Brenda M Bruns, M.D

3015 69th Ave SE, Mercer Island, WA 98040    (503) 523-6206

Creative, energetic, action-oriented, articulate, and accountable Physician Executive with proven success as a C-suite, operational and cross-organizational leader and a builder and developer of high performing customer-centric organizational initiatives.   Known for ability to integrate national healthcare trends and innovations, organizational information and metrics and creativity of teams into the development of game-changing and sustainable quality and affordability programs and services.

Key Achievements

• Led the design and implementation of multiple comprehensive population health and clinical programs that connected patient care across the continuum.  Recently led workgroup to develop Post-acute Sequela of COVID  (PASC) program that identifies, stratifies and assesses members with significant symptoms and provides referral to specialized centers.   Expert panel established.  Program moved into business and outcome evaluation ongoing

• Oversaw and facilitated enterprise affordability targets of >$1.5 billion in medical cost savings.

• Organized cross-functional workgroups that addressed emerging medical cost and quality issues (e.g. Sepsis management, Catastrophic Care, Pain Management, Transition Management) and designed actionable strategies for the health plan, consumers, and employer groups.

• Served as key architect of innovative, market-changing model that coordinated clinical, analytic and financial resources to enhance trend management and member outcomes for large national marquee accounts.   Clients in this model experienced a 5% lower risk-adjusted medical cost trend and a 43% better (compared to book) satisfaction with their health plan.

• Restructured and realigned medical management, clinical operations and client-services organizations within health plans, hospitals and medical groups resulting in enhanced clinical quality, efficiency, collaboration and end-user satisfaction

• Led development of program that was highlighted by America’s Health Insurance Plans for its results:  a 1-5% decrease in unnecessary healthcare costs (readmit rates, preventable admissions), increased identification of members/patients at risk for disease progression and 25% improvement in member satisfaction with care

Core Leadership Strengths & Subject Matter Expertise

• Healthcare system strategy and market economics

• Creation of innovative clinical, affordability and quality programs in provider, payer and public sector spaces

• Leadership of cross-organizational teams in large and complex companies

• Medical and operational leadership---direct and matrix

• Medical Management of all lines of business: Medicaid, Medicare, Commercial

• Population health:  Care management, disease management, analytics

• Design and implementation of provider metrics for cost and quality of care

• Development of hospital, provider and health plan pay-for-performance and ACO models

• Contract negotiation on behalf of health plans, hospitals and medical groups

• Clinical and financial management strategies for both vertically integrated and community network models

• Clinical and trend management for large marquee national accounts

• Presentations on health care topics for national and regional audiences

Professional Experience

Chief Medical Officer and SVP, Health Services Transformation, UHG Medical Affairs     12/20---present

Key Accomplishments/Roles

• Developed model for identifying Referral Centers for complex conditions

  • Thyroid and Adrenal Diseases

  • Post-acute COVID

• Led clinical management workgroup for Post-acute Sequalae of COVID enterprise initiative.

• Development of identification and stratification tool

• Development of scoring tool for nurses in order to comprehensively evaluate and guide members with PASC

• Organization of Expert Panel, consisting of major medical centers/providers with PASC programs and services as resource for clinical expertise and referral site for UHC complex PASC members

• Integration of program into existing Optum Solutions products and adoption by both Optum and UHC of new program

• Provided consultation and clinical model for Research Corporate Affairs staff on Disease Progression for use in proof points of efficacy of Medicare Advantage programs vs Medicare FFS.

• Led cross-organizational committee on Metric Evaluation.  Springboard for Cardiometabolic Initiative, currently in development

Chief Medical Officer, Enterprise Healthcare Value, United Clinical Services, UHC  6/19—12/2020

Minnetonka, MN

Key Accomplishments/Roles

• As Business segment CMO for EHCV I oversaw the enterprise affordability initiatives and process as part of the EHCV, and  Affordability teams.      The enterprise affordability target for both 2019 and 2020 exceeded $1.5 billion in medical cost savings.    I also developed and led specific affordability enterprise strategies including:

  • Market Chief Medical Officer Affordability structure and process

    • CMO Medical Cost Action Plan playbook and education program

    • Weekly CMO in-service sessions and support for the Clinical Continuum

    • Clarification and education regarding CMO panel tool to provide real-time patient-specific information for CMO’s to use in clinically managing their markets

    • Development of bi-directional referral tool for Optum clinical programs

  • Metric Compendium

    • Led a team that aggregated all provider-facing metrics across all lines of business for UnitedHealthcare and built a Quality/Value Compendium

      • Serves as resource for all stakeholders within UHC to identify both quality and cost metrics that have the most impact on quality and/or value

      • Metrics will be used in the development of value-based contracts with ACO’s and providers

      • Ensure that providers have “one voice” from UHC regarding most important metrics for clinical and affordability improvement

  • High Performing Provider program

    • Led the development of Clinical Levers that define the key clinical actions that lead to improved care and lower cost for members.

      • Levers have been developed through a defined process based upon evidence-based clinical actions that are most relevant and critical to closing clinical quality gaps and avoiding low value care.

