Terry A. McInnis, MD, MPH, CPE, FACOEM
203 Frenchmans Bluff Drive
Cary, NC 27513
Mobile- 864-918-9998
E-mail-
RESUME
SUMMARY OF QUALIFICATIONS
-Physician Executive with C-suite knowledge versed in benefit design strategies, with extensive healthcare reform and policy expertise
-Nationally recognized speaker and effective communicator- educating and galvanizing broad stakeholder audiences on the key elements necessary for redefining healthcare
-Broad business knowledge capable of not only translating, but aligning and operationalizing policy, benefit design, and delivery system infrastructure for success in the move to value
-Strategist with the leadership skills to collaborate and gain consensus to translate ideas into operational real world solutions
-Recognized expert and physician champion on integration of comprehensive medication management services as a transformative population health strategy while evolving the role of pharmacists as core team-member providers
My goal is to be an effective change agent and enabler in successfully and sustainably moving the U.S. to a patient-centered value-based healthcare system where providers love to practice.
PROFESSIONAL EXPERIENCE:
BLUE THORN, INC.-06/10-PRESENT
President and Founder
As president and founder of Blue Thorn Inc. (BTI) a healthcare and policy consulting firm, my 25 years of experience covers the gamut from clinical practice and leadership positions in both military and civilian hospital/private group practice settings to Corporate Medical Director roles. With responsibility ranging from management of employer health benefits to developing, influencing, and promoting national and state healthcare policy redesign, I focus on enabling all clients to not only understand the economic, policy, and delivery system changes necessary to remain viable, but to successfully create a sustainable healthcare payment and delivery system- proactively.
As an SSB Solutions senior medical consultant and recently as Chief Transformation Officer for Cornerstone Health Enablement Strategic Solutions (CHESS), I have first-hand knowledge of the challenges and roadmap needed for providers to successfully transition from fee-for-service to value. For example, I co-led a project that included in-depth analysis, structured interviews, and frequent senior management interactions for a newly integrated hospital/provider network (clinically integrated network) charged to understand culture, IT/EMR, and delivery system barriers in moving to risk. This included in-depth knowledge of the capital, payer contracts, coding and documentation efforts, analytics, physician compensation realignment challenges, and governance, while enabling a roadmap for the organization to move toward MSSP ACO participation and other risk arrangements with commercial plans. Success resides in not only sharing best practices, but recognizing what isn’t working and rapidly adjusting.
In 2014, I was the lead medical consultant for the North Carolina Medical Society (NCMS) on major Medicaid and overall ACO reform efforts.
-Crafted a strategy document paired with the proposed legislation effectively servingas a roadmap for positions the NCMS would 1) support, 2) not support/non-starters or 3) springboard for proactive agenda setting/change
-Successfully aided NCMS as “the credible voice” for physicians with meaningful steps toward patient-centered ACO efforts
-Changed the debate from “guaranteed cost” by managed care to a move from fee-for-service to provider-led value.
As an example of my ability to effect national change, from 2007-2012 I Co-Chaired the Center for Public Payer Implementation of the Patient-Centered Primary Care Collaborative (PCPCC) a multi-stakeholder organization (1000+) recognized as leading PCMH coordinated care efforts.
-Led positions galvanizing Medicaid and CMS education and best practice sharing in buy-in for the move to value
-Content developer for contracting template sections of the PCPCC “Purchaser’s Guide”, while contributing legislative positions and policy adoption for changes in qualified HDHPs
-Recognized the key role medications play for the success of care integration, then gained support for, founded, and co-led the Medication Management Taskforce. Subsequently spearheaded the development, content, and acceptance of the nationally recognized 2010 and 2012 editions of the PCPCC Resource Guide: Integrating Comprehensive Medication Management to Optimize Patient Outcomes.
Dr. Paul Grundy (PCPCC President and IBM’s Global Director of Healthcare Transformation)wrote-“the world’s foremost expert on Real "Pharmacy of the future" and the integration of that into a working delivery system is Terry McInnis.”
As Chair of the Board for the Alliance for Integrated Medication Management (AIMMc)- I lead national efforts enabling clinical pharmacist teams to operationalize emerging integrated practice and payment models- expanding prior HRSA funded innovation as a critical key to delivery system reform.
An effective communicator and national spokesperson in healthcare reform and redesign, I am on numerous speaker bureaus and present at the request of multiple stakeholders including government agencies, legislative bodies, professional associations, provider and integrated delivery systems, health plans, business coalitions, academia, the pharmaceutical industry, and patient advocacy groups.
Cornerstone Health Enablement Strategic Solutions (CHESS) 01/13-10/13
Chief Transformation Officer
Led the clinical team responsible for developing the capability to engage clients in defining the delivery system redesign necessary to assure optimized patient outcomes for this start-up venture of Cornerstone Health Care (a 350 provider multi-specialty group). Marketed and consulted with provider group and health system/professional organization clients (ex. GAFP, Health Care Connect IPA) on ACO overall strategy to effectively bridge from current volume-based to value-
-“ACO Merits and MSSP” presented at the GA Academy of Family Practice annual meeting and board session enabling an “informed” strategy for MSSP ACO statewide efforts
-Developed staffing models, physician compensation guidelines, client gap assessment tools designed to determine “next steps” in resource management, which operationalized maximum financial and clinical impact.
