Paul Tomilo has extensive experience leading strategic initiatives and process improvement projects in healthcare. Some of his accomplishments include:
- Reducing cost per day variation among Kaiser hospitals through a benchmarking initiative, resulting in $13 million in savings.
- Improving diabetes management and reducing related hospital admissions through care pathway reviews and increased adherence.
- Enhancing specialty appointment access by analyzing schedules, appointment types, and backlogs to meet targets.
- Implementing new accounting systems and streamlining accounts payable and general ledger processes to reduce expenses.
This document provides an overview of monitoring and evaluation (M&E) processes at Room to Read. It discusses key M&E concepts like indicators, data collection, and the Global Solutions Database. It also outlines Room to Read's approach to M&E, including defining goals and objectives, collecting and analyzing global and country-specific indicators, ensuring data quality, and using M&E data to track progress and improve programs. Examples of indicators for different Room to Read programs like reading rooms and girls' education are also presented.
Participatory Monitoring and Evaluation background, concepts and principles, goals of PM&E, the PM&E process, stakeholder analysis, PM&E framework, plan, worksheet, a case study using PM&E
This document discusses the importance of results-based monitoring and evaluation (M&E) in government. It defines results-based M&E as regularly collecting data on performance indicators to see if projects are achieving their goals. Traditional M&E focuses only on implementation, while results-based M&E demonstrates whether goals are being met. The document provides examples of a results chain from inputs to long-term goals and explains why selecting outcome indicators is important for monitoring progress toward outcomes. Results-based M&E helps improve management, focus interventions, demonstrate successes, and ensure accountability by showing that programs are producing benefits.
The document is a presentation on making monitoring and evaluation (M&E) accessible to grassroots organizations. It discusses guiding principles for M&E with grassroots groups, including meeting them where they are and building their ability to do their own M&E. It explains the differences between monitoring, evaluation, outputs, outcomes and impact. Challenges to M&E for grassroots groups are addressed, and tips provided on collecting and analyzing data simply and involving the community. The goal is for groups to use M&E for learning and improving programs while not being overburdened by it.
Workshop: Monitoring, evaluation and impact assessmentWorldFish
The document introduces monitoring and evaluation in results-based management and discusses key concepts like logic models and theories of change. It provides 3 key points:
1) Results-based management focuses on achieving important organizational changes and improvements in performance through defining expected results, monitoring progress, reporting on performance, and learning lessons.
2) Logic models graphically illustrate program components and how activities lead to outputs, outcomes and impact. Theories of change explain the underlying assumptions and causal pathways of change.
3) Evaluations are used to assess what was implemented, the strength of causal models, intended outcomes, and ultimately the impacts of interventions. Different evaluation strategies are suited to simple, complicated and complex interventions.
The document discusses the governance structure of Head Start programs. It describes how Head Start programs are governed by a governing board, policy council, and staff. The governing board assumes legal and fiscal responsibility, the policy council assumes responsibility for program direction, and staff assume responsibility for day-to-day operations. It emphasizes the importance of these three groups working collaboratively and sharing information to effectively operate Head Start programs.
Self-Assessment of Organizational Capacity in Monitoring & EvaluationMEASURE Evaluation
Presentation that captures self-assessments of two teams of Ethiopian health officers (most of whom have M&E responsibilities): those from SNNP Regional Health Bureau and those from the Sidama Zonal Health Department.
Usaid tips 01 conducting a participatory evaluation-2011 05Fida Karim 🇵🇰
This document outlines the key aspects of conducting a participatory evaluation. It discusses that participatory evaluations involve stakeholders throughout the evaluation process, from planning to acting on results. The main characteristics are that they are focused on participant needs, include diverse views, and are a learning process. Rapid appraisal methods are used to gather empirical data. Facilitators guide participants, who conduct the evaluation themselves. The benefits are that participants are empowered to improve performance, while disadvantages can include perceived lack of objectivity. The steps outlined include deciding on participation level, scope of work, team planning, data collection, analysis, and creating an action plan.
Monitoring is the continuous collection of data and information on specified indicators to assess the implementation of a development intervention in relation to activity schedules and expenditure of allocated funds, and progress and achievements in relation to its intended outcome.
Evaluation is the periodic assessment of the design implementation, outcome, and impact of a development intervention. It should assess the relevance and achievement of the intended outcome, and implementation performance in terms of effectiveness and efficiency, and the nature, distribution, and sustainability of impact.
