Vicki Loner
Hinesburg,VT
Summary
A proven Executive Leader, Registered Nurse, and Certified Health Care Administrator with a unique combination of clinical, quality, financial, analytics, public policy, and insurer and provider health care expertise.
Overview
31
31
years of professional experience
1
1
Certification
Work History
Principal
Health Management Associates (HMA)
Boston, Massachusetts
01.2023 - Current
- Provide strategic planning, advice and programmatic support for States, health plans, health care providers, and foundations
- Lead efforts to support MassHealth in evaluating value-based care strategies for their long-term care program
- Co-lead efforts to support the Northern New York in Social Care Network strategy
- Advise major insurance carriers with RFP responses pertaining to population health and value-based care programs
- Provide strategic planning support to FQHCs on ACO programs and enhancements, including corrective action plans
- Lead efforts to help FQHCs and long-term care entities in starting up their own ACOs
- Lead efforts to help ACOs win MCO contracts in their state
- Develop educational webinars and strategic roadmaps for associations and states relating to value-based care.
Senior Vice President and Chief Executive Officer
OneCare Vermont and University of Vermont Health Network (UVMHN)
Colchester, Vermont
01.2019 - 01.2023
- Drive direction and value of the ACO across key stakeholders and partners to achieve the vision of a statewide accountable care organization
- Lead diverse, high performing team supporting all aspects of Value Based Care contracts for Managed Medicaid, Medicare, and commercials programs, supporting over 280,000 Vermonters
- Develop and manage annual budget of $48 million, with total cost of care accountability of $1.4 billion in Medicare, Medicaid and Commercial insurance risk based ACO payer programs
- Lead statewide provider network and contracting for over 5,000 providers, in value-based care programs
- Successful expansion of >300% since 2017 by negotiating favorable State and Federal payer contracts
- Led efforts to receive federal recognition as a 501c3 organization
- Led organization through strategic planning process to stabilize, evolve and guide the organization through the next 5 years
- Led organization through sole parent membership governance change, from UVMMC and Dartmouth as joint members to University of Vermont Health Network as sole member to ensure sustainability and scalability.
Vice President and Chief Operating Officer
OneCare Vermont and University of Vermont Health Network (UVMHN)
Colchester, Vermont
01.2016 - 01.2019
- Set organization’s strategy and led executive-level stakeholder communication
- Functions led include Clinical Operations and Quality Improvement, Informatics/Analytics, Network Management, Project Management, General Operations, Commercial and Governmental Programs Strategy, and Public Policy and Communications
- Led the efforts to respond to the RFP for the initial ACO risk program, organizing the readiness review for Medicaid consisting of 300+ requirements
- Lead all State and Federal funded reform contracts and initial contracts with commercial and self-funded insurers
- Lead negotiator for Medicaid securing $10 million in funding to support care coordination, HIT, and prevention
- Lead efforts to obtain and maintain ACO certification required to operate in the state by Vermont Rule 5.000
- Lead efforts to provide statewide network education, including the development of a tailored approach to address the unique needs of the communities
- Lead all legislative efforts including providing regular testimony to the VT state legislature and GMCB on ACO reform efforts
- Led efforts to grow network participation from 4 to 10 communities in Year 2 and from 10 to 13 communities in Year 3
- Led legislative efforts to preserve Medicaid funding of $4M.
Vice President, Clinical and Network Operations
OneCare Vermont and University of Vermont Health Network (UVMHN)
Colchester, Vermont
01.2015 - 01.2016
- Strategic oversight and development of the clinical model and initial population-based health care reforms in VT
- Led development and approval of the ACO population health model supporting people in health and sickness
- Led the development and implementation of statewide regional clinical committees: developed a standardized charter and secured funding to support the ongoing work of the groups and the ACO
- Secured multi-year SIM grants in health information connectivity and integrated care coordination grant; Multi-year Robert Wood Johnson Grant for care coordination; and Center for Medicare and Medicaid innovation grant.
Director, ACO Care Coordination and Quality
OneCare Vermont and University of Vermont Health Network (UVMHN)
Colchester, Vermont
01.2013 - 01.2015
- Strategic oversight of accountable care clinical and quality reform efforts on a statewide basis
- Developed clinical, quality, and care coordination program specifications necessary for expansion to Medicaid and Commercial ACO shared savings programs
- Developed the care model manual, readiness assessments for all new communities, statewide trainings for care coordination, and quality improvement expectations
- Led-multi-departmental team in the transition from a physician hospital organization to an accountable care organization; required closing out all payer regulatory requirements that were delegated to the PHO, i.e
- Transition people who were in case management, transferring all member and provider services, transitioning all utilization review requirements, network notification, and contract management.
