Dr. Hassanpour has had over 20 years of experience in clinical and administrative medicine, including both provider (Physician group / IPA) and payer (Health Plan) sides of the industry. He is experienced in state health programs and in Commercial lines of business. He is presently working on health plan preparations for the State Health Exchange and organizing of delegated medical groups who will serve this line of business. His provider side experience has been with large multispecialty medical groups, Federally Qualified Health Centers (FQHC) and IPAs. He has served on board of directors of both non-profit and for profit health care provider organizations and as the chair person for finance, professional peer review, Quality and Healthcare IT committees. He has served on several professional committees encompassing Clinical quality, Healthcare IT, Marketing and Strategy. He is experienced in strategic planning, developing multiyear strategy and marketing plans for healthcare provider organizations.
Specialties:
Medicare/Medicaid
Commercial MC
HCC/RAF scores
EMRs, Analytics
Management Systems
Medical Policies
Network Development
Care Management
Disease Management
Utilization Management
Quality Management
HEDIS, P4P, NCQA
Credentialing
Peer Review
Board Leadership
Process Innovation
Strategic Planning
Workforce Development
Managed Care Contracting
Provider Contracting
Compliance & Gov. Affairs
Pt. Centered Medical Homes
Federally Qualified Health Centers (FQHC)
State Health Exchange (Covered California)
Chief Medical Officer @ California Health & Wellness, a wholly-owned subsidiary of Centene, has been notified by the California Department of Health Care Services (DHCS) of its intent to award a contract to serve Medicaid beneficiaries in 18 counties, outside of Sacramento, pending regulatory approval.
As CMO I am responsible for directing and coordinating the medical management, quality improvement and credentialing functions for the statewide health plan. Serve as a clinical advisor and educator of the medical management staff, ensuring the clinical quality and efficacy of patient care. Identify trends in patient treatment data and proactively develop programs to address and improve patient health and wellness needs. As an integral part of the health plan’s senior leadership team, I have an active role in supporting the clinical strategic plans and vision of the organization.
Some of my duties are:
Oversee internal medical review guidelines to ensure clinical integrity and compliance and acts as a resource for staff members throughout the operation
Coordinate with other departments, the responses needed to address regulatory accreditation concerns pertaining to management issues
Perform medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services
Facilitate the achievement of the Medical Management Program goals through an effective health services delivery system
Responsible for physician review and oversight of all potential adverse determinations including pre-certifications/prior authorizations, concurrent review and appeals/retrospective
Responsible for HEDIS improvement and strategy
Participate and manage auditing preparation of medical management processes and corrective action team projects for medical management
Participate and advise in the development of corporate medical policies for UM, pharmacy, and new technology From July 2015 to Present (4 months) Sacramento, California AreaMedical Director @ Statewide responsibility over quality of care for members in the healthcare exchange. Responsible for cost of care and quality management of Anthem BlueCross members in a given region of southern California.
Supported the RVP in redesign of the medical management department and medical director responsibility into a management POD/ field medical director responsibility
Represented the medical department in redesign of UM process.
Supported the RVP in design of clinical analytics data sets (medical group profile) From August 2013 to July 2015 (2 years) Woodland HillsChief Medical Officer @ Responsible for leadership and management of the clinical department providing all of the healthcare services delivered to the patients of St. John’s (general medical, prenatal, dental and behavioral health) generating over $22 m in revenue. The care is provided by approx. 30 providers and over 100 staff members. Responsible for clinical quality, access to care and health outcomes. Lead implementation and management of several health services projects - examples include projects designed to test better delivery systems, expand scope of primary care delivery, reduce affects of social determinant of health- supported by grants from multiple donors, universities and government organizations. Lead business development efforts in expanding scope of services, merger and acquisition efforts, provider and payor contracting and new innovative methods of patient care delivery. Lead new contract negotiations and rate setting for new and capitated services. From June 2012 to August 2013 (1 year 3 months) Greater Los Angeles AreaChief Medical Officer @ Physician hospital consortium (PHC) between CHOC Children’s hospital and CHOC Physician Network (managed by Schaller Anderson, a subsidiary of Aetna) with 300 primary care physicians and over 600 specialist and caring for 114000 children and young adults in a dual risk arrangement with Medicaid in California.
Responsible for all medical affairs related to medical management, utilization management, quality management, and case management. Responsible for staff of 35 members with staff budget of $5MM and medical cost management budget of over $65MM.
Led preparation for implementation of a ACO for children with special healthcare needs.
Saved over $27MM annually In medical costs by directing members to appropriate payers.
Reduced hospital bed days by 12 per thousand, an eight percent reduction (approx. $3MM saving)
Chaired Quality Management, Utilization Management, Credentialing, and Peer Review committees.
Reported to Board of Directors monthly.
Designed new HEDIS improvement program to align provider incentives with HEDIS measurement methodology.
Implemented new Medical Management technology including ProFax, and Case Trakker. Implemented major upgrade to QNXT (medical management and claims management system) an upgrade to AboveHealth (internet based PA program). These programs have significantly improved efficiency and accuracy of medical management processes.
Developed and started implementation of project plan to reduce emergency department utilization through improved urgent care center network, outreach calls to members with high utilization, outreach letters to PCP’s whose members have high utilization, improved PCP access, improved after hour availability of PCPs and addition of nurse advice line.
