Our Team

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Dr. William Stinson is a consultant and the president of Incentive Medical LLC which provides custom solutions to healthcare providers leveraging Information Technology to increase access to quality health care for communities at risk. He is a retired Vitreo Retinal Surgeon having served the public trust with distinction as a practicing physician, surgeon, and medical educator for 3 decades in Massachusetts, Florida, and New Hampshire. Dr. Stinson is a skilled entrepreneur and administrator both inside large hospital organizations; as a Principal Investigator for a NIH-SBTT Grant at Massachusetts Eye & Ear Infirmary/Harvard Medical School, as the Founding Director of the Eye Center at the Hunt Center (now a Beth Isreal Lahey Health System (BILH) subsidiary), and in the start up companies; William G. Stinson MD, Essex Vitreo Retinal Services Inc. (now, too, a BILH subsidiary), Total Med Discount Plan LLC, and Incentive Medical LLC. Dr. Stinson has implemented medical informatics as an early adopter of an on-prem EHR at Essex Vitreo Retinal Services Inc., and as a former consultant to the Nextgen EHR Ophthalmology module, the Northeast PHO and New England Ophthalmologic Society Committee on Electronic Medical Record standards and practices.  

Rusty D. Pickens is the Co-founder of Inaji Industries, former Senior Advisor for Digital Platforms at the U.S. Department of State, and former Acting Director for New Media Technologies at the White House, where he led teams who operated cloud platforms for the Obama Administration to increase public engagement, improve user experience, enhance staff productivity, and heighten security posture. During this time, Rusty created new systems for and built new teams to lead Whitehouse.gov, the White House email outreach services, the Presidential correspondence system, the We The People petitions system, the White House Appointment Center, and the U.S. Embassy contact management systems.

Rusty’s two decades of leadership experience aligning organizational vision with technology strategy across top federal agencies and start-up environments included the Federal Salesforce Community of Excellence, the U.S. Small Business Administration, the 2009 Presidential Inaugural Committee, Obama for America 2008, and the Chickasaw Nation of Oklahoma. He currently advises clients on unlocking the potential of cloud computing and agile software delivery to vastly improve their digital presence and citizen experience.

At Incentive Medical Consulting, we specialize in helping businesses transform their operations and achieve their goals. Our team of experienced consultants provides a range of services, including strategic planning, financial management, and marketing analysis. We work closely with our clients to identify areas for improvement and develop customized solutions that drive real results. Whether you're looking to improve efficiency, expand your customer base, or increase profitability, we have the expertise and experience to help you get there.

WORK EXPERIENCE  

April 2010 – Present INDEPENDENT HEALTHCARE CONSULTANT                                

Projects Include:    

 1) Accountable Care Organization (ACO) consulting and oversight management.  Also claims oversight and analysis for Next Generation ACO.     

2) Grady Hospital, Atlanta, GA…Feasibility study to determine needs to become an ACO and identify resolutions for concerns on a newly installed EHR.     

3) Build a Third Party Administrator in Miami to prepare for Florida Medicaid reform.     

 4) Participated in ACO feasibility study for doctor group in Knoxville, TN.    

 5) Operational audit for Metropolitan Jewish Health Systems in Brooklyn.     

6) Assisted and partnered in the origination of a licensed Discount Health Plan in Florida.    

June 2008 – March 2010 AMERICHOICE HEALTH PLAN (subsidiary of United Health Care) (Unison purchased by AmeriChoice on 5/31/08) Pittsburgh, PA office 2.8 million Members –Medicaid/Medicare HMO  Position:  Senior VP Operations (as of 1/1/09)  

Responsibilities: Claims Administration, Customer Service, Enrollment Processing and Health Plan Operations.  Direct and indirect oversight of approximately 1600 employees.  

Some Accomplishments:    

 • Worked with Legal to originate a compliance parameter grid for all products in 20 states for Call Center, Claims Administration and Enrollment.     

• Moved toward centralizing operational activities.     

• Developed management tool to minimize staff needed for processing.    

 • Initiated Mississippi Chip product without regulatory concerns.     

• Increased auto adjudication rate by 2%.    

 • Decreased annualized interest payment.  Decreased staffing in Call Center by 14% in 2009 while meeting all regulatory requirements.  January  2001 – May 2008 UNISON HEALTH PLAN (aka Three Rivers Health Plan) Pittsburgh, PA 400,000 Members – Medicaid/Medicare HMO  Position:  Senior VP Operations  Responsibilities: Direct reports included Claims Administration, Document Imaging, Customer Service, Enrollment, IT and Health Plan Operations.  Approximately 450 employees.  Some Accomplishments:    

 • Prepared HMO operationally for product expansion.  Added 10 products in 6 states.  Also added Medicare Advantage on 1/1/06.  Joined the HMO with 120,000 members.     

• Operationalized HIPAA transactions and code sets in 2003.    

 • Operationalized flows to initiate national NPI process.    

 • Initiated pharmacy COB process that increased COB recovery to 3% to 4% of premium, depending upon product.    

 • Input NCCI edits into processing system for all products saving approximately $3 million annually.    

 • Initiated EDI for claims in 2001 in NSF.  

April 2000 – November 2000 THE WELLNESS PLAN OF NORTH CAROLINA Charlotte, North Carolina 85,000 Members – HMO, POS, Medicaid  Position:  Independent Consultant  Responsibilities: 

Contract included but not limited to the restructure of the Claims department, the development of EDI, meaningful management reports, reduction of turnaround time and installation of nationally accepted cost containment methods.  

Accomplishments:     

• Coordinated the installation of EDI for both facility and professional claims.     

• Restructured Claims department workflow for the purpose of reducing turnaround time from two months to one week with 40% less staff.    

