Mike Opich is a Senior Consultant at Gorman Health Group (GHG). In this role, he has assisted clients with Medicare Advantage (MA) and Special Needs Plan (SNP) network development and served as project manager on several engagements. Mike has expertise in hospital and integrated delivery system contracting, reimbursement methodology, rate setting, and adequacy analysis. He has also assisted clients with Accountable Care Organization (ACO) formation and application, as well as Medicare contract language compliance. Mike brings GHG clients over 20 years of experience in the healthcare industry.
Mike has held executive positions in provider network development, contract negotiation, and reimbursement systems development in Medicare, Medicaid, and Health Insurance Marketplace plans. He has extensive experience in contracting with individual hospitals, multi-hospital systems, and large integrated delivery systems, and has extensive expertise in facility reimbursement methodologies. His background combines his extensive experience in network management and operations with experience developing and supporting information technology solutions for payers and providers.
Mike has worked as a senior network development consultant for multiple health plan clients in markets across the United States. He focused on hospital and hospital system contracting and assisted clients with facility reimbursement strategies and methodologies. Mike also managed project teams and developed outreach tracking tools to facilitate status reporting and workload management.
Mike has worked with national clients developing commercial and Medicare ACOs. He completed applications and/or served as PM on five of the original 32 Medicare Pioneer ACO applicants selected and additional ACOs in subsequent application cycles. Mike has also assisted clients with The Center for Medicare & Medicaid Innovation (CMMI) Bundled Payment Initiative applications, providing all data analytics and financial analysis for the projects.
Mike has served as Chief Operating Officer of a large physician-hospital organization (PHO) in Scottsdale, Arizona. He was responsible for health plan contracting strategy, physician and hospital system reimbursement and incentive programs, claims operations, and all information technology. Mike has also held several executive positions at major health plans in the Southwest marketplace where he worked in Medicare and commercial network development, provider contracting, utilization and quality analysis, and Healthcare Effectiveness Data and Information Set® (HEDIS) and compliance reporting.
Mike worked for a leading healthcare software development firm responsible for developing and enhancing software to manage provider data, contract information, and administer Medicare and commercial reimbursement methodologies. He also directed the firm’s product support department, responsible for customer relationship management and identifying and resolving software anomalies.
Mike served as the Arizona regional president for a national physician billing and information technology company. His operations background and knowledge of Medicare and other reimbursement programs proved very effective in maximizing provider reimbursement while reducing administrative cost through streamlined operations. Mike also founded and ran his own physician billing company for several years. Mike founded and ran a document imaging company that employed proprietary technology and software to capture health care information from claim forms and automate data entry through scanning and optical character recognition.
Mike holds a Master’s degree from Michigan State University in econometrics and a master’s degree in Economics from the University of Detroit.