Provider Network Management is one of the key challenges faced by health insurance providers in the US health care ecosystem. The interactions between insurance providers and health care providers are multi-dimensional, all the way from claims submissions to contract management to collaborating towards better health care outcomes. A holistic approach is required to resolve all the ensuing, strategic, tactical & operational challenges faced while managing this complex relationship. We intend to elaborate more on the nuance to the relationship & how digital technology can help solve the key problems and bring structure to the multi-faceted management paradigm required to solve the same.
Provider network management encompasses a wide variety of components, from preventing referral leakage to managing the price for a given clinical procedure. Healthcare provider network management helps the payers access accurate provider data, verify it, and update it as needed.
This webinar will focus mainly on the importance of payer provider collaboration to achieve enhanced care delivery to members and reduce overall costs. It talks about the rising cost burden on health plans due to data fragmentation and how it is affecting healthcare. Learn how payers can overcome inefficiencies across functions and generate more savings and better patient outcomes.
Patricia Cleary, PhD
Director of Provider Operations
Community Care Plan
Patricia Cleary is the Director of Provider Operations at Community Care Plan, the Health Plan with a Heart, and is responsible for developing and maintaining provider networks, contract negotiations, and credentialing for the organization.
Prior to joining the Community Care Plan, Patricia served in various capacities for hospital systems and health plans, including The Pinnacle Group, Citrus Health Plan, WellCare Health Plan, and Columbia/HCA. Patricia holds a PhD and a Bachelor’s degree from the University of California at Berkeley. Patricia also obtained a Six Sigma Black Belt.
Senior Vice President and Chief Operating Officer
Community Care Plan
Ken Walters is the Senior Vice President and Chief Operating Officer at Community Care Plan, the Health Plan with a Heart, and is responsible for spearheading and overseeing all daily operations for the organization. Ken plays a major role in ensuring that the local activities of the health plan comply with contract requirements and operations run efficiently and effectively; thereby, creating an environment where both members and providers obtain superior customer service.
Ken holds a Bachelor’s degree in Industrial and Systems Engineering from the Georgia Institute of Technology.
Elizabeth D. Bierbower
B-Time Podcast with Beth Bierbower
Elizabeth Bierbower (Beth) is a strategic leader with more than thirty years of proven executive-level experience in the health insurance industry, including her former roles served at Humana, most recently as their President of the Group and Specialty division.
Beth serves on the Board of the American Telemedicine Association, where she is a member of the Education and Finance Committees. Additionally, she sits on the Board of BlueSprig, a clinic-based provider of Applied Behavior Analysis (“ABA”) therapy services to children with Autism Spectrum Disorder.
Prior to joining Humana, Beth held leadership roles with Highmark Blue Cross Blue Shield as Vice President of Healthcare Strategy, and Coventry Health Plans of Pittsburgh, PA, as Chief Operating Officer.
David Nace, MD
Chief Medical Officer
Dr. David Nace is the Chief Medical Officer at Innovaccer Inc and is the past Board Chair of the PCPCC. Previously, Dr. Nace served as Vice President, Clinical Development for McKesson Corporation, Senior Vice President and Chief National Medical Officer with Aetna, and subsequently with United Health Group.
He is also currently a Board Member for the Integrated Healthcare Association, a statewide multi-stakeholder leadership group that promotes quality improvement, accountability and affordability of healthcare in California; and the Care Continuum Alliance, based in Washington, DC. Dr. Nace earned his medical degree from the University of Pittsburgh.
Fran Soistman Jr.
Executive Healthcare Advisor
Healthcare Management and Transformation Advisory Services LLC
Fran Soistman is the Founder and President of Healthcare Management and Transformation Advisory Services LLC (HMTAS). Prior to this he was Executive Vice President at CVS Health-Aetna , where he led their Government Services Business portfolio, the growth engine of the company.
Fran also represented Aetna on the Health Care Transformation Task Force, and served as its Chairman until his retirement from CVS Health-Aetna on October 1, 2019. He was a recipient of the 2004 Ernst & Young Entrepreneur of the Year award in the Healthcare Technology/Services category.