TOM MIKUCKIS

Tom is a Partner in Oliver Wyman’s Health & Life Sciences practice, based in Boston. He works on issues of strategy, growth, and transformation for healthcare clients, with a particular focus on health plan and provider value-based healthcare strategy and commercialization.

Relevant Experience

For a national health insurer, led the comprehensive redesign and implementation of an enterprise medical cost management strategy, including establishing a redesign cross-functional operating model and better optimizing cost, setting $100M+ capability investment
priorities, and improving ROI across previously siloed functions.

For a regional health insurer, led a comprehensive value and operational cost assessment of member and provider clinical programs, developing and supporting execution of recommendations for optimizing ROI and achieving multi-million dollar admin cost improvements.

For multiple insurers, built care delivery and network innovation strategies, including defining role of digital and virtual care innovation, determining significant M&A decisions, and aligning C-suite and board leadership on entering care delivery and care delivery enablement spaces more directly.

For a Blues plan, led the development and contracting of a series of innovative networks and products for commercial exchange and group market, including overall network and product design, developing financial case and value proposition for providers to participate, and facilitating extensive partnership discussions and negotiations between the plan and providers.

For multiple insurers, led the development of next-generation product innovation strategies, including bringing to market product with alternative network and experience components,
incorporating digital and tech disruptor innovations.

For a Blues plan, led the development of a comprehensive assessment, redesign, and deployment of provider value-based incentive and payment programs across commercial and Medicare lines of business, including external benchmarking and facilitation of provider discussions to optimize near-term program impact on key quality and cost performance outcomes.

For a national hospital system and a health insurer, led the development and negotiation of a joint venture to serve the Medicare Advantage market, launching a number of differentiated value-based product offerings.

For a Blues plan, led the development of a comprehensive healthcare reform strategy for the individual and small group business segments, supported by the development detailed actuarial modeling of market outlook and reform impact and a rigorous assessment of client capabilities.