      • As of 12/20, Clinical levers have been developed for 6 specialties, including primary care.  Projected savings from implementing these initial clinical levers is estimated at ~$170-200 million over 3-5 years by providing real-time feedback for physicians regarding their performance on these key aggregate and discrete metrics.

      • Metrics will be tied to rewards and incentives for providers.

  • Discharge Planning and Transition Management Program

    • Led the development of a new transition management program that is currently in pilot phase in 3 market for fully insured Employee and Individual members

    • Model is poised to roll-out to additional markets during 2021 with affordability target of $52 million in medical cost savings and improved connectivity between Inpatient clinical services and providers, ACO’s, Optum specialty programs and members and their families

Chief Medical Officer, National Accounts, Employer and Individual, UnitedHealth Care

Senior Vice President Strategic Business Relations, UnitedHealth Group

Minnetonka, MN            02/12—6/19

Key Accomplishments/Roles

• Chief Medical Officer for the National Account (NA) division of Employer and Individual line of business. National Accounts manages relationships with more than 500 self-funded employers, representing >9.5 million members.    Led and supported the NA business including operational, clinical and strategic aspects.  Oversaw team of medical directors and clinical operations leaders.   During tenure developed and led:

  • Standardization of medical director client assignment process (One-stop Medical Director process)

  • “Mega-education” session for all client-facing medical directors and leadership team to address identified opportunities and level-set knowledge base

  • Clinical affordability structure for total NA book including establishment of trend goal, trend management reporting tool, UHC and Optum operational goals and “top 10” list of affordability strategies that will be spread to all NA teams

  • Personally, served as CMO for Account Management team for multiple large NA’s (>750k members)

Senior Vice President Strategic Business Relations, UnitedHealth Group   02/12----06/19

Minnetonka, MN

• Member of UHG Chief Medical Officer team addressing corporate medical affairs and business relations

• Key architect of Virtual Health Plan model which coordinates clinical, analytic, engagement, and medical director expertise across the organization in order to aggressively manage client trend and member outcomes for our largest National Accounts

  • Model has grown from 3 clients in 2013 to more than 44 in 2019 (>4 million members), including >26 clients that have trend guarantees totaling ~$200 million.   Revenue from client adoption of recommended programs has average >$300 million each of last 3 years.

  • VHP tools, including the Medical Cost Action Plan (MCAP) and trend tracker and Executive Dashboard have enabled Account Management teams in this model to achieve a 5%  better risk-adjusted medical cost trend than book and NPS scores of 85-90.

  • Learnings from VHP have been transitioned into the development of the clinical integration model for the new NA Advocacy/Hub approach----allowing our pilot account to achieve first year trend guarantee target.

• Executive sponsor, led and/or participated in cross-organizational projects:  Catastrophic Care (CC); Emergency Department Services Initiative; Opiate Use and Misuse; Sepsis Management and Pain Management.

  • CC project developed the NA team management model of the Blended Census Report (BCRT);    augmented  Advanced Notification reports to  inform clients of potential financial risks;  developed CC Client Report which  provide client and member-level metrics and developed “First fill” report for high-cost medical injectable drugs

  • Sepsis Management project has identified >$200 million in medical cost savings across the Employer and Individual book.  It will also be spread to Medicare and Community and State plans

Executive Medical Director, Health Plan Services and Group Health Cooperative Medical Director

Group Health Cooperative, Seattle, WA                 2008-2012

Group Health Cooperative (GHC), together with its subsidiary Group Health Options, Inc., provides medical coverage and care to more than 700,000 residents in Washington State and Northern Idaho who are covered by health plans offered by Group Health Cooperative or its subsidiaries.  The GHC Medical Director is delegated responsibility by the GHC Board for oversight of cost and quality for all GHC members. The Executive Medical Director, Health Plan Services, in partnership with the Executive VP/Health Plan Division, is accountable for the Health Plan Services Division’s performance.

Key Accomplishments/Roles

• Member of Executive Leadership Team; staff member for both Group Health Permanente and Group Health Cooperative Boards;

• Designed and implemented new infrastructure for assessing, monitoring and initiating clinical expense reduction innovations and strategies including: Shared Decision-making for preference-sensitive care; High-end imaging program; deployment of Medical Home;  new approaches to HEDIS improvements; and re-design of Care Management programs

• Executive Co-sponsor for Emergency Department and Hospital Inpatient (EDHI) Initiative which decreased (2009-2010) enterprise-wide ED and inpatient costs by 5-7% and improved member satisfaction with inpatient care by 25%.  Program received Innovation Award from eValue8 in 2010

• Key member of Contracting Oversight Group which monitored and negotiated all outside provider contracts over $1 million.  Overall rate increase of <4% for 2010

• Developed Sales Consultancy program to provide standardized Employer Group Reports and presentations to large purchasers.

• Developed Provider profile and ACO (accountable care organization) Integrator model

• Co-led Medicare Stars Committee--achieved 5 star rating in first year of participation.

Chief Medical Officer

Health Net Health plans of Oregon                    2006-2008

Health Net Health Plans of Oregon insures ~150,000 PPO, HMO and Medicare PPO option plus members in the Pacific Northwest.  Reporting to the Regional Health Plan Officer, oversaw the Health Services department which encompassed care and case management, disease management, wellness and prevention, medical policy design and implementation, medical audit, prior-authorization review, concurrent review, and quality management.

