KPMG US

As a Principal at KPMG, my role revolves around using my management consulting skills to provide financial analysis and strategic business planning guidance. I work closely with healthcare executives, empowering them to navigate the complexities of budgeting within the evolving landscape of healthcare payments. By cultivating leadership development and leveraging my analytical skills, I help these professionals sustain and grow their organizations effectively.

Principal

Managing Director

Director

American Heart Association

As a member of the executive leadership team for the American Heart Association's Heart Walk, I leverage my skills in management consulting and leadership development to drive fundraising efforts, community engagement, and awareness campaigns. I am deeply involved in budgeting and financial planning for fundraising activities, utilizing my analytical skills to maximize efficiency and reach. My role is focused on raising awareness about the impact of heart disease and stroke in Maryland, forging strong connections with the community, and providing strategic guidance to optimize our mission's impact.

Heart Walk Executive Leadership Team Member

Healthcare Financial Management Association (HFMA)

In my previous role as President of the Maryland Chapter of the Healthcare Financial Management Association (HFMA), I led a professional network of financial executives in the healthcare sector. I applied my management consulting expertise and financial analysis skills to oversee educational development and foster leadership development within the organization. A significant part of my work involved guiding members in comprehending and navigating the intricacies of healthcare payments, budgeting, and analytical techniques, thus contributing to their individual growth and the overall advancement of the chapter.

President of Maryland Chapter of HFMA

I am a Principal at KPMG, where I use my management consulting skills to provide financial analysis and strategic business planning guidance to healthcare executives. With a Masters of Health Science from The Johns Hopkins University, I have a strong background in health finance and management, which enables me to navigate the complexities of budgeting within the evolving landscape of healthcare payments.

My role is focused on empowering healthcare professionals to sustain and grow their organizations effectively, by cultivating leadership development and leveraging my analytical skills. I have delivered keynote speeches at healthcare conferences, trained professionals at Johns Hopkins Bloomberg School of Public Health, and advised executives on payment policy design for maximum community impact. I am also a member of the executive leadership team for the American Heart Association's Heart Walk, where I drive fundraising efforts, community engagement, and awareness campaigns. I am passionate about collaborating for a sustainable future.

Ever wondered what it should cost to deliver seamless, coordinated care to your community? I recently tackled this question in the DMV (D.C., MD, VA) area, estimating a 2025 total cost of care at ~$13,200 per resident. 

Here’s a step-by-step guide to help you generate this estimate for your organization, ensuring accuracy and actionable insights. Let’s dive in! 

**Why Estimate Total Cost of Care?**

The total cost of care (TCOC) is a critical metric for healthcare leaders. It helps you benchmark efficiency and plan value-based care models. Whether you’re a hospital system or a community provider, this exercise reveals what “seamless care” could look like in your region.

**How I do it**

1️⃣ Define Your Service Area and Population

What to do: Identify your geographic scope (e.g., a metro area, county, or state). Use U.S. Census data or regional projections for 2025 population estimates.

Example: For the DMV, I used a 2025 estimate of 6.5M (D.C.: 11%, MD: 46%, VA: 43%) based on 2024’s 6.44M plus 1.4% growth.

Pro tip: Break down sub-areas if costs vary (e.g., urban D.C. vs. suburban VA).

2️⃣ Understand Your Organization’s Care Model

What to do: Define “seamless care” for your context (e.g., coordinated care reducing ER visits). Research your organization’s patient encounters, revenue, and programs (e.g., care navigation).

Pro tip: Review annual reports or CMS data for your organization’s impact.

3️⃣ Gather Baseline Per Capita Costs

What to do: Find recent per capita healthcare spending for your area (all payers: private, Medicare, Medicaid, etc.). Kaiser Family Foundation (KFF) or CMS provide state-level data.

Example: 2022 KFF data showed D.C.: $13,136, MD: $10,997, VA: $9,508. National 2023 benchmark: $14,570.

Pro tip: If local data is scarce, use national averages and adjust for regional cost-of-living.

4️⃣ Project Costs to Your Target Year (e.g., 2025)

What to do: Apply annual cost growth rates. Nationally, CMS projects 8.2% for 2024, 7.1% for 2025. For value-based regions (e.g., MD’s TCOC), use lower rates (~5%).

Example: I projected D.C.: $16,350 (no TCOC), MD: $13,670 (TCOC-capped), VA: $11,820 (national trend). Weighted DMV average: $13,162.

Pro tip: Validate growth rates with CMS or state health commissions.

5️⃣ Adjust for Seamless Care Efficiencies

What to do: Estimate savings from your care model (e.g., reduced hospitalizations, better care coordination). TCOC programs show 2–10% reductions; use 2–3% for conservative estimates.

Example: Maryland’s TCOC cut Medicare costs 3% below national averages. I applied a 2% reduction to the DMV’s $13,162, yielding ~$13,200.

Pro tip: Cross-check savings with peer organizations or studies (e.g., Health Affairs, CMS evaluations).

6️⃣ Validate and Contextualize

What to do: Double-check data sources (e.g., KFF, CMS, your organization’s reports). Acknowledge limitations (e.g., policy changes, partial market share). Compare to national trends ($16,340 projected for 2025).

James Case

census.gov

Census.gov | U.S. Census Bureau Homepage

I talk about strategy, project management, and career development for professionals in the healthcare industry | Two decades in management consulting | National HIMSS/ HFMA Speaker

**The Best Way to Start Learning about CONs in Maryland**

I have loved learning about the CON process in Maryland.

Unfortunately, when I first got interested in the topic, there was no where to learn.  No books to read, no courses to take, and I had a hard time figuring out where to start.

So if you’re trying to learn more about CONs, here’s the best way to get started:

**Meet with Lawyers** 

While the regulations are posted online, the process is as much about the people as it is about the regulations.  With there being no written knowledge of the people, the only way to acquire the knowledge is to soak it up from people who have experience with working with the various players.  For the most part, those are lawyers in the State.

**Understand demand planning and financial feasibility well** 

The core of the CON application has to do with proving two ideas.  First, that there is a need in the population for the services that you want to provide or the capacity that you want to build.  And second, that the project you are considering is efficiently considered and financially feasible for your organization.

**Understand the timelines and question response requirements**  

While there are lots of unique regulations around the CON process, the most impactful area to understand has to do with timelines.  There are windows for CONs to be filed, there are timelines for responses to questions, and there are timelines associated with disputes.  All of those need to be figured into your strategy and construction plan.  Missing one or being off can cost your organization millions of dollars in delays.

Focus on these three areas and you will exponentially accelerate your learning process.

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