Scott Wheeler
Rochester
Summary
National CAHPS & HOS leader with 10+ years of experience driving Medicare Stars performance across delegated provider groups and health plans. Hired by PwC as the firm’s national CAHPS & HOS expert, leading survey operations, provider accountability frameworks, predictive modeling, and multi-market Stars execution. Proven track record directing internal teams and external clients to deliver 1–2 Star improvements, secure $18.5M in new Stars program investments, and ensure survey readiness and CMS compliance across diverse markets. Deep expertise in end-to-end CAHPS/HOS administration, proxy surveys, risk segmentation, provider incentives and performance management frameworks, and fostering cross-functional partnerships to align operations to 5-Star goals. Recognized for translating strategy into scalable action plans that elevate experience, engagement, and performance.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Stars & Member Experience Leader (CAHPS & HOS)
PwC
01.2024 - Current
- Hired as PwC’s national CAHPS & HOS subject matter expert to lead Stars transformation strategies for national payers and delegated provider groups.
- Directed internal delivery teams and advised executive clients on CAHPS/HOS readiness, provider performance enablement, and Stars-aligned engagement strategy.
- Led CAHPS & HOS workstreams as part of Stars Command Center engagements, delivering 1.0 and 0.5 overall Star improvements across two contracts by overseeing 60+ initiatives and managing a team of 4 PwC consultants.
- Developed and implemented CAHPS/HOS provider performance playbooks adopted by national and regional plans to drive survey readiness, operational accountability, and frontline execution aligned to 5-Star goals.
- Designed and delivered proxy survey protocols, targeting models, and member risk segmentation strategies to optimize survey outreach and campaign prioritization.
- Partnered with national Chief Quality Officer to conduct a Stars capability maturity assessment, develop a multi-year strategy, and secure $18.5M in new Stars program investments through a Board-facing business case.
- Advised provider groups and health plans on integrating CAHPS and HOS survey operations, CMS compliance, value-based incentive structures, and care coordination workflows.
- Created and facilitated CAHPS & HOS trainings through PwC’s Quality Community of Practice, enabling 50+ consultants and delivery leads to support Stars client engagements with confidence and consistency.
- Played a key role in building PwC’s internal Stars delivery toolkit and go-to-market CAHPS/HOS strategy content used across pursuit and delivery teams.
Director, Customer Experience (CAHPS & HOS)
Honest Medical Group
10.2022 - 12.2023
- Led enterprise CAHPS, HOS, and experience strategy across a rapidly expanding full-risk delegated provider model to ensure Stars performance accountability and survey readiness.
- Managed a team of 3 Quality Transformation Leads.
- Oversaw CAHPS & HOS strategy across 5 ACOs, contracting with CMS-approved vendors and achieving 100% compliance and $200K in cost savings.
- Designed provider performance playbooks and governance dashboards, aligning survey execution with Stars incentives and accountability frameworks.
- Developed and deployed pre-survey priming, disruption mitigation, and service recovery strategies in collaboration with clinical and care teams.
- Delivered Stars-aligned CAHPS training curriculum, achieving 82% provider completion and enabling Year 1 market readiness.
- Contributed to 4.3-Star average performance across ACOs during multi-market expansion.
Associate Director, Member Experience (CAHPS & HOS)
Oscar Health
09.2020 - 10.2022
- Directed survey strategy, predictive analytics, and member engagement programs across 23 contracts, supporting Stars and QHP performance.
- Led a team of 4 (2 Quality Specialists, 2 Analysts).
- Administered CAHPS and QHP surveys in 17 states, achieving 100% compliance and driving $85K in operational efficiencies.
- Partnered with DecisionPoint to implement CAHPS & HOS predictive modeling, surfacing risk-based scripting to front-line staff.
- Developed and operationalized Oscar’s first CAHPS proxy survey solution, achieving a 32% response rate and enabling Stars inclusion in VBC programs.
- Led engagement campaigns that improved CAHPS response rates by 15%, reduced CTM volume 18%, and boosted retention by 12%.
- Delivered Stars and experience analytics platforms to provider partners via +Oscar tools.
Stars Experience Manager (CAHPS & HOS)
Excellus BlueCross BlueShield
01.2018 - 01.2020
- Achieved 1–2 Star improvements across multiple CAHPS and HOS measures through strategic redesign.
- Built a real-time BI dashboard and risk score model enabling targeted outreach and pre-survey campaign design.
- Designed homegrown proxy CAHPS solution and presented results at the BCBSA National Summit.
Healthcare Improvement Administrator
Excellus BlueCross BlueShield
01.2016 - 01.2018
- Supported enterprise-wide performance projects including HEDIS and survey-based quality initiatives.
- Managed a team of 3 administrators, facilitating cross-departmental collaboration.
Medicare Retention Specialist | Customer Care Advocate
Excellus BlueCross BlueShield
01.2014 - 01.2016
- Developed foundational expertise in Medicare Stars, member retention, and experience operations.
Education
MBA - Health Systems Management
St. John Fisher College
Rochester, NY12-2015
Bachelor of Science - Health Care Administration
Ithaca College
Ithaca, NY05-2014
Skills
- CAHPS and HOS strategy
- Proxy survey and risk modeling
- Provider enablement and playbooks
- Survey compliance and CMS readiness
- Value-based incentives
- Stars performance execution
- Member engagement and targeting
- Experience analytics
- Cross-functional team leadership
Certification
Certified Human-Centered Design Practitioner, LUMA Institute
References
References available upon request.
Timeline
Stars & Member Experience Leader (CAHPS & HOS)
PwC
01.2024 - Current
Director, Customer Experience (CAHPS & HOS)
Honest Medical Group
10.2022 - 12.2023
Associate Director, Member Experience (CAHPS & HOS)
Oscar Health
09.2020 - 10.2022
Stars Experience Manager (CAHPS & HOS)
Excellus BlueCross BlueShield
01.2018 - 01.2020
Healthcare Improvement Administrator
Excellus BlueCross BlueShield
01.2016 - 01.2018
Medicare Retention Specialist | Customer Care Advocate
Excellus BlueCross BlueShield
01.2014 - 01.2016
MBA - Health Systems Management
St. John Fisher College
Bachelor of Science - Health Care Administration
Ithaca College
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