Deputy Commissioner, Health Services and Managed Care Division
Department of Vermont Health Access
Williston, Vermont
01.2008 - 01.2013
- Oversight of all Health Services and Medicaid Managed Care functions, including care coordination; clinical, managed care, and pharmacy benefit management; finance; program integrity; quality improvement; and member and provider services
- Accountable for a staff of >100 staff and~ $1B budget
- Led development and execution of the statewide Hub and Spoke transformation; identified funding sources, built straw model, secured funding; results included near-complete elimination of waiting lists
- Achieved and maintained high levels of Federal regulatory compliance (>90%) as the Medicaid Managed Care Organization
- Provided regular testimony to the VT state legislature on health services and managed care programs and the budget
- Led effort to secure a five year CHIPRA quality demonstration grant in partnership with ME, which was instrumental in expanding VT’s nationally recognized Blueprint for Health into the pediatric population
- Integrated the Medicaid care coordination and disease management initiatives into a single public-private partnership, recognized as outstanding program by Vermont Governor
- Led negotiation efforts with outside care coordination vendor to secure a contract that guaranteed a $5M ROI
- Led multi-departmental team in developing a coordinated approach to address high risk pregnancies.
Manager, Utilization Management
MVP Health Care
Williston, Vermont
01.2001 - 01.2008
- Oversight of Care Management, Member Services and Quality staff and programs in VT and NH
- Developed and managed the Care Coordination Programs (Care Advocacy) for VT and NH, covering 45K commercial and managed Medicare lives
- Successfully achieved and maintained state regulatory compliance and National Committee for Quality Assurance (NCQA) excellence accreditation
- Led oversight and audit efforts for Case Management programs for Physician Hospital Organizations
- Performed claims review for overutilization and medical necessity.
Senior Case Manager
Central Vermont PHO
Barre, Vermont
01.2000 - 01.2001
- Develop and implement all care management, utilization, and credentialing programs for the Physician Hospital Organization
- Developed and implemented the PHOs Care Management and Credentialing programs
- Secured delegation contracts with major health care insurers- MVP and BCBSVT.
Senior Health Resource Coordinator
BCBS – The Vermont Health Plan
Williston, Vermont
01.1998 - 01.2000
- Develop all policies and procedures, hired, and trained all new clinical staff (6 in total), and implemented the original care model
- Oversaw career development and evaluation for Registered Nurse Health Care Coordinators and the non-clinical health care staff
- Developed the statewide audit toll and provided oversight and evaluation of utilization management and credentialing functions for five Physician Hospital Organizations in VT and NH.
Utilization Review/ Case Management Nurse
MVP Health Care
Plattsburgh, New York
01.1997 - 01.1998
- Primary nurse case management for 30K members
- Developed, in collaboration with hospitals, onsite utilization and discharge planning processes for NY
- Led home care and care coordination programs in upstate NY and VT.
RN, Occupational Health
Comprehensive Rehabilitation Associates
Albany, New York
01.1994 - 01.1997
- Clinical Nursing Experience
Education
Master of Health Care Delivery Science -
Dartmouth College
Hanover, NHBachelor of Science, Health Care Administration and Nursing -
Rochester Institute of Technology
Rochester, NYAssociate of Applied Science, RN Nursing Program -
Clinton Community College
Plattsburgh, NYSkills
- Organizational Leadership
- Operational Excellence
- Sustainable business models
- Change Management
- Process Improvement
- Stakeholder Management
- Regulatory Compliance
- Revenue Growth
- Negotiation Tactics
- Leadership and People Development
- Interpersonal Communication
- Process Improvements
Certification
- Professional, Academy for Healthcare Management (PAHM) - Academy Health Insurance Plan - 2008
- Management Professional (MP) - MVP - 2007
- Health Systems Administration - Rochester Institute of Technology - 2001
- Certification in Professional Utilization Review (CPUR) - McKesson - 2001
- Certification in Managed Care Nursing (CMCN) - American Association of Managed Care Nurses - 2000
- Certification in Case Management (CCM) - Commission for Case Manager Certification - 1999
- Certified Case Manager - New England Health Care Assembly - 1998
- Licensed Hiking and Outdoor Guide - New York State - 1996
- Registered Nurse - Vermont - 1998
Accomplishments
- Leader of ACO and population health programs for public and commercial payers for over 5,000 health care providers, fourteen hospitals and 160 organizations.
