Vice President, Contracting & Payer Relations for California, Texas, New Mexico @ Providence St. Joseph Health
Vice President, Network Management, Arizona and Nevada @ Cigna
President @ Mitchell Zack Healthcare Management Consulting Services
Bachelor of Arts (BA), Biology @
University of California, Los Angeles
Mitchell possesses twenty two years of healthcare management experience leading businesses into strategic and operational changes that are a step ahead of most other organizations within the industry. Mitchell is highly recognized for leading organizations from relying solely on volume to embracing value and population management, while consistently leveraging payor and provider relationships, to create win/win outcomes.
Mitchell possesses twenty two years of healthcare management experience leading businesses into strategic and operational changes that are a step ahead of most other organizations within the industry. Mitchell is highly recognized for leading organizations from relying solely on volume to embracing value and population management, while consistently leveraging payor and provider relationships, to create win/win outcomes. As a versatile executive, Mitchell successfully uses teamwork, communication, and education to achieve consensus among groups of administrators, physicians, and payor stakeholders whose interests may not always be aligned.
Mitchell’s key strengths:
▪ Innovative thinker with broad-based healthcare expertise in operations, payor relations, and business development
▪ Proven ability to quickly analyze key industry drivers and develop strategies to grow the bottom-line
▪ Built a strong record of accomplishments managing start-ups, turnarounds, and rapidly growing companies
▪ High-integrity leader known for ability to envision and create successful outcomes in complex situations
▪ Diverse industry experience and functional knowledge leading to increased sales, profit, and market share
Vice President, Network Management, Arizona and Nevada @ Executive leadership and management responsibility for growing relationships between Cigna and hospital, physician, and ancillary providers in Arizona and Nevada. Manage teams in Phoenix, Tucson, and Las Vegas, to drive local initiatives, grow membership, and address the unique relationships in each of these markets.
Lead market-based efforts to build health plan/provider collaborations to incentivize healthcare providers to transition from volume to value delivery models, succeed in our mutual efforts to achieve the Triple Aim, and increase market share for all participants as a result of providing greater value to healthcare purchasers. Work closely with Cigna Medical Group physician and executive leaders to structure their involvement in Cigna’s collaborative efforts, leverage their exceptional value, and ensure their success in a rapidly evolving healthcare delivery environment. From April 2014 to Present (1 year 9 months) President @ Completed engagements involving physician alignment, business development, and payor contract negotiations for healthcare clients, including Palo Alto Medical Foundation and Hill Physicians Medical Group. From June 2013 to April 2014 (11 months) Vice President, Employer and Payor Relations @ Led the strategic planning and implementation of all innovation activities, including commercial and Medicare ACOs, bundled payments, health insurance exchange, payor contracting and relations, and employer-broker relations, for a regional non-profit healthcare system with $1.4 billion in annual revenue, two acute-care hospitals, a behavioral health hospital, a medical foundation, a home health agency, a regional laboratory, and two joint-venture surgery centers.
• Successfully negotiated a commercial Accountable Care Organization (ACO) agreement with Blue Shield of California with a projected $10 million in annual savings, exceeding the initial expectation of $6 million in savings. Developed, implemented, and oversaw John Muir Health’s commercial ACO governance and operational components.
• Led the Medicare ACO application process and team resulting in CMS’s approval of John Muir Physician Network’s Medicare ACO in July 2012.
• Designed John Muir Health’s payor strategy and negotiated all payor contracting representing $850 million in revenue for two acute-care hospitals, associated physicians, a behavioral health hospital, and two surgery centers, as well as the downstream contracting for 800 IPA physicians and ancillary providers.
• Championed and recognized as the initial architect of the health system’s clinical integration programs that established a foundation for the startup of ACOs.
• Achieved a $100 million turnaround through payor negotiations and consistently secured contract rate increases year after year, regardless of the underwriting cycle.
• Fully responsible for the development and coordination of all strategies, tactics, legal and antitrust aspects, and public relations related to contract negotiations.
• Consistently achieved consensus among groups of administrative and physician stakeholders whose interests were not aligned. From June 2000 to June 2013 (13 years 1 month) Executive Director @ • Recruited to consolidate and manage three Management Service Organizations (MSO) in the San Francisco area.
• Solely responsible for the leadership and operations of Personal Choice Medical Group, a 400 physician IPA serving 12,000 managed care members.
• Managed, motivated and advised the Personal Choice Board of Directors, and co-chaired Board of Director meetings.
• Led all MSO operations and personnel, including the medical director and 28 support staff.
• Oversaw physician recruitment, physician relations, marketing, payor contract negotiations, strategic planning and business development.
• Actively participated in CHW corporate and regional committees throughout California.
• Successfully restructured and guided the IPA toward profitability concurrent with, and subsequent to, their emergence from bankruptcy protection.
• Instituted operational changes that produced $2.8 million in savings to the IPA. From March 1998 to December 1999 (1 year 10 months) Regional Director & Chief Operating Officer @ • As a member of the executive team, oversaw an MSO operating four IPAs, comprised of more than 900 physicians, 111,000 managed care members, and 50 payor contracts.
• Managed quality improvement, claims processing, utilization management, provider relations, health information management, member services, and eligibility functions in the MSO.
• Directly ran three IPAs, chaired Board of Directors meetings, and worked closely with physician leaders on financial analysis, strategic planning, and market development.
• Collaborated in strategic planning and physician relations with seven CEOs from Tenet-owned hospitals throughout Orange County. From 1996 to February 1998 (2 years) Associate Director @ • Managed operations of a 170-member multi-specialty IPA with annual revenue of $9 million and an enrollment of more than 17,000 managed care members.
• Led payor contract negotiations, as well as with primary, specialty, and tertiary providers.
• Developed a comprehensive strategic marketing campaign, in conjunction with contracted hospitals and health plans, which substantially increased membership within the first year of implementation. From 1995 to 1996 (1 year) Administrator - Medical Center @ FHP Medical Center – Las Vegas, Nevada
Promoted to expand FHP’s medical center presence in the Las Vegas region. Provided leadership and support for two medical offices with six primary care physicians, 40 support staff, and a revenue of $10 million.
FHP Medical Center – Anaheim, California
Led operations for a medical group with 16 primary care physicians, 10 specialists, 250 employees, and revenue of $62 million per year. Chaired the quality committee and participated in local and regional leadership councils at various medical centers. Restructured the processes for utilization management that resulted in cost savings of $835,000 in outside specialty costs over a seven-month period.
FHP Medical Center – Laguna Hills, California
Manager of Support Services
Oversaw the operations of health information management, patient relations, pharmacy, physician and patient scheduling, facilities, health education, reception, and social services for a medical group of 15 primary care physicians and two specialists that generated annual revenue of $44 million.
FHP Corporate – Fountain Valley, California
Completed a three-month executive management development program for the second largest HMO in California with 838,000 managed care members and $2 billion in annual revenue. Program consisted of rotational training in various corporate and regional departments. From 1993 to 1995 (2 years)
Master of Business Administration (MBA), Business Administration, Healthcare Emphasis @ University of California, Irvine - The Paul Merage School of Business From 1991 to 1993 Bachelor of Arts (BA), Biology @ University of California, Los Angeles From 1974 to 1979 California Health Leadership College Mitchell Zack is skilled in: Managed Care, Medicare, Healthcare, Healthcare Management, Hospitals, Provider Relations, Revenue Cycle, Physicians, HIPAA, Health Insurance, Medicaid, Executive Management, Leadership, Quality Improvement, Physician Relations
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