About

John Murphy, M.B.A – Principal

Using analytics, change management, and creativity; John has worked on some of the most challenging issues in the business of health care. His 20+ years of experience includes roles as Board Member of a community health center, Consultant and Analyst at the National Perinatal Information Center, advisor on Tufts Health Plan’s transplant credentialing committee, and Director of Contract Settlement & Analysis at Blue Cross Blue Shield of Massachusetts

On the payer side John has been involved in the design and negotiation of risk contracts, both commercial and Medicare Advantage, for over 15 years. He has also worked extensively with provider groups on the development and implementation of strategies to ensure success under full risk and value-based contracts. The provider groups with whom he has worked range from nationally recognized health systems in the Boston area to newly developed provider organizations with no prior alternative payment model experience.

John’s experience in Medicare Advantage also spans both the payer and provider side. While managing the Medicare Advantage Operations at Tufts Medicare Preferred, he coordinated the response to a targeted RADV (“Risk Adjustment Data Validation”) as well as a multi-departmental response to significant vendor issues effecting both provider network and corporate financial position. On the provider side, he was tasked to lead the analytics department of a large multispecialty organization where his focus was on optimizing the organization’s revenue from the Medicare Advantage Risk Adjustment payment model.

Risk Adjustment Consulting

In January of 2013, John started Risk Adjustment Consulting so he could focus on his passion for providing strategic planning based on strong analytics and organizational and behavioral management methodologies. Since then, Risk Adjustment Consulting has enjoyed a great deal of success helping clients in their development of best in class Medicare Advantage offerings. John has had the honor of speaking at national conferences on topics such as “Managing a RADV audit”, “Risk Adjustment: From Age/Sex to Condition Based Modeling” and “CMS Medicare Advantage & ACA Commercial Risk Adjustment”.

Beginning in 2015, Risk Adjustment Consulting is expanding into the Value-Based Payments arena; providing strategic and operational consulting services for health plans, ACOs, and provider groups. We are very excited to bring years of analytic and strategic experience to clients considering, or looking to improve, their positioning for this critically important shift in the business of health care.