The Company
Our Services
Contact Us
Site Map
Home
|  |
Edward D. Hutt, M.D., M.B.A., F.A.A.F.P - Health Care
Consultant
Over 21 years of managed care physician expertise gained in solo practice
and group practice experiences with capitation of Medicare, Medicaid and commercial
members, and, as full-time medical director for five major HMOs ranging from
direct medical management to multi-state management of medical directors.
Substantial financial expertise in capitation, risk, and incentive funding
structures and non-traditional compensation alternatives. Extensive experience
in hospital and physician contracting strategic planning, negotiations and
analysis.
Proven HMO and physician leadership skills in tactical and strategic management. Recognized
as an innovator and change agent with professional skills related to IPA and
network development, physician education and utilization management.
Extensive information systems capabilities and experiences ranging from billing
and collection software, to decision support applications, to practice guideline
software. Comfortable in mainframe, mini-computer and personal computing
environments.
WORK EXPERIENCES
Medical Director for Carolina Care Plan, Columbia, South
Carolina.
Full responsibility for medical oversight of utilization review, pharmacy,
credentialing, and the budgeted medical cost ratio for a 70,000 member commercial
and Medicare Advantage HMO operation in South Carolina.
Director of Managed Care for Carle Clinic Physicians Association,
Urbana, Illinois.
Responsibility for the management of the risk HMO subcontract
of Health Alliance Medical Plans, a 260,000 member MCO owned by the Carle Clinic
Physicians, Inc. Director with oversight duties involving utilization review,
contracting, and market development for the 300 member Carle Physician organization.
Senior Vice President and Chief Medical Officer for Neighborhood
Health Partnership, Inc.
A 140,000 member Commercial, Medicaid, and Medicare
NCQA certified HMO. Responsibilities for corporate and Medical policy direction
for the physician and hospital owned HMO operating in three southern Florida
counties.
Vice President of Medical Affairs for Columbia Provider Services, Inc. Dallas/
Fort Worth, Texas. Responsibilities range over 14 Columbia/HCA hospitals and
their 9 respective IPAs. Professional responsibilities oversight of a delegated
at full risk commercial plan contracted from Prudential HealthCare of Texas
and a delegated full risk Medicare contract delegated by Cigna Health Care
Inc., of Texas.
Medical Director for Southern Health Services, Inc. a Coventry
Health Care, Inc. Company
Responsibilities included statewide medical direction
for a 73,000 member commercial and 3,000 member Medicaid HMO. Medical supervision
over three part-time medical directors, over-sight for continuing certification
for NCQA, implementation of electronic medical decision system by InterQual.
Other responsibilities include oversight of network design and contracting,
direct medical utilization and quality management programs with practicing
physicians in Virginia. As an active member of 10 committees and chair of the
pharmacy and therapeutics committee, my responsibilities ranged over provider
relations, member services, grievances, appeals of commercial, and Medicaid
program members.
Vice President and Corporate Medical Director for Managed
Health Services Insurance Corp.
Responsibilities as a corporate director for
Coordinated Care Corporation parent to Medicaid and commercial HMOs in Illinois,
Wisconsin, Texas, and in Northern Indiana. Responsibilities include oversight
of medical policy formation and implementation of Title 19 Medicaid and commercial
HMO contracts in Wisconsin, Illinois, and Indiana, corporate oversight in physician
and hospital contracting and compliance with state and federal regulatory agencies
and policies of Quality Assurance agencies.
Regional Medical Director, MetLife HealthCare, Inc., South
Central Region, Houston, Texas.
Region includes Texas, Oklahoma, Louisiana and
Arkansas. Responsibilities
include medical director management and training, medical involvement in hospital
and physician contracting, implementation and monitoring of HEDIS and NCQA
requirements for Texas, Arkansas, Oklahoma, and Louisiana.
Senior Medical Director, FHP, Inc., Arizona Region, Phoenix,
Arizona.
Responsibilities included Medicare full risk Senior contract management
of a mixed model staff and IPA delivery system directly 86,000 Medicare full
risk seniors and 87,000 commercial members, development and implementation
of the HRM and the Sony Decision System for utilization management. During
this period represented FHP in 5 television Health Tip infomercials aired in
5 western states.
Family Practitioner, Los Angeles and North Hollywood, California.
Senior Medical Advisor, IPAMAN, Inc., Los Angeles, California.
Provided
medical direction for a software company specializing in mini-main frame computer
programs designed for IPA physician management and funds distribution.
Director of Professional Review and Physician
Advisor, United Health Plan,
Watts Health Foundation, Los Angeles, California.
Chief Physician, United Health Plan, Los Angeles, California.
Management
responsibilities for medical group management and patient care in a primary
care group clinic, Compton MedCenter, Compton, California.
Medical Director/Owner, Family Medical Group, a multi-specialty private group
practice in Compton, California.
Responsible for full-time clinical practice
and administration including physical plant, personnel, and full financial
responsibilities for accounts payable, accounts receivable, business computer
management and legal affairs.
Deputy District Health Officer, Los Angeles County Public Health Department,
Compton, California.
Responsible for clinical duties for treatment of
sexually transmitted diseases at 2 clinics, budgeting process and planning,
implementation of changes in protocol and procedures at the Compton STD Clinic.
MEMBERSHIPS
- Fellow of American College of Utilization Review Physicians
- Fellow of American Academy of Family Physicians
- Distinguished Fellow, American College of Medical Quality
- American College of Physician Executives
- American Medical Association
EDUCATION
- June 1975 The Pritzker School of Medicine at the University of Chicago, Chicago
Illinois. M.D.
- 1994 Post M.B.A. Marketing Certificate, University of Phoenix, Phoenix, Arizona.
- 1989-1991 Completed M.B.A. program at University of Phoenix, Phoenix, Arizona
- 1988-1999Certificate Program at University of California at Irvine School
of Business, Irvine, California, Physician Management Fellowship program. 1988
- 1989.
- Attendance at various seminars and classes in the health care field to meet
Continuing Education requirements. 1977 - Present.
- Clinical Pathology Residency at University of California San Diego Medical
Center, San Diego, California. 1976 - 1977.
- Straight Internal Medicine Internship at University of California San Diego
Medical Center, San Diego, California. 1975 - 1976.
- Undergraduate, Eastern Illinois University, Charleston, Illinois,
- Bachelor of Science in Medical Technology. Lakeview Memorial Hospital Center,
Danville, Illinois, School of Medical Technology Internship. 1962 - 1967.
CREDENTIALS and LICENSES
- Commonwealth of Virginia Physician and Surgeon License
- American Academy of Family Physicians Fellow
- State of Arizona Physician & Surgeon Certificate
- American Board of Quality Assurance & Utilization Review Physicians
- California Physicians Assistance Supervisor Certificate
- Drug Enforcement Agency Class II Narcotics License
- State of California Physicians and Surgeons Certificate
- State of Illinois Physician & Surgeon License
AWARDS
- Nominated and selected for the National Directory of Who's Who in Executives
and Professionals
- Distinguished Fellow American College of Medical Quality
- Fellow in the American Academy of Family Physicians
- FHP Quality Improvement "Pursuit of Quality Award”
- American Medical Association Physician Recognition Award
For more information on how our health care business management and consulting services can improve your bottom line, contact Allied Management Group today.
|
