Commonwealth of Pennsylvania

Bureau of Fee-for-Service Programs Division of Rate Setting

RFQ Number BFFSP-FY-10

Kevin Quinn – Project Manager

Summary of Qualifications

  • Sixteen years of experience designing, implementing, and operating Medicaid provider payment methods, including three years leading the ACS fiscal agent account for Montana
  • Started, and continue to build, ACS’ nationwide line of business in helping Medicaid agencies improve provider payment methods and implement these methods in claim processing systems. No other company offers clients the continuum of service from assessing policy options to designing methods to systems implementation
  • Played a lead role in the design or analysis of payment methods for inpatient, outpatient, physician, nursing facility, or pharmacy services in D.C., Massachusetts, Mississippi, Montana, North Dakota, Rhode Island, Texas, Washington State, and overseas for the U.S. Agency for International Development
  • Author of articles on Medicaid payment methods published in Health Affairs, Inquiry, Health Care Financing Review, Journal of Ambulatory Care Management, Healthcare Financial Management
  • Other health care analyses published by The Wall Street Journal, the Congressional Budget Office, the Canadian Medical Association Journal, the Commonwealth Fund and the Journal of Emergency Medical Services
  • Health policy experience in the United States Senate, the Congressional Budget Office, and the Saskatchewan Department of Health
  • 20 years’ part-time clinical experience in emergency care, including current work as a paramedic

Professional Experience

ACS Government Healthcare Solutions2004 – Present

Director, Payment Method Development

  • Direct ACS Government Healthcare’s growing nationwide line of business in developing payment methods for Medicaid agencies
  • Project manager for payment method or Medicaid policy projects in the District of Columbia, Mississippi, Montana, North Dakota, Rhode Island, and Texas
  • Frequent presenter on payment methods, value purchasing, and paying for quality
  • Supervise a staff of seven consultants across the U.S.

Emergency Department, St. Peter’s Hospital, Helena, Montana2000 – Present

ParamedicPart-time

  • Serve as paramedic on 911 emergency incidents within City of Helena and Lewis & ClarkCounty. Between calls, provide patient care in Emergency Department
  • Certified in Advanced Cardiac Life Support, Advanced Burn Life Support and Pediatric Education for Prehospital Professionals (course coordinator)
  • Frequent instructor on emergency care topics in Helena and Lewis & ClarkCounty

Montana Medicaid Account, ACS Government Healthcare Solutions2001 – 2004

Executive Account Manager

  • Managed fiscal agent services for the Montana Medicaid and Mental Health Services programs, with a staff of 60 and annual budget up to $8 million
  • Range of services included claims processing, provider relations, call center, MMIS programming, decision support system, payment method consulting, fraud and abuse protection, coordination of benefits recoveries, website management, and technical writing
  • The account received perfect scores on customer satisfaction surveys in 2003 and 2004

ACS Government Healthcare Solutions, Montana Medicaid Account2000 – 2001

Manager, Payment Method Development

  • Advised the Montana Medicaid program on the design and implementation of provider payment methods, especially physician services, dental services, and hospital care

Abt Associates Inc., Washington, DC1994 – 2000

Senior Health Economist

  • Served as Project Director or Senior Health Economist on about 25 projects over 6 years
  • Designed and/or evaluated provider payment methods related to hospital inpatient services, hospital outpatient services, physician services, dental care and nursing facility care for the Montana Medicaid program, the Massachusetts Medicaid program, the Washington State Department of Labor and Industry, and the U.S. Agency for International Development
  • Researched and wrote five studies on health insurance for the Commonwealth Fund, as well as a book-length study on the sources and types of health insurance
  • Member of the team that evaluated the Operation Restore Trust anti-fraud initiative for the Office of Inspector General, U.S. Department of Health and Human Services

Congressional Budget Office, United States Congress, Washington, DC1992 – 1994

Health Economics Analyst

  • Wrote CBO analysis for Congress of the Heritage Foundation and American Enterprise Institute proposals to restructure the health insurance system
  • Built agency-wide interactive database of health reform initiatives undertaken by the states

United States Senate, Washington, DC1992

Legislative Assistant for Health Policy

  • Briefed Senator David Durenberger (Minnesota) and advanced his legislative agenda on health issues, especially Medicaid managed care, health care reform, mammography standards, and mental health coverage

Saskatchewan Department of Health, Regina, Saskatchewan, Canada1989 – 1991

Director, Economics and Evaluation

  • Led a staff of five, performed studies of health care utilization, and developed proposal to use capitation funding within single-payer system
  • Represented Saskatchewan on National Health Information Council

