Health Hospital Administration Expert Witness

Expert No. 2792

Ohio

Education

Ph.D., Sociology (special field examination in Medical Sociology), University of Chicago 1975

M.A., Social Psychology, University of Chicago 1964

B.A., Sociology, Syracuse University 1961

Military Service

U.S. Army, Honorable Discharge - Served a 3 - year enlistment, trained as a Russian linguist.

Consulting

Arcadian Health Plan (Oakland, CA)

Division of HMO Qualification and Compliance, HEW

Group Health Association of America

Memorial Hospital of Garland, Texas

Wayne State University School of Medicine

Cook County Hospital, Department of Psychiatry

Eastern Kentucky Health Demonstration Project

Student American Medical Association - International Exchange Project

University of Illinois, College of Dentistry - Dental Fluoridation Project

Office of Economic Opportunity, Neighborhood Health Center Site Evaluation Project

Operation Medical and Dental Head Start, Chicago Board of Education
Areas of Expertise

Health/Hospital Administration, and Physician Credentialing, Health Insurance, Managed Care, HMO and PPO.  Health Care Developmental, Contractual, Operational, and Regulatory Executive.

Professional Experience

(Dates available upon request)

A Company, Washington, DC
One of the developers and principals of a physician/hospital executive based consulting company providing services to hospitals and medicals staffs on a national basis.

Senior Consultant, Arcadian Health Plans, Oakland, CA,
Development and implementation support for the Medicare Advantage product in the Southeast market.

Principal, Quadrus, LLC, Washington, DC
One of four founding members of a company providing Social Security advocacy services to the hospital and Medicaid managed care industry. Current contracts involve health plans with operations in eight states with enrollment of over 800,000 lives.

Principal, Healthcare Litigation Support, LLC (f/k/a Managed Liability Associates), Petersham, MA
Healthcare Litigation Support was a team of professionals with experience in medical practice, healthcare operations and health insurance, providing case review and expert witness testimony, as well as risk management consulting, to law firms, healthcare organizations and insurers.

President, Mercy Health System Physician Hospital Organization, Inc., Toledo, OH
The Mercy Health System PHO was based in an urban hospital network and provided care for over 50,000 covered lives under contracts with two HMO's, utilizing 600-plus physicians and a four-hospital integrated delivery system as its provider base. Products included Medicare, Medicaid and commercial risk and non-risk programs. The PHO was at risk for over $90M of premium revenue.

Director, Research & Grants, United Health Services, Inc., Binghamton, NY
Responsible for establishing a research and grants function for a four-hospital system in upstate New York.  Worked with local, state, regional and national funding sources.

Executive Director, Chief Executive Officer, Susquehanna Regional Physician Hospital Organization, United Community Health Plan, Inc., Binghamton, NY 1994-1998.
United Health Services, Inc., a four-hospital system in upstate New York, was the focal point for developing an integrated delivery system, managed care product involving a network of physicians and a multi-county service area. The effort focused on creating a joint venture with a managed care partner, and with this partner establishing a strong managed care presence in a developing market. In the first year over 300 physicians contracted for the delivering of care to commercial, Medicaid and Medicare risk markets, generating a gross profit approaching $1M. Market leadership was achieved in three years. The 1999 total revenue was $50M. I made several presentations at national meetings during this tenure.

Executive Director, Methodist Delivery System, Inc., Indianapolis, IN
Responsibility as Executive Director to take a joint physician/administration work group from theory to reality. Organized and led the fast-track development of an at-risk Physician Hospital Organization that served as the single point of entry into the fourth largest private hospital in the country. Developed and implemented a unique full-risk PHO model for Methodist Hospital of Indiana and its medical staff of 1,200 that drew national interest resulting in multiple presentations at industry meetings.

President, Chief Executive Officer, CCS, Inc., Nashville, IN
Developed and managed a computer software/consulting company.

Executive Director, Vice President, Travelers Health Network of Illinois, Inc., Chicago, IL
Established and managed a three-county PPO working with all area hospitals for the greater Chicago area, Travelers' largest market.
 
Executive Director, Vice President, Maxicare Health Plans, Inc., Chicago, IL
Assumed operational leadership of 115,000-member HMO. Managed a staff of 125 with responsibility for all areas including systems, UR/QA, marketing and provider relations. Increased membership by 30,000 in eighteen months. Implemented Medicare risk contract.  As Vice President, held national HMO development responsibilities.

President, Heller Associates
Planned and managed projects, hired other consultants as needed and coordinated the elements necessary to deliver a consulting product to the client.  Worked with a number of developing and operational programs on a national basis, providing consulting in all areas of HMO development and operations including marketing, systems, claims, UR/QA premium development/actuarial evaluation and underwriting issues. Consultant to Federal office of HMOs, where evaluated 40+ programs on a national basis.

Executive Director, Roosevelt Health Plan (now Chicago HMO)
Began as a consultant to Roosevelt Memorial Hospital to develop a feasibility study for a Medicaid HMO. Then hired to implement the HMO and obtain state licensure and Medicaid contract. Started up Medicaid HMO, the first HMO licensed in Illinois. Wrote and submitted application for state qualification.

Teaching, Consulting and Doctoral Completion 

Senior Director of Research, Blue Cross Association (Chicago)
Responsibility for developing national policy and planning and implementation of national managed care activities.  Recruited a staff of 12, including professionals for national technical assistance and development functions.  Obtained federal funding for a national demonstration project.

Teaching and Research Experience

Adjunct Assistant Professor, Binghamton University, NY.  Developed and taught a healthcare marketing and economics course to Executive MBA students.

SUNY Upstate Health Science Center, Binghamton Clinical Campus, NY. Health Economics presentations to 3rd year medical students.

Adjunct Assistant Professor, Northern Illinois University, Introduction to Social Psychology. 1

Assistant Professor of Community Medicine and Community Health in the Abraham Lincoln School of Medicine and in Health Care Services, School of Public Health, University of Illinois, Chicago.

Adjunct Assistant Professor, Illinois Institute of Technology, Introductory Sociology, Chicago.

Adjunct Assistant Professor, Sociology and Biostatistics, State University of New York at Buffalo.

Presentations and Publications

Available upon request.

Honors, Awards, and Associations

Available upon request.