 • Developed claims reporting package to determine trends in workflow.    

 • Initiated system enhancements that saved the plan approximately $4 million in liability annually.     • Initiated claim flows/programs that saved approximately $2 million in liability annually.    

 • Developed work measurement program and enhanced quality program within Claims department and initiated related management reports.  

1997 – 2000 NEIGHBORHOOD HEALTH PARTNERSHIP Miami, Florida 145,000 Members – HMO, POS, EPO, Indemnity Carrier for Commercial Group, Medical and Medicaid  Position:  Vice President – Administration  

Responsibilities: Direct reports included Member Services, Enrollment, Account Services, Claims Administration and the Grievance Department.  180 Employees  

Accomplishments:    

 • Account Services – New telephone routing system, work flows and procedures implemented for the purpose of increasing service levels to commercial groups.     

• Claims – Implemented productivity and quality programs, distributed processing guidelines for Medicare, Medicaid and Commercial products, increased training levels, decreased turnaround time.  The result:  a product within regulatory compliance and recoveries of overpaid claims of amounts in excess of $1 million.  Installation of unbundling software (HPR Code Review).    

 • Member Services – Productivity and quality programs initiated, increased quality of calls through increased training, increased customer satisfaction ratio, and initiated an automated telephone response system that decreased calls to Member Services by up to 55%.    

 • Enrollment – Productivity and quality programs initiated, workflows generated to bring department within regulatory compliance.  

1996 – 1997 PRINCIPAL HEALTH CARE OF FLORIDA, INC. (Tampa Division) 80,000 Members – HMO, POS, PPO, Indemnity Carrier for Commercial Groups  Position:  Regional Manager  Responsibilities: 

Responsible for regional profit and loss. Direct reports included Finance, Marketing, Enrollment, Utilization Management, Network Development, Provider Relations, Claims Administration, Underwriting and Customer Service.  50 Employees  

Accomplishments:    

 • Increased plan profitability by approximately 12% through provider recontracting, development of consistent claims operation, initiating delinquency procedures to reduce bad debt and creating multi-functional task force to address utilization management process improvement.    

 • Participated in corporate operational task force for the purpose of assisting other regions in the localization of workflow.  

1991 – 1996 PHYSICIAN CORPORATION OF AMERICA, INC. Miami, Florida 360,000 Members – HMO, POS, PPO, Indemnity Carrier for Commercial Group and Individual Medicare and Medicaid  Position:  Vice President – Claims Administration  

Accomplishments:    

 • MSO Operations – Responsible for all operational PCA MSO transitions and maintenance of all relative inter and intradepartmental activities thereafter.    

 • Built workflow to maximize efficiency and service within the Claims Department and Provider File Maintenance.     

• Created an Audit and Training area, which maintained a quality claims product and fulfilled departmental and corporate claims training needs.    

 • Consistently exceeded regulatory claims turnaround requirements throughout a membership growth from 60,000 to 360,000 members.     

• Initiated cost containment methods that realized a $9 million annualized savings to medical expenses.    

 • Coordinated statewide electronic claims transfer project.     

• Oversight of procedural initiation and maintenance for all lines of business as they related to claims processing, provider file, vendor file, provider pricing and benefit maintenance.     

• Maximized automation for new product initiation (PPO and POS).    

 • Completed due diligence process and integrated staffing and workflow resulting from three acquisitions.     

• 140 employees 

 1989 – 1991 LIFE GENERAL SECURITY INSURANCE COMPANY Miami, Florida Commercial Indemnity/PPO Carrier – 40,000 Insureds  Position:  Director – Claims Administration  Accomplishments:     

• Directed inter and intradepartmental workflow as it related to the ultimate processing of claims.     • Developed cost savings criteria within the Internal Audit Department that related to an annualized savings in excess of $1,000,000.     

• Analyzed software and prepared department for fully integrated automation.     

• Originated the administration of a new PPO product manually with subsequent automation.    

 • Initiated changes that controlled the flow of work throughout the claims area to maximize efficiency.     

• Directed 40 employees.  

1987 – 1989 COMPREHENSIVE AMERICAN CARE, INC. Miami, Florida IPA/Staff Model HMO – 60,000 Members  Position:  Vice President - Administration  

Accomplishments:    

 • Coordinated all internal workflow including file criteria origination, claims procedure documentation and interdepartmental training relative to a total software conversion.     

• Redirected all mail flow to meet corporate needs and maximize cost savings.    

 • Generated savings in excess of $750,000 in annualized costs through recontracting of trades vendors.    

 • Coordinated the origination of Corporate Personnel policies, benefit package, salary and training programs.     

• Managed all internal operations as they related to Claims Processing, Data Entry, Membership, Human Resources and Administration Services.  

1985 – 1987 CAPITAL DISTRICT PHYSICIANS HEALTH PLAN, INC. Albany, New York IPA Model HMO – 53,000 Members  Position:  Director of Internal Operations 

Accomplishments:     

• Directed, organized and provided analysis of total system transition as it related to enrollment, group billing reconciliation and claims processing criteria.     

• Integrated interdepartmental workflow, policies and procedures, etc. for Claims, Member Services, Provider Relations and Mail Services.     

• Analysis and maintenance of provider fee schedule.     

• Developed staffing analysis and prepared claims operations for quadrupled enrollment within a three month time span.     

• Analyzed and initiated telephone systems, development of communications statistics, etc.    

• Reduced administrative cost and automated mail and microfilm services.     

• Directed 20 employees 

 EDUCATION:  

Siena College, Loudonville, New York  Bachelor of Science  Major – Mathematics Minor – Education and English’    

REFERENCES AVAILABLE UPON REQUEST