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Summary
This Fractional CIO/COO & Transformation Consultant is an experienced technology and business transformation leader. A collaborative and courageous leader who aligns business goals, technology strategy, financial measures, and regulatory framework with business change/implementation approach to deliver results and manage risks. Held leadership roles in technology and business consulting, “big data” start-up, and large global organizations to lead innovative transformations, customer-centric strategies, restructuring, M&A due diligence, and creation of new businesses. This Fractional CIO/COO & Transformation Consultant worked across organizations from boardroom to business managers; principally in customer-centric industries: healthcare, financial services, and B2C/B2B distribution and retail. He is a talented relationship builder who is adept across multiple cultures and difficult environments with proven ability to manage large, geographically distributed, and diverse teams; lived and worked in US, Asia, Latin America, and Europe.
Highlights
- Technology Strategy and Roadmaps
- Technology Transformation
- People Leadership and Development
- Digital and Business Transformation
- Staff / Vendor Roadmaps
- Member Portals and Mobile App Experience
- Cyber Risk Frameworks
Relevant Accomplishments
- As COO and CIO for BCBS of Kansas City, held a dual role to lead operations and technology across commercial/employer, individual, medicare, ancillary, federal employee lines, and captive clinics. Overall accountable executive for operations (benefits, claims, payments, member and provider services, etc), technology (strategy, architecture, solution delivery, digital, infrastructure, data center, etc), and vendor management/sourcing. My initial focus was to shift operations and technology organizations to be outcome-centric and transform the operational processes and organizations with enabling technology capabilities for the health plan and clinic-based care delivery.
- Drove outcome-centric IT and business alignment to drive clearer accountability to achieve business objectives and spend on technology.
- Established a strategic vendor management framework anchored on business outcomes, reward/penalty, accountabilities with metrics, and began to shift some services to a managed service model. Reduced technology non-labor technology spend by 15% and labor spend by 40%.
- Created an end-of-life model and platform stability framework for infrastructure and >400 applications to reduce technology complexity and ensure vulnerability risks are addressed.
- Accelerated Azure cloud migration to reduce time to deploy technology solutions and further reduce overall cost to maintain technology stack.
- Refined prioritization approach to align with external stakeholders to better align business objectives and develop technology solutions to meet true needs while accelerating digital transformation and reducing overall technology spend and on-going costs.
- Led effort to rationalize critical data domains (member, provider, benefit, clinical, and claims) as underpinning to core data and analytics capabilities. Led definition of the data strategy and roadmap across IT and business teams to support the health plan, external stakeholders, and critical analytics.
- Achieved 99%+ accuracy for 2023 annual enrollment at end-2022 and reduced claims inventory by nearly 30% and moved plan to meet/exceed minimal operational Blue Cross and Blue Shield Association metrics within 6 months.
- Established a multi-discipline ‘tiger team’ to address exceptions, root cause, and implement solutions to reduce exceptions and enhance member, provider, and employee experience.
- Moved nearly 40% of claim volume to an outsourced BPO vendor for sustained throughput and 20% SG&A reduction.
- Defined strategy and roadmap for health plan’s future state operating model. Evaluated options to improve operational efficiency, improve operations resilience, enhance member/provider experience, improve clinical operations capabilities to drive care path outcomes, and enabled by a more extensible technology platform including materially improved data quality and analytics.
- As CIO and COO for United Healthcare, transformed enabling technologies across UHC operations: commercial, individual, specialty, medicare, medicaid, and provider/network management. My role was expanded to lead technology-enabled transformation of operational processes and organizations with primary goals to improve efficiency and enhance experience for members/customers/brokers/providers. I assumed accountability for execution/ delivery units across enrollment, claims, and provider to rationalize a centralized/de-centralized structure and staff/vendor partner roadmap for on-/off-shore staffing. I was later asked to partner with senior colleagues to drive a strategy and roadmap for a clinical care platform (PA/UM/CM/DM) across UnitedHealth Group. Throughout my tenure, I was also the COO for the 7,000+ global staff of UHC Technology organization and collaborated with UHC finance on total technology spend at UHC spanning infrastructure, labor, investment, and on-going operations. Led and actively contributed to the BCBSVT sustainability initiative, ultimately achieving a successful affiliation with Blue Cross Blue Shield of Michigan (BCBSM).
- Led transformation of enrollment, claims, and benefits to implement a more centralized model and better aligned outsource vendors leading to material cost savings. Reduced NPS detractors.
- Refined automations to improve auto-adjudication across medical claims by >2ppt to an average 93% first pass rate across all lines which enable flat staffing to absorb post-covid claims increase.
- Led transformation to e-deliver required member and provider transactional documents driving significant costs savings over print/mail. Increased member and provider NPS.
- Led stabilization effort for call center platform: business configuration complexity and technology instability.
- Led to stable and successful 2020 AEP/OEP for more than 35K agents (employee and vendor) across all medical and ancillary lines plus provider operations. Reduced NPS detractors.
- Defined a multi-year roadmap to rationalize 29 claim platforms across UHC business lines and provide shared data analytics across the health plan and provide an improved, platform independent member and provider experience.
- Defined and implemented a common integration approach to enable multi-channel member and provider services. Critical to driving digital adoption and reducing cost of agent-assisted services.
- Led adoption of LeSS and Scrum concepts to drive greater collaboration across business and technology teams to focus on highest priority outcomes and reduce time to deliver solutions.
- Defined and led proof of concepts to improve member portal and mobile app experience with syntactical search leveraging AI and enhance member journeys across channels by applying AI to estimate care from paid claims and current provider contracts.
- Led collaboration across business and technology teams to define and implement data publishing and consumption approach to support transaction systems, member/provider services, clinical decisions, plan and business line analytics with an underlying goal to get same answer for all channels and experiences. Reduced NPS detractors and accelerated digital adoption.
- Collaborated with CISO team to define and implemented an enhanced cyber risk framework for strategic operations vendors to protect member data risks inside and outside the UHG platforms.
- Defined a total cost of ownership (TCO) for UHC to better inform decisions and future technology investments/spend including the prioritization of critical business objectives with technology stability, risks, and vulnerabilities. Result was a well aligned IT labor plan and priorities.
Roles
- CIO / COO, Blue Cross Blue Shield of Kansas City
- CIO / COO, United Health Group
- Vice President, Enterprise Implementation, Ameriprise Financial, Inc.
- Managing Director, HSBC, Global Banking and Markets
- SVP, Seisint Limited
- SVP, eLoyalty
- Partner, Andersen Consulting