This document outlines a 3-day training on result-based monitoring and evaluation (M&E) taking place from January 24-26, 2012. The overall objectives are to build conceptual clarity around result-based M&E and improve participant skills in planning, monitoring, and reporting on programs. Specific outputs include increased knowledge of result-based management concepts and enhanced abilities to determine program results and develop appropriate indicators. The agenda covers topics such as basic M&E concepts, the logical framework approach, developing indicators, performance management frameworks, risk analysis, and result-based reporting and work planning. Sessions use presentations, exercises and discussions to equip participants with skills for participatory, results-focused M&E.
The document discusses monitoring and evaluation of education programs for sustainable development. It aims to identify learning processes aligned with ESD and their contributions. Key learning processes include collaboration, engaging stakeholders, and active participation. ESD learning refers to gaining knowledge as well as learning critical thinking and envisioning positive futures. However, data on ESD processes and outcomes is limited. The review recommends improved data collection focusing on experiences rather than literature. More evidence is still needed to fully understand ESD's contributions to sustainable development.
Monitoring and evaluation is a vital component that determines the effectiveness of a corporation's assistance by establishing clear links between past, present and future initiatives and results. The process helps in improving the programme performance and achieving desired results. It provides opportunities for fine-tuning, re-orientation and planning of the programme effectively, without which it becomes impossible to measure the success and impact of the programme even if the approach is right.
The document outlines the objectives, principles, content areas and task levels of the Division Monitoring and Evaluation framework. The key points are:
1. The objectives of the framework are to provide management information to improve education service delivery, implement projects and programs effectively, allocate resources appropriately, and assess organizational performance.
2. Principles of the framework include ensuring quality information, strengthening existing systems, achieving results efficiently, transparency, synergy between entities, and using M&E for continuous learning and accountability.
3. Content areas of focus for M&E in the division are delivery of education services, educational programs/projects, curriculum implementation, technical assistance, resources, and organizational effectiveness and support.
Monitoring and Evaluation of Health ServicesNayyar Kazmi
This document provides an overview of monitoring and evaluation (M&E) of health services. It discusses the key differences between monitoring and evaluation, and explains that M&E is important to assess whether health programs and services are achieving their goals and objectives. The document also outlines the main components and steps involved in conducting evaluations, including developing indicators, collecting and analyzing data, reporting findings, and implementing recommendations.
This document outlines a Monitoring and Evaluation Policy developed by Komal Zahra for HAADI. The policy aims to establish a results-focused and accountable approach to monitoring, evaluating and learning from HAADI's compact and threshold programs. It requires the development of detailed M&E plans for each program that identify indicators, data collection methods, evaluation questions and responsibilities. The M&E plans will be used to regularly monitor progress, evaluate impacts, and ensure accountability. The policy also establishes procedures for modifying, approving and reporting on M&E plans over time, as well as conducting data quality reviews and evaluations of the policy itself.
The document discusses results-based management (RBM) and the logical framework approach (LFA). It defines key RBM concepts like inputs, activities, outputs, outcomes, and impact. The LFA is presented as an RBM tool used for planning, implementation, monitoring, and evaluation of projects. Key steps of the LFA include stakeholder analysis, problem tree analysis, objectives tree analysis, and developing a logical framework matrix to link objectives with indicators and assumptions.
The document provides guidance for trainers on conducting a workshop to teach participatory monitoring and evaluation techniques to project staff, with the goal of enabling staff to help communities set up their own participatory monitoring and evaluation systems to assess project activities and impacts. It outlines pedagogical approaches, content, and logistical details to structure the training sessions, with a focus on practical implementation of participatory monitoring and evaluation at the local level.
This document summarizes a presentation about building sustainable accountability into strategic routine immunization (RI) planning in Nigeria. It discusses the development of an Accountability Framework for Routine Immunization in Nigeria (AFRIN) to improve goal-directed spending, performance monitoring, and consequences for missed targets. The framework maps the immunization system process and defines roles and responsibilities. It also discusses developing appropriate performance and output indicators, potential incentives and sanctions, the importance of monitoring, and new roles for communities and donors in accountability.
Monitoring and evaluation provide real-time information on project implementation and more in-depth assessments, respectively. Monitoring checks progress toward goals and identifies issues to inform adjustments, while evaluation assesses what worked and didn't work independently. Both are integral to program management. Effective monitoring and evaluation establish what will be monitored and evaluated, responsibilities, methods, resources, and timing of activities to validate the program's logic and encourage improvements.
