Carrie Monger

• Oversight of the Equality Care Incentive Program (ECIP), Equality Health's flagship value-based care offering to its network across 5 markets, including program evolution, tool deployment to network providers, and integration with CareEmpower, a proprietary population health platform that supports ECIP.
• Develops and executes all practice-facing communications that support ECIP, including contract addendums, provider satisfaction surveys, training documentation, etc.
• Launched and leads a new centralized support team for practices and internal associates to leverage continuous improvement and drive performance. Provides day-to-day support with the development and oversight of the central support function for the network and network-facing communications.

• One of the two initial team members recruited to build Equality Health's network, presence, and name recognition in the Virginia market as it launched in 2024.
• Led efforts to build a recruitment pipeline from scratch and implemented it into the Salesforce CRM for consistency in reporting and growth projections.
• In year 1, we exceeded growth expectations with 25 participating practices and over 20K in membership attribution. We established relationships and name recognition, leading to a tripling of network and membership growth in year 2.
• Recruited, hired, and deployed a team of network development professionals to continue growth in the Virginia market.

• Recruited to develop and deploy all tools, templates, staffing models, and strategies for the newly established Network Development organization for the Medicare Advantage Special Needs Plan in 20+ markets (tasks formerly performed by business development team members).
• Implemented a recruitment strategy to inform prioritization and process for all network development projects.
• In accordance with local and national regulatory requirements, I wrote physician, health system, and vendor contract templates for use in local, regional, and national negotiations.
• Secured contract templates and established version control for ongoing maintenance in a shared environment; established the PADU framework (Preferred, Acceptable, Discouraged, Unacceptable).
• Recruited, hired, and trained a team of 20 network development associates to support the vision of this newly launched organization.

• Promoted into this strategic role within the centralized Value-Based Strategies (VBS) division to transition Commercial, Medicaid, and Medicare Advantage risk contracting from 20+ local market teams to VBS, and create greater visibility in overarching value-based contracting progression.
• Deployed change management and stakeholder engagement alongside local market leaders in the development of a RACI framework (Responsible, Accountable, Consulted, Informed) to define accountability in the achievement of shared goals.

• Leader within the National Network Operations division at Anthem that provided centralized strategic support for national commercial accounts, with an emphasis on national network penetration, performance/efficiency, and benefit design.
• Served as Executive Director for a custom commercial ACO pilot that supported a jumbo-sized national account; led all programming between National Account Management Leaders, participating primary care practices, and another BCBS plan in whose market this unique pilot existed.
• Outperformed established scorecard metrics quarter over quarter; drove down ED visits by greater than 20%, and increased primary care visits by greater than 15%.

• Led, managed, and tracked all network development activities and projects in the Mid-Atlantic Region (VA, DC, MD, DE), representing approximately $1 billion in annual health care spending.
• Oversaw and led to completion all critical negotiations for the region, including the initial participation agreement or revisiting the relationship to include/enhance Value-Based Addendums.
• Change leader who navigated the region through significant divisional reorganization; the market lauded it for its highly successful transition.
• Leveraged operational and process improvements that allowed the team to perform at the highest and most efficient levels in times of reductions in force; vocal leader to centralized network operations leaders—advocated for market needs and promoted best practice sharing with other markets.
• Quantifiable Highlights: Built two compliant statewide networks to support Duals Demonstration and Medicaid Long-Term Services and Support Programs; value-based contracting penetration grew from 15% of membership to 75%; contracted 100% of eligible provider groups on episode bundled payment model agreements; following reorganization and inheriting the provider inquiry queue, reduced monthly census from over 1,200 to less than 50.

Over 10 years, my Anthem career evolved from individual contributor with Virginia focus to East Region and National Leadership. Highlights:

Bundled Payment Director (October 2012 - December 2013):

• Developed and delivered an episode-bundled payment toolkit for the deployment of bundled payment programs across the enterprise.
• Performed market analysis, examined billing patterns, costs, and clinical data required to identify how evidence-based, high-quality health care aligned with episodes of care to target 5-10 partners in each market.
• Completed the contract template with corresponding exhibits to fully explain roles and responsibilities within the program; performed legal due diligence, outlining regulatory and legal risks in 14 states.

National Network Management Director (December 2009 - September 2012)

• Promoted within the department.
• Set and executed strategy and direction for national, regional, and local ancillary provider networks across the enterprise.
• Led a virtual team, providing enterprise-wide guidance with local market execution.
• Led key provider relationships via quarterly joint operating committee meetings to ensure stakeholder awareness of all network expansions, payment innovation programs, system migrations, and downstream impact to the provider community.
• Implemented a successful project plan for Anthem's first-ever national amendment strategy by amending all DME contracts concurrently in all markets.
• Led negotiations with impactful national providers to achieve significant cost savings, and established a process for evaluating unit cost across all markets, and then varied claims systems and data platforms.

Sr. Provider Network Manager (November 2007 - November 2009)

• Promoted within the department.
• Set and executed strategy and direction for East Region ancillary provider networks (GA, VA, NY, CT, NH, ME).
• Coached the team through the Market Analysis process to identify and recommend efficiencies and savings associated with their networks (e.g., transitioned HIT providers in CT from UB04 billing to the industry standard CMS1500, negotiated Air Ambulance away from a percent of charge to a fee schedule).

Network Manager (September 2003 - November 2007)

• Responsible for day-to-day management of DME, O&P, Ground and Air Ambulance, and Home Infusion Therapy networks in Virginia.
• Subject matter expert for assigned provider specialties, and responsible for keeping key stakeholders, including Pricing/Coding, Medical Management, Claims, and Legal.