Bruce P. Himelstein
Royersford,PA
Summary
Award-winning senior executive with a distinguished career in healthcare leadership, clinical expertise, and organizational management. Adept at ensuring organizational success through collaboration and partnerships with senior business executives. Proficient in directing healthcare strategies/programs and driving transformative initiatives to enhance patient care, operational and cost efficiency, and overall healthcare outcomes. Skilled in leading cross-functional teams and fostering a culture of excellence and continuous improvement. Possess a strong blend of medical knowledge, business acumen, and interpersonal skills.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Chief Medical Officer
eternalHealth, Boston, MA
02.2024 - Current
- Accountable for all clinical operational and strategic initiatives for a two-state Medicare Advantage start-up company.
Consultant
Himelstein Consulting, LLC
07.2023 - Current
- Sole proprietor and founder of consulting company specializing in management of government programs payors.
Senior Vice President, Associate Chief Medical Officer
AmeriHealth Caritas, Newtown Square, PA
01.2021 - 01.2023
- Monitored end-to-end healthcare functions of multi-state managed care organization worth $20B spanning diverse marketplaces and business lines, such as commercial/exchange products, Medicare, and Medicaid.
- Ensured effective management of clinical systems and systems vendors by developing and establishing informatics department, governance, and business-led strategy.
- Achieved set performance goals by developing and implementing company-wide multi-year utilization management, health informatics, clinical subcontractor, pharmacy and PBM Strategies.
- Added >$200M in margin impact by establishing the Medical Cost Council to evaluate medical, pharmacy, and network trend adversity.
Senior Vice President, Chief Medical Officer
MVP Health Care, Schenectady, NY
01.2019 - 01.2020
- Performed senior physician executive functions for a health plan serving NY and VT across all lines, including Medicare, Medicaid, commercial and exchange products with revenue valued at $4B.
- Directed all facets of Health Management Department establishment, including utilization management, appeals, care management, pharmacy, and quality programs.
- Generated a holistic member care portfolio, including physical and behavioral health, requiring behavioral health insourcing from Beacon Health Options by implementing integrated health initiative.
- Successfully negotiated Pharmacy Benefit Management contract valued ~$1B. Accomplished medical expense savings worth > $24M.
Senior Executive Medical Director, Government Solutions
Health Care Service Corporation, Chicago, IL
01.2017 - 01.2019
- Managed 3M Medicare/Medicaid members across five states, including IL, TX, OK, NM, MT while serving as a physician executive for Blue Cross Blue Shield.
- Devised and deployed three-year palliative care strategy across group, government, and retail lines of business.
- Mitigated financial pressures in Medicaid, resulting in over 350 process improvements, and set the stage for ongoing savings to date of over $200M by executing Project Jackrabbit (a rapid process improvement multi-state strategy).
Chief Medical Officer
Aetna Better Health of Illinois, Chicago, IL
01.2015 - 01.2017
- Maintained efficient clinical and financial performance for Medicare, Medicaid, and Dual Eligible medically complex members while performing as senior physician. Led overall care management redesign in statewide interdisciplinary pod structure. Drove the Managed Long-Term Services and Support (MLTSS) new line of business.
- Formulated and implemented effective cost-saving initiatives that resulted in savings by $60M.
- Ensured anticipated reduction in total cost of care $2M+ for select populations by cultivating multiple value-based contracts with community entities offering supportive housing services.
Florida State Medical Director (2014-2015); Medical Director (2013-2014)
WellCare Health Plans, Inc., Tampa, FL
01.2013 - 01.2015
- Monitored medical coordination required for effective utilization and quality management of the Medicaid network. Managed all major clinical and quality program components, delivering medical management leadership for the health plan. Aligned company’s mission with clinical and medical operations towards quality and financial outcomes by implementing comprehensive three-year health services strategy.
- Drove Medicaid managed care 350,000-member expansion while serving as a senior physician executive.
- Steered overall clinical direction of medical services and quality improvement functions at the Medicaid expansion plan level for ~1M members. Spearheaded over $20M in medical expense initiatives.
Pediatric Medical Director
Chapters Health System, Tampa, FL
01.2012 - 01.2013
- Expanded pediatric service area and broader access to the Florida Partners in Care (together for Kids concurrent care for children palliative care program) by creating and implementing a five-year strategic plan for a pediatric program spanning multiple corporate subsidiaries.
- Increased pediatric service volumes by 10X by developing interdisciplinary pediatric palliative care consultation services and by leading change management efforts on physicians’ behavior.
Chief Medical Director
Managed Health Services (Centene Corporation), Milwaukee, WI
01.2011 - 01.2012
- Delivered community providers risk-adjusted specialty-matched quality and cost of care performance data while leading enterprise provider profiling initiative.
- Drove successful state re-procurement bid for Medicaid line of business in close collaboration with plan and enterprise stakeholders. Established and maintained medical management analytics dashboard and trend review forum.
Medical Director for Pediatric Hospice & Palliative Care and the Maternal/Child Program
Wheaton Franciscan Home Health and Hospice, Milwaukee, WI
01.2008 - 01.2010
- Led clinical, quality, cost, and administrative management strategies as singular pediatric palliative care director.
Education
MBA -
University of South Florida
Tampa, FL06.2016
MD - Medicine
New York University School of Medicine
New York, NY06.1987
BA -
Harvard University
Cambridge, MA06.1983
Skills
- Strategic Healthcare Leadership
- Pharmacy Management
- Managed Care Operations
- Medical Education & Research
- Quality Improvement Programs
- Continuous Process Improvement
- Clinical Excellence
- Hospice/Palliative Medicine Expertise
- Patient Advocacy
- Healthcare Innovation
- Community Engagement
- High-Quality Patient Care
- Culture of Collaboration
- Healthcare Delivery Models
Certification
- Hospice and Palliative Medicine
- Active medical license in New York
Timeline
Chief Medical Officer
eternalHealth, Boston, MA
02.2024 - Current
Consultant
Himelstein Consulting, LLC
07.2023 - Current
Senior Vice President, Associate Chief Medical Officer
AmeriHealth Caritas, Newtown Square, PA
01.2021 - 01.2023
Senior Vice President, Chief Medical Officer
MVP Health Care, Schenectady, NY
01.2019 - 01.2020
Senior Executive Medical Director, Government Solutions
Health Care Service Corporation, Chicago, IL
01.2017 - 01.2019
Chief Medical Officer
Aetna Better Health of Illinois, Chicago, IL
01.2015 - 01.2017
Florida State Medical Director (2014-2015); Medical Director (2013-2014)
WellCare Health Plans, Inc., Tampa, FL
01.2013 - 01.2015
Pediatric Medical Director
Chapters Health System, Tampa, FL
01.2012 - 01.2013
Chief Medical Director
Managed Health Services (Centene Corporation), Milwaukee, WI
01.2011 - 01.2012
Medical Director for Pediatric Hospice & Palliative Care and the Maternal/Child Program
Wheaton Franciscan Home Health and Hospice, Milwaukee, WI
01.2008 - 01.2010
MBA -
University of South Florida
MD - Medicine
New York University School of Medicine
BA -
Harvard University
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