This document discusses the evaluation of national health programmes, specifically focusing on the evaluation of India's Revised National Tuberculosis Control Programme (RNTCP). It begins by defining evaluation and describing its purposes and types. It then provides details about the RNTCP, including its history, structure, processes for monitoring and evaluation at various levels, and external funding sources. Key aspects of evaluating the RNTCP involve assessing performance indicators, conducting internal and external evaluations, and repeating surveys to measure disease prevalence and drug resistance over time.
Tonya Keightley is an experienced executive with a background in multi-project management, strategic planning, and change management. She has over 10 years of experience leading regional operations and launching new facilities for healthcare companies. Her expertise includes improving inefficient processes, building high-performing teams, and meeting strategic goals on time and under budget.
Deniz Akpece is a senior consultant with 18 years of experience in change management, program management, and operational strategy. She has expertise in leading large-scale transformation projects across industries. Her experience includes managing change initiatives at HSBC and leading organizational transformations at Vodafone Turkey and IBM. She has a track record of successfully executing strategic projects, improving processes, and meeting program goals across multinational organizations.
Danika Tynes has over 17 years of experience in program management, analytics, and management consulting. She specializes in driving large projects, introducing change initiatives, and collaborating with stakeholders. Her background includes strategy development, program delivery, process improvement, change management, and technology integration. Currently she is a Research Professor at Georgia Tech Research Institute, where she provides program support as the Systems Integrator for Georgia's Medicaid Management Information System transformation initiative.
The document discusses the role and key components of a Portfolio Management Office. It aims to:
1) Ensure alignment with national strategies through redesign of services, engagement with public/patients, and system partnership working.
2) Consolidate and expand its portfolio to respond to growing customer needs.
3) Provide key components like resource planning, status reporting, risk management, and finances forecasting to effectively manage projects and programs.
4) Establish standard processes, templates, and support for projects while facilitating recruitment, quality assurance, and knowledge sharing.
John Michael Finn has over 28 years of experience in clinical data management. He is currently the Global Head of Clinical Data Management Excellence at Hoffmann-La Roche, where he leads a department of 28 staff members and oversees clinical data management processes, training, and systems. Previously, he held director roles at Roche and Pfizer, as well as positions at PAREXEL International, where he managed large clinical data management teams.
The document is a resume for Michelle L. Base that outlines her professional experience as a senior management executive, including positions as CEO and VP of Operations for Hunter Health Clinic. As CEO, she turned the underperforming clinic around from a $1.2M loss to a profit of over $700k within 10 months by negotiating reduced vendor payments, increasing productivity and revenues, eliminating unnecessary expenses, and analyzing fees. As VP of Operations, she oversaw systems to improve patient access and led operational growth through expansion projects and a new call center.
Amy Halliday has over 15 years of experience in change management, project management, and strategic communications. She has a track record of increasing employee engagement through effective communication strategies and cultural initiatives. Her background includes managing change efforts, analyzing metrics, improving processes, and implementing organizational changes.
Pyramid Consulting International provides strategy, capability, and execution consulting services to help clients translate their strategy into successfully executed programs and projects. Their service lines include strategic alignment, resource management, portfolio optimization, financial performance, infrastructure development, process improvement, organizational change management, and project monitoring and control. They have helped clients realize benefits such as increased capital project throughput, cost savings, process efficiencies, and standardized project management processes. Representative case studies described include developing project lifecycle management processes, establishing a portfolio management office, conducting a capital project management assessment, performing a process compliance audit, facilitating strategic planning, prioritizing capital projects, and developing a risk management plan.
This document discusses using a benefits-driven approach to change management and service transformation in the NHS. It provides examples from demonstration projects that delivered benefits like reduced wait times, improved patient and staff experience, and cost savings. The key messages are that a benefits approach keeps stakeholders engaged, makes evaluation and reporting of progress easier, and helps change initiatives contribute to shared objectives over the long term.
Lane Hickey has over 25 years of experience in healthcare administration, finance, and operations. He holds a Master of Public Health degree and has held leadership roles at Kaiser Permanente, Dermpath Specialists, and Portland State University. Currently, he owns and operates Dermpath Specialists, a medical billing and pathology lab services company serving dermatologists and other providers.
Kimberly Nelson-Wright has over 15 years of experience managing operations for healthcare organizations. She has a proven track record of spearheading startups, managing budgets of up to $5 million, and overseeing teams of up to 69 professionals. Her areas of expertise include leadership, strategic planning, business development, fiscal management, and facilities operations. Currently, she is seeking a new opportunity to apply her skills leading and growing healthcare services.
