Dr. Oliver works with his clients to drive value into healthcare. Using powerful data analytics he helps private and public sector clients use data to better understand the complex issues healthcare faces: managed care, outcomes, care management, value-based contracting and healthcare reform.
Medicaid Reform – Arkansas implemented the Affordable Care Act (Obamacare) through a unique “Private Option” approach. The enabling legislation required that the state reconsider the approach in 2016. Dr. Oliver’s team conducted the analysis the legislature and governor depended on to improve the funding of healthcare services in the state. Some of the breakthrough analyses included:
Evidence of whether Private Option claims (through insurance companies) were less expensive through the insurance plans than through Medicaid. Dr. Oliver’s team found that few of the beneficiaries in the two systems were sufficiently comparable: Medicaid mostly covered youth and the aged, and 74% of Medicaid claims related to behavior health. In contrast, the Private Option members were 21-64 years old and not in the categories of Aged, Blind and Disabled. One area where claims are comparable is maternity. Dr. Oliver’s team was able to determine the comparative costs between the two programs, finding that private insurance was much more expensive.
Finding that Private Option members had higher Emergency Department visits than Medicaid. It is widely expected that insurance companies will drive patients into physician offices – through higher co-pays for ED and setting up a relationship with a Personal Care Provider. However, Dr. Oliver’s team found that the insurance companies had not succeeded in moving their members into the ED. Instead, Dr. Oliver found many in the insurance pool had not yet established a PCP and were using the ED 5, 10, even 20 times a month. The insurance companies rightly pointed out that this was a problem of taking on members that were not previously covered, and had a habit of using the ED.
74% of Arkansas Medicaid is for services to the Aged, Blind and Disabled. The legislature had been focused on the direct costs of providing specific services to this community—such as behavioral health and nursing homes. Dr. Oliver’s team obtained an extract of 140 million individual claims in order to determine the full healthcare costs of this population, including medical costs. The team found that the $2 billion in direct program costs did not count for an additional $800 million in other medical costs for those beneficiaries.
Dr. Oliver’s team help the legislature chase down rumors that behavioral health providers had been billing for similar services to the same beneficiary on the same day. For example, it was rumored that providers might bill for individual and group therapy for the same patient on the same day. Dr. Oliver extracted over 10 million claims covering a year of services for over 10,000 patients. In a massive data program, his team arrayed the claims by day and beneficiary and compared claim codes. Dr. Oliver’s team found that 34% of claims were for services on the same day as similar services. This represents a major opportunity for Arkansas to improve policy and case management to assure that beneficiaries are receiving services that tie to their Master Treatment Plan.
Blue Cross Blue Shield of Massachusetts – Dr. Oliver led teams to help the CFO and CTO improve systems and processes for this major insurance carrier. For the CFO, Dr. Oliver developed better claims processes—reorganizing the claims adjudication team and eliminating over 4 years of backlog. Dr. Oliver worked with the CFO to redesign the monthly closing process, dropping it from six to 3 weeks. For the systems area, Dr. Oliver managed a user acceptance team that managed bug-fix, assessed controls and evaluated performance of a major new claims processing system.
Practice Management Systems – Dr. Oliver served as the CFO for this emerging software company. While the initial plan was to seek VC, Dr. Oliver was able to manage cash flow in a manner that the company was able to avoid outside investment. PMS developed a suite of practice management systems including billing and medical records. It sold and serviced physician practices directly, serving the region from Long Island to Vermont. It grew from start up to largest number of sales in New England in only three years. The company then sold out to a competitor as part of a national roll-up.
deNovis – Dr. Oliver led the $140 million second round of funding for this innovative software company. The company developed and successfully marketed contracting software that allowed for automatic adjudication at a rate of nearly 100%. The software was purchased by insurance companies and the Center for Medicare and Medicaid Systems (CMS). It was sold in a successful trade exit.
St Vincent Hospital, Indianapolis –Dr. Oliver led a team of 100 consulting and client professionals to improve clinical processes. Worked with cardiologists and nursing staff to redesign Cath Lab scheduling. this made the Lab so much more efficient the hospital was able to cancel plans for adding labs. Worked with a team of doctors to develop clinical processes and data tracking. Improved admission process. Improved tie between ED and admissions.
Trustees of Health and Hospitals, Boston University Medical Center – worked as interim CFO to turn around this floundering organization that managed healthcare grant funds for individual researchers and other institutes associated with BUMC.
Hospital Best Practices – Dr. Oliver helped Bain & Company develop its first foray into healthcare consulting. Teamed with Baxter, Dr. Oliver’s team developed a method for comparing best practices across client hospitals and working with clinical focus groups to standardize hospital processes to reduce cost while improving quality.