-Developed and operationalized a transparent financial variance by severity of illness scorecard comparing average RAF (HCC severity coding) by provider linked to their costs for MA plans to allow for a meaningful discussions of “how sick my patients are” and opportunities for cost reductions and appropriate coding.
GLAXOSMITHKLINE01/04– 06/10
Top 3 Pharmaceutical Company
Medical Director- Healthcare Policy and Advocacy(01/08 – 06/10)
Worked for the VP of Government Affairs and VP of Policy as the medical expert and external spokesperson to influence the environment and formulate internal positions to enhance the value proposition for pharmaceuticals through coordinated care, HIT integration, and outcomes metrics
-Developed the GSK Health Reform adopted Policy positions on the support for PCMH- coordinated care, comprehensive medication management (MTM), and minimal credible coverage aligning both US Policy and Government Affairs by dually reporting to both the VP Government Affairs and VP Policy
-Served as an external expert supplying legislative language (by working with HELP committee staffers) that resulted in successful incorporation in section 3503 “Medication management services in treatment of chronic disease”
-Served on the PhRMA Rx Benefits Committee-argued for provisions of minimal credible coverage and comprehensive MTM which were adopted for the industry- helped write model legislative language used by PhRMA to lobby at the state level
-Represented GSK on the US Chamber Benefits Committee- presented and was successful in supporting the US Chamber to adopt and publish positions on the medical home/coordinated care
-State Government- Presentations for NGA, NLGA, ALEC, NCSL, WIG, MN, MA, VT, FL etc. Gov. Strickland, Sec. Sibelius, CHT- Speaker Newt Gingrich- all have been venues to advance understanding and buy-in of coordinated care models and the need for comprehensive medication management integration
Medical Director- Health Management Innovations(01/04– 01/08)
Worked as an internal and external advisor on key market trends and benefit design evolution to evaluate the impact on access to pharmaceuticals, quality metrics, outcome measures, IT progression, and total healthcare cost impact
-National GSK speaker, representative, and project advisor in major efforts that demonstrated the role of medication adherence and compliance to better health outcomes including the data and additional studies needed to prove and promote the value proposition
-Key message development for senior executives-(Bob Ingram- Vice Chairman and President- Chris Viehbacher) and GSK positions, literature on Rx benefit design, medication management, etc. which they then presented nationally
-Interacted weekly with large employers, health plans, politicians, advocacy leaders, physicians, and quality organizations
Proactive Health Strategies (PRxO EHS, INC.)10/02 – 12/03
Medical Director and Benefits Consulting Firm
President /CEO/Founder
Work includedcontracts as Corporate Medical Director and Health Benefit Consultantto clients in the arena of health and productivity management. Results include:
-Medical Benefit redesign with successful major drug coverage inclusions
-Developed a cost-benefit analysis of an existing vs. a recommended revised substance abuse policy that demonstrated over $10 million dollars a year in quantifiable savings and operationalized for union buy-in for a fortune 100 company
-Physical Abilities Testing and Carpal tunnel screening programs that demonstrated a 30:1 ROI and over $1.4 million in savings annually
-Assistance and policy development/analysis in regulatory compliance including guideline, audit, and Management Systems (Health Care Benefits, OSHA, HIPAA, ADA, and EEOC)
Major clients included Michelin NA, GE, and Fluor Daniel
Michelin North America, Inc01/00 – 10/02
Global Tire Manufacturer
Corporate Medical and Health Director(2001 – 2002)
Corporate Health and Safety Director (2000 – 2001)
Chief Medical Officer leading the corporate management and strategic direction of the medical, industrial hygiene, safety, ergonomic, and industrial /environmental (IH) lab divisions for Michelin North America (Canada, US, Mexico) in a highly matrixed organization. External face, internal decision maker, and communicator responsible for these key areas for 16 major facilities and a dispersed workforce
-Recommended health care benefit design changes with a cost/benefit analysis that resulted in the introduction of preventive services out-of-pocket cost coverage to the medical plan and benefit design changes for the non-union US employees
-Led the development of business continuity planning and strategy resulting in operationally dealing with SARs, anthrax, and a natural disaster (with plans in place for terrorism threats)with local plants and health authorities in affected areas
-Led a $5 million workers’ compensation and disability corporate cost reduction team as a part of the $125 million North American challenge
-Worked with a global team to restructure and reorganize the environmental, health, safety, industrial hygiene, ergonomics, security, and fire divisions with minimal operational impact.
