Testifying Expert Brian Heller, Ph.D.
Areas of Expertise:
Health/Hospital Administration, Health Insurance, Managed Care HMO and PPO, Academic Teaching, and Physician Credentialing & Organization Management. Health Care Developmental, Contractual, Operational, and Regulatory Executive.
Professional Experience:
Principal, Quadrus, LLC, Washington, DC 2004 - Present
One of four founding members of a company providing Social Security advocacy services to the hospital and Medicaid managed care industry. Current contracts involve health plans with operations in eight states with enrollment of over 800,000 lives.
Principal, Healthcare Litigation Support, LLC (f/k/a Managed Liability Associates), Petersham, MA 2000-2007
Healthcare Litigation Support is a team of professionals with experience in medical practice, healthcare operations and health insurance, providing case review and expert witness testimony, as well as risk management consulting, to law firms, healthcare organizations and insurers.
President, Mercy Health System Physician Hospital Organization, Inc., Toledo, OH 2000-2002
The Mercy Health System PHO was based in an urban hospital network and provided care for over 50,000 covered lives under contracts with two HMO's, utilizing 600-plus physicians and a four-hospital integrated delivery system as its provider base. Products included Medicare, Medicaid and commercial risk and non-risk programs. The PHO was at risk for over $90M of premium revenue.
Director, Research & Grants, United Health Services, Inc., Binghamton, NY 1998-2000
Responsible for establishing a research and grants function for a four-hospital system in upstate New York. Worked with local, state, regional and national funding sources.
Executive Director, Chief Executive Officer, Susquehanna Regional Physician Hospital Organization, United Community Health Plan, Inc., Binghamton, NY 1994-1998.
United Health Services, Inc., a four-hospital system in upstate New York, was the focal point for developing an integrated delivery system, managed care product involving a network of physicians and a multi-county service area. The effort focused on creating a joint venture with a managed care partner, and with this partner establishing a strong managed care presence in a developing market. In the first year over 300 physicians contracted for the delivering of care to commercial, Medicaid and Medicare risk markets, generating a gross profit approaching $1M. Market leadership was achieved in three years. The 1999 total revenue was $50M. I made several presentations at national meetings during this tenure.
Executive Director, Methodist Delivery System, Inc., Indianapolis, IN 1993-1994
Responsibility as Executive Director to take a joint physician/administration work group from theory to reality. Organized and led the fast-track development of an at-risk Physician Hospital Organization that served as the single point of entry into the fourth largest private hospital in the country. Developed and implemented a unique full-risk PHO model for Methodist Hospital of Indiana and its medical staff of 1,200 that drew national interest resulting in multiple presentations at industry meetings.
President, Chief Executive Officer, CCS, Inc., Nashville, IN 1990-1993
Developed and managed a computer software/consulting company.
Executive Director, Vice President, Travelers Health Network of Illinois, Inc., Chicago, IL 1987-1989
Established and managed a three-county PPO working with all area hospitals for the greater Chicago area, Travelers' largest market.
Executive Director, Vice President, Maxicare Health Plans, Inc., Chicago, IL 1984-1987
Assumed operational leadership of 115,000-member HMO. Managed a staff of 125 with responsibility for all areas including systems, UR/QA, marketing and provider relations. Increased membership by 30,000 in eighteen months. Implemented Medicare risk contract. As Vice President, held national HMO development responsibilities.
President, Heller Associates 1977-1983
Planned and managed projects, hired other consultants as needed and coordinated the elements necessary to deliver a consulting product to the client. Worked with a number of developing and operational programs on a national basis, providing consulting in all areas of HMO development and operations including marketing, systems, claims, UR/QA premium development/actuarial evaluation and underwriting issues. Consultant to Federal office of HMOs, where evaluated 40+ programs on a national basis.
Executive Director, Roosevelt Health Plan (now Chicago HMO) 1975-1977
Began as a consultant to Roosevelt Memorial Hospital to develop a feasibility study for a Medicaid HMO. Then hired to implement the HMO and obtain state licensure and Medicaid contract. Started up Medicaid HMO, the first HMO licensed in Illinois. Wrote and submitted application for state qualification.
Teaching, Consulting and Doctoral Completion 1972-1975
Senior Director of Research, Blue Cross Association (Chicago) 1965-1972
Responsibility for developing national policy and planning and implementation of national managed care activities. Recruited a staff of 12, including professionals for national technical assistance and development functions. Obtained federal funding for a national demonstration project.
