Category: Subject Matter Experts

Andrew is a Senior Manager at ProspHire. A solution-oriented leader, Andrew has extensive experience within Government Programs Operations, including the delivery of large-scale program assessments and accompanied growth strategy recommendations. His work also has included support of merger and acquisition activities, development of membership growth strategies, and identifying synergies across the enterprise to reduce cost and increase effectiveness.

Andrew’s work within managed care has a particular focus on Medicare Quality Improvement and Medicaid Performance Improvement Programs. Andrew leads our Medicare Stars Performance Improvement Service offering, where he oversees the delivery and execution all of Stars project work, including contract assessments, program transformations, amongst other services.

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 quickly and effectively assess the key opportunity areas, establish strong partnerships within the organization, determine the ‘math path’ to success, streamline processes in order to optimize their Stars score potential, and ultimately achieve 4 Stars and Quality Bonus Payment revenue.

Fun Fact: An avid reader and lover of 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. 

Luc is a Manager for ProspHire. He is an experienced healthcare professional, passionate about continuous quality improvement with a goal to achieve the quadruple aim. He offers a diverse background in academic research, clinical management, international public health, pharmacy administration, quality management and value-based reimbursement.

Prior to joining the Firm, Luc was a Clinical Transformation Consultant for the True Performance Program, a Highmark Health value-based reimbursement program. The True Performance program is a dynamic value-based reimbursement contract with quality improvement, per member per month cost and utilization management components offering participants gain-share and risk-share opportunities. He assisted primary care providers, ranging in size from single practice to multi-hospital health systems, improve performance in the True Performance program. To be a valued asset to his clients, he provided knowledge and insights in clinical operations, disease state management, HEDIS and NCQA quality measures, population health, practice transformation and risk adjustment to assist participants identify and deploy performance improvement strategies.

Fun Fact: Luc has cycled from San Francisco, CA to Washington, DC and Miami, FL to Tallahassee, FL to raise funds and awareness for people with disabilities.