Denise Shue has 15 years of experience leading complex projects in healthcare. She served as the Project Manager for an Epic Resolute implementation involving 2,800 providers across 6 hospitals. Under her leadership, the project was completed on time and within budget. She also centralized payment operations, implemented payment automation systems, and developed a custom follow up system to reduce accounts receivable days. Her experience includes process improvement, team leadership, data analysis, and system implementations.
Ola Lawson has over 15 years of experience in project management, performance monitoring, and transformation projects across various sectors including healthcare, banking, and local government. She has a strong background in Prince2 project methodology and the coordination of projects from initiation through completion on time and on budget. Her skills include financial and performance reporting, risk management, change management, and the use of software such as MS Project, Excel, and GIS tools.
Enisa Sheppard. resume 2015- professional profileenisa sheppard
The document provides a qualifications summary and resume for Enisa Sheppard, who has over 9 years of experience in healthcare finance management, including roles as a Finance Manager and Financial Analyst. Sheppard has a Masters in Economy and skills in areas such as financial analysis, budgeting, cost control, and continuous process improvement. The resume outlines her career progression, responsibilities, accomplishments, and education.
Stephanie Ward has over 20 years of experience in administrative, project management, and leadership roles. She has a track record of developing high-performing teams, improving processes, and achieving cost savings. Currently she is a Clerical Coordinator and Administrative Manager at Danbury Hospital, where she led staff, implemented new customer service standards, and oversaw a facility renovation.
Strategy Implementation for Institutional Services Department of PANELCO IIIJo Balucanag - Bitonio
Institutional Services Department: functions and responsibilities, organizational structure, KRAs, strategy implentation process, long term plan, medium term and short term, programs and projects
Larry J. Zimmel is an experienced healthcare executive seeking a Vice President of Operations position for physician practices. He has over 15 years of experience managing multi-specialty physician groups, developing strategic and operating plans, negotiating contracts, and improving operations. His background includes increasing revenue, transitioning compensation models to value-based systems, and implementing quality improvement initiatives.
This document provides a summary of Yren Berry's experience and qualifications. She has over 15 years of experience managing commercial and government contracting operations for major pharmaceutical companies. Her experience includes implementing contract management software upgrades, assessing pricing and market access capabilities, restructuring organizations for increased efficiency, and analyzing the financial impact of healthcare reform. She has a proven track record of successfully completing projects on time and under budget while addressing both business and IT requirements.
The document provides a summary of Dawn Marie Rady's skills and experience. It includes 3 paragraphs:
1) Her objective is to lead a large patient-centered service group and provide high quality care. She has skills in management, training, care management, and quality improvement.
2) She has a Bachelor's in Nursing and is licensed in Wisconsin. Her education includes a nursing degree from Marian College.
3) Her experience includes over 15 years in quality improvement and management roles for health insurance and hospital organizations, where she improved processes, oversight programs, and patient outcomes.
Robert Pettit has over 25 years of experience in revenue cycle management and leadership roles. He has a proven track record of reducing bad debt and driving cost savings and efficiencies. Some of his accomplishments include designing an interface that has generated $30 million in payments and collaborating on initiatives that reduced bad debt by over $7 million and $14.5 million. He currently serves as Vice President of Revenue Cycle Management, leading a diverse team to manage revenue for various medical groups.
1. Paul J. Tomilo, CPA...
22651 Brookdale St. • Farmington, MI 48336 • (202) 210-8409 • paul.tomilo@icloud.com
SUMMARY OF EXPERIENCE LEADING STRATEGIC INITIATIVES
Hospital Operations Improvement Project (HOIP)
Organization: Kaiser Foundation Health Plan
Role: Senior Healthcare Consultant
Overview
This strategic benchmarking initiative sought to reduce cost per day variation among the Kaiser hospitals in
northern and southern California. Cost per day information (by bed type) was shared with hospital
leadership so they could see how they compared to their peers and were charged with developing
action plans to improve cost per day performance.
Responsibilities
• Provided analytic support and staff leadership for the project
• Developed highly effective partnerships with local design teams and assisted in development of
operational plans
• Reviewed design plan documents submitted by local HOIP design teams for proper calculation of cost
savings initiatives and overall reasonableness of operational plan
• With Project Director and Analytic Lead, formulated policy decisions and approved changes to
methodology when appropriate
• Generated HOIP statistical reports to assist local and Divisional leadership in monitoring progress toward
meeting financial targets
• Developed executive level presentations for Divisional Steering Committee and Executive Sponsors
detailing status of current analytical issues
• Developed methodology to incorporate HOIP targets into service area budgets; created template to
reconcile local budget submissions to communicated targets
Outcome
Project was highly successful, resulting in an estimated $13 million in savings for the California Division.
