Provider Risk Immersion Day:
Cliff Frank, MHSA
Cliff is currently the 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. SQP earned bonus for 2016 of $1.873 million for a commercial ACO contract of 13,000 lives. For 2017, 35,000 lives are in shared savings arrangements.
Cliff is also President of Healthcare Management Solutions, Inc. a managed care consulting firm located in Dunedin, Florida. He has more than 25 years of healthcare experience 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.
Cliff has a Masters of Health Services Administration degree from the University of Michigan, and a Bachelors degree from UCLA and is co-author of a book titled: Physician Empowerment through Capitation.
Markus Mueller, Ph.D., MBA
Markus Mueller has more than 25 years of C-level health care management experience with Blue Cross Blue Shield of Florida, Employers Mutual, Inc., Beyond Conceptual, Inc., FirstCare Health Plans, and Prominence Health Plan. He has been involved in several successful start-ups and turnarounds as a consultant, Founder, COO, CFO, and CEO in the USA as well as in Europe. Other assignments included provider network development, reimbursement negotiations for both payers and providers, and strategic plan development. In addition, Dr. Mueller collaborated on the development of a managed care information system in Europe as the SME.
Recent consulting engagements included ASO development, MSSP Application, core system replacement for a national TPA, conversion of a self-funded health plan to a fully insured plan for a large health care system, and leading the due diligence process in a provider-owned health insurer divestiture. Mr. Mueller is also the author of an upcoming book on the Volume to Value transition.
Dr. Mueller earned a Ph.D. in Management and Decision Sciences from Walden University, his MBA with a concentration in Accounting from the University of North Florida, and his postgraduate management certificate from Harvard University.
Sanjay Seth, M.D., MHA
Dr. Sanjay Seth brings over 20 years of experience to his role at HealthEC. Prior to joining HealthEC, Dr. Seth was a part of the turnaround team for Interfaith Medical Center, Newark Beth Israel, Hospital Center at Orange and East Orange General Hospital leading resolution and implementation of complex hospital and physician clinical, financial, contractual and compensation relationships. He has lead numerous physician groups in their formation or re-structuring efforts including review and changes to the billing systems, implementation of the EMR’s and partnership agreements.
Currently he has organized physician groups leading to the formation of Accountable Care Organizations under the MSSP initiative, where the ACO’s have saved over $ 21 million in 2017. Dr. Seth has created care coordination collaborative arrangements, and introduced technology and processes to manage ACO operations. In addition, he transformed a few multi-specialty physician groups to create Clinically Integrated Networks and negotiated Commercial and Medicare value based contracts.
Additionally, Dr. Seth conceived, created and implemented a common EMR platform, and billing and collection processes that are being offered as MSO services to other groups. Dr. Seth supports the provider organizations that look to transforming in to a Clinically Integrated Network and a move to Value Based Contracting. He holds a Masters in Health Administration from Cornell University.
George Mayzell, M.D.,
Dr. George Mayzell is the new Chief Clinical Officer of Vizient Southeast. He recently left his own consulting company, Rx Health Partners, which specialized in population health, care management redesign, clinical variation and clinical integration.
He was the past Senior Vice President/Chief Medical Officer and Chief Clinical Integration Officer for AMITA Health, an integrated health system serving communities in western and northwestern suburban Chicago. AMITA Health is a Joint Operating Company formed in February 2015 by Adventist Midwest Health and Alexian Brothers Health System, encompassing nine hospitals and an extensive physician provider network of more than 3,000 physicians.
Dr. Mayzell joined Adventist Midwest Health in January 2013, after serving as CEO of Health Choice and Senior Vice President of Methodist Le Bonheur Healthcare in Memphis, Tenn.
He previously served as senior medical director of managed care for University of Florida and Shands Hospital. He spent more than 10 years with Blue Cross Blue Shield of Florida, working as regional medical director for care and quality and corporate managing medical director for pharmacy and care. Additionally, he has more than 10 years of practice experience.
Dr. Mayzell is a board certified internist and geriatrician. He received his medical degree from the University of Medicine and Dentistry of New Jersey and his MBA from Jacksonville University.
Dr. Mayzell has co-authored several books including “Leveraging Lean in Healthcare” and “Physician Alignment, as well as a recent book on Population Health.
David Kalb, BBA
With over 25 years of managed care reinsurance experience, Dave Kalb has witnessed firsthand the dynamic changes in the health care marketplace. He has worked with more than 100 health care companies through the years, making his experience broad and deep.
As a Principal at Dubraski & Associates, Dave assists in the growth of our health care practice. He works with health care companies to manage their insurance, reinsurance and risk management needs.
Dave began his career on the actuarial and underwriting side of the business, having underwriting responsibility for several of the largest
managed care reinsurance companies, including Allianz (now HCC), Lincoln and ING Re (now RGA).
Dave had significant involvement in working with commercial health plans in a partnership capacity, providing solutions beyond reinsurance. He assisted health plans in expanding their product portfolio by adding POS and PPO options where they did not have the appropriate license, helping to design the strategy to move them into the ASO marketplace and even adding ancillary products such as life and dental insurance to their product offering.
Dave also had underwriting responsibilities for a large block of employer stop loss reinsurance business written through health plans which serves him well when assisting Health Plans looking to grow in this market segment. As the government looked to the private sector to assist in managing the Medicare and Medicaid budgets, Dave was very involved with numerous startup health plans, assisting with their reinsurance needs. He also created unique catastrophic risk management strategies to help them reduce overall costs.
In 2001, Dave moved to the brokerage side of the business and has been there since. Today Dubraski & Associates is extremely involved with the Medicare and Medicaid Health Plans as well as ACO’s, Cooperatives, Bundled payments, Capitated providers and the multitude of other risk arrangements. With Dave’s financial background he is uniquely positioned to assist his clients in these very dynamic times whether that is to manage their capital and surplus or design other risk mitigation strategies.
Dave earned his BBA in Actuarial Science from the University of Wisconsin