Developed project plan to improve accuracy of IPA membership’s risk score designated by CalOptima (Medicaid Health Plan) through improved encounter data submission and capture. From January 2010 to June 2012 (2 years 6 months) Orange County, CAMember of Board of Directors @ Member of Finance Committee - oversaw budgetary performance, grants funds expenditures, fund raising activities. From November 2009 to July 2010 (9 months) Los Angeles, CARegional Medical Director @ Responsible for region covering much of Los Angeles County and parts of Orange, San Bernardino, Riverside, and San Diego counties, over 200,000 members, and approximately 45 large medical groups and independent practice associations (IPA).
Led regional efforts for involvement of medical groups in California Quality Collaborative (CQC) projects such as: improving patient experience, increasing practice efficiency and adopting healthcare information technology in addition to other projects.
Participated in several committees including: member satisfaction, credentialing, peer review, state health programs quality improvement, delegation oversight, and vendor oversight committees.
Led projects to better manage admissions and length of stays, by collaboration with home infusion vendor. Resulted in increase in out-patient start of infusion therapy and avoidance of unnecessary hospital admission, and decrease in in-patient length of stay.
In collaboration with other internal departments, worked with medical group to increase HCC/RAF scores by improved capturing and reporting of clinical data. Resulted in increase of several percentage points in HCC/RAF scores of these groups.
Communicated and trained medical groups regarding CMS’s 2010 requirements of coordination of care for SNP members. From February 2007 to January 2010 (3 years) Los AngelesMember of the finance committee @ Oversaw grants received and allocations of funds to achieve the missions of the grants. Planned resource allocation, fund raising activities, increasing dues. From February 2009 to October 2009 (9 months) Member of Board of Directors , Chairman of Finance Committee & member of strategy committee @ As a member of board of directors, and by serving on its strategy committe and chairing its finance committee, I help this non-profit organization in achieving its mission of providing speach, hearing, physical therapy and occupational therapy to the underserved residents of Orange County. From March 2008 to September 2009 (1 year 7 months) Associate Medical Director @ Supported Medical Director and Chief Medical Officer with health plan functions and oversight of contracted IPA’s, and hospitals.
Provided medical management for IEHP Direct,which increased membership from 55,000 to 65,000, and over 100 primary care providers,,including UM, CM, and QM, and credentialing activities among others. Worked directly with Network Management to add new providers and ensure adequate specialty coverage. Worked closely with other departments such as Claims, Operations and Marketing in overall management of IEHP-Direct.
Implemented Chronic Care Model throughout organization. Redesigned Care Management activities in attempt to better identify and manage care of members with care management needs. Plan has been implemented and has been very successful.
Worked closely with Quality Management department to implement new processes for IPA oversight and improvement of quality parameter (HEDIS, NCQA, P4P).
Spearheaded start of Breathmobile program in cooperation with local county hospitals and other stakeholders to bring mobile asthma clinic to schools in underserved regions.
Worked closely with Information Technology department and health plan leadership in configuration and implementation of multimillion dollar medical management software. From 2005 to 2007 (2 years) Los AngelesScientific Affairs Liaison @ Developed network of thought leaders to support company’s product and act as advocates of company in educational and promotional settings.
Developed business relations with 25 key thought leaders in the first six months in position.
Delivered over 50 presentations of clinical data, educational material and clinical updates to audiences of five to 150 professionals. From October 2004 to October 2005 (1 year 1 month) San DDirector / Staff Physician @ Member, Board of Directors
Associate Medical Director (part time)
Primary Care Pediatrician
Formed strategic plans and implemented decisions in regards to governance, compensation, strategic planning, marketing and finances.
During two years on this board, the medical group, through increased revenue and better cost management became profitable; physician and patient satisfaction improved and group regained its prominence in the community.
Developed successful and busy practice within the first year in practice.
Assisted group’s Medical Director in day-to-day functions and provided full time coverage in his absence. Worked with executive management team including CEO, COO and directors of multiple departments to develop strategic plans for growth and more efficient operations of medical group and its related entities
Other Committee and Leadership Activates:
Healthcare Guidelines Advisory
Utilization Management
Quality Management
Information Technology (Chair)
Fee For Service Task-force
Compensation
Customer Satisfaction Task Force
Credentialing
Facility Quality Review
Open (Advanced) Access Scheduling From November 1996 to November 2004 (8 years 1 month) MBA @ Developed a comprehensive strategic plan for my medical group. Developed a strategic decision-making tool for opening new clinical sites. Developed an operational plan for call center management. From 2001 to 2003 (2 years) Pediatric resident @ From 1992 to 1995 (3 years)
MBA, Healthcare @ University of California, Irvine - The Paul Merage School of Business From 2001 to 2003 DO, Medicine @ Des Moines University From 1988 to 1992 Farid MBA is skilled in: Managed Care, Medical Management, Utilization Management, Care Management, Quality Management, Health Plans, HMO, Health Insurance, Healthcare, Budgeting, Pharmaceuticals, Medical group management, Strategic Planning, Healthcare IT, Healthcare Management, Healthcare Information..., Healthcare Marketing, Health Policy, Pharmaceutical Industry, Network Development, Budgets, EMR, Hospitals, Medicaid, Physicians, Quality Improvement, Medicine, Credentialing, Clinical Research, Disease Management, Practice Management, NCQA, HEDIS, EHR, PPO, Provider Relations, Healthcare Consulting, Informatics, Medicare, Medical Education, Healthcare Industry, Revenue Cycle, Internal Medicine, Accountable Care, Family Medicine, Public Health, HIPAA, Pediatrics, Board Certified, Case Management
Websites:
http://cahealthwellness.com