B.I.G. Consultants

Pamela M. Waymack, CHFP, MBA, BA
B.I.G. Senior Consultant and Project Manager

Ms. Waymack has more than twenty years of experience in managed care strategy and operations development in health plans, hospitals, medical groups, MSOs, and IPAs. She has held senior management positions at Chicago's Children's Memorial Hospital, Northwestern Memorial Hospital, University of Maryland Medical System, and the Johns Hopkins Hospital. In 1980, she co-authored the Illinois Hospital Association's "Sourcebook on Health Maintenance Organizations."

Among other achievements, she has:

• evaluated information systems and options to support capitation, case management, group practice management, and credentialing to meet requirements of both commercial and Medicaid managed care;
• identified and evaluated outsourcing and joint venture arrangements, such as MSOs and data centers, to provide a variety of administrative services under capitation;
• selected technological tools and software to improve the cost-effectiveness of administrative operations under capitation;
• utilized her leadership and consensus building skills in her role as chief strategist for health plan and hospital-physician organizations.
• assessed and redesigned operations at HMOs, PHOs, IPAs, and MSOs to improve these organizations' efficiency and accuracy of claims processing and to help them use their selected information systems more effectively to meet industry benchmarks and requirements of regulators;
• audited managed care contracts to ensure proper payment by health plans;
• advised a Fortune 500 company regarding development of an electronic product that would permit providers and payers to exchange data.

Ms. Waymack is certified as a Managed Care Professional by the Health Care Financial Management Association (HFMA). Her other professional memberships include the Health Care Information and Management Systems Society, the American Association of Health Plans, HFMA, and the Chicago Health Executive Forum. She frequently is invited to speak on issues related to managed care information systems and operations. She received her B.A. degree from the College of William and Mary and her MBA from the University of Chicago.

HIPAA Specific Experience

For a major Medicaid and children's insurance health plan, Ms. Waymack led the EDI component of the overall HIPAA Readiness Assessment. In addition, she participated in the development of the interview tools and documentation methodology developed for health plan readiness assessment. Ms Waymack diagrammed the current EDI and paper information flow status of the health plan's multiple trading partners, led the construction of the creation of a budget for EDI implementation, and developed the metrics by which the client can evaluate clearinghouse capabilities. The EDI analysis included HIPAA readiness for code sets and identifiers. She also participated in the privacy and security readiness assessment components of this project. She was the principal writer of the final report detailing the findings, recommendations, and documentation of HIPAA Readiness/Gap Analysis.

Ms. Waymack, in collaboration with a large regional telecommunications vendor, facilitated the development of a model HIPAA Project Plan for use by payers, health plans, and vendors. The model HIPAA Implementation Plan includes eight phases to implementation with detailed tasks addressing transactions, identifiers, security, privacy, and education.

Ms. Waymack has developed a customized client specific HIPAA Project Plan for a multi-state health plan. The health plan has Medicare Supplemental, Medicare private fee-for-service, and TPA operations. Working with the health plan's Senior Executives, the HIPAA Project Plan from 2001 to 2003 was developed with task level detail and time frames.

She wrote the article, "HIPAA: The Good, the Bad and the Ugly" with Steve Lazarus that appeared in Tips on Managed Care published in May/June, 2001. The article focuses on the business implications of the eligibility transaction to risk organizations.

Ms. Waymack has had extensive experience in workflow and work process improvement based on the utilization of advanced information systems in managed care in the provider and payer settings. She has helped clients plan and select systems that can support eligibility verification at the point of pre-registration, management of payer identifiers, registration and billing processes, utilization of Master Person Index software to cross-reference individual records in an enterprise, and electronic claims processing and remittance acceptance. She has contributed to the development of policies and procedures in health care organizations to accommodate changes in regulatory mandates that result in new product needs and systems requirements.

Click here to access Phoenix Services Web site.