Heather Holland, MD

• Responsible for leading practice affairs with clinicians, internal leadership, and healthcare facility executives
• Served as Chairman for Clinical Quality and Professional Affairs Committees
• Physician Liaison to hospital based Radiologists and Teleradiologists promoting education, clinical quality, documentation compliance and collaborative communication with administrative staff
• Developed trusting relationships and promoted timely resolution of clinical and operational issues with executive leaders and vendors at contracted facilities
• Traveled quarterly to all contracted facilities both in AZ and out of state to attend Medical Executive meetings, provided informational presentations on radiology services and quality program, addressed clinical and operational issues, and enhanced collaboration with Providers and hospital leadership

Accomplishments:

• In two months as Project Manager seeking accreditation by The Joint Commission, drafted necessary policies and procedures and successfully lead multi-department leadership team and receive prestigious accreditation as an Ambulatory Care Center by The Joint Commission.
• Designed and drove fully revised Clinical Quality program providing tracking, monitoring and notification to contracted facilities and Radiologists regarding reports containing clinical quality concerns.
• Assisted company executives during clinical quality decision-making process by compiling and summarizing radiologic reports to suggest corrective action.
• Developed Ongoing Practice Performance Evaluations and FPPE with recommendations for further education when indicated for Quality Committee and Board of Trustees.
• Interviewed and toured prospective radiologists with 90% acceptance rate of employment offer and contract.
• Reallocated staff resources and recruited radiologists to form and professionally lead Professional Affairs Committee (PAC) in review of radiologist application files for initial appointment and reappointment in accordance with primary source verification requirements of The Joint Commission
• Created and timely communicated educational flyers, posters and emails in response to issues identified as requiring additional educational for radiologists and departmental staff.
• Provided documentation of processes to comply with regulations and company policies.
• Offered friendly and efficient service to customers, handled challenging situations with ease

• Collaborated with CEO and Co-founders as subject matter expert and strategist to increase payer reimbursements, provider engagement and quality-driven patient care
• Improved radiologic accuracy and reporting automation of missed or under reported medical conditions associated with HCC and RAF
• Involved at ground level in development of pilot program to implement radiological artificial intelligence technology with machine learning to enhance accurate reporting of chronic conditions that risk adjust

• Physician Liaison/ Physician Educator for Quality Improvement - Managed Care
• Developed highly effective communication, interpersonal and persuasion skills, which were used for interacting with people of all different backgrounds and cultures.
• Forged and maintained strong working relationships with Provider Practices to ensure engagement with HCC/STAR initiatives
• Markedly improved network providers clinical quality documentation, coding and billing of CMS HCC Risk Adjustment and Quality Star Measures

Accomplishments:

• Increased documented medical conditions and payment reimbursement associated with Risk Adjustment on average of two to three Hierarchical Condition Categories (HCC) per medical chart review
• Provided individualized provider practice reports and educational tools in multi-department collaborative initiative that increased Network's CMS STARs rating of 3.5 in 2016 to 4.5 in 2017
• Collaborated with multiple Network departments to optimize and accurately reflect Network RAF through face-to-face educational Provider sessions
• Created user-friendly tools to enhance Provider knowledge of HCC, RAF, STARS and coding compliance
• Identified opportunities for process improvement and communicated best practices to improve overall Provider and interdepartmental efficiency.

Clinical Quality Consultant-Medicare STARS telecommute

• Delivered outstanding service to clients to maintain and extend relationship for future business opportunities.
• Developed market business plans and achieved CMS quality rating of 4 Stars or higher for 24 Providers of United HealthCare Medicare Advantage with 10,000 enrolled members throughout Arizona
• Supported Providers and medical staff as STARs subject matter expert with skilled analysis of patient data, patterns of utilization, gaps in care and strategic opportunities for provider education and performance improvement

Accomplishments:

• Created monthly actionable work plans that substantially increased provider practice's self-sufficiency and ability to identify and close gaps in care.
• Intensive support of population health management and expert consultative efforts on Part C and D quality measures resulted in raising CMS STAR rating of Medicare Advantage plan from 3.5 Star rating to 4 STAR rating over course of only 6 months in 2016
• Predicted health plan's timely need to track fourth quarter Part D high risk medication prescribing trends
• Generated provider specific reports to guide discussions surrounding high-risk medication alternatives and strategies to avoid permanent care gaps on Part D measures in upcoming year
• Created innovative provider binder of relevant external facing documents and resources that successfully secured and increased Provider engagement with health plan's STARs performance improvement initiative and bonus incentive program
• Collaborated with multiple functional areas and strengthened Corporate HIPAA compliance and privacy policy by conducting thorough review of department's use of PHI.

• Worked directly with AIP Chief Medical Officer (CMO) to provide organizational support of utilization review, case management, disease management and population management in Arizona's West corridor for Medicare Advantage plan and Pioneer ACO
• Optimized organizational performance around quality metrics put forth by CMS STARS, HEDIS, and PQRS
• Conducted peer-to-peer consultations to address prior determination decisions, appeals and grievances
• Provided clinical leadership of AIP's Care Management Committee comprised of 10 private practice physicians and COO
• Duties included physician file review for network credentialing, evaluation of provider performance issues and facilitation of corrective actions when necessary

Accomplishments:

• Received 4.5 CMS STARs rating in 2012 for 13,000-member Medicare Advantage plan
• Developed benchmarks and thresholds for incentivized Pay for Performance primary care physician program
• Led POD meetings and identified relevant annual quality metrics for PCPs and specialty physicians
• Supervised Risk Adjustment Factor quality program with population health vendor to improve medical documentation and coding accuracy
• Achieved HCC increase from 1.0004 to 1.0629 across network
• Provided clinical direction and leadership of AIP in partnership with Banner Health for network's 52,000 member Pioneer ACO (PACO) through first CMS year with accurate and complete data reporting resulting in total Net Shared Savings of 3.3% from benchmark and (pre-risk Share) Net Income of $3.59M
• Developed innovative comprehensive patient quality assessment form to assist capture of relevant data to meet specifications of PACO quality measures
• Project management of incentivized initiative for AIP primary care physicians to complete comprehensive exam of high-risk PACO members
• Reviewed 741 patient exams and educated physicians on documentation deficiencies
• Efforts resulted in 6% decrease in network's hospital 2012 readmissions
• Successfully embedded case managers in two high volume physician practices improving care coordination and patient satisfaction
• Directed care transitions of radiation oncology patients into exclusive capitated narrow network managed by oncology care vendor dedicated to cost effective evidence-based medicine.

• Board certified Ob/Gyn staff physician
• Performed high risk and uncomplicated obstetric deliveries, preventative and annual women's health care, gynecologic surgeries, inpatient care and consultation
• Served as mentor to new physicians having just completed residency.
• Kept detailed records of patient treatments and needs throughout medical processes

• Clinical provider of private Ob/Gyn practice. Served as departmental Ob/Gyn Vice Chairman at Banner Desert Hospital, Mesa, AZ
• Hired and managed employees to maximize productivity while training staff on best practices and protocols.