Tanya Morgan

A market-facing position working with Cigna's sales team supporting our clients and responsible for growth and persistence. Responsible for the performance of Accountable Care Organizations and the market total medical cost. Single point of contact for market and network issues that need to be resolved quickly.

• In collaboration with the Regional Medical Director, we created the first emergency department high-utilizer (EDHU) program in 2018 and was implemented nationally in 2022. Between 2018- 2023, our year-end EDHU beddays stayed between 92/K - 106/K.
• COVID-19 prompted us to implement a national telehealth program. My role included teaching ASOs, sharing telehealth tools, and assisting providers with claims issues. MDLive was acquired by Cigna in 2021, and NorCal socialized the information. A new service, eConsult, has been launched to better support our network PCPs.
• Affordability in NorCal has consistently been the highest performer across the country in 2018. NorCal PMPM savings in 2023 were $1.45 or .25% trend deflection. This exceeded our overall savings target of $1.9M by 230% with a yearly savings of $7.3M. NorCal accounted for 50% of the positive variance to West-Region plan, even though it is the most expensive area in the country.

Responsible for handling post-market clinical complaints in 70 countries. Lead a team of biological science experts to investigate customer concerns. Managed a wide variety of high-profile adverse events, including MDRs, BBB complaints, MedWatch complaints, legal and lawsuit matters.

• Improved efficiency and effectiveness by developing and implementing service standards, operating systems, and procedures. Introducing new processes led to a 20% reduction in productivity across the department.
• > 60% of aging clinical complaint cases were resolved in my initial four months.
• First Technical Inspection Association (TUV) - English, Technical Inspection Association; product safety certification since Cool Sculpting was released in 2009. This was partly due to new standards and processes being implemented, along with the removal of clinical complaints.

Served as the manager of the inpatient and case management departments for CO, Medicare, Medi-Cal, Duals, and SNP populations and was responsible for Quality Management activities.

Developed and modified all departmental policies and procedures, operational processes, and regulatory letters in multiple languages across all key patient care areas. Multilevel liaison with providers, ancillary providers, and regulatory agencies.

• Implemented changes across the entire department's policies, procedures, operational processes, and regulatory letters in multiple languages to comply with federal, state, and local regulations. Worked closely with our aligned FQHC and county hospitals.
• Developed multiple Tableau reports to monitor clinical, financial, and population health risk performance.
• Increased 24 hour arrival notification by >89% and processed in under 4 hours.
• Regulatory requirements for documentation and denial processes were met by > 90% within 6 months.
• Reviewed over 500 CA children's services (CCS) cases to resolve claim backlogs.
• Develop INPT face sheet OCR process in collaboration with hospital, IT, and third party vendor.

Piloted C3 (Coordinated Care Collaboration) RN Program to prepare delegates to succeed in an ACO. Analyzed PM reports based on my own risk trajectory model, as well as standard PM analysis. Maintain relationships with key hospital providers, hospitalists, and ancillary service providers. C3 program expanded throughout the state.

• Solid 1.4 M savings in facility cost in the initial 5-months at the community hospital.
• Reduced ADC by 19% and ALOS by 7% within 5 months at academic center.
• Reentered previous IPA while in ACO and decreased CO BD's from 178 to 141 within 60 days.
• Simplified FACETS documentation process and changed inpatient oversight duties at BSC, saving IPA nurses 3 hours a day.

Transformed INPT department, streamlined roles and responsibilities for clinical staff and non-clinical staff, implemented cost reduction strategies, improved risk stratification methods, streamlined CM/Disease Management referral processes, and enhanced clinical and financial reports to manage clinical operations. Implemented onsite hospitalist rounds at high volume hospitals and gained EMR access across hospital providers.

• Over an 18-month period, integrated a new clinical system across PA, INPT, and CM, enhanced the INPT portion, managed parallel systems, transitioned, and trained the staff.
• Performed MD-level tasks, addressed medical group/IPA concerns, regulatory issues, supported hospitalists and hospitals in Northern California, and handled day-to-day operations in the region.
• Six Health Plan Corrective Action Plans were eliminated within the first year.
• 75% reduction in the frequency of HP audits (quarterly to annual audits)
• Compliance with health plan regulatory letters was achieved within 9 months.