Frank L Brown Jr

Frank L Brown, Jr, MD, FCP, FACP has senior physician executive experience developed in the managed health care industry for over 30 years.

Dr. Brown is a Yale-educated, NIH-trained physician executive in the health insurance industry. Having been certified as a Health Insurance Executive, he has held line and administrative positions in national insurance companies (Oxford Health Plans, Blue Cross & Blue Shield, Wellpoint, Anthem, Cigna).

His areas of responsibility and accountability have included case management, disease management, population health management, fraud & abuse, physician credentialing, peer review, physician grievances & appeals, patient grievances & appeals, patient safety, value-based care, quality of patient care, patient outcomes, and patient safety.

Metrics managed during his career include average length of stay; discharge and readmission rates; pharmacy management; physician follow-up; comprehensive quality, and patient safety metrics; emergency department visits; mental health management; and fraud & abuse by doctors and patients.

He has conducted over 5,000 physician credentialing reviews; over 5,000 medical necessity/utilization management reviews; and over 2,000 patient/physician committee and in-person grievance & appeal reviews. In addition, Dr. Brown has served as an Examiner for the Malcolm Baldrige National Quality Award, as well as the National Committee for Quality Assurance.

He holds patents for improved emergency patient flow system design and improved effectiveness for patient engagement in obesity, cholesterol, high blood pressure, and diabetes management.

With current licensure in Kentucky, North Carolina, Pennsylvania & Virginia, Dr. Brown is board-certified in emergency medicine and internal medicine. As an experienced public speaker and communicator, he serves as the Founding Chief Medical Correspondent and Medical Contributor at station WVGB-FM in Beaufort, South Carolina.

KEY AREAS OF FOCUS/COMPETENCY:

• Defamation
• Credentialing
• Pharmacology
• Health Equity
• Pre-authorization
• HMO & Managed Care
• Value-Based Care/ACO
• Healthcare Fraud/Qui Tam

AREAS OF EXPERIENCE:

Appeals & Grievances
Case Management
Disease Management
Medical Insurance
Medical Necessity
Medical Records
Medication Errors
Patient Grievances and Appeals
Patient Safety
Pharmacology
Physician Grievances & Appeals
Physician Quality of Care
Physician Sanctions
Population Health Management
Utilization Review