Summary

Early Adopter of Managed Care – 1976 Capitated Allergy Programs in 15 HMO’s around the country – Consulting Allergy
Joint Venture with Pharmacia – US Allergy – Consulting Allergy
MD with extensive hands-on experience in every aspect of managed health care organizations, including participation in established programs, initiation of new care-delivery packages, and start-up of a new health maintenance plan.
Co-developer, with information technology specialist, of ASP programs to integrate Internet-based technology with various aspects of e-health care.
Demonstrated ability to articulate the value of collaborative integration of physician groups with management and to incorporate innovative technologies in the medical arena.
Helped develop a new physician owned local HMO from physician discussions to a fully operational HMO of 5,000 members with an MLR of 89%.
Medical Director of a Medicare “triple option” HMO jointly owned by 7 provider groups and Tenet Health – Prototype of Medicare Advantage -People Health
Continued clinical involvement with Allergy and Immunology practice.
Medical Director of Consumer Driven Health Care benefit – Ameriplan Health
HIPAA Compliance Officer for Family Care Partners
CMO First Coast Advantage – PSN – Medicaid University of Florida. Health
Regional Medical Director Alignment Healthcare – Medicare Advantage – Value Based Payment System
Current interest and focus: 1)Pre-acute Care – Direct SNF admissions 2) Transitional Care – High Risk Patients 3) Telehealth – Telemedicine 4) Long Term Care 5) Direct Patient Care 6) Regenerative Health
7) Cannabus Treatment
8) Pain Medication Management

Professional Experience

Medical Director - Allergy Free Labs Inc. Ancillary Allergy Services

Comprehensive cost effective allergy program for group practices and value-based payers. Discontinued

Regional Medical Director – Alignment Healthcare – Medicare Advantage – Value Based Payment System – 2015 – 2018

Quasi-staff Model HMO; Acted as “Extensivist”; Medical Management of High Risk Members; Administration of three PA’s; Followed patients from Acute Care to SNF to Home; Post Acute Care in our Facilities; Responsible for HEDIS, Stars and RAF scores; Achieved Los 4.1; Readmission rate 7.5%; Admits/1000 150;

Chief Medical Officer – First Coast Advantage – PSN with 60,000 lives 8/2012-2015 U.F. Health Medicaid Managed Care

Medical Management; Population Health; Integration of Clinical and Claims data; Incentive for HEDIS measures, Pharmacy Management, PPAs, Fair Medical Hearings, Credentialing;

Medical Director – Part Time Family Care Partners – Primary Care Physician Group 2010-2012

Medical Director – Ameriplan Health Democracy Drive Plano Texas – 2003-2006

Developed contracted network in 11 States

Consultant for the formation of a financial health care access instrument designed for the working un-insured and as a wrap around for Health Saving Accounts. Developing a national network of affiliated providers.

Allergist – Clinical Practice 2345 Park Street; Lake City Florida with a P.A. to current

Family Care Partners, Jacksonville, FL. 32227 01/2002

Allergist and Director of Clinical Research and Outcomes, HIPAA Privacy Officer

Director of Allergy program. Development and deployment of an asthma program comporting to the NHLBI guidelines. Working on a collaborative system with insurers to reward provider initiated disease and case management programs based on outcomes. Worked with a group to make the organization HIPAA compliant.

Medical Director

Peoples Health Choice, New Orleans, LA. 05/2001 – 01/2002

Director of all medical management and quality programs of a Medicare + Choice Plan co-owned by 7 IPAs and Tenet Hospital System.

Responsibilities; Directed all aspects of the medical management process and quality process. I worked with the boards of the IPAs, a physician advisor from each IPA and hospital administrators from 7 hospitals to effect a medical management process that brought bed days form over 2400 bed days per thousand to 1700 bed days per thousand. I implemented a hospitalist program with one IPA and a hospital. I managed a full staff of on-site in-hospital UR nurses and case managers. The total health services staff consisted of 45 professionals. I supported PCP’s with a “no hassle” program that supported their back office activities with the HMO’s administrative personnel.

Specialized Skills;

Developed a three tiered formulary in conjunction with the P&T committee
Oversight and coordination of a Congestive Failure program that comported with QSMC and CMS extra payment program
Helped develop an alternative medicine benefit for Medicare HMO Plan
Aided in implementing online information systems to aid physicians in managing risk
Worked closely with provider groups to improve financial and clinical outcomes

Founder and President

CareNet, Jacksonville, Florida 1998 to 2005

Founder and co-developer of a medical application service provider, incorporating a suite of totally web-centric applications for the physician front office and interactive physician web sites.