Key Accomplishments

• Direct oversight of Medical Management services for all lines of business

• Chair of regional Health Care Cost Committee, Physician Advisory Committee, Quality of Care and Utilization Management Committee and Pharmacy and Therapeutics Committee

• Implemented an internally developed advanced imaging program (10% decrease of utilization in the first year),

• Developed intensive case management program (acute, post-acute) and augmented utilization management to reduce Medicare admit rates by 10%.

• Developed physician profiles on quality and efficiency to provide feedback to network  physicians in collaboration with physician advisory group

• Augmented disease management and developed new wellness programs with vendor (Health Dialog)

• Developed and conducted a course on Cost and Quality in Healthcare for Portland State's graduate business program.

Medical Director

Blue Cross of Idaho                   2003-2006

Blue Cross of Idaho insures ~400,000 covered lives across the state of Idaho.  It offers managed care, traditional, PPO and Medicare Advantage products.  Reporting to the Senior Vice President of Medical Management, oversaw disease management, quality improvement and clinical outcome review, and participated in Medical Policy development, case, and utilization management.  Served as a member of the Management Advisory Committee and chaired the Clinical Quality Management and the Physician Advisory Committees.

Key Accomplishments

• Developed and implemented in-house Disease Management programs for Congestive Heart Failure, Diabetes and Asthma. Improved clinical outcome measures by 5% and achieved ROI of 1: 1.5

• Coordinated the development of a statewide Hospital Quality Incentive Program which utilized Centers for Medicare and Medicaid (CMS) quality indicators and safety measures to promote and reward hospital quality improvement achievements.

• Assisted in development of community collaborative of back surgeons and rehabilitation staff to implement an evidence-based program that decreased unnecessary back surgery by 10% over 3 years

• Project Lead for statewide implementation of a vendor-administered radiology utilization management program.  Realized net of ~$2 million in savings in first year of operation

Chief Medical Officer

Providence Everett Medical Center

Everett, WA                                                1997-2002

PEMC is a 350-bed, 3 campus medical center with a 500-member medical staff. It is one of the largest facilities in the Sisters of Providence Health System (SPHS). Provided operational leadership to the Medical Staff in the development and implementation of the medical management infrastructure: Medical Staff services, Quality Review and Improvement, Clinical Research, Clinical Program development, Medical Records, Utilization Management, Care management, Discharge Planning, Decision Support (Total of ~150 employees and 18 service-line medical directors). Reported to CEO and served as a member of the Northwest Washington Service Area executive leadership team.

Key Accomplishments

• Led development of measurement system for clinical care outcomes, cost and quality. Facilitated the implementation of CaduCIS (a risk-adjusted clinical outcomes software product)

• Coordinated and facilitated the development and integration of Disease Management and Clinical/Quality improvement projects with physician medical groups and other medical facilities.

  • Diabetes project decreased inpatient costs by 8% for all patients with diabetes as co-morbidity

  • CHF project decreased readmits from ~15% to ~8%.

• Assisted in the Development of Patient safety improvement initiatives, including enhanced reporting of medication events, fall prevention and insulin IV orders.

• Developed the Technology Assessment Committee to improve review and approval of capital acquisitions and clinical programs.

• Designed and developed a new Clinical Research Program; developed budget, hired manager and marketed program to providers.

• Facilitated the re-structuring of the medical staff peer review and quality assessment processes which successfully provided comprehensive and consistent review of all aspects of physician performance

Prior Tenures

Medical Director, CMO

HealthFirst Medical Group, Portland, OR

Associate Medical Director for Satellites Services,

Sunnyvale Medical Clinic, Sunnyvale, CA

Medical Director,

Alameda County Emergency Medical Services District, Oakland, CA

Assistant Clinical Professor of Surgery,

Associate Medical Director, Emergency Services

Stanford University Medical Center, Stanford, CA

Assistant Clinical Professor of Medicine,

San Francisco General Medical Center, San Francisco, CA

Medical Director, Paramedic Division

Department of Public Health, City and County of San Francisco

Emergency Department Physician

Kaiser-Permanente Hospital, South San Francisco, CA

Education and Medical Training

Fellowship, Critical Care Medicine

California Pacific Medical Center

San Francisco, CA

Residency, Internal Medicine

Faulkner Hospital, Boston, MA

Flexible Internship

Virginia Mason Hospital, Seattle, WA

EDUCATION

Master of Science, Management

Stanford University, Palo Alto, CA

Stanford Graduate School of Business, Sloan Program

Doctor of Medicine

University of Washington School of Medicine, Seattle, WA

Bachelor of Science, Biology,

Stanford University, Palo Alto, CA

Graduated ‘with Distinction’, Phi Beta Kappa

CREDENTIALS

Board Certified: Internal Medicine,

Licenses:       Washington

Board Affiliations – Seattle Opera Board of Directors (since 2008); Former:   Puget Sound Health Alliance (NBGH); American Group Practice Association.