Saskatchewan Department of Energy and Mines, Regina, Saskatchewan, Canada1985 – 1991

Policy Analyst

  • Evaluated data on potash fertilizer demand and supply; Saskatchewan’s private-sector potash fertilizer industry is the world’s second-largest supplier
  • Organized and participated in market development missions to China, India, Brazil, Indonesia, Sri Lanka, and Malaysia

University of Regina, Regina, Saskatchewan, Canada1985 – 1991

Sessional Lecturer, Department of EconomicsPart-time

  • Taught 10 courses, including industrial organization and the introductory and intermediate levels of microeconomics and macroeconomics

The Wall Street Journal, Toronto Bureau1981 – 1985

Staff Reporter

  • Wrote major articles on such diverse topics as healthcare, the modern prospector, forest fires, the farm machinery industry, labor unions, hockey, and politics

Selected Presentations

  • “Payment Methodologies” and “The World of Claims, Codes and Payments,” both tutorials for Medicaid managers sponsored by the New England States Consortium Systems Organization and available at
  • At the national Medicaid Management Information Systems (MMIS) conference:

–“After the Revolution: DRGs at Age 25” – Nashville, TN, 2008

–“The Challenge of Value Purchasing in Medicaid” – San Diego, CA, 2007.

–“New Directions in Medicaid Payment for Inpatient Care” – San Diego, CA, 2007.

–“Paying for Quality: What Strategies? What Systems?” – Big Sky, MT, 2005.

–“Dividing a Trillion-Dollar Pie: Payment Methods, Cost Containment and Value Purchasing,” – Oklahoma City, OK, 2004.

  • “How Much is Enough? A Framework for Setting Medicaid Payment Levels,” National Association of State Medicaid Directors, Washington, DC, 2004.
  • “Lessons from Ambulatory Patient Groups,” St. Anthony’s Ambulatory Payment Classification Conference, Crystal City, VA, 2000.
  • “What Outpatient PPS Means for You and What to Look Out For,” Outpatient PPS and Ambulatory Payment Classifications Conference, San Francisco, CA, 1998.
  • “How Outpatient Prospective Payment Affects Observation Units,” Observation Units for the Emergency Department Conference, Lake Buena Vista, FL, 1998.
  • Also dozens of project-related and business development presentations to Medicaid agencies, provider staffs or other audiences in California, Colorado, D.C., Florida, Massachusetts, Mississippi, Missouri, Montana, New Hampshire, New Mexico, North Dakota, Rhode Island, South Dakota, Utah, Washington, and Texas

Selected Publications

Sole Author

  • “Achieving Cost Control, Care Coordination, and Quality Improvement in the Medicaid Program,” Journal of Ambulatory Care Management, January-March 2010
  • “New Directions in Medicaid Payment for Hospital Care,” Health Affairs, January/February 2008
  • “The Ins and Outs of Patient Meds,” Journal of Emergency Medical Services, April 2008
  • “How Much Is Enough? An Evidence-Based Framework for Setting Medicaid Payment Rates,” Inquiry, Fall 2007
  • “Dividing a Trillion-Dollar Pie: What’s Next for Healthcare Payment,” Healthcare Financial Management, April 2004
  • “Working without Benefits: The Health Insurance Crisis Confronting Hispanic Americans,” The Commonwealth Fund, 2000
  • “The Sources and Types of Health Insurance: Comprehensive Population Counts for 1985 to 1993,” Abt Associates Inc., 1998
  • “A Qualitative Analysis of the Heritage Foundation and Pauly Group Proposals to Restructure the Health Insurance System,” U.S. Congressional Budget Office, 1994
  • “Deficits Plague Canada’s Health-Care System,” The Wall Street Journal (editorial page), December 16, 1982

In Collaboration

  • “Medicaid’s Role in the Many Markets for Health Care,” Health Care Financing Review, Summer 2008 (with M. Kitchener)
  • “On Their Own: Young Adults Living without Health Insurance,” New York: The Commonwealth Fund, 2000 (with C. Schoen and L. Buatti)
  • “Hospital Payment Policies and Reforms: Issues and Options in Russia,” Journal of Health Administration Education, Spring 1996 (with J.C. Langenbrunner, A. Wouters, and T. Makarova)
  • “A Population-Wide Profile of Prescription Drug Use in Saskatchewan, 1989,” Canadian Medical Association Journal, June 15, 1992 (with M. Baker and B. Evans)
  • Also, approximately 50 project reports on provider payment methods delivered to Montana Medicaid, Mississippi Medicaid, D.C. Medicaid, Massachusetts Medicaid, Virginia Medicaid, Rhode Island Medicaid, Washington State Department of Labor and Industry, Office of Inspector General in the U.S. Department of Health and Human Services, and the U.S. Agency for International Development

