John Frias Morales
Director of Analytics, Value-based Care @Gainwell Technologies
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WORK HISTORY
Director of Analytics, Value-based Care @Gainwell Technologies
Sacramento, CA, US
In my role at Gainwell Technologies, I oversee analytics for Medicaid/Claim patients, aiming to bridge the gap between healthcare spending and patient care. I manage a team of 6 developers and 2 subcontracting companies, with a focus on innovating data strategies and solutions to enhance population health management.→ Streamlined healthcare costs by 3.3% Per Member Per Month (PMPM), leading to a 15% decrease in inpatient admissions and a 10% reduction in pharmacy scripts via comprehensive value engines.→ Collaborated with university researchers to create the Medicaid Risk Stratification Segmentation Tiering model, identifying Medicaid members at risk and enhancing their care.→ Developed a pioneering patient-level prediction model (RSST), significantly improving care for at-risk Medicaid members.→ Mentored and upskilled team members that resulted in 2 of them pursuing master\'s degrees in computer science.→ Spearheaded the development and implementation of a statewide analytics and visualization strategy, emphasizing Risk Stratification and Segmentation Tiering algorithms to address care gaps.→ Established a joint state and contractor governance process for high-quality data management, adhering to privacy and security best practices.→ Created clinical quality dashboards that significantly improved stakeholder engagement and operational efficiency.→ Secured executive approval for a comprehensive statewide analytics plan, incorporating 5 PHM monitoring KPIs and a prognostic model.
EDUCATION
Stanford University School of Medicine
Health For All Fellow, Prevention Science
Golden Gate University
Master's, Computer Science
Golden Gate University
Doctorate, Business Administration, Management and Operations
California State University-Sacramento
Bachelor of Arts, Political Science
San Jose City College
Transfer
SKILLS
ABOUT JOHN FRIAS MORALES
As Director of Analytics in Population Health Management, I specialize in transforming healthcare data into actionable insights, fostering improvements in population health and value-based care. My focus is on developing innovative healthcare solutions that effectively bridge healthcare spending with patient care quality.My career highlights include creating a groundbreaking Medicaid Risk Stratification Segmentation Tiering model and reducing healthcare costs by 3.3% PMPM, demonstrating my capability to deliver impactful healthcare solutions. I have successfully managed significant projects, like a $340M clinical quality and operational dashboard initiative, driving both stakeholder engagement and operational efficiency.At Gainwell Technologies, I currently lead analytics for Medicaid/Claim patients, concentrating on minimizing healthcare spending and addressing care gaps. My role involves overseeing a large team and where I\'ve implemented crucial innovations and strategies in patient-level prediction models and statewide analytics.My expertise spans strategic leadership, data analytics, and team development, with a particular focus on predictive modeling and stakeholder engagement. These skills enable me to drive organizational goals and lead teams toward excellence in healthcare analytics.In sum, my career is defined by my dedication to advancing healthcare delivery through innovative analytics and strategic leadership, providing unique value to the healthcare sector.
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