Gary Pilling II, MBA
Wesley Chapel,United States
Summary
Accomplished senior executive leader with proven success in developing, implementing, and optimizing business processes to enhance long-term profitability. Astute leader with strategic mindset demonstrated over 20-year Healthcare career. Collaborate cross-functionally on large-scale initiatives to meet dynamic industry challenges. Innovative Value Driver that seeks win-win solutions.
Overview
28
28
years of professional experience
Work History
SVP/VP Clinical Services Group
InnovaCare Health
Orlando , FL
08.2021 - Current
- Scaled & Built Out Corporate Departments: Risk Adjustment, Quality, & Care Management
- Led Centralization & Standardization of 120+ FTE's, including restructuring operating model & staff (120+ FTE's)
- Drove high impact efficiency & revenue initiatives, including bringing AI tech vendor solution to streamline processes which had 32% impact to Risk Revenue
- Responsible for key P&L drivers: average 3% above market revenue gains & current cost savings to Part A Spend...reducing MLR
- Change Managed through Equity Event & 4 Staff Reductions in 12 month period
- Led $9m Q4 Initiative in 2022 & $15m in 2023 to appropriately capture Risk Revenue
- Organized & Implemented Care Management Redesign in 2024, reducing FTE's by over 1/3, improving revenue via CCM by approx $400k & expected cost reductions in the $5-$8m range
- Reduced Quality Staff overhead by 50%, while improving efficiency via AI Tech
VP Risk Adjustment Operations & Strategy
Boston Medical Health Plan
Boston, MA
05.2021 - 08.2021
- Oversaw Process Improvement Strategy Playbook for Medicare Advantage & ACA Exchange Lines of Business: Expected net revenue & savings of $20m
- Drove creation of new analytic & tracking report creation plus improved patient suspecting improvements to capture appropriate risk factors
Corporate VP: Strategy & Risk Revenue Operations
Lumeris
St Louis, MO
11.2017 - 05.2021
- Led Strategy & Risk Revenue Operations for: Owned Medicare Advantage Health Plan, Joint Venture with Health System owned MA Plans, & FFS to VBC PHSO Joint Ventures
- Managed Operations which saw an average of 10% improvement YOY in revenue
- Partnered with Health System Senior Executives to implement & manage journey from Fee for Service to Value Based Care
- Regular contributor to both internal & external Board of Directors to outline operational efficiency & revenue focused strategic decision making
- Responsible for over $20m budget & overall segment P&L of $250m
- Oversaw department restructure which included buildout of tech solutions, PCP education, analytics package, & joint partner reporting package
- Partnered with BayCare, Mount Sinai, Scripps, Stanford, & Cerner via joint venture partnerships to improve value based care positioning
- Moved previously low performing PCP group into surplus with 16% improvement to revenue while partnering with CMO to hold medical cost
VP Risk Adjustment Strategy & Operations
InnovaCare Health (MA Plan)
San Juan, Puerto Rico
10.2015 - 11.2017
- Oversaw Strategy & Risk Revenue Operations for 8th Largest MA Plan in US
- Improved RAF Revenue by over $300m in 2 years
- Created Disease Identification & Management Program netting $190m in revenue, while reducing medical cost by 25%
- Helped lead revenue, operations, & compliance areas for Equity Due Diligence - eventually maturing to 2 sales in 18 months (Private Equity, Anthem)
Director Market Risk/Quality Operations
Optum Health
Minne, Minn
03.2011 - 10.2015
- Oversaw & Manage the buildout of Operations in 8 States
- Improved Health Plan Risk Revenue via Primary Care Clinic partners by over $20m
- Developed Key In Office Program later adopted by Optum as a sales driver to health plans for Value Based Care improvements
- Partnered with assigned state health systems to help drive behavior change & operational results for Medicare Advantage & ACA Lines of business
Health Plan Market Director
Universal American Health Plan
Fort Wayne, IN
09.2008 - 03.2011
- Partner to Corporate Office for expansion of Medicare Advantage Plan into Indiana
- Oversaw contracting of new network which beat targets by 300% in less than 6 months
- Grew Broker channels by 50% YOY
- Led extensive conversations with key health system partners to remove contracting barriers & ensure systems were paid appropriately
- P&L Responsibility for over $20m
Progressive Roles
Health & Finance
Fort Wayne, IN
01.1997 - 09.2008
Education
MBA - Business Administration & Finance
DeVry University
Downers Grove, IL11-2011
Bachelor of Science - Business Administration And Management
Capella University
Minneapolis, MN05-2006
Skills
- Change Management
- Operations Management
- Cross-functional team leadership
- Innovation management
- Performance Improvement
- Value Based Care
- Strategic Planning
- Operational leadership
References
References available upon request.
Timeline
SVP/VP Clinical Services Group
InnovaCare Health
08.2021 - Current
VP Risk Adjustment Operations & Strategy
Boston Medical Health Plan
05.2021 - 08.2021
Corporate VP: Strategy & Risk Revenue Operations
Lumeris
11.2017 - 05.2021
VP Risk Adjustment Strategy & Operations
InnovaCare Health (MA Plan)
10.2015 - 11.2017
Director Market Risk/Quality Operations
Optum Health
03.2011 - 10.2015
Health Plan Market Director
Universal American Health Plan
09.2008 - 03.2011
Progressive Roles
Health & Finance
01.1997 - 09.2008
MBA - Business Administration & Finance
DeVry University
Bachelor of Science - Business Administration And Management
Capella University
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