Paul E. Portsmore, Jr.
Greater New York City Area
Summary
25+ years of experience driving growth by optimizing market share in current footprint and leading expansion efforts in untapped customer bases and geographies. Expertise creating retail, commercial, and government-sponsored healthcare insurance products and services, cultivating provider partnerships, and leveraging incentives to achieve cost efficiencies while enhancing quality of care. Robust network of provider relationships. Pioneer of some of the fastest-growing payer-side initiatives, including value-based reimbursement and health equity programs and health-tech interfaces that streamline administrative functions while improving customer experience.
Overview
28
28
years of professional experience
Work History
CEO and Board Chair
HELLO PEDIATRICS
07.2023 - Current
- Company Overview: Hello Pediatrics is a pediatrician-founded telemedicine service dedicated to partnering with pediatric practices to deliver after-hours care. This strategic collaboration significantly improves the patient experience while reducing unnecessary low-acuity emergency and urgent care visits.
- My responsibilities extend to providing focused strategic direction to the board and management team. I am also tasked with leading creative value-based opportunities and executing win/win/win solutions that benefit pediatricians, patients, and parents alike. A key outcome of these efforts is the reduction of healthcare costs for risk-bearing entities.
Founder and CEO
SEQUOIA HEALTH SOLUTIONS, INC
01.2021 - Current
- Boutique strategic advisory firm focused on mending payer and provider relationships through unique solutions and value-based arrangements.
- Serve as an advisor, board member, and investor for mature organizations as well as start-up/early-stage healthcare organizations.
President, City of NY GRS
EMPIRE BLUE CROSS BLUE SHIELD AT ANTHEM (now Elevance Health)
01.2021 - 01.2023
- Company Overview: Second largest medical insurance provider by total members (45M+) with $138.6B in revenues.
- Selected to define business vertical from the ground up and implement strategies for business development, operational alignment, talent acquisition/onboarding, and strategic partnerships. Regularly engage with senior leadership and investor relations. Annual Revenue over $3B. Staff: 750 at peak.
- Built product strategy/operational infrastructure to launch Medicare alternative benefit plan for 250K City of NY retirees, representing largest procurement of retiree population in Anthem’s history.
- Created Medicare Advantage Plus plan with robust PPO, telehealth, concierge, and health app capabilities to drive customer satisfaction and improve quality scores.
- Developed/executed value-based contracts with key providers and vendors that incorporated risk coding strategies for tracking population health and aligning incentives for wellness to facilitate success and share risk.
- In just 4 months, staffed dedicated 750-employee clinical, non-clinical and call center teams to service business.
- Following court ruling barring City from charging retirees for current medical coverage, facilitated Anthem’s withdrawal from the contract and unwound operations.
Senior Vice President, Head of Growth
HEALTHFIRST
01.2012 - 01.2021
- Company Overview: Largest non-profit health insurer in New York: $11B revenues, 1.5M members, 40,000 providers, and 80 hospitals.
- Recruited to create new products and sales channels to diversify revenue streams while growing legacy business. Led all aspects of $11B P&L at peak for Medicaid, Medicare, and Commercial lines of business. Oversaw business development, product development, M&A sourcing/negotiations, strategic partnerships, community engagement, marketing, and public relations. Managed contracting, relations, and value-based incentives with health system sponsored health plan. Reported directly to CEO. Budget: $150M. Staff: 800.
- Doubled membership to 1.5M+ and revenue to $11B+ (12% CAGR). Realized 5-7% market share growth, and 4% selling, general, and administrative expenses (SG&A) rate.
- Retail / Commercial Growth & Brand Recognition Strategy – Grew from zero to $2B
- Launched Healthfirst Insurance Company, a wholly owned subsidiary of Healthfirst offering commercial, off-exchange health coverage to individuals and small businesses. Managed 15 health system sponsors.
- Achieved average of 5% margins over 8 years and captured 10% of market share.
- Facilitated acquisition of 10,000 new members and enabled strong retention across existing business lines by providing affordable coverage options for members no longer eligible for lower-income plans.
