Cliff Frank
Healthcare Management Solutions, Inc.
caphelp@msn.com cliffsconfab@gmail.com (904) 874-6134
PROJECTS / CLIENTS
Projects and clients highlighted here are but a small sampling of some of our more recents works.
Additional project and client information can be made available upon request.
Vermont Managed Care - Burlington, VT
Clinical and Financial Integration:
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Accomplished turnaround and operated a 2,000-provider capitated network for 40,000 commercial lives
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Contracted with payer partners on a percent of premium or global capitation basis
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Operated a self-insured employer benefit plan and network at-risk for cost/quality/ patient satisfaction outcomes
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Managed natural tensions between academic medical center and community providers of care
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Developed clinical standards of care for review, analysis and intervention by Medical Director or PCPs
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Managed care for high risk patients across the continuum of care using a patient advocacy model
Shared Savings Model
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Vermont Managed Care Network comprising primary care physicians, specialty physicians, other providers and hospitals
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Providers agree to a 15% withhold
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Necessary to qualify as 'risk-based organization'
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Withhold is retained by VMC and distributed to network providers based on the financial performance of each plan
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If total plan costs vary from medical expense target by more than 15% +/-, the payers/plan sponsors either receive a rebate or fund additional dollars
Target PMPM & Distribution Withhold
Shore Medical Center - Somers Point, NJ
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Built and operated ACO for Medicaid, Commercial and Medicare beneficiaries
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35,000 lives
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$4 million+ in provider bonuses
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Measured, monitored, reported and affected appropriate utilization, quality metrics, and HCC risk scores
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Developed risk model for Track C MSSP for 1/1/2020
Connecticut Childrens’ Medical Center - Hartford, CT
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Renegotiated major contracts for medical center and faculty practice
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Negotiated bundled payments for Crohn’s and ulcerative colitis including infusion medications
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Conducted strategic pricing review with consumers shopping for commodity type clinical services
Borland Groover Clinic - Jacksonville, FL
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Restarted payer negotiations with Blue Cross
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Designed bundled payment for Crohn’s and ulcerative colitis including infusion medications
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Designed bundled payment for screening colonoscopy
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Conducted organizational assessment and leadership initiatives
Palos Medical Center - Chicago, IL
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Renegotiated major contracts with Blue Cross and others
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Designed and build a commercial CIN – Chicago Health Colleagues
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Secured 1st contract with Blue Cross
Centivo - NY
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Built new model of provider network for large self-insured employers
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Designed PCP-centric care model to provide close patient relationships and prudent use of hospital-based outpatient services