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Denise Kress, MS, GNP, BC, CHIE

by Jasmine Batchelor

July 2, 2019

Vice President, Senior Products,
Tufts Health Plan

Denise is an accomplished Healthcare executive with over 35 years of experience in healthcare delivery specializing in the fields of geriatrics and physical rehabilitation. Denise has practiced as a Nurse Practitioner in a variety of settings: developing, implementing clinical programs and providing primary care to multi-morbid older adults in both community and inpatient post-acute settings.
She has been employed within the Senor Products division of Tufts Health Plan for the past 19 years collaborating with providers and internal plan stakeholders to develop and implement clinical programs and interventions to improve quality while reducing avoidable cost and utilization.

Over the past two years, key areas of focus have included:
• Providing consultation and subject matter expertise in population health and care management areas for the THP Ventures and Development team supporting Medicare Advantage opportunities
• Participating in assessment of new opportunities for geographic expansion/joint venture, specifically provider organization population health and care management capabilities and systems.
• Leading the development and implementation of the collaborative care model for Medicare Advantage in new expansion markets. Collaborating with clinical leadership and management from the provider partner and THP to develop and document the collaborative care model identifying and leveraging the mutual strengths of THP and the provider partners.
• Overseeing initial operation of the model to ensure effectiveness, consulting with provider organization to adjust the model as needed in the startup phase.
• Providing clinical and business insights and expertise to the cross functional THP Senior Products Provider Performance team in assessing the financial, utilization and quality performance of all contracted provider organizations. Accountable for achieving performance results in value based contract arrangements by developing meaningful collaborative relationships, engaging, influencing and supporting the group/IDN providers and care management team.
• Leveraging clinical, cost, utilization data to identify specific opportunities for improvement and making recommendations for interventions to reduce unnecessary utilization while improving the health outcomes of chronic, complex and frail members. Consulting, advising and collaborating with providers and THP staff to develop and support implementation of high impact interventions, strategies, programs and models of care to achieve desired outcomes within specific risk bearing practice/group/IDN as well as alternative approaches for providers on early path to risk.
• Developing and documenting processes, protocols, best practices and interventions for effective provider organization population health and care management performance
• Advising and participating in identification and assessment process of Medical Cost and Innovation team on potential programs, vendors, services, technology and interventions designed to improve care and reduce medical cost