Teaching and Research Experience:
- Adjunct Assistant Professor, Binghamton University, NY. Developed and taught a healthcare marketing and economics course to Executive MBA students. 1998-2000
- SUNY Upstate Health Science Center, Binghamton Clinical Campus, NY. Health Economics presentations to 3rd year medical students. 1998-2000
- Adjunct Assistant Professor, Northern Illinois University, Introduction to Social Psychology. 1973
- Assistant Professor of Community Medicine and Community Health in the Abraham Lincoln School of Medicine and in Health Care Services, School of Public Health, University of Illinois, Chicago. 1972-73
- Adjunct Assistant Professor, Illinois Institute of Technology, Introductory Sociology, Chicago. 1967-68
- Adjunct Assistant Professor, Sociology and Biostatistics, State University of New York at Buffalo. 1964
Selected Presentations (recent):
- Co-Chair, "The Legal Forum for Healthcare Attorneys and Corporate Counsel in Health Care Organizations," American Conference Institute. Baltimore, MD 2000
- "Quality and Performance Measures," The New HealthCare Marketplace, Syracuse, NY 1999
- "Medicare Risk Contracting in a Joint Venture Hospital Model," CAPCON Conference. Orlando, FL 1998
- "Community Hospital - HMO Joint Venture Development," American Association of Health Plan's Annual Meeting. Seattle, WA 1997
Publications (recent):
- "Health Care Litigation," LNC Resource, Vol 1, No. 8 August 2004
- "Capitation and Litigation," Capitation Management Report January 2004
Honors, Awards and Associations:
- "Brian Heller, Ph.D." Scholarship to the Executive MBA program in Healthcare at the State University of New York at Binghamton established, 2004
- Member, Board of Directors, Mental Health Association of the Southern Tier of New York, 1996-2000 President, 1999-2000
- Founder, Broome County Managed Care Users Group, 1995
- Recipient of World Health Organization Travel Fellowship, 1973
- Fellow, American Public Health Association, 1969
- Recipient of National Institutes of Health Graduate Training Fellowship, 1964-1965
- Member, Alpha Kappa Delta, National Sociological Honorary Society
Education:
- Ph.D., Sociology (special field examination in Medical Sociology), University of Chicago
- M.A., Social Psychology, University of Chicago
- B.A., Sociology, Syracuse University
Military Service:
- U.S. Army, honorable discharge – served a 3-year enlistment, trained as a Russian linguist.
Consulting:
- Division of HMO Qualification and Compliance, HEW
- Group Health Association of America
- Memorial Hospital of Garland, Texas
- Wayne State University School of Medicine
- Cook County Hospital, Department of Psychiatry
- Eastern Kentucky Health Demonstration Project
- Student American Medical Association – International Exchange Project
- University of Illinois, College of Dentistry – Dental Fluoridation Project
- Office of Economic Opportunity, Neighborhood Health Center Site Evaluation Project
- Operation Medical and Dental Head Start, Chicago Board of Education
Pre-Corporate Presentations:
- Society for General Systems Research, "Interpersonal Methods for Coping with Stress: Helping Families of Dying Children" 1975
- American Public Health Association, "The Ubiquitous HMO and Health Care Innovation: A Study in Contrast" 1971
- American Public Health Association, "An Analysis of Two Different Approaches to Cost Controls in Hospitals" 1970
- American Sociological Association, "The Effects of Parents and Peers on Student Smoking Behavior" 1967
- National League for Nursing, "The Effect of Medicare on Hospital Utilization". 1967
- Group Health Institute, "Research Needs in Medical Care" 1967
- Society for Social Research, "Stratificational Approaches to the Prediction of Symptoms of Stress" 1964
Pre-Corporate Boards and Committee Memberships:
- Editorial Board (Book Review Editor) Inquiry, a journal of medical care organization, provision and financing 1967-1980
- Executive Committee, American Friends Service Committee, Midwest Region 1971-1974
- Review Committee of the Illinois Regional Medical Program 1971-1974
- Illinois House Committee on Health Care Reform in Prisons 1974
- Special House Committee to review and update Illinois hospital licensing requirements 1974
Pre-Corporate Publications:
- Journal of Dental Education (Vol. 29, No. 2, 6/65), "Selection of Students for Dental Education"
- Patients, Physicians and Illness , G. Jaco, Editor, "The effects of Parents and Peers on Student Smoking Behavior" 1969
- Chicago Student Health Project: Summer, 1967 (Chicago Student Health Organization, 1968, pp. 170-179) in, A Summer of Change, published by the Student Health Organization and the University of Illinois
- Inquiry , (Vol. 4, No. 4, December, 1967), "A Systematic Framework for Relating the Behavioral Sciences to the Health Care Fields"