- Leader of the innovative Integrated Medication Assisted Treatment (IMAT) Hub and Spoke initiative for the State of VT.
- Leader of the Vermont Medicaid’s Managed Care Organization, elevating it to receive high federal quality standards.
- Leader of legislative and governmental education and testimony at State and Federal level on Value Based Care.
Boards
- RIT Center for Health Science and Technology National Council - 2024-Present
- Vermont Information Technology Leaders - 2019 – 2020
- Vermont Center on Behavior and Health Advisory Committee - 2014 – Present
- Leadership Champlain - 2014 – 2020
- Case Management Body of Knowledge Editorial Board - 2014 – 2018
Presentations
- NAACOs briefing to Congress, Washington DC, Value Based Care Act - July 2021
- Dartmouth Symposium, Leadership in a Time of Crisis - May 2021
- NAACOs Capitol Hill Briefing, Washington DC, Accountable Care - Oct. 2019, 2020
- Leadership Champlain Health Care Day, Burlington VT, Health Care Reforms in Vermont - Mar 2019, 2020, 2021
- On the Waterfront with Melinda Moulton, Putting the Health in Health Care. Live interview - Jan 2019
- Centers for Health Care Strategies, Accountable Care Collaborative. Keynote on VT’s Bold Experiment - Nov 2018
- What Matters this week (22 and 44) with Lauren Maloney, Rise VT and OneCare Partnership, Live TV interview - Oct 2018
- World Health Congress, Washington DC, Innovations in Medicaid Value Based Care - Apr 2018
- UVM Health System Science Learning Session, Burlington VT, Population Health, and Triple Aim - Mar 2018
- Robert Wood Johnson Foundations, New Jersey, Speaker on Vermont’s Community Care Coordination Program - Oct 2017
- Transforming Primary Care, Essex VT, Vermont’s Health Care Reform Experience - Sept 2016
Timeline
Principal
Health Management Associates (HMA)
01.2023 - Current
Senior Vice President and Chief Executive Officer
OneCare Vermont and University of Vermont Health Network (UVMHN)
01.2019 - 01.2023
Vice President and Chief Operating Officer
OneCare Vermont and University of Vermont Health Network (UVMHN)
01.2016 - 01.2019
Vice President, Clinical and Network Operations
OneCare Vermont and University of Vermont Health Network (UVMHN)
01.2015 - 01.2016
Director, ACO Care Coordination and Quality
OneCare Vermont and University of Vermont Health Network (UVMHN)
01.2013 - 01.2015
Deputy Commissioner, Health Services and Managed Care Division
Department of Vermont Health Access
01.2008 - 01.2013
Manager, Utilization Management
MVP Health Care
01.2001 - 01.2008
Senior Case Manager
Central Vermont PHO
01.2000 - 01.2001
Senior Health Resource Coordinator
BCBS – The Vermont Health Plan
01.1998 - 01.2000
Utilization Review/ Case Management Nurse
MVP Health Care
01.1997 - 01.1998
RN, Occupational Health
Comprehensive Rehabilitation Associates
01.1994 - 01.1997
- Professional, Academy for Healthcare Management (PAHM) - Academy Health Insurance Plan - 2008
- Management Professional (MP) - MVP - 2007
- Health Systems Administration - Rochester Institute of Technology - 2001
- Certification in Professional Utilization Review (CPUR) - McKesson - 2001
- Certification in Managed Care Nursing (CMCN) - American Association of Managed Care Nurses - 2000
- Certification in Case Management (CCM) - Commission for Case Manager Certification - 1999
- Certified Case Manager - New England Health Care Assembly - 1998
- Licensed Hiking and Outdoor Guide - New York State - 1996
- Registered Nurse - Vermont - 1998
Master of Health Care Delivery Science -
Dartmouth College
Bachelor of Science, Health Care Administration and Nursing -
Rochester Institute of Technology
Associate of Applied Science, RN Nursing Program -
Clinton Community College
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