development of a comprehensive suite of Aetna Health Fund Consumer Driven Healthcare studies including, but not limited to, trend analyses, behavioral aspects, self-care, ambulatory-sensitive care, chronically ill member Quality & Appropriateness of Care and Life-Treating v. Discretionary Pharmacy Consumption components. Drafted white papers for release to the Office of the Chairman, National Accounts, etc.
The management of an informatics programmer/analysts’ staff responsible for a diverse range of studies (e.g., Active Health Management, Aetna Pharmacy Management, NMS Disease and Case Management) reflecting the many aspects of research, to include; health policy and clinical program evaluations, product and decision-making tool development initiatives.
The development of the Medical Management Modeler, a predictive model-driven, “what-if scenario” tool allowing for underwriting/marketing staff to iteratively build Disease Management Program, case-mix and illness-burden adjusted, direct and indirect cost/utilization return on investment predictions complete with confidence intervals as an interpretive guide.
Participation in project life cycle vetting workgroups to include the Virtual Methods and Program Analytics.
Aetna U.S. Healthcare, U.S. Quality Algorithms - Senior Research Manager
Medical Informatics & Quality Metrics, Outcomes Informatics
September 1996 – August 2002
As Senior Research Manager I was responsible for leading the research, study design and methodological development of key clinical study, performance measurement and predictive modeling initiatives. Through my leadership USQA/Aetna Integrated Informatics designed the following custom case-mix and burden of illness adjusted model-driven tools.
Generic risk stratification models that predict future health status based on a roster of key predictor variables.
An Inpatient Performance Measurement System reflecting 31 case-mix adjusted DRG specialty driven predictive models comprised of length of stay, adverse event and c-section measures. The system was designed to facilitate complex querying of actual and expected inpatient performance results for hospitals, specialists, Integrated Delivery Systems and other healthcare provider collectives.
A refined derived case algorithm producing clinically intelligent information to serve as the foundation for key research initiatives and critical business decisions.
A Hospital Quality Review performance measurement tool with a unique design that interrogates data for both pre and post discharge markers of quality. The tool is comprised of 7 outcome (adverse event) and process (prescription of medications known to prolong the lives of cardiac patients) measures with accompanying member lists to help hospitals identify systemic breakdowns in the delivery of care.
U.S. Healthcare, Corporate Health Administrators – Research Manager
Clinical Data Management Unit
October 1994 – August 1996
As Manager of the CHA Clinical Data Management Unit, I lead the development of clinical-based algorithms and reporting/analysis mechanisms focusing on chronic disease prevalence and specific disease states. Through my leadership CHA innovated:
Diabetes and Asthma Report Cards and a Chronic Disease Database with a client-centric focus in addition to the traditional provider focus.
Member lists comprising at risk non-HMO members were derived and integrated into Health Status Reviews and presented twice annually at client meetings.
Disease Management Intervention mechanisms and programs to track effectiveness and return on investment.
U.S. Healthcare, Corporate Health Administrators - Senior Programmer/Analyst
Data Management Unit
August 1992 – September 1994
As Senior Programmer/Analyst of the CHA Financial Data Management Unit I developed and led revenue producing data management, ad-hoc reporting and analysis teams that focused on client specific, financial reporting mechanisms. These mechanisms included:
Benefit plan design models, indigenous and vendor-contracted managed care network effectiveness (return on investment/quality of care) and feasibility (access reasonability predicated on “within-miles” proximity of key specialty physician groups and acute hospital campuses) models.
Normative data algorithms, which sampled (randomly), our client base by demographic, geography, industry-type and plan design components to construct financial benchmarks for fair and equitable comparison analyses.
A multi-dimensional database and querying tool allowing for twenty dimensions of data interrogation, aggregation and advanced analyses.
A programmatic “market basket” approach to equalizing the cost and utilization disparities between product lines of differing benefit and reimbursement strategies.
The Sachs Group
Senior Team Member
Research and Development Group
September 1990 – July 1992
As a Senior Team Member with the Sachs Group, I was responsible for developing data integrity and sufficiency algorithms preparatory to staging health system data into the required software structural criteria. Further, I was responsible for developing demographic/cartographic algorithms preparatory to mapping of hospital patient data for use in physician, market and practice planning strategies.
Prudential Insurance Company
Programmer/Analyst
Data Management Unit
August 1983 – August 1990
As a programmer/analyst with the Data Management Unit I was responsible for developing financial algorithms for use in fiscal year-end contract negotiation strategies. In this capacity I interacted with key finance and underwriting contacts to develop fluid, issue-specific algorithms and intuitive information delivery mechanisms.
Education
Temple University, Philadelphia, PA
Studies: Undergraduate School of Education
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