About - MedVision Advisory Group
The MedVision Advisory Group (MAG) is formed to provide key guidance and direction within the continued evolution of the healthcare landscape today. As it relates to technology-based solutions and services associated with process and workflow improvement, MAG's visionaries assist our firm with strategic insight. Comprised of seasoned professionals in healthcare operations and business execution, each one assists to tactfully bridge needs requirements across the patient / member and provider / payer continuum. With forward uncertainty in regulatory change looming and its effect on healthcare delivery models, MAG will remain a key conduit in the transformational needs of the clients we serve, the products we deliver and the services we provide.
We introduce the 2017 MedVision Advisory Group:
Dr. Jose Pelayo is a hard charging, entrepreneurial executive with a solid history of creating business models, organizational structures, and strategic plans in the health care marketplace. His career trajectory includes operating in diverse healthcare environments, ranging from years of hands-on clinical activity to years of managing multiple practices and MSOs.
Dr. Pelayo is a seasoned executive with over 25 years of health care experience across several sectors of the medical business, including extensive expertise in Practice Management, Management Service Organizations (MSOs), Health Maintenance Organizations (HMOs), and Third Party Administrators (TPAs).
His expansive career began in 1986, when he received his Doctorate from New York Chiropractic College. Dr. Pelayo's entrepreneurial spirit was ignited soon after earning his degree, developing and operationalizing Pelayo Health Centers (PHC), an entity comprised of seven multidisciplinary medical centers throughout South Florida.
Pelayo Health Centers grew as it broaden its clinical treatment options by offering a robust set of medical specialties. Dr. Pelayo's ability to attract first-rate specialists in the areas of Internal Medicine, Cardiology, Orthopedics, Neurology, Podiatry, Rheumatology and ENT, plus a compliment of exceptionally qualified support staff made PHC a success in every community it served.
As one of the founders and Board Member of Provider Network Solutions, (PNS), Dr. Pelayo is intimately involved in the overall strategic direction of the company and oversees the operations of our Third Party Administrator (TPA) and Physician Specialty Networks, which services over 1,000,000 lives on behalf of the major managed care plans in Florida as well as in Louisiana.
Presently, Dr. Jose Pelayo is Chairman of the Board of National Medical Management, an organization based in the commonwealth of Puerto Rico comprised of freestanding emergency rooms, IPA/MSO and soon to operate staff model medical facilities.
Thomas Barela is Principal with Optimum Healthcare Consulting. Thomas has over 30 years of healthcare finance, contracting, and provider network development experience. Tom's clients have included health plans, hospitals, and physician groups. Tom has collaborated with other consulting and Audit firms on financial compliance, account reconciliation, and forensic accounting projects. Recently, Tom has collaborated with Alignment Healthcare in the design and development of an online decision support tool, providing financial, clinical, and operational analytics. The tool was developed to assist finance, contracting, network and utilization management assess IPA, regional, Product line and Benefit Plan (SNP, Dual, ESRD) financial performance. Tom has assisted health plans develop and acquire primary care physicians and medical groups as a means for improved MLR utilization, enrollment growth, HEDIS, and Risk Score improvement. The physician acquisitions have also increased physician compensation 30% through pay for performance, capitation, and other quality incentive measures. Tom has developed Pro Forma cash flow forecasts and health plan expansion models incorporating assumed changes in HCC Risk Scores, star ratings, annual and mid-year sweeps. Tom has collaborated with actuaries in the development of IBNR and CMS Health plan Bid submissions.
Tom received his Bachelor of Science degree from California State University – Long Beach. Tom is also a member of Healthcare Financial Management Association (HFMA).
Leslie Harris is the Director of Claims Operations for Meritage Medical Network. Meritage Medical Network provides health care and administers benefits for a significant segment of HMO members in Marin, Napa, and Sonoma Counties in California. Leslie brings a progressive 30+ year career history of successful managerial and operational expertise, and, skilled in short and long-term strategic planning. She has managed operations in both HMO plans and Independent Practice Associations (IPAs) throughout her career in addition to extensive experience in internal auditing and health practice administration.
Mr. Marten has over 25 years of experience in the healthcare field. He has expertise in HealthPlan/Provider Contracting. He has held executive management positions such as Lead Contracting Executive, COO and CEO with payers and providers over that period of time. He currently is the President and CEO for Athena Group Consulting, LLC. Athena Group Consulting is a healthcare consulting firm specializing in improving contracting results for providers, such as hospitals, IPAs and surgery centers. Athena Group Consulting also works with health plans in network analysis, market expansions, and competitive intelligence. This history enables him to serve the client's needs in multiple areas.
Mr. Marten has successfully helped Hospitals, IPAs, MSOs and Health Plans in increasing revenues above anticipated levels in health plan negotiations. Additionally, the negotiations also produced operational efficiencies that assisted the providers in daily operations. Athena Group Consulting has helped provide Managed Care Assessments, Contract Negotiations, and Strategic Planning needed for successful Health Plan negotiations.
Dottie Robinson has been working in Healthcare and IT for over forty years. She specializes in project management, configuration of software: both managed care and clinical management software for insurance companies, health plans, IPAs and medical management organizations.
Dottie has extensive operational experience and 29 years of system implementation experience and training. She is quick to translate client needs and is a knowledgeable resource working with stakeholders, business users and vendors. She assists clients in improving business processes in order for them to make efficient business decisions while understanding and utilizing maximum system functionality.
Michael Skolnik is CEO and Senior Consultant with the Value Based Health Care Institute. The VBHCI is instrumental in developing and contracting effective managed care networks, recommending and implementing value based incentive models, collaborating with partners in implementing population health programs, and helping ACOs and Self-Funded Employer plans operationalize and go to market.
Michael brings two decades of experience designing and commercializing innovative commercial, Medicare and Managed Care solutions that empower providers and consumers to take a more active role in their health. Michael's clients include Alameda Health System, Canopy Health, CareMore and many mid-sized self-funded health plans, employer groups and Medical Groups/IPAs. Michael's Wellness initiative with UPS was featured on the Rachel Ray Program and on CNN with Sanjay Gupta.