- An innovative quality-driven leader with end-to-end healthcare industry knowledge, twenty-five years of experience in accountable care, and deep knowledge of applied executive and tactical population health management, risk contract management, complex care coordination, healthcare informatics, and healthcare data science.
- Expert in the funding and data requirements for health care initiatives from Purchaser to Plan to Delivery System and how to optimize the blend of initiatives within the context of Fully Insured or Self-Funded plan requirements. Special expertise in accountable care, value-based health care, patient centered medical homes, and chronic disease management from Physician Office to Health Plan to Purchaser.
Kevin J. O’Brien
Executive Advisor and Consultant
Highlights
- ACCOUNTABLE CARE MANAGEMENT: Pursued, negotiated, acquired, and successfully managed multi-million dollar, multi-year Percent of Premium, P4P, and Quality Improvement contracts with Major Health Plans and National, Middle Market, and Taft Hartley Self-Funded accounts providing both significant improvements in quality, ROIs ranging from 1:5:1 to 7:1, and “Full Risk” contract surpluses exceeding $20 PMPM. Led innovative care coordination/patient centered medical home pilot with an IPA alliance, Horizon and NJ State Health Benefit Program
- MULTI-STAKEHOLDER RELATIONSHIPS: Cultivated multi-stakeholder relationships with Aetna, Cigna, Horizon, the NJ Health Care Quality Institute, the Center for Health Value Innovation, the Health Care Payers Coalition, Key Self-Funded Plans including the NJ State Health Benefits Program, Benefit Consultants, Pharmacy Benefit Managers, and other Key Benefit Plan Affiliates
- Healthcare Informatics / data science: Reverse engineered payor-based risk and analytic models to isolate key contractual variables, built clinician-driven complex case models for care coordination program design, integrated clinical, utilization, financial, and actuarial metrics into cohesive multi-stakeholder value propositions
- GOVERNANCE: Served as a Board Member, Advisor, and Contributor in various for-profit and not-for-profit organizations and special projects.