Diabetes Care Management
Organization: The Permanente Medical Group
Role: Medical Office Controller
Overview
Working with clinical leadership, spearheaded strategic initiative to improve percentage of diabetic
population with controlled diabetes to reduce frequency of acute episodes requiring hospitalization.
Responsibilities
• Provided project leadership and analytic support for the initiative
• With Assistant Physician-in-Chief (APIC) and internal medicine service chief, led review of existing care
pathways to:
o Reduce care fragmentation and develop processes to create a single, coordinated continuum of
care for diabetic members
LEVERAGING EXPERTISE IN FINANCE AND
ACCOUNTING AS A STRATEGIC BUSINESS PARTNER
2. Paul J. Tomilo, CPA Page 2
o Identify key care “hand off” points and opportunities to improve communication between care
providers
o Develop strategies for increasing member adherence to foot care, eye screening and HgA1c testing
protocols
o Support increased self-management through enhanced diabetic outreach efforts
Outcome
The initiative was highly successful, resulting in a significant reduction in hospital admissions due to
complications from diabetes and improved member satisfaction.
Specialty Appointment Access
Organization: The Permanente Medical Group
Role: Project Manager
Overview
Partnered with Assistant Physician-in-Chief (APIC) to improve specialty appointment access as part of a
strategic initiative to achieve an initiated-to-seen interval of < 10 days for 80% of specialty appointments.
Responsibilities
• Served as project and analytic support for the initiative
• With APIC and department service chiefs, reviewed schedule profiles to assess:
o Available appointment types, consolidating, adding and deleting where necessary
o Appropriateness of appointment mix offered based on member demand, revising as necessary
o Underlying causes of fail-to-keep appointments and appointment backlogs, and develop strategies
to address
• Reviewed physician administrative time vs. time spent in clinic, adjusting administrative time allocations
for outliers
• Partnered with physician schedulers to modify individual schedules as warranted by analysis
Outcome
Efforts resulted in a substantial improvement in backlog levels and specialty access, with the majority of
specialty departments meeting or exceeding the 10-day initiated-to-seen target.
Phone Performance Initiative
Organization: The Permanente Medical Group
Role: Project Manager
Overview
Using Automated Call Distribution (ACD) software, collaborated with clinical department leaders to improve
appointment and advice phone performance. Initiative focused on analyzing current performance and
developing strategies to answer 90% of calls within 1 minute and achieve a call abandonment rate ≤5%,
Responsibilities
• Maintained ACD system and provided phone volume and performance statistics to department
leadership; monitored ongoing performance to identify areas for improvement
• For under-performing departments, partnered with department leadership to:
3. Paul J. Tomilo, CPA Page 3
o Review average speed to answer and transaction time statistics for appointment and advice lines to
determine root cause(s) underlying drivers of below target performance
o Compare current call volume to budgeted volume to assess adequacy of staffing levels; assisted
department managers in preparing justifications for additional staff, as needed
o Assess daily and weekly call patterns to ensure staffing levels are consistent based on anticipated
fluctuations in volume
o Review individual performance to identify opportunities for additional training and coaching
• Assisted departments in developing performance improvement plans for presentation to medical center
leadership
Outcome
Initiative resulted in significantly improved appointment and advice phone performance, as evidenced by
improved phone satisfaction scores as reflected on the Member Patient Survey tool.
General Ledger and Accounts Payable Implementation
Organization: Mid-Atlantic Permanente Medical Group
Role: Senior Director, Corporate Finance
Overview
Spearheaded the transformation of rudimentary, unsophisticated accounting processes into a state-of-the
art system through simultaneous implementation of PeopleSoft general ledger/accounts payable modules
and transition to a uniform chart of accounts. Project included transition of accounts payable processing
from our Health Plan partners.
Responsibilities
• Led the local implementation team during the year-long project and was responsible for overall project
management
• Responsible for project plan development and monitoring, as well as oversight of key project work
streams:
o Transaction history and chart of accounts conversion
o Report conversion and development
o Interface conversion and development
o Creation of new process workflows, controls and desktop procedures
o System security and data access
• With senior leadership, developed and executed communication and staff training plans
Outcome
Implementation was highly successful, with modules implemented on time and under budget. General
ledger implementation resulted in streamlined accounting processes, reducing monthly close timeline from 8
to 6 days. Implementation of accounts payable module and internalization of AP activities reduced average
expense report and direct invoice processing from 3 weeks to 1 week.
