Patrick Coulson

Patrick Coulson

SVP, Business Development, Integra Service Connect

Patrick Coulson is a successful healthcare executive with more than 20 years’ experience leading healthcare sales with expertise in Medicare Advantage, risk adjustment and member engagement. He brings a proven success record in hyper-growth organizations, doubling revenue year after year for multiple years. Patrick’s sales and management experience includes health insurance, disease management, and provider industries. He is particularly adept at early stage companies, C-level new business sales, new product launches, sale force recruitment and training.

Patrick’s healthcare career is focused around Medicare and Medicaid. His career began with skilled nursing facilities and home health agencies. Early on in his career he started a new home health agency in Phoenix, AZ. As the healthcare industry adopted disease management, Patrick began managing sales for disease management programs including diabetes, end-stage renal disease and coronary artery disease. Patrick had the opportunity to help start and manage one of the first Medicare Advantage Chronic Special Needs plans. After the Special Needs Plan, Patrick began managing sales in the HCC risk adjustment revenue industry for Medicare Advantage plans as well medical cost containment programs for Medicare Advantage, Medicaid, and commercial health plans.

His Medicare Advantage, provider, and vendor experience provides a greater understanding of what health plans do well and where vendor partnerships can result in greater success for the health plan and its members.


Tags: Patrick Coulson, Integra Service Connect, Board

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LA Care CEO Statement on the Graham-Cassidy Health Care Bill

L.A. Care is strongly opposed to the Graham-Cassidy health care bill, which is worse for L.A. Care members – and all of California – than the Repeal and Replace bill passed by the House in May and the bill that was defeated in the Senate in August. What is it?* The Graham-Cassidy bill is a last ditch effort by several Republican Senators that lumps Medicaid and the subsidies for the Exchange into block grants in 2020, leaving it to the states to decide how to allocate funding between Medicaid and the Exchange. It moves the funding formula for the block grants to a method that penalizes the states that expanded Medicaid, like California. Due to these changes, the Medicaid expansion population would be essentially eliminated by 2027. It also eliminates the mandate for individuals to have health insurance – a move that could destabilize the Exchange. This bill will fundamentally alter the federal/state partnership that has been in place since Medicaid’s inception since 1965. These changes will not only impact those who gained coverage through Medicaid expansion under the Affordable Care Act (ACA), but also for mothers, children, developmentally disabled and elderly in nursing homes – all who have limited incomes. According to a recent Avelere study, California would be the hardest hit under this proposal, with a reduction in federal funding between $50 billion to $78 billion by 2027....
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MACRA Mini Series Overview: Part 1 of 4

Spurred by the passage of the Patient Protection and Affordable Care Act (ACA) in 2010, the healthcare industry is in the midst of an unprecedented transformation. The ACA was passed in an effort to increase access to health insurance and healthcare, while simultaneously improving the quality of healthcare and slowing the growth of healthcare costs.i President Donald Trump has made continued healthcare reform an immediate focus of his presidency, leaving the future of the ACA uncertain. While the future of the law is unknown, it is unlikely the pace of healthcare transformation will slow because reform efforts like the Medicare Access and CHIP Reauthorization Act (MACRA) are expected to move forward as planned.ii MACRA represents the most sweeping change to physician payment for Medicare services in over two decades. With Medicare accounting for $618.7 billion, or 20 percent of national health expenditures, MACRA is guaranteed to have a substantial and immediate impact on both hospitals and physicians.iii In reacting to the implementation of MACRA’s Quality Payment Program (QPP), physicians will need to examine their existing organizational structure, evaluating their relationships with hospital partners. This five part article series examines how MACRA functions as a driving force for the evolving hospital-physician relationship. Part 1 provides an overview of the legislation and Part 2 explores the strategic implications of the legislation, while Part 3 looks at what the legislation may mean for hospital-physician alignment. Part 4 examines the legislation’s financial implications and Part 5 will wrap things up, providing you with some next steps for your organization. ...
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The Risk Adjustment Forum: Operational Integration and Compliance 

This is your can't-miss opportunity to gain proven strategies for enhancing the compliance of your coding and risk adjustment data. You also will get unparalleled insight and tools to help streamline the integration of risk adjustment and quality initiatives, and take away critical lessons learned from plans breaking down operational silos. You will also hear directly from CMS! 

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Walking the Line: Balancing Claims, Premiums, and Compliance for Medicare Advantage Plans

Medicare Advantage plans walk a tight line when paying claims, managing premiums, and monitoring compliance demands. On one hand, they must ensure they receive the right premiums from CMS and pay claims correctly to cover the cost of care for their membership. On the other hand, CMS needs to ensure plans spend premiums responsibly in accordance with regulations. Medicare Advantage Plans must carefully consider the intertwining dependencies within their plans and with CMS, which can impact their ability to maximize the bottom line while managing compliance.

 

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