GlobalHealth: Achieving MLR Reduction Through Predictive Analytics

  • June 10, 2016
  • 11:00 AM – 12:00 PM ET
  • Online
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GlobalHealth is an HMO offering Medicare Advantage plans for seniors and retired government employees. GlobalHealth also covers a large percentage of Oklahoma’s state and federal government employees, including educators. Since 2014, GlobalHealth has utilized predictive and prescriptive analytics as the basis for a proactive outreach program. This outreach program was established to find the members whose health was most likely to change for the worse in the next 12 months and prevent catastrophic health events.

The webinar examines the circumstances around GlobalHealth’s decision to start a proactive outreach program built on Big Data with a new predictive and prescriptive analytics paradigm. Working with its partner, VitreosHealth, this webinar reviews the how the program has evolved since its inception, the impact it has had, and the overall and ongoing results.

Attendees will learn how this new model for predictive and prescriptive analytics helped GlobalHealth achieve:

  • An 18 percent reduction in emergency room encounters and emergent hospital admissions
  • Seen a 22 percent reduction in readmissions
  • And achieved a per-member per-month (PMPM) reduction in medical cost of about 6 to 8 percent, spread across all members

Who should attend: 

  • Any payer with Medicare and Medicaid populations.
  • Any payer with population health management programs currently using or hoping to use predictive analytics within these programs.
  • Any payer incorporating value based care financial models

Speakers:


R. Scott VaughnR. Scott Vaughn, CPA, President and CEO of GlobalHealth
Scott is the president and chief executive officer of GlobalHealth, a $250 million health maintenance organization. GlobalHealth provides affordable health care coverage to over 45,000 Oklahomans.

Before joining GlobalHealth in December 2010, Scott was a partner with a top 10 national CPA and consulting firm for 17 years. During his tenure with the firm, he served as the National Industry Partner providing oversight to the firm’s national health care audit, tax and consulting practice. During early 2010, he chaired a task force which researched the monumental health care reform legislation that was signed into law earlier in the year, analyzing the impact of reform on the firm’s health care clients throughout the U.S.

Scott has been actively involved in community and civic organizations, most recently co-chairing the Tulsa Area United Way’s Alexis de Tocqueville committee with his wife Kayla. He has also served as the president of the Child Abuse Network, a member of the advisory board for the Salvation Army – Tulsa, and as a member of the advisory board for the Oklahoma State University School of Accounting. In 2008, the Speaker of the Oklahoma House of Representatives appointed Scott to serve on the board of investors for the Oklahoma Tobacco Settlement Endowment Trust.

Scott received his bachelor’s degree in accounting from Oklahoma State University in 1993. Scott and his wife Kayla have a 4 year old son, Benjamin.

Jay ReddyJay Reddy, CEO of VitreosHealth
Jay Reddy co-founded VitreosHealth and serves as its CEO since 2009. Prior to Vitreos, Jay was the Chief Marketing Officer at CombineMed, a joint venture with the University of Pittsburgh Medical Center (UPMC), helping healthcare organizations drive savings through strategic sourcing technologies.

Before joining CombineMed, Jay was the CEO of MindFlow Technologies, a firm he founded with the vision of delivering operations productivity improvements for global 1000 enterprises through optimization-based decision support technologies. Under his leadership, MindFlow was ranked in the visionary quadrant by Gartner and ranked in the Top 100 emerging companies by ComputerWorld, prior to its acquisition in 2006.

Jay holds an undergraduate degree in chemical engineering from IIT, Delhi, and earned his MBA from the University of Michigan, Ann Arbor.

David ThompsonDavid Thompson, Senior Vice President and Chief Operating Officer, GlobalHealth, Inc.
David is the senior vice president and chief operating officer for GlobalHealth, Inc.; an Oklahoma-based health maintenance organization.  His role as senior vice president and chief operating officer includes responsibility for all operational aspects of the business including benefits administration, membership eligibility & enrollment, clinical case management, pharmacy and behavioral benefit management, quality improvement, provider contracting, claims processing and health plan customer service.

David brings 17 years of healthcare experience to GlobalHealth, Inc. as a former financial controller with a national specialty hospital system and as a former management consultant with a top 10 national CPA and consulting firm.  During his tenure with the hospital system, he served as the lead on initiatives that enhanced healthcare data management and reporting by way of streamlining information system exchanges and improving process and procedural integrity.  During his tenure with the firm, he served in a client service capacity by identifying and helping implement financial and operational solutions to a national provider client base.

David received his bachelor’s degree in accounting with an emphasis in management information systems from Oklahoma State University.

David has been actively involved in community and civic organizations, most recently serving on the financial advisory board of the Hospitality House of Tulsa.  David and his wife Kerrie are Oklahoma natives and proud parents of their three children Tess, Mira and John.