Responsibilities: Investor relations – presentation of CareNet products to potential investors; development of investor relationships in the U.S. and Poland.

Business partner development – presentation of CareNet products to physician groups as they relate to commercial and clinical aspects of e-health care.

Workflow development – collaborated with programmer on user interfaces and data development

Regulatory development -- supervision and oversight of a HIPAA compliance program.

Specialized skills: Information technology relating to the Internet, including COM+ and SQL database services, html and various scripting languages. Integrating the technical and clinical aspects of e-health care to the benefit of physicians and patients.

Learned information technology relating to the Internet such as a variety of web services including COM+ and SQL database services
Client side operations such as VB Scripting and server side Active Server Pages
HTML programming using an editor (Front Page)
Ability to supervise an enterprise HIPAA compliance program
Appreciation for the commercial and clinical aspects of e-health care
Co-developed a complete suite of web centric practice management applications that are HIPAA compliant for the time of HIPAA regulation release

Medical Director, CEO

Vantage Health Plan, Jacksonville, Florida 1995 – 1999

Responsibilities: Leader of the initiative to develop a provider-sponsored health maintenance organization in northeast Florida. Oversight of all UR/UA, credentialing, CQI and TQM activities.

Key Accomplishments: Acquisition of a Florida COA. Chief negotiator for growth of the plan from 450 lives to 4700 lives in eight months. Development of a network of 900 providers and three hospital systems. Key Accomplishments:

Contributed to the writing of the policies and procedures of the plan for the purpose of getting the COA including medical review policies, review of appeals of denials credentialing, etc. – NCQA compliant
Set up the entire credentialing process including the development of our own credentialing software program
Grew the provider network to over 900
Lead the growth of the plan from 450 to 4800 lives in an 8 month period by working closely with the local brokers and employers
Supervised a physician lead utilization review process which produced practice pattern guidelines
Developed an emergency on call program that reduced ER utilization from over 10% to under 2%
Reviewed over $800,000 worth of claims and found duplications and inappropriate charges in over half of the claims
Worked with a local Oncologist who specialized in autologous Bone Marrow Transplantation to provide a capitated product to be used for expansion of the service beyond the geographic borders of Jacksonville
Developed a program to direct 20% of the acute care admission into a skilled nursing facility reducing per diem costs from $2000 TO $300.

U.S. Allergy Corporation, Woodbury, New Jersey President, Medical Director 1984 – 1996

Responsibilities: Management of a joint venture with Pharmacia Diagnostics for a consulting allergy program to provide allergy diagnostics and treatment to patients of non-allergists. Management and supervision of 40 nurses, sales representatives and laboratory technicians.

Key Accomplishments: Development of a consulting allergy program unique in the U.S. Activities resulted in revenue growth from start-up to $1 million per year in three years.

President and CEO

ONAC, (Okie National Allergy Company) Woodbury, New Jersey 1976-1993 Responsibilities: Development and implementation of an allergy delivery program in multiple group-staff and IPA-model health maintenance organizations throughout the U.S. Contracted capitated agreements with groups including U.S. Health Care, CIGNA, HealthAmerica/MaxiCare, Blue Cross Blue Shield of Florida and Pennsylvania, Rutgers Community Health Plan/HIP.

Key Accomplishments: More than 1 million HMO members ultimately capitated into the plan; outcome benchmarks showed significantly decreased costs for care, lower rate of emergency room visits and lost workdays compared with national averages.

Applied the principles of disease and demand management to the allergy programs and provided services for 1/3 of the traditional costs

Managed Care Consultant

Schering Plough, Kenilworth, New Jersey 1989 – 1990

Responsibilities: Strategic planning for new product development and increasing activities in managed care. Instructing key personnel in the dynamics of managed care.

Private Practice Woodbury, New Jersey

1974 – 1994 Jacksonville, Florida 1990 to current

I have continued to stay clinically active and currently seeing patients 2 days per week in my office.

For the past three years I have taken direct patient care of high risk-complex patients through pre and post acute care.

