Medicare Market Entry & Partnership Architecture

 

I led the evaluation and entry strategy for a tech-enabled behavioral health platform across Medicare Part B, MA, D-SNP, and C-SNP segments. This involved developing the comprehensive business case and GTM model, including pressure-testing the durability of unit economics. I directed the outreach to health systems and payers to identify strategic champions, navigating the complex procurement and clinical integration layers of both Academic Medical Centers (AMCs) and PE-backed provider roll-ups.

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Defined requirements for partnership models and time-to-pilot, resulting in national launch strategies covering 100M+ lives and $50M in new payer contract value.

Prior Authorization & Physician Efficiency Systems

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Administrative friction in prior authorization was stalling clinical throughput and straining payer-provider relationships. I redesigned end-to-end clinical workflows to automate approvals for high-performing physicians, aligning clinical needs with administrative efficiency. This work established the operational framework for high-trust payer-provider partnerships and streamlined the path to clinical intervention.

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Identified opportunities to reduce processing time by 25% per claim.

Reimbursement Optimization & Site-of-Care Architecture

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A fragmented health system roll-up faced significant revenue leakage and inconsistent payer contracting, threatening the projected EBITDA of the portfolio. I developed a comprehensive remediation strategy that standardized inpatient and outpatient reimbursement models and optimized site-of-care delivery to align clinical delivery with the highest-value reimbursement.

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Located $10M+ in annual revenue leakage and architected the strategic negotiation framework for new enterprise payer contracts, establishing a repeatable commercial model for future portfolio acquisitions.

Portfolio Growth & Member Activation

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Crafted enterprise strategies for a $78B revenue portfolio across D-SNP, C-SNP, and Group MA segments. Developed C-suite business cases for technology investments and venture/M&A partnerships.

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Influenced strategy for a 5.2M-member portfolio and prepared leadership for critical CMS regulatory engagements.

Specialty Biologic Market Access

 

Led the creation of a new Life Sciences business line focusing on specialty biologics in the home infusion site of care. Analyzed first-of-its-kind datasets to develop go-forward recommendations for the business unit CEO.

 

Architected the product roadmap and site-of-care strategy used to drive enterprise adoption and identify unique market opportunities.

​Med-Tech Commercialization Strategy

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Directed the pre-marke strategy for a Series A cardiology diagnostic startup. Built a scalable sales pipeline and partnership framework to bridge the gap between clinical clearance and market adoption.

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Established the reimbursement pathways and strategic partnerships necessary for immediate post-market viability.