- Rolled out health plan for small businesses that aided member retention and was upsold to customers who became eligible based on changed employment status.
- Created inaugural Healthfirst brand footprint in Hudson Valley. Opened retail centers, oversaw PR campaigns, developed network to support products, and led acquisition of Crystal Run Health Plan, resulting in Healthfirst being recognized as fastest growing health plan in Hudson Valley in 2020.
- Developed middle-income retail strategy. Rebranded community offices and mobile units, improved digital capabilities, refurbished centers, created new sales channels, and retrained salesforce to improve quality and elevate patient experience.
- Managed first-of-its-kind and industry-leading value-based reimbursement system focused on quality and preventative health that drove $200M+ in cost savings awarded to the health systems directly.
- Introduced new Long-Term Care integrated product providing a complete care solution that captured market share from Medicaid and became a market leader with 15K members and a 65% market share.
- Legacy Core Business Expansion – Grew from $6B to $9B
- Grew Medicaid business by ~20% representing a $1.2B revenue opportunity.
- Closed acquisition of 200K+ life Medicaid plan, including integration of 100+ employee sales force. Retained 75% of the membership.
- Developed basic health plan product (Essential Plan) in 2015 in response to regulatory risk associated with administrative change in Washington. Grew to 180K members and $900M in revenues by 2020.
- Improved health outcomes for vulnerable populations while enhancing product performance by introducing Health & Recovery Plan (HARP) for members with behavioral health issues.
- Returned Medicare Advantage products to profitability following 3 years of losses by redesigning product and reducing costs while improving margins on premiums.
- Earned distinction as a 4-star federal Medicare health plan and top-ranked Medicaid plan in NY State for quality.
- Leadership
- Demonstrated operational agility and sound judgement during periods of significant industry disruption and crisis, including Hurricane Sandy, 2016 election, and 2020 pandemic, social justice, and health equity challenges.
- Built and managed salesforce comprised of 80% diverse staff. Achieved 90%+ staff retention.
Vice President, Health Services
AMERIHEALTH INSURANCE COMPANY OF NJ
01.2006 - 01.2012
- Company Overview: New Jersey subsidiary of $15B healthcare solutions provider.
- Managed cost of care, quality management, case management, utilization management, population health, and wellness for 200K+ member commercial health plan. Revenue: $800M. Budget: $50M. Staff: 80.
- Eliminated premium deficiency reserve and achieved 4% profit margin for parent company.
Assistant Vice President, Network Contracting
EMPIRE BLUE CROSS BLUE SHIELD
01.1998 - 01.2006
- Company Overview: $5.5B health insurance provider with 5M members.
- Held earlier roles as Provider Relations Representative, Physicians Health Services (1996–1998) and Income Maintenance Caseworker for Bergen County Board of Social Services (1992–1996).
Education
MBA - Health Care Administration
Baruch College, Zicklin School of Business
New York, NY01.2000
BA - Political Science
Providence College
Providence, RI01.1992
Skills
- Effective decision making
- Operational excellence
- Customer focus
- Strategic visioning
ADDITIONAL INFORMATION
- Adjunct Professor, Healthcare Economics & MBA Healthcare Capstone
- Molloy College, Rockville Center, NY, 2016–2021
- Awarded Empire Role Model Leadership Award for creation of inaugural e-business technology
Timeline
CEO and Board Chair
HELLO PEDIATRICS
07.2023 - Current
Founder and CEO
SEQUOIA HEALTH SOLUTIONS, INC
01.2021 - Current
President, City of NY GRS
EMPIRE BLUE CROSS BLUE SHIELD AT ANTHEM (now Elevance Health)
01.2021 - 01.2023
Senior Vice President, Head of Growth
HEALTHFIRST
01.2012 - 01.2021
Vice President, Health Services
AMERIHEALTH INSURANCE COMPANY OF NJ
01.2006 - 01.2012
Assistant Vice President, Network Contracting
EMPIRE BLUE CROSS BLUE SHIELD
01.1998 - 01.2006
BA - Political Science
Providence College
MBA - Health Care Administration
Baruch College, Zicklin School of Business
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