KellyAnn Laffey is a Senior Consultant of Network Development and Operations at Gorman Health Group (GHG). In her role, she is instrumental in developing provider networks for start-up health plans as well as expansion for existing plans. She has also been involved in projects for Centers for Medicare & Medicaid Services (CMS) Star Rating Assessments. KellyAnn brings GHG clients more than 20 years of experience in provider network development, contracting, business development,Medicare Advantage (MA) Star Ratings assessments, and healthcare marketing. She has extensive experience in the areas of provider contracting analyses and negotiation and provider reimbursement, including Medicare and Medicaid Request for Proposal (RFP) strategy development and implementation of provider networks.
Kelly created her own consulting company in 2004 and has been engaged in providing network development assistance to managed care organizations (MCOs). She has developed provider networks in several states across the U.S. with a focus on MA, Medicare Special Needs Plans (SNPs), Medicaid, and Medicaid Long-Term Care networks. Kelly has developed provider networks for established MCOs such as Fallon, Universal Health Care, Care N’ Care, and Care1st, as well as start-ups such as Meritus CO-OP, LifePrint (UnitedHealth Group), Bridgeway Health Solutions (Centene), Total Aging in Place, and DaVita’s Dual Eligible Special Needs Plan for end-stage renal disease patients. She has been instrumental in the success of several major health plans being awarded contracts to operate provider networks across the country.
Additionally, Kelly assists physicians and ancillary providers with managed care contract negotiations and strategy. She has negotiated contract language and rates for all products including commercial, Medicare, Medicaid, and workers’ compensation plans. She represents a variety of provider specialties including urgent care, emergency room physicians, outpatient surgery centers, outpatient behavioral health programs, gastroenterologists, skilled nursing facilities, urologists, sleep centers, outpatient rehabilitation, and orthopedic surgeons, to name a few. She is well-versed in dealing with complex data, billing, and governmental issues related to managed care.
Kelly has also assisted MA plans with preparations in the network area for the 5 Star Quality Rating System known as “Stars.” Kelly has been instrumental with assessing the performance of the network department and their influence in each of the 50 measures to alert the plan to necessary changes for achieving the highest Star Ratings and bonus payout.
Prior to consulting, Kelly served as Region Market Development Manager for a national provider of outpatient diagnostic medical imaging services (Comprehensive Medical Imaging) and as Director of Sales and Business Development for NovaCare Outpatient Rehabilitation. Her responsibilities included managed care contracting and strategy, business development, marketing, and sales. A significant portion of her time was dedicated to network development and identification of opportunities for growth through strategic alliances with providers and employers.
Kelly has also held positions with MCOs such as BlueCross BlueShield of Arizona where she was responsible for network development and provider relations. She negotiated managed care contracts on behalf of payers to maximize the financial impact of the arrangement and to incorporate language which would be beneficial for the MCO during contract negotiations. Additionally, she held a position as Network Development Consultant for a large hospital system. Her responsibilities included development of a statewide alternative/complimentary medicine provider network and the development of contract and credentialing guidelines.
Kelly holds a Master’s Degree in Business Administration from the W.P. Carey School of Business and a Bachelor of Arts Degree in Communications from Arizona State University.