Education

Bachelor of Science, Albright College, Reading, PA 1961 – 1965

Medical Degree, Jefferson Medical College, Philadelphia, PA 1965 – 1969

Intern Straight Pediatric, St. Christopher’s Hospital for Children, Philadelphia, PA 1969 – 1970

Resident, St. Christopher’s Hospital for Children, Philadelphia, PA 1970 – 1971

Chief Resident, St. Christopher’s Hospital for Children, Philadelphia, PA 1971 – 1972

Allergy/Immunology Fellowship, Jefferson University Hospital 1972 – 1974

American College of Physician Executives PIM I, II, Finance, Informatics Three Faces of Quality 1994 – 2003

Professional Certifications and Licensure

Held active licenses in 18 states from 1977 to 1990

(List available upon request)

Current license Florida

Board Certified, Pediatrics 1974

Board Certified, Allergy and Immunology Conjointly from American Board of Internal Medicine and American Board of Pediatrics 1977 Diplomat, National Board of Medical Examiners 1972 and 1974

Professional Organizations

Member American College of Physician Executives

ACPE – PIM I, II, Informatics I, Finance I, Three Faces of Quality

Member HIMSS

Fellow, American Academy of Pediatrics

Fellow American College of Allergy and Immunology

Fellow American Association of Certified Allergists

Member Academy of Regenerative Medicine

Board of Directors Delaware Valley Clean Air Council

Miscellaneous

Clinical Trials: Ceterizine, Zileuton, Serevent, HIB Vaccine, Cost-benefit outcome studies

Editor, Monograph: Strategies for Optimal Use of Antihistamines: Achieving Effective Therapy in Contract Health Care Settings

Program Speaker: Glaxo Welcome, Pfizer

Member, Committee on Alternative Care Delivery Systems, Joint Council of Allergy and Immunology 1985

Consultant to Shering Plough’s Managed Care Division 1988-89

Patient Education Programs

Additional Training

ACPE – PIM I, II, Informatics I, Finance I;Three Faces of Quality

Suboxone Course
HIPAA Course Tulane University

Multiple State Licensures

Required for my programs in different states – let them all expire except for Florida.

Graduate degree from an accredited school of medicine

Jefferson Medical College Philadelphia Penna. 1969

Board Certification in an approved Specialty (preferably primary care)

Boarded Pediatrics 1974

Boarded Allergy & Immunology 1977

Clinical Practice

Continued some degree of clinical practice since 1974 until the present

Managerial Experience in an HMO environment

Started with HMO Activity in 1976 at Rutgers Community Health Plan with Dr. Paul Lenz. Set up an allergy program, which included disease and demand management and provided outcomes, which were equal in quality to the traditional delivery but ½ the cost. Continued with capitated contracts all over the country with a number of HMOs including US HealthCare, Cigna, BCBS Florida, Health America, etc. Ran the company that had 1.5 million lives under capitated contracts for allergy services.

Years as Medical Director and CEO

Started and became Medical Director of a physician owned HMO in Jacksonville in 1995 (Vantage Health Plan) until 1999. Sold the lives when we couldn’t get additional capital. Plan grew to 4800 lives.

Medical Director of Medicare HMO program in New Orleans, LA.

Strong knowledge of managed care concepts

Worked as a consultant to Schering Plough in 1989 for their managed care division; On the Alternative Health Care Delivery Committee for the American College of Allergy and Immunology; Editor of “Use of Antihistamines in a Contract Care Environment”; Many lectures given on Managed Care for multiple organizations;

Demonstrated UM skills

Performed UM for Vantage for 4 years; Developed clinical guidelines with providers; Established best practice parameters; established report cards and no PPA for highest performing providers.

Proven Medical cost cutting abilities

Developed a plan to direct about 20% of our acute care hospitalizations to a SNF unit reducing per-diem charges from $4,000 to $400. (Involved the use of an Intranet and involved the PCP); VHP’s Medical loss ratio varied between 84 and 91 percent (very small population base); Set up program that reduced ER utilization to less than 2% from over 10%;

Excellent written, verbal and organizational skills

Speaker program for Glaxo , Schering Plough, Pfizer:

Editor - Strategies for Optimal Use of Antihistamines: Achieving Effective Therapy in Contract Health Care Settings

Effective problem solving and resolution abilities

Guided a provider sponsored HMO from a concept to a fully functional HMO.

Interests and Expertise – Integrated Provider Networks:

Direct Patient Care
- Consumer Driven Healthcare
Telehealth – Telemedicine
Pre-Acute Care – Direct Admits to Skilled Nursing Facilities
Virtual Networks
Risk Contracting – Value Based – Risk Scoring (HCC-RAF) – HEDIS
Long Term Care
Pain Medication Management
Virtual Health
Digital Health
Sub Acute Care,
Pre-Acute Care
Post-Acute Care
Endocannibinoid therapy Certified in the State of Florida
Regenerative Health

Allen Okie MD Dipl. ABAI, FACAI, FAAP