Lisa Mattie

Lisa has more than 20 years of experience providing guidance and support to health insurers, managed care organizations, hospitals, disease management vendors, TPAs, pharmaceutical firms, and other healthcare entities, with a focus on reducing healthcare costs and utilization and improving performance and operational efficiency.

She has significant experience conducting healthcare management operational assessments and program evaluations, developing evaluation tools, validating data analytics and performance outcomes, and recommending/implementing healthcare management operational improvements.

Lisa has considerable experience assisting managed Medicaid, Medicare Advantage, and PACE programs with application development, compliance, delegation oversight, operational readiness /efficiency, reimbursement strategy and network development, government audit preparation and corrective action responses, and policy and procedure design and implementation.

She collaborates extensively with other healthcare management, actuarial, and contracting staff on a variety of initiatives.

Examples of these of initiatives include:

• Analyze the qualitative and financial impact of healthcare management initiatives
• Identify new and improve existing healthcare management programs
• Evaluate financial feasibility, perform due diligence and pro forma development for new healthcare management programs
• Create alternative provider reimbursement and incentive programs, such as ACOs
• Assess the impact of ICD-10 code conversion on health plans and providers and assist with readiness
• Perform data validation
• Identify opportunities to optimize performance, improve outcomes, and maximize revenue, such as CMS Star Ratings, HEDIS, and CAHPS results

Lisa’s experience prior to joining Milliman encompasses seven years in the managed care industry, including five years with a Blue Cross/Blue Shield plan as the director of the Medical Cost Analysis department. In this role, Lisa was responsible for the start-up, development, and management of a comprehensive department dedicated to the measurement, monitoring, and interpretation of medical and pharmacy costs, utilization, and quality trends and the evaluation of plan performance for all product lines, including HMO, PPO, indemnity, Medicare, and Medicaid.