The Healthcare Redesign Group provides advisory, program development, project management and implementation support services in the areas of:
Health Policy Reform and Systems Strengthening
Health Sector Strategy
Public-Private Investment Partnerships
Change Management
Health Financing and Insurance
Social and National Health Insurance
Private Insurance and Managed Care
Financial Protection for Underserved Communities
Provider Payment that Aligns Incentives between Providers and Payors
Strategic Business Planning and Reengineering
Organizational Design and Management
Public and Private Contracting
Medical Management and Quality Assurance
Health Policy Reform and Systems Strengthening
Serve as technical advisor to the Turks and Caicos Islands on health systems reform encompassing a ground-breaking public private investment partnership to strengthen infrastructure by building two hospitals offering state-of-the-art health services, along with the implementation of a national health insurance program to ensure universal health coverage and financial sustainability.
Developed a Blueprint for Reform for the World Bank financed project to reform financing and delivery system for Government of Ecuador. This included creating a national benefits package, a plan for purchasing and providing services, devolving decision making to regional and local authorities and introducing provider incentives supported by a DRG payment system.
Organized international conference for Latin American leaders on health care reform in Latin America for the World Bank. Event attended by health ministers, leading academics and heads of major donor and development agencies.
Led World Economic Forum (WEF) initiative on improving health systems in Sub-Saharan Africa through sustainable public/private partnerships. Published report on strengthening health care systems in Sub-Saharan Africa which was launched at the WEF Africa Summit in June 2006.
Served as technical advisor to Global Health Forecasting Group convened by the Center for Global Development, to increase access to essential drugs and products to the developing world, through improvements in forecasting and supply chain management. Published report on demand forecasting for improving access to essential medicines and technologies. Wrote several background papers for Group’s work.
Developed background paper for World Bank to initiate strategic focus on health services delivery in developing countries. Project will include publishing evidence on all aspects of health services delivery including organization of services, stewardship and governance, performance monitoring, and financial management.
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Health Financing and Insurance
In collaboration with the California Health Foundation and FundSalud in Mexico, sponsored high level bi-national dialogue of private and public decision makers on cross-border health insurance. Modeled health coverage options and evaluated regulatory, policy and financial feasibility of cross-border health insurance plans.
Developed and launched first-of-its-kind cross-border health insurance and managed care program for Mexican workers and their families, for leading U.S. commercial insurer. Managed all aspects of program including business planning, regulatory approvals, policy approvals, cross-national provider contracting, product and benefits design, and pricing and marketing. Plan was launched in Sept. 2000, received national recognition, and is most successful one of its kind.
Served as technical advisor and speaker for World Bank Institute capacity building program for launch of Nigeria’s national health insurance program. Program was attended by leaders of HMOs, providers, and national insurer.
Conducted strategic and operational assessment of recently accredited HMO for participation in Nigeria’s new national health insurance program.
Served as technical advisor to government of Armenia on health financing reform options with a particular emphasis on the role of private health insurance. Published report in collaboration with the World Health Organization, European Region.
Served as technical advisor and speaker on private health insurance, insurance regulation and managed care for the General Insurance Corporation, India’s national insurer.
Evaluated business opportunities for insurance claims processing in India for large private insurers and third party administrators.
Created automated tool to assess impact of capitation vs. fee-for-service reimbursement for pediatric institutions. Provided training to financial planners on use of tool and on fundamentals of capitation contracting.
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Strategic Business Planning and Reengineering
Member of executive turnaround-team to bring large private U.S. health plan into profitability. Led reengineering of operations in contracting, medical management, claims payment, marketing and risk management.
Developed Medicare Risk program to insure the elderly through managed care, for nation’s largest HMO. Over 200,000 members enrolled in program. Analyzed business and financial processes, and reengineered business system to support new program.
Developed business strategy for converting area’s largest multi-specialty medical group (2000+ physicians) and hospital system from fee-for-service to capitation. Group became most successful capitated network, receiving national acclaim as a “second generation IPA”.
Conducted comprehensive assessment of contracting, medical management, and utilization review and quality assurance programs, with recommendations for improving cost-effectiveness, quality, and performance, for large private insurer in the United Kingdom.
Developed strategic expansion plan and business models for large capitated physician and hospital group consortium in U.S.
Evaluated multi-national partnerships with public and private sector providers in Singapore, for large private US insurer.
Evaluated potential business opportunities in India’s emerging health insurance market, for large private U.S. insurer. Developed business plan for integrated health insurance and delivery model, based on extensive interviews with government regulators, corporations, ministry of health officials, and private and public providers.
Conducted comprehensive managed care readiness assessments for pediatric institutions across the United States. Developed restructuring and assessment tool which covered all aspects of managing the finance and delivery of pediatric services under a variety of managed care and capitated arrangements.
Facilitated high level team to fundamentally reengineer sales and marketing processes, for large U.S. west coast insurer.
Created epidemiological model to project physician
requirements for pediatric hospitals. Created windows-based CD Rom software application and provided Blue Shield training to several hundred physicians and planners on population-based physician planning.
Organized and taught numerous seminars on leadership, quality assurance, organizational design, management and technical skills development, for the Kaiser Permanente Institute, Aravind Eye Hospitals in India, Blue Shield of California, Child Health Corporation of America, and other U.S. and international organizations.
