Thomas Barela

Thomas Barela

Thomas Barela is a principal of 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 by 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, and annual and midyear 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).