Budget Process Improvement
Organization: Mid-Atlantic Permanente Medical Group
Role: Senior Director, Corporate Finance
Overview
4. Paul J. Tomilo, CPA Page 4
With a change in leadership, implemented a more detailed budget process to help clinical leaders utilize a
“bottoms up” approach to building operating budgets and ensure alignment with overall organizational
strategy.
Responsibilities
• Led numerous training sessions on budget preparation and understanding monthly variance reporting to
assist clinical leadership in managing their departments
• Implemented a more detailed budget process which required budget owners to submit line item detail
regarding how budget amounts were derived and how budget linked to organizational strategy
• With my team, partnered with individual budget owners to act as thought partner and to assist in
documenting assumptions/calculations supporting budget amounts
Outcome
Both department and senior leadership positively received process change, with budget owners able to
develop budgets based on an understanding of operational drivers vs. applying high-level inflation factors
applied to historical spend patterns. New budget practices resulted in budget owners having a significantly
improved understanding of department budgets and a greater sense of ownership. With improved
understanding, clinical leaders were better prepared for COO budget review sessions, which were
significantly more productive. Efforts realized a 10% reduction in operational expenses.
Electronic Timesheet Implementation
Organization: Mid-Atlantic Permanente Medical Group
Role: Senior Director, Corporate Finance
Overview
Spearheaded the organization’s implementation of the PeopleSoft Timekeeping module to replace existing
manual paper processes.
Responsibilities
• Led the implementation team and was responsible for overall project management
• Drove project plan development and oversaw several key work streams including timekeeping policies,
process workflows, history conversion, reporting, and communication & training strategy
• Conducted system functionality demonstrations with key stakeholders to vet system and gather end user
requirements
• With project team and senior leadership, reviewed activity codes, consolidating and establishing
additional codes as needed
• Collaborated with executive leaders to revise physician pay practices and establish a new time off
benefit
• Oversaw user acceptance and parallel testing efforts
• Partnered with payroll vendor in the creation of automated data interfaces from physician scheduling
system to payroll, eliminating existing manual processes
Outcome
The project was very successful and resulted in enhanced efficiency and timeliness due to the elimination of
manual paper processes. Data quality was also significantly improved, leading to a substantial reduction in
the number of payroll errors. Improved efficiency allowed for a substantial reduction in the payroll processing
timeline from 8 to 4 days.
5. Paul J. Tomilo, CPA Page 5
Annual Rate Setting Process
Organization: Kaiser Foundation Health Plan / Mid-Atlantic Permanente Medical Group
Role: Manager, Operating Forecast and Planning / Senior Director, Corporate Finance
Overview
In early January, both the health plan and medical group would partner for the annual rate setting
process. Rate setting is the process by which Executive Leadership would determine the premium
increases that would be quoted to employer groups for the following year.
Responsibilities
• Led finance support for the process and was a key member of a multi-disciplinary team including
colleagues from marketing, membership and service area leadership
• Performed financial scenario modeling including expense assumption development, complex
revenue/expense modeling and financial strategy development
• Developed presentational materials to communicate results of scenario modeling; worked
collaboratively with process team members to develop joint recommendations for presentation to
Executive Leadership
Outcome
Efforts were ultimately successful, as they provided executive leadership with critical information needed to
make strategic rate decisions, in accordance with established timelines, to ensure long-term fiscal health.
6. Paul J. Tomilo, CPA Page 5
Annual Rate Setting Process
Organization: Kaiser Foundation Health Plan / Mid-Atlantic Permanente Medical Group
Role: Manager, Operating Forecast and Planning / Senior Director, Corporate Finance
Overview
In early January, both the health plan and medical group would partner for the annual rate setting
process. Rate setting is the process by which Executive Leadership would determine the premium
increases that would be quoted to employer groups for the following year.
Responsibilities
• Led finance support for the process and was a key member of a multi-disciplinary team including
colleagues from marketing, membership and service area leadership
• Performed financial scenario modeling including expense assumption development, complex
revenue/expense modeling and financial strategy development
• Developed presentational materials to communicate results of scenario modeling; worked
collaboratively with process team members to develop joint recommendations for presentation to
Executive Leadership
Outcome
Efforts were ultimately successful, as they provided executive leadership with critical information needed to
make strategic rate decisions, in accordance with established timelines, to ensure long-term fiscal health.