by Jasmine Phiri
May 11, 2020
President and Chief Executive Officer,
Optum Medical Benefit Management (MBM)
Roger Shedlin, MD, JD has worked throughout his career to rethink how we deliver on the Quadruple Aim, improving patient and provider experience while reducing total cost of care and encouraging better outcomes.
As the president and CEO of Optum Medical Benefit Management (MBM), Shedlin and his team work with employers, payers and providers to manage medical benefits for more than 124 million members, with a focus on high-cost, complex diseases including cancer, kidney disease, musculoskeletal disease, transplantation and more. Dr. Shedlin is also the president, CEO and chairman of OrthoNet, the nation’s largest musculoskeletal benefit management company, which he has led since 1996. OrthoNet was acquired by Optum in 2014.
Dr. Shedlin has also founded and built benefit management companies in other specialties including oncology, hematology, kidney disease, women’s health and rare chronic diseases. He is a frequent speaker at industry conferences and symposia. He has also represented the United States on numerous health care trade missions to various Western and Eastern European countries, Russia and Asia.
Dr. Shedlin is a graduate of the Northwestern University Six Year Honors Program in Medical Education and the Northwestern University Medical School, where he was inducted into Alpha Omega Alpha, the national medical honor society. After earning his medical degree, he trained in orthopedic surgery. He is also a graduate of Harvard Law School.
Topics of Expertise:
How an integrated strategy – including the utilization management, care management, network strategies (Centers of Excellence) and claim review – is able to increase clinical quality and decrease total cost of care while making the health care experience easier and more seamless for patients and providers.
• Strategies of successful benefit management for complex conditions – Experienced, condition-specific providers and case managers can best help patients toward the best outcomes and lower cost of care while providing an excellent patient experience. Optum negotiates robust network contracts at Centers of Excellence, applies utilization management and hires experts who have years of experience in complex care, so patients get the best treatment at the best value.
• Cancer care – As the 4th highest contributor to health costs, it is vital to improve oncology care by addressing the rising costs of drug treatments and holistically improve the patient care experience, from diagnosis through survivorship. Innovation highlights include emphasizing evidence-based regimens and creating preferred treatment pathways for providers, creating a seamless patient experience through dedicated case management and innovative tools and developing strong cancer networks with both academic and community practices. (We will be able to add appropriate data when/if needed in speaking proposals.)
• Kidney condition care management – Renal disease costs increased by 24% in the last five years, and it is essential to prevent the need for costly and disruptive dialysis treatments, encourage home-based dialysis, and when needed, ensure that a patient is able to get a preemptive kidney transplant. This topic has been the subject of recent legislation and proposal from the Trump administration to realign incentives in the marketplace. (We will be able to add appropriate data when/if needed in speaking proposals.)
Highlighted prior speaking engagements:
“Strategies for the Effective Clinical Management of the Complex Patient”
Presented at: OptumHealth Education Annual National Conference 2019, Minneapolis, Minnesota
“Identifying the Key Components of a Successful Disease Management Program”
Disease Management Track Moderator at: The Midwest Managed Care Health Congress, Chicago, Illinois
“Orthopaedic Disease Management and Capitation”
Presented at: Orthopaedic Managed Care Congress, Washington, D.C.
‘The Successful Specialty-Specific Management Program: A Case Study”
Presented at: Tufts Managed Care Institute, Boston, Massachusetts
“Cancer Care Network Design, Development and Operation”
Presented at: American Hospital Assn. Cancer Care Symposium, Chicago, Illinois
“Chronic Disease Management: Essential Elements and a Case Study”
Presented at: Disease Management, Santa Fe, New Mexico
“Empowerment of Academic Medical Centers”
Keynote speaker at: Association of Academic Medical Centers, Washington, D.C.
Harvard Journal of Law and Technology – Editor
The FDA: Is it Protecting the Public With One Hand Tied Behind Its Back?, LAW, MEDICINE & HEALTHCARE, Vol 20, pg. 253 (1992).