Michael Morris, FACHE

Experience

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  Quorum Health Resources

  Jan 1986 - Jan 1990

  Assistant Administrator, Chief Financial Officer

  Hunt Memorial Hospital.

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  Addison Gilbert Hospital

  Jan 1990 - Jan 1993

  Vice President Operations, Chief Operating Officer
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  US Healthcare, Inc

  Jan 1993 - Jan 1996

  Vice President

  Vice President, Network Manager (MA, NH, RI Locations)Directed, motivated, and managed all provider network relationships in these three states. Executed on a plan that resulted in 104% increase in participating providers. Planned and implemented specialty capitation programs to include ophthalmology, radiology, and MRI. Negotiated and implemented first full risk/reward contract in New England. Modified and renegotiated selected provider contracts to more closely align them with organizational objectives. Achieved and maintained one of the lowest medical cost ratios within the company. Show less

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  Aetna

  Jan 1996 - Jan 2011

  Directed physician, hospital, and ancillary provider recruitment, compensation, and network contracting in the states of Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont. Supervised and managed a completely telecommuting staff of 27 full-time equivalents. Built and maintained relationships with 56,000+ physician providers and 196 acute-care hospitals with over $2.3 billion in annual spend.Devised and executed plan to participate in first multi-payer Patient Centered Medical Home model in New England. Strategized expansion of PCMH to introduce Accountable Care Organizations (ACO) models. Converted the State of Vermont from a rental network to a direct network, through negotiations with the 14 acute hospitals; saved $2M annually, without any terminations of facilities or providers. Successfully recruited largest non-hospital affiliated physician group in New England resulting in $1.4M in annual savings as well as 6% growth in participating primary care physicians. Achieved and maintained ‘Excellent’ accreditation status in all eligible markets. Renegotiated critical hospital and provider contracts within time frames and without network disruption. Developed and oversaw network growth and implementation of strategies for both the commercial as well as the Medicare Advantage lines of business and products. Developed, negotiated, and maintained the first pay for performance contract in the Northeast Region. Implemented and supported the revised Provider Service Model and all related organizational dynamics. Show less Directed, motivated, and maintained all physician, facility, and ancillary contracting and maintenance for Massachusetts, New Hampshire, and Rhode Island. Supervised, through direct reporting managers, 41 full-time equivalents, managing in excess of 21,000 provider relationships and 102 acute care hospital contracts. Devised and executed plan resulting in 207% increase in participating and contracted providers. Met or exceeded recruitment and financial targets during entire seven year tenure. Show less

  • Vice President/Network Market Head - New England Region

    Jan 2003 - Jan 2011

  • Assistant Vice President

    Jan 1996 - Jan 2003
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  ACCOUNTABLE CARE SOLUTIONS, LLC

  Jan 2011 - Jan 2012

  Principal and Consultant

  Provided consultative services with Acute Care Hospitals and Physician Groups on their Managed Care and Health Plan relationships to include strategy, pricing, contracting, quality measures, and incentive targets. Re-negotiated existing managed care relationships, terms and conditions of participation, and target pricing consistent with budgeted revenues.

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  UnitedHealth Group

  Jan 2012 - Jan 2018

  Vice President, Network Management

  Managed recruitment, negotiations and re-negotiations with 148 acute care hospitals, 42,000 physicians and 260 ancillary providers in Maine, Massachusetts, New Hampshire and Vermont with annual total spend of $5.1 billion. Worked with 16 remote staff to ensure adherence to pricing parameters, competitive positioning, access and availability standards, and member preference. Ensured 100% of provider participation status was renewed. Supported sales and marketing staff, consultants, brokers and producers in each market. Developed and implemented performance based contracting methodologies with three healthcare systems and 4 independent hospitals along with their associated physicians. Consistently delivered annual results meeting or exceeding unit cost targets which significantly contributed toward closing gaps toward best in class. Completed 100% of contract revisions to comply with ICD-10 coding revisions. Implemented network optimization strategies to improve performance of Medicare Advantage products. Attained 97% employee engagement and 94% employee satisfaction scores through company- wide confidential employee survey (the highest in the Eastern Region for Network staff). Show less

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  ACCOUNTABLE CARE SOLUTIONS, LLC,

  Jan 2018 - Jan 2019

  Principal and Consultant

  Advised large Massachusetts based healthcare system (a flagship tertiary teaching hospital and 4 affiliated community hospitals and their physicians) with $2.3 Billion in annual revenue. Handled strategy, messaging, contracting, and communications with the two largest for-profit managed care organizations in New England. Modified agreements with predictable increases exceeding inflation by working with managed care consultants on rates, terms, and conditions contained within two national managed care opportunities. Utilized timing, message, and methodologies to maximize reimbursement opportunities; leveraged specialty physicians in targeted geographies resulting in increases of 15% for physician providers. Developed calendar, time-line, and notification methodology to ensure desired results coincided with annual enrollment period. Show less

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  B.E. Smith

  Jan 2019 - now

  Interim Vice President Managed Care - Erie County Medical Center (ECMC)

  Assist the CFO for 4the acute hospital as well as the long term care facility ($1.1 billion in gross revenue annually and 1,000 licensed beds). Lead negotiations with National Managed Care organizations (Aetna, United) and renew agreements with local managed care organizations (Blue Cross of Western NY, Independent Health, Univera, Fidelis). Establish relationships, open negotiations, renew contracts, and implement agreements for Commercial, Medicare Advantage and Medicaid Managed Care platforms. Establish working relationships with Patient Access, Legal, Revenue Cycle, Utilization Management, Finance, Business Development and Strategy. Initiated communication and dialogue with Managed Care contacts after 4 month position vacancy. Implemented pricing adjustments, payment increases, and reimbursement rates for the two largest regional payers representing over $174M in revenue. Audited all known contracts/payer agreements for accurate pricing and reimbursement levels. Negotiated settlement with large national payer for 5 year old claims representing $750,000 in charges. Led initiative to obtain credentialing status for physician with offshore training and experience with payer where others had failed with previous three attempts. Negotiated 80 case agreements with non-participating payers resulting in 600,000 in reimbursable cash. Show less