Robert Millette
Estero,FL
Summary
Market building, outcomes focused operator, in enterprise level transformation. Focused on Population Health, Primary Care and Specialty Services, Health Care Strategy, Health Plan Operations and Payor Contracting. My passion is aligning systems of care and payor relationships in a value-based approach, to drive quality and affordability throughout the system. An expert in Primary Care, Direct to Employer, Payor Contracting, Medicare Advantage, ACO's, Medicaid and Commercial 2-sided risk/capitated model contracts, implementing strategies, MSO services, and clinical tactics leading to performance in patient outcomes and quality-based reimbursement. Finance lead by training, with deep analytics, hospital and medical group operations, technology integration, lean process improvement, and contract negotiation experience.
Overview
20
20
years of professional experience
Work History
Senior Vice President - Regional Lead
Astrana Health
Providence, USA
03.2022 - Current
- Responsible for Primary Care functions, all clinical and health plan operations including managed care contracting, MSO functions, payor contracting, clinical integration, utilization management, pharmacy support, and governance of our 500-member Independent Physician Association, covering over 85,000 lives.
- Built from the ground up a globally capitated Medicare Advantage payor arrangement with BCBS RI, fully delegated, managing 180M of direct health plan revenue.
- Designed, developed, and lead network of physicians, advanced providers, and staff in managing 85,000 lives in various two-sided payor risk arrangements.
- Globally capitated model resulted in $11M surplus, in 2022; 19M in 2023, and 16M in 2024.
- Lead 20% EBITDA growth, 2022 to 2024, across all lines of business.
- Designed and oversee MSO services, covering health plan functions, including claims payments, network contracting, staffing, payroll, and back-office functions and analytics.
- Transformed primary care payment model to capitation and surplus, providing average payment of $120K annually, the last 3 years.
- Designed and implemented specific performance metrics for select specialty groups, resulting in savings of 10% in Pharmacy spend and 9% in surgical spend, year 1.
- Built and manage teams around quality, risk adjustment and coding, utilization management, and OP care management programs, which helped improve Medical Loss Ratio on managed lives from 91% to 82%, 2021 to 2022, with a top performance of 73% in 2023.
- Improved MA star rating from 3.8 to 4.3, 2021 to 2022, to 4.4 in 2023, 4.11 in 2024, through AWV performance, AI partnership to 'scrap' medical charts for care gaps and HHC codes, and other on the ground support programs for PCPs.
- RAF improvement of 20% (.98 to 1.11) 2022 to 2024 on MA lives, through development of coding team focused on pre-visit planning, HHC recapture, and introduction of AI documentation review tool.
- Only system of care with top quality marks in the state, 3 years running, around management of 25K Medicaid lives.
- Improved Medicaid and Commercial management surplus by 65% over three-year period, totaling over $16m in 2023, 11M in 2024.
- Oversee MSSP & REACH ACO Model, producing average savings rate of 4.1% for the past 2 years.
- Astrana Health is a leading physician-centric, technology-powered, risk-bearing healthcare management and service delivery company.
Vice President of Population Health
Integrated Care Solutions
08.2021 - 03.2022
- Oversee client engagement and overall performance in our value-based portfolio, including beneficiaries in BPCI A, DCE's, and multiple ACO's across the country.
- Developed executive level service line plans, driving over 1.5M in new investment around Cardiology and Orthopedics, resulting in 17% cost savings in BPCI A program.
- Built preferred network reporting package and action plans, which included SNF and Home Health readmission, LOS, leading to 2% to 5% improvements across all metrics.
- A 2-year-old start up organization, focusing on delivery clinical and technology solutions to drive improved patient outcomes and lower cost of care.
Executive Director, Clinically Integrated Network
Lee Health Inc.
Fort Myers, USA
03.2018 - 07.2021
- Executive lead over Population Health Strategy, Operations, and Managed Care for Lee Health, with a total staff of over 40 FTE's, managing $300M in at-risk contracts, for employed and independent physicians.
- Built and led a clinical integrated network (CIN) through an offering which included various partnership levels for independent physician organizations, made up of over 2200 providers, including 250 PCPs, as well as multiple acute and ambulatory facilities.
- Led negotiations with multiple payors, resulting in total cost of care models in MA, Medicaid, and commercial with 30M in opportunity, including infrastructure revenue on UM/CM delegation which added 3m in revenue to IPA.
- Built from ground floor Risk Adjustment, High Risk Care Management, and Quality infrastructure.
- MA surplus performance of 2.4M, 3.1M, and 3.9M in successive years.
- Drove 8.3% savings rate ($8M) in BPCI A (Bundles) Program, through decrease in SNF LOS, utilization, and lower readmissions rate.
- Top decile quality performance across our owned Medicaid plan, Vivida, resulting in 9M in shared savings.
- Help delivered utilization decrease of 18% in ED and 22% in hospital based surgical case work, over 2 years, in our self-insured plan, overseeing 35K lives.
