Senior Director, Provider Strategies
Elena Martin is Senior Director of Provider Strategies at Gorman Health Group (GHG). In this role, she has acted as Project Manager for numerous network expansion projects on a national level and has been a key consultant in Accountable Care Organization (ACO) and End-Stage Renal Disease Seamless Care Organizations (ESCO) application and development. Elena brings GHG clients more than 20 years of experience as a healthcare executive with a strong focus in all aspects of project management, sales, contracts and provider network development. In addition, she has extensive experience in hospital and physician contracting, governance and implementation, marketing, customer service training programs and human resources. Elena has worked for and held management positions for leading emergency medicine management companies and commercial, Medicare, and Medicaid health plans.
Elena has worked with national clients conducting audits and preparing integrated delivery systems, hospital systems, Independent Practice Associations (IPAs), and medical groups in assembling commercial and Medicare Pioneer ACOs. Of the original 32 Pioneer ACOs, Elena worked on applications for five of the applicants selected. In addition, she completed applications for clients applying for all subsequent Medicare Shared Savings Program (MSSP) submission dates. Concurrently, she has worked on the Center for Medicare & Medicaid Innovation (CMMI) Bundled Payment Initiative and the Centers for Medicare & Medicaid Services (CMS) Initiative for ESCO providing expertise in project management, application processes, governance, compliance, and care coordination.
As a consultant and then Human Resources Director, Elena assisted in writing a grant to re-open a closed community hospital and developed the human resources infrastructure. She has also worked with clients applying for the Healthcare Innovation Grants Round 2.
While working with two emergency physician management companies, Elena oversaw the contracting, recruitment and retention, credentialing, and staffing for over 22 hospitals in three states. She was also responsible for physician payroll for the southeast region, including budgeting and bonus dollar management.
As a provider network manager for a regional health plan offering commercial and Medicare plans, she was responsible for managing a territory with 45,000 member lives and over 1,000 providers including, hospitals, skilled nursing facilities, physicians and ancillary providers. In this role, she was also responsible for ensuring National Committee for Quality Assurance (NCQA) and governmental compliance for the provider network region. Elena’s expertise includes managed care contracting on behalf of providers, including tertiary care hospitals, ancillary providers, Physician-Hospital Organizations (PHOs), and universities. Additionally, consulting with the solo and group practice, established and start up physician organizations, provider networks, third-party administrators, healthcare facilities, and employers’ access, as well as expertise to navigate through their managed care contracting, credentialing, and reimbursement issues.
Elena has worked extensively as a consultant for health plans in the expansion and start-up phases – from the initial application for a Certificate of Authority to state-level requests for proposals, to building an adequate provider network and going live with the plan and membership. She has developed and managed networks in Alabama, Arizona, Pennsylvania, West Virginia, Ohio, Georgia, South Carolina, Massachusetts, Kentucky, Virginia. Further, she has extensive network development in Texas with a focus on the following markets, El Paso, Houston, Dallas/Fort Worth and San Antonio. She has consistently provided excellent results for clients in all network development projects.
Elena was admitted to the Women Business Leaders of the U.S. Healthcare Foundation and chaired the 2013 Congress on ACOs. She holds a dual BS Degree in Government/Public Service and a concentration in Personnel Management.