Starlette Johnson

Scope

800K+ Members | $60M Budget | 60 Staff | 7K Provider Groups | 2K Incentivized Providers | 8 Vendors

• Served as the organization's source of truth for quality performance information and advised executive leadership regarding provider engagement, investments, enterprise transformation initiatives, and network management decisions.
• Directed the Quality Assessment and Performance Improvement governance framework and presented quarterly updates to the Board Quality Assurance Committee.
• Redesigned executive reporting materials to emphasize strategic priorities, risks, and decision points, significantly improving Board engagement.
• Partnered with the CEO, CFO, COO, and CMO to design provider pay-for-performance methodologies influencing reimbursement, service level agreements, provider attribution, contracting decisions, and network participation.
• Implemented incentive programs representing between $5M and $10M annually, supporting more than 2,000 eligible provider organizations.
• Managed approximately $60M annually and reduced expenditures by 10% by challenging long-standing investments, eliminating low-value forecasting programs, and redesigning around vacant positions rather than workforce reductions.
• Improved Medicare Star Ratings from 3.0 to 3.5, increasing rebate opportunities and supporting Medicare product growth.

• Designed and implemented MetroPlus' first centralized quality analytics repository, replacing fragmented annual reporting with transparent monthly reporting aligned to CMS, NCQA, and NYSDOH methodologies.
• Evaluated commercial aggregators, RHIO organizations, and provider electronic connectivity solutions based on anticipated capture rates and projected return on investment.
• Recommended prioritizing RHIO integration despite resistance from executives and Board members who favored competing approaches.
• Led contracting, testing, implementation, and cross-functional coordination for a cloud-based RHIO exchange capability that generated improvements across more than 30 quality measures.
• Produced gains exceeding 30 percentage points within select populations and secured Board approval for expansion funding prior to formal business case submission.
• Created and led an 18-person Quality Coordinator team, with each coordinator supporting approximately 20 provider groups and practices.
• Developed provider scorecards and consultative engagement strategies that increased provider willingness to electronically share clinical information.

• Designed and implemented a clinician-facing navigation platform supporting outreach to members with unresolved care gaps.
• Modernized a paper-based medical record review operation supporting retrieval of more than 100,000 charts annually by designing an automated workflow that increased transparency, retrieval rates, and quality performance.
• Supported Shared Savings initiatives through provider performance reporting and analytics.
• Utilized SQL, SAS, encounter data, and reusable code libraries to streamline reporting and train analysts.

• Conducted forecasting, statistical analyses, budget evaluations, and policy assessments to inform and support strategic operational planning.
• Presented analytical findings and recommendations to Commissioners and senior leadership, facilitating informed decision-making.
• Developed analytical and reporting solutions with SQL, Crystal Reports, SSRS, Cognos, Business Objects, Microsoft Access, and VBA to enhance data-driven decision-making.