Education

Master of Arts, Economics, University of California, Los Angeles, California, 1979 – 1981

  • Recipient of the Mackenzie King Scholarship and various UCLA grants

Bachelor of Arts, Economics and Political Science, Concordia University, Montreal, Quebec, Canada, 1974 – 1978

  • Salutatorian of the Arts & Science Class of ’78; recipient of the top award for extracurricular achievement at commencement; editor of the student newspaper; member of University Senate; vice president of the students’ association

Darrell Bullocks – Deputy Project Manager

Summary of Qualifications

  • 10 years of management experience
  • 10 years of strategic and tactical planning experience
  • 10 years of administrating employee disciplinary action including terminations
  • 10 years of making oral presentations and providing meeting facilitation
  • 7 years of technical analysis in the area of management information systems
  • 6 years of operational analysis in a large scale organization
  • 6 years of interviewing potential candidates for employment
  • 2 years of experience managing and analyzing large claim datasets for inpatient and outpatient hospital services
  • 2 years of experience using 3M Core Grouping Software specializing in inpatient AP and APR-DRG Grouping

Professional Experience

ACS State Healthcare, LLC1/2008 – Present

Senior Consultant, Payment Method Development

  • Provide analytical support to Medicaid programs around the country on the topics of payment method development for inpatient and outpatient hospital services
  • Responsible for gathering, analyzing and processing large inpatient claim data sets through the 3M Core Grouping Software, AP and APR Grouping
  • Successfully grouped inpatient data sets for Medicaid programs to include: Montana, District of Columbia and Mississippi Medicaid
  • Created and analyzed datasets consisting of claim volumes between 65,000 and 400,000 lines of data utilizing Microsoft Excel and Access
  • Develop test plans for AP and APR-DRG System Design Development and Projects for District of Columbia and Mississippi Medicaid programs
  • Execute test plans for AP and APR-DRG pricing methodology system implementations for Montana, Mississippi, and District of Columbia Medicaid Programs

ACS State Healthcare, LLC5/2006 – 12/2007

Business Analyst

  • Lead Business Analyst in $700 million Inpatient/Outpatient Prospective Payment Method System Design project for Mississippi Medicaid
  • Contributed analytical and logistical support to pre-implementation activities related to APR-DRG pricing methodology for Inpatient Hospital Services for the Mississippi Division of Medicaid
  • Developed queries using a Decision Support System (DSS) to gather and analyze historical claims data
  • Developed flowcharts that depict claim adjudication processes
  • Developed project charter, communications, staffing management, and stakeholder documents for Joint Application Design sessions

ACS State Healthcare; Mississippi Medicaid, Ridgeland, Mississippi7/2002 – 4/2006

Operations Manager; Quality Assurance

  • Oversaw Quality Management Department directing the workflows of nursing, training, and operational personnel
  • Developed and/or improved procedures utilized to measure and monitor contractual performance
  • Developed and provided feedback to departmental directors of various functional areas which detailed the results of actual performance measured against contractual requirements
  • Compiled, analyzed, and graphically illustrated data related to organizational performance and disseminated findings to Senior Management on a monthly basis
  • Researched and analyzed historical data and compiled performance statistics to graphically illustrate findings to upper management utilizing various software programs
  • Researched complex Medicaid Medical Review claims processing issues and makes recommendations to resolve issues
  • Monitored the implementation of corporate and local training initiatives to ensure that objectives were met

ACS State Healthcare; Mississippi Medicaid, Ridgeland, Mississippi9/2001 – 6/2002

Operations Manager; Claims

  • Oversaw Claims Processing Department’s functional areas comprised of 50 employees. Functional areas include: Claim Support (Resolutions and Adjustments), Claims Processing (Data Entry and Mailroom)
  • Researched and identified anomalies within claims processing operations and worked with the appropriate organizational department to resolve those issues
  • Ensured that changes to operational procedures were documented appropriately, incorporated into operational procedure manuals and communicated to the affected work groups

ACS State Healthcare; Mississippi Medicaid, Ridgeland, Mississippi6/2001 – 8/2001

Operations Manager; Provider Services

  • Interviewed potential candidates for start up of Mississippi Medicaid Fiscal Agent Account
  • Researched, developed, and documented procedures to be utilized by Mississippi Medicaid Provider and Beneficiary Call Center Associates in the resolution of provider and beneficiary telephone requests for information

