OUR STAFF
Kenneth J. Mayes, CPA
Kenneth J. Mayes, CPA/MBA, is an experienced health care executive with over twenty five years of industry experience covering a broad array of health care initiatives. He has served in a senior executive capacity in managed care organizations over the last twenty years. His areas of expertise include: Finance, Operations, Information Systems and Medical Management Initiatives. Ken has played a key role in 7 successful turnarounds, served as President of three MCO’s, initiated medical cost initiatives, achieved significant cash and investment management successes and participated in several innovative medical management programs including congestive heart failure and diabetes.
He joined Morgan Healthcare Audits earlier this year.
At the conclusion of this assignment, Ken joined TMG Health – a Business Processing Outsourcing company in the Medicare field.
After the sale of Fidelity Insurance Group to United HealthCare, Ken was recruited by the Chairman of XL Health to assist in building their Medicare Advantage Special Needs Plan for the Chronically Ill. He was instrumental in the development of their risk bearing HMO anchor plan and securing its licensure approval. This SNP has become one of the most successful and fastest growing plans in the country.
Ken joined Fidelity Insurance Group in October, 2002 as CFO. Later that year he was promoted to President and achieved a $10 million profit improvement over a two year period. He played a key role in the successful turnaround at Fidelity by introducing new cost savings initiatives, implementing medical cost reductions, establishing a strong financial discipline, building a disease management program for an employer with 30,000 lives, emphasizing the expansion of low risk revenue sources and improving the group retention rate to over 97%. His initiatives included the establishing the Company’s first P&T Committee, developing its customized formulary. He was able to Change PBMs in less than sixty days after detecting multiple cost overcharges that were confirmed by outside audit firm – Morgan Healthcare Audits. The well organized conversion plan led to a seamless transition with no customer fallout and a 15% savings from the major pharmacy cost saving initiatives.
Prior to joining Fidelity, Ken directed his own turnaround/ interim management healthcare firm for over six years. His key assignments involved directing the successful turnaround of an HMO in Maryland, the first HMO to successfully emerge from bankruptcy and pay its providers and creditors 100% of their prepetition liabilities plus interest. Ken also served as interim President at Doctors Health Plan where he implemented an innovative strategic plan that jumped annualized sales revenue from $13 million to over $40 million in less than one year, resulting in a competitive offer of $24 million – an increase in valuation of 300%. Ken determined that the actuary had under priced the pharmacy rider by more than 50%. He designed and filed new riders increasing the available pharmacy plan options, recovering greater cost through higher co-pays and providing incentives for formulary products. Other significant assignments have included business development activities for medical software companies, disease management, predictive modeling and medical device firms.
Ken served as the Vice President of Finance for Keystone Health Plan East for over five years. He played a lead role in building this HMO into the fastest growing one in the country. He served as a key leader in developing the M+C Medicare program, which has grown into one of the five largest in the country. Dun & Bradstreet recognized Keystone as the best in class for Receivable Management due in large part to his innovative programs. Ken also played a lead role in the development of its maternity wellness program -Baby Blue Prints and the Neonatal Care program, both of which received national recognition. Ken was selected by the Chief Medical Officer to develop the company’s first formulary program and develop its P&T Committee.
Prior to its acquisition by Keystone, Ken served as President of Vista Health Care where he led a very successful two-year turnaround. He established their first PBM relationship and developed its first pharmacy committee. Ken also served as the Corporate Controller & Director of Systems for John Hancock Health Plans where he played a key role in the turnaround of its Georgia subsidiary AmeriHealth HMO – a 120,000 member plan. He also served as the Vice President of Finance & Operations for Greater Atlantic Health Plan, a former subsidiary of John Hancock Health Plans, and played a lead role in its successful turnaround from a $6 million loss to a profit in one year.
Ken also achieved several significant turnarounds during his fifteen year manufacturing career which included several health care companies. He interfaced with operating management in developing a strategic plan for the second largest subsidiary of a Fortune 500 company resulting in its return to profitability and the completion and successful integration of three acquisitions. He was recognized by the Executive Vice President of a Fortune 500 company as Employee of the Year and awarded a special bonus for his outstanding performance in the successful turnaround of a $40 million manufacturing division.
Ken received his Masters degree in Business Administration from Kent State University and his Bachelor of Arts degree from Baldwin-Wallace College. He is a member of the American Institute of CPA’s.
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