- Improved star performance in MA arrangement over 18 months, from 3.5 to 4.5 through care gap reporting automation, driving multimillion dollar financial performance across commercial risk contracts.
- Developed physician led governance structure with employed and community physicians driving improved clinical outcomes and high value network performance across multiple plans.
- Grew Direct to Employer model from zero clients to more than 60K covered lives, over six organizations.
- 100-year-old public health system with four adult hospitals and one children's hospital, totaling 1800 beds. Employed physician group of eight hundred plus providers.
System Director of Strategy and Business Development
Ascension Healthcare
Austin, USA
09.2014 - 03.2018
- Build and manage system level strategic planning and business plan development, including facilities and service line planning. Led a team of eight analyst and acute care-based strategy directors.
- Drove over $400M in investments over a 3-year period.
- Developed and executed service line plans which increased market shares across Cardiology, Woman's and Children's Services, Orthopedics, and Oncology, by a 2.5% average per year.
- Built provider business development model, investing an average of $10M annually in acquisitions, resulting in key geographic and provider expansion.
- Developed value-based care strategy and entered MSSP arrangement with CMS, managing over $100M in total spend.
- Supported Seton Health Plan strategic plan development, including introduction of new HMO products in the Austin market.
- A system with eleven acute care facilities, over one thousand employed physicians, managing over five thousand beds and employing 18,000 plus across central Texas.
Director of Clinical Operations
Southern Illinois Medical Group
Carbondale, USA
01.2012 - 09.2014
- Accountable for all operations and physician contract oversite of the medical group, including twenty-five locations made up of PCP's, medical and surgical specialties, and a support staff of over five hundred.
- Led and oversaw the growth of operational revenue from $90M to over $200M over a 2-year period, through growth in specialty procedures.
- Developed new physician compensation model and oversaw all recruitment efforts, to support our strategic plan, resulting in growth of medical group of forty new providers in 1 year.
- Expanded Woman's and Infants program by hiring four new OBGYN's in 2 years, driving up overall birth volumes by 25% in year 1.
- Built Neurology Center of Excellence, adding both cranial and spinal surgeons to help support community need, resulting in Level 2 Trauma designation for Carbondale Memorial.
- Led the purchase of a surgery center to expanded surgical services, leading to $15M in first year revenue and increased market share in E&T, Orthopedics, and General Surgery of 25% in 2 years.
- Oversaw Patient Centered Medical Home certification through NCQA, Level 2, to better position ourselves to drive quality contracts, which resulted in first value-based arrangement.
- A rural healthcare system, made up of three acute care facilities with eight hundred beds in total and an employed medical group of 250 physicians.
Director of Finance
BJC Healthcare/ Washington University Medical School
St. Louis, USA
01.2006 - 01.2012
- Finance lead for various system business lines, including Behavioral Health, Barnes Jewish Acute Care Hospital, and BJC Medical Group. Own P&L performance for all assigned business lines.
- Led all monthly accounting functions, including closing books and developing financial reports for operators, to drive action plans. Provided leadership over both IP and OP services, including acute adult and psychiatric services.
- Achieved average net margin of 6% each year.
- Built Joint Venture with State of Missouri Medicaid and SSM on expansion of psychiatric service in St. Louis, re-opening and operating a 150-bed facility state run facility.
- A non-profit health care organization that includes two nationally recognized academic hospitals which are both affiliated with the Washington University School of Medicine.
Education
Master of Business Administration -
Webster University
St. Louis, MO01-2013
Bachelor of Art - Clinical/Organizational Psychology
DePaul University
Chicago, IL01-1994
Skills
- Full P&L Ownership
- Managed Care Contracting
- Clinical Integration
- Utilization Management
- Population Health Strategy
- Performance metrics Design
- Data Analytics
- Cost Reduction Strategies
- Effective Communication
- Problem Solving
- Payor Negotiations
- Financial Management
- Budget Preparation
- Process Improvements
- Partnership Development
- Public Speaking
- Revenue Generation
- Strategic Leadership
- KPI Development & Tracking
- Operational Excellence
Affiliations
- American College of Healthcare Executives, Fellow
- Member Medical Group Management Association
- National Associates of ACO's
Timeline
Senior Vice President - Regional Lead
Astrana Health
03.2022 - Current
Vice President of Population Health
Integrated Care Solutions
08.2021 - 03.2022
Executive Director, Clinically Integrated Network
Lee Health Inc.
03.2018 - 07.2021
System Director of Strategy and Business Development
Ascension Healthcare
09.2014 - 03.2018
Director of Clinical Operations
Southern Illinois Medical Group
01.2012 - 09.2014
Director of Finance
BJC Healthcare/ Washington University Medical School
01.2006 - 01.2012
Master of Business Administration -
Webster University
Bachelor of Art - Clinical/Organizational Psychology
DePaul University