Mississippi State Department of Mental Health, Whitfield Mississippi11/1999 – 5/2001

Hospital Administrator

  • Promoted three times in first five years of employment at Mississippi State Hospital
  • Co-directed after-hours functional operations of a 400 bed facility
  • Provided leadership to a diverse range employees and subordinates
  • Created numerous professional correspondence(employee satisfaction surveys, memos, reports, and letters) to address a wide scope of organizational issues
  • Analyzed operations to find and correct deficiencies and improve value add to clients and stakeholders
  • Co-directed preparation activities for multiple successful Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) surveys

Mississippi State Department of Mental Health, Whitfield Mississippi10/1997 – 10/1999

Unit Manager

  • Provided leadership to a diverse range of employees and subordinates
  • Created databases utilizing Microsoft Access to track inventory valued at $180,000
  • Created spreadsheets to track employee time and attendance balances
  • Created numerous professional correspondence (employee satisfaction surveys, memos, reports, and letters} to address a wide scope of departmental issues

Mississippi State Department of Mental Health, Whitfield Mississippi7/1995 – 9/1997

Unit Supervisor

  • Provided leadership to a diverse range of employees and subordinates
  • Recommended employee disciplinary action for rule infractions
  • Created spreadsheets to track employee time and attendance balances
  • Supervised delivery of direct patient care during assigned eight hour shift

Education

Master of Science, Business Administration, Belhaven University,Jackson, Mississippi, August 1999

Bachelor of Science, Finance, Jackson State University, Jackson, Mississippi, May 1994

Hardware/Software Experience

  • 10 years of Microsoft Word, Excel, PowerPoint and Access
  • 7 years of Medicaid Management Information System (MIS) utilization and analysis
  • 2 years of 3M Core Grouping Software Utilization experience with AP and APR–DRG

Connie Courts – Cost ReportsAdvisor

Summary of Qualifications

  • Thirteen years of experience analyzing financial and clinical health information with a focus on managed care and Medicaid payment modeling, including ten years in the hospital finance arena
  • Played a key role in the design or analysis of payment methods for inpatient, outpatient, physician, or nursing facility services in D.C., Rhode Island, and New Hampshire
  • Served as project leader of cost accounting decision support system implementations at two HCA hospitals and later directed the corporate Decision Support function of a multi-entity healthcare system in Kentucky
  • During hospital finance tenure, negotiated managed care contracts and established a successful payment variance program
  • Certified Healthcare Finance Professional (CHFP) since 2004
  • Registered Health Information Administrator (RHIA) since 1997

Professional Experience

ACS Government Healthcare Solutions2007 – Present

Senior Consultant, Payment Method Development

  • Served as key analyst for inpatient and outpatient payment methods in Rhode Island, which included detailed cost estimation project
  • Provided support for design and analysis of nursing facility payment method in Rhode Island
  • Leads annual update projects for physician and DME fee schedules for Washington, D.C.
  • Analyst for new outpatient payment method project in New Hampshire

Appalachian Regional Healthcare, Lexington, Kentucky2002 – 2007

Director of Decision Support

  • Managed Decision Support function for multi-entity healthcare system (nine hospitals, eight employees)
  • Initiated Payment Compliance Program (three auditors). Cash recoveries from February 2004 to June 2007 were over $7 million
  • Led implementation of detailed cost accounting project
  • Directed managed care function including negotiations and building payment models, including KY Medicaid, WV Medicaid and commercial payers

Central Baptist Hospital, Lexington, Kentucky1999 – 2002

Decision Support Analyst

  • Provided ongoing data analysis regarding clinical outcomes, cost analysis, and resource utilization for various clinical committees: Stroke Team, Total Joint Replacement Team, and Diabetes Team
  • Responsible for building and maintaining payer contract models, including Medicaid and commercial payers
  • Modeled and evaluated all payer contract proposals during contract negotiations
  • Provided cost and profitability analyses on feasibility of new projects and proposals

Appalachian Regional Healthcare, Lexington, Kentucky1998 – 1999

Decision Support Coordinator

  • Interfaced with system users, dept. managers, clinicians, and administration to determine information needs
  • Analyzed and recommended equipment, software, and long-range information systems plans relative to Decision Support

Frankfort Regional Hospital, Frankfort, KY and Good Samaritan Hospital, Lexington, Kentucky1997 – 1998

Decision Support Systems Analyst

  • Served as on-site project leader for implementation of cost accounting systems at both above facilities
  • Built payment models for Medicare, Medicaid, and commercial payers
  • Developed hospital costs at a billing procedure level detail

Education