Healthcare Management Solutions, Inc.
Cliff is President of Healthcare Management Solutions, Inc. a managed care consulting located in Dunedin, Florida. He has more than 30 years of healthcare experience working with payers, hospitals, IPAs, PHOs, and Clinically Integrated Networks (CIN), with demonstrated abilities in managed care contracting, provider/payer relationships, bundled payment design, capitation program design and management, accountable care design and operations, and evaluation of managed care models and structures. Throughout his career, his focus has been on reducing waste and enhancing quality for the benefit of patient care. Creating clinical and financial alignment among providers and payers has been a central theme to his professional work across a variety of settings and organizations. Cliff provides leadership to CINs operating shared savings relationships with payers and Medicare, and routinely consults to organizations on their managed care contracts, strategy, preparation for provider risk transfer, and innovative provider-payer partnerships.
As Founder and President of Healthcare Management Solutions, Inc., some of his more recent and past consulting arrangements have included:
--Interim Executive Director of Shore Quality Partners, a clinically integrated network in Somers Point, NJ. This accountable care organization works with commercial payers, managed Medicaid, and Medicare MSSP products. SQP earned net bonus for 2016 of $1.873 million for a commercial ACO contract of 13,000 lives. For 2017, some 35,000 lives are in shared savings arrangements.
--Co-founder of Partnera, where he tested innovative products and services designed to grow Health Systems’ market share and brand loyalty. Specializing in designing managed care products that offer financial incentives for patients to use efficient and high quality health care providers.
--CEO, FirstCare Health Plans, including turnaround CEO of FirstCare Health Plans of Texas, a 140,000 member health plan that has commercial HMO and PPO plans, self-insured products, Medicare HMO plans and Medicaid managed care, where he eliminated a $14 million annual deficit.
--CEO of Vermont Managed Care, a capitated physician-hospital network in Burlington, Vt. integrating care for both community physicians in half the state and the academic medical center. The organization consistently returned over 100% of physician risk funds over his 12-year tenure at VMC.
--VP Managed Care, St. Vincent's Health System, negotiating traditional payer agreements, as well as Administrator for Baptist/St. Vincent’s Integrated Delivery Organization handling full risk capitated contracts, PPO contracts and physician administrative support services through aligned clinical and financial incentives.
--Product Development Consultant for the actuarial firm of Tillinghast, a Towers Perrin Company.
Earlier in his career, Cliff held positions as Director of Marketing and Operations for a provider-owned HMO (Medical Center Health Plan), Director of Product Development for Blue Cross, and Group Practice Administrator.
He has a Masters of Health Services Administration degree from the University of Michigan, and a Bachelors degree from University of California, Los Angeles.
Cliff also co-authored a book titled: Physician Empowerment through Capitation (Aspen, 2000) and has published numerous articles on capitation mechanics, operations, and risk assessment.
He is a member of MGMA and AAIHDS, and is a frequent speaker at conferences on population health including HIMSS, National Association of Managed Care Physicians, and National Association of ACOs.
Cliff is the Founder, organizer, and host of the annual Confab of healthcare consultants and managers.
Although most of Healthcare Management Solutions' consulting services are provided solely by Cliff, he will sometimes enlist the services of additional support staff, depending on the project. More information available upon request.