-Was responsible for development and implementation of competency, certification, and training requirements for corporate and facility EHS personnel
-Devised metrics and communicated critical information including disability costs, audit recommendations, and cost justification to product line managers in the health and safety arena
-Senior executive responsible for formulation of corporate guidelines, policies, procedures, and contract management to assure legal compliance and standard processes as an expert resource to the facilities and clinics
General Electric –Power Systems (GEPS) 06/98– 01/00
Fortune 5 Conglomerate
Associate Medical Director GEPS Health Care Manager for NC/SC
Corporate management of the occupational medicine program and health care manager and sourcing responsible for the HMO POS product for over 22,000 GE eligible members and > $40 million budget
-Successfully re-bid regions devising an aggressive risk-reward contract in SC to address serious employee satisfaction critical to business planned moves, saving over $270,000 per year on administrative fees
-Served as a direct liaison to the insurers for the HMO-POS products to interpret the GE Plan, oversaw all account and functional aspects while representing GE employee issues
-Oversight of risk/reward targets which included HEDIS semi-annual goals
-Consultation, policy and procedure development, and auditing of the occupational medicine programfor GEPS facilities assuring OSHA, ADA, and other governmental compliance
-Project leader for the design and start up of the onsite fitness facility including equipment purchase and management contract and six sigma green belt certified with 3 projects completed resulting in cost savings of over $73,000 and OSHA record-keeping compliance
TheHughston Clinic, P.C.- Auburn, AL07/96– 06/98
Medical Director of Occupational Medicine
Responsible for startup, management, marketing, and practice of an occupational medicine clinic in Auburn, AL as a new venture in an orthopedic practice with 20+ orthopedic clinics
-Became profitable and acquired another existing practice within one year exceeding business plan expectations with over 250 employer clients
-Developed plans including budget, operational design, site location, and marketing analysis for additional expansion into Atlanta
Centerfor Business and Occupational Medicine01/95 – 06/96
Medical Director of Occupational Medicine- Columbus Regional Medical Center
Management of occupational health and safety services for an integrated hospital system including two hospitals, nursing homes, home health care, and multiple ambulatory care center activities with over 3000 employees and 300 outside business clients in Columbus, GA
-Associate Clinical Faculty for the Family Practice Residency Program
United States Air Force09/88– 12/92
Chief of Flight Medicine- (Captain)
Flight Medicine and Physical Standards and Evaluation section chief in charge of applying the regulations to determine fitness for dutyby performing periodic aero-medical and occupational examinations in accordance with Air Force directives and OSHA requirements for military and civilian workersout of Patrick AFB, FL
-Physician on board HH-3 helicopters for air-sea rescues and 38 space shuttle launch/landings
-Medical oversight of the Military Public Health (Safety) and Bio-environmental engineering (IH) functions for Patrick AFB, Cape Canaveral, and the Eastern Test Range
-Military awards and decorations included: Meritorious Service Medal, Air Medalfor a lifesaving air-sea rescue, Air Force Commendation Medals (2) for lifesaving air-sea rescues, and National Defense Service Medal- Military service during Desert Storm
- Company GradeOfficer of the Year – 1990 Hospital Squadron
EDUCATION
University of Oklahoma Health Sciences Center, Oklahoma City, OK
-Occupational Medicine Residency 01/1993-12/1994Chief Resident – 1994
-Occupational Physician Scholarship Fund Recipient- x2 years - 1 of 12 in US
-M.P.H.- Occupational Health/Industrial Hygiene1993- Distinguished Graduate
Spartanburg Regional Medical Center, Spartanburg, SC, Internship – 1987-1988
The Bowman Gray School of Medicine of Wake Forest University, Winston Salem, NC, M.D. – 1983- 1987
-Air Force Health Professionals Scholarship Program
-Bowman Gray Student Scholar (NIH- National Science Education Program to encourage research and academic medical career 6 students per class)
Erskine College - Due West, SC, BS -Summa Cum Laude1979-1983
CERTIFICATIONS
-Board Certified in Occupational and Environmental Medicine- American Board of Preventive Medicine- January 15, 1996
-Certified Physician Executive- Certifying Commission in Medical Management- Feb. 2015
PROFESSIONAL BOARDS, AFFILIATIONS ACTIVITIES
-Fellow- American College of Occupational and Environmental Medicine1993 – present
-House of Delegates- 2001-2004, Internal Affairs Committee 2001,
Business Development Committee2002
-Alliance for Integrated Medication Management- Chair2015– present
Board of Directors2012 – present
- Board of Pharmacy Specialties- Director- physician representative2016-
-NCMS-consultant2012 – 2014
Communications and Membership Advisory Committee2014 – present
- Health Care Industry Access Initiative- Advisory Board2015 – present
-Women Business Leaders in the US Healthcare Industry Foundation 2011 – present
-URAC- Pharmacy Advisory Group2012 – 2015
-Course Advisor / Guest Faculty to the Dept of Continuing Ed, Harvard University2007 – 2009
-National Business Group on Health
National committee work included: Employer Sponsored Health Benefit Redesign, EAP, and Pharmaceutical Affiliation 2004 – 2008
- US Chamber Benefits Committee member (representing GSK)2008 – 2010
ACTIVE STATE MEDICAL LICENSES
-South Carolina, Georgia, and North Carolina
PUBLICATIONS, RESEARCH GRANTS, AND SPEAKING ENGAGEMENTS
-Please see my most recent speakers bio for an extensive current listing
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