HAPCO International, LLC
Public Sector / Medicaid
- 2009 to Present: Facilitated and assisted in IT and Operations strategy and formulated new process descriptions and proposal responses for major Medicaid HMOs with successful outcomes in Virginia, Pennsylvania, Nebraska, Mississippi, New Hampshire, Florida, Kansas, Missouri, Arizona, Michigan, Kentucky, Louisiana, Illinois, Indiana and Texas. Strategic positioning included assistance for electronic prescribing, EMR, HIE and provider web portal efforts in these states. Formulated and executed new approaches to competitive monitoring of IT capabilities to inform market positioning and ongoing IT strategy.
- 2008: Formulated new approach to RFP response for IT and Operations areas for major bid by Medicaid plan in Tennessee; leading to significantly improved score and helping health plan to win $1B contract.
- 2006 - 2008: For one of the top 2 health insurance companies in the nation, led multi-disciplinary team in design, development, and deployment of web based application for the collection, processing, reporting, and ongoing monitoring of mental health assessment information in Middle Tennessee in support of the TennCare program.
- 2004: Assessed Medicaid Managed Care Plan data processing and communications capabilities vis-à-vis Federal Government Guidelines; for a 75,000 member HMO in Southwestern Michigan - in 60 days.
- 2002: Developed a database which accepted financial & clinical utilization data from 6 hospitals and over 30 community mental health clinics in the Dayton, Ohio area. Almost 500,000 such records were analyzed. Resulting analysis will be presented to the President's New Freedom Commission on Mental Health in February, 2003.
- 2001: Assessed technology prerequisites, client's capabilities, and resulting gaps & strengths for one of 3 largest US prescription benefits management companies for their plan to enter the public sector & Medicaid market.
Web Portals & Payer-Provider Connectivity
- 2008 - 2009: Managed geographically dispersed team of developers, analysts, IT and business executives, and vendors in the successful design, development, test and rollout of healthcare provider web portal; enabling access to real time eligibility, claims and other information; and with over 16,000 registered provider users.
- 2007 - 2008: Led multi-disciplinary healthcare team in the careful evaluation and selection of benefit plan modeling tool for members; and subsequently managed the implementation and launch of tool for Fortune 500 account in NY State.
- 2005 - 2006: Advised Manhattan based financial firm on investments in healthcare connectivity.
- 2005: For regional HMO, led multi-disciplinary team in the requirements definition, market assessment, and selection of strategic web based cost transparency tool selection; and overall healthplan members web decision support tools strategy. Presented findings to CEO and gained agreement on recommendations and plan.
- 2003: Assessed IT architecture and formulated strategy for behavioral healthcare start-up; including e-commerce strategy.
- 2001: Formulated return on investment modelling tool for Web provider portal with analysis and implementation strategy for $1 B/year managed care company - obtaining commitment for use of the World Wide Web for a variety of health administration transactions.
Consumer Driven Healthcare
- 2012-Present: Served on Advisory Board of successful health software start-up.
- 2007: Assessed CDH market outlook and opportunities for major health provider system in the midwest.
- 2005: Managed implementation of an integrated High Deductible Health Plan and Health Savings Account product for January, 2005 launch; including IT development and integration, coordination with major financial institution, debit card producer and processor, employer-sponsors, legal, customer service, web services, and claims processing operations.
- 2005: Formulated CDH IT and product competitive analysis for one of largest health plans in the US.
- 2000-2002: Organized and managed a product launch for e-Health Consumer Driven Healthcare start-up, involving the orchestration of over a dozen technology projects & operations initiatives. Pilots with 3 accounts (2 of them Fortune 1,000 companies) began August 2001.
System Selections & Consolidations
- 2013: Developed RFP and managed RFP response process for an Enterprise Data Warehouse for Maryland statewide network of Behavioral Health providers.
- 2010/2011: Developed RFP for new claims administration and CDH functionality for major hospital system's insurance subsidiary. Issued RFP's, analyzed and summarized responses, facilitated client's decisions, and presented summary results to CEO.
- 2010/2009: Evaluated the MIS implications of in-sourcing key functions for large Blue Cross / Blue Shield plan in Midwest, leading to executive recommendations. Senior consultant for IT and Operations to assist the carrier in their in-sourcing and integration of behavioral health operations, subsequent to recommendations.
- 2007: Developed strategic options for IT consolidation of 5 large Community Mental Health Centers in North Carolina in line with new managed care business model.
- 2006: Lead role in assisting two merging HMO's (each with over 300,000 lives) in the selection of appropriate MIS applications; in an accelerated process lasting 3 months.
- 2014: Performed comprehensive HIPAA Security Risk Assessment for leading Population Health / Care Management company.
- 2011-2013:Successfully worked with multiple law firms, and regulatory agencies in DC, VA, and MD to obtain licenses, credentials and certifications in order to operate Hospital based integrated delivery system's Population Health and Care Management program.
- 2007 - 2009: Managed ongoing HIPAA privacy/security oversight and audit activities for major client of CDH health plan.
- 2006 - 2007: Developed Operational and Financial internal controls for healthplan - for Sarbanes-Oxley Section 404 compliance.
- 2005: Assessed impact and formulated plan for HIPAA National Provider Identifier (NPI) compliance for HMO and (separately), CDH administrator.
- 2005: Performed HIPAA Security Risk Assessment, including identification of Threats, Vulnerabilities, and associated Risks; Security Rule Gap Analysis; and go-forward tactical and strategic action plan - for 2,500 employee, 12 site hospital/health plan system. Performed similar risk and gap assessment for leading edge hospital web portal software firm.
- 2001 - 2004: Assessed IT architectures for HIPAA transaction readiness at 20 different health plan administrators. Clients included 4 Taft-Hartley groups, 2 Third Party Administrators, 2 multi-line HMO's, 8 Medicaid HMO's, 1 Medicare HMO, 1 IPA, 1 County, 1 Blue Cross/Blue Shield plan and 1metropolitan health clinic. Formulated components and implementation plans to address subsequently identified IT infrastructure gaps in electronic commerce, processing functionality, and legacy system remediation. Most of subsequent recommendations are currently being implemented at these accounts. Similar work done on HIPAA privacy readiness at a managed care software vendor, and a Medicaid HMO. Formulated components and implementation plans to address subsequently identified IT infrastructure gaps in electronic commerce, processing functionality, and legacy system remediation. Client environments included core applications from Amisys, Trizetto, QCSI, CSC Healthcare, OAO, and internally developed applications in Unix, IBM mainframe & AS/400, and Hewlett Packard environments.
 Consumer Driven Healthcare