Category: Subject Matter Experts

Andrew is the Medicare Advantage Practice and Stars Capability Leader at ProspHire, specializing in health plan growth strategies, operational effectiveness and regulatory navigation. With expertise in the Medicare Stars Program, he helps health plans exceed quality standards and adapt to industry changes. As an emerging thought leader, Andrew stays at the forefront of developments, positioning clients for sustained success.

One of his key areas of expertise is in the Medicare Stars Program where he takes a lead role in guiding health plans through the program, ensuring they meet and exceed quality standards and successfully navigate regulatory changes. An emerging thought leader in the field, he actively engages with new developments and industry changes, positioning clients for success.

Andrew has served in interim leadership roles for Medicare Stars programs, overseeing teams of individuals, managing budgets and evaluating/implementing vendor partnerships. His latest Medicare Stars transformation work involved two recently merged managed care organizations both with declining Medicare Stars performance. Andrew and team were able to assess the key opportunity areas quickly and effectively, establish strong partnerships within the organization, determine the ‘math path’ to success, streamline processes to optimize their Stars score potential and ultimately achieve 4 Stars and Quality Bonus Payment revenue.

In the Medicare Advantage space, Andrew has successfully supported client’s growth strategy development, from ideation through implementation. A recent project at a plan saw membership growth from ~2k members to >50k members in a 4-year period including two separate acquisitions/mergers, while also expanding into two new states.

Fun Fact: An avid reader and lover of Presidential history, Andrew named his dog, Fala, after President Franklin Roosevelt’s beloved Scottish Terrier.

Caitlin is a PMP-certified Senior Manager at ProspHire. 

She has 10+ years’ experience in the healthcare industry and Medicare, Medicaid and provider sectors. Caitlin excels at managing complex programs and projects, identifying gaps and driving significant cost savings and revenue generation for clients. 

Recently, she drove an organizational assessment for a major health plan and monitored compliance for Affordable Care Act marketplace regulations. The work resulted in outlined processes to achieve URAC accreditation and certification as a Centers for Medicaid & Medicare Services Qualified Health Plan. 

Fun Fact: Caitlin once spent 11 days hiking 100 miles through New Mexico with her family.