Our Mission
To manage our relationships with managed care companies and to excel in the provision of care for our patients.
Our Charter
The UMMHC Managed Care network was established to facilitate collaboration between our clinicians in the care of our patients. By leveraging incentives provided by our managed care companies, together with quality initiatives developed both internally and in conjunction with the payors, care is being integrated across the network. The results of these efforts are demonstrated through increased patient satisfaction, disease prevention and management, and reduced costs.
The network also represents our clinicians in contract negotiations with the payors and in issues related to credentialling, referral and authorization management, and provider relations and adjudication of claims.
Our Staff
Robert Klugman, MD, currently serves the UMass Memorial Health Care system as Medical Director for the Managed Care Network and as Vice Chair for Clinical Affairs and Chief Quality Officer for the Department of Medicine. He is an internist with 26 years of experience in clinical practice, and he has actively engaged with health insurers regarding payment methodologies since the birth of managed care. His commitment to quality of care and clinical integration across the UMass Memorial Health Care system are demonstrated both in his individual practice and by his participation on numerous committees and task forces for overall system improvement.
Edward Westrick, MD, PhD, is the Vice President of Medical Management for UMass Memorial Health Care. He works primarily for the organization's Managed Care Network, assisting its members in achieving quality improvement goals. On behalf of the network he maintains relationships within the managed care and quality improvement communities of Massachusetts as well as with pertinent national organizations such as the IOM, NCQA, NQF, and CMS. He received his clinical training in Internal Medicine in the Brown University program and finished his PhD training at the University of Rhode Island in the Pharmacoepidemiology and Pharmacoeconomics program.
Elaine Fontaine is a healthcare professional with over twenty years of experience in health care technology, financing and quality. She has worked in health center, hospital and health plan settings with a focus on using information to improve the quality of care delivered to patients. Before joining UMass Memorial in 2005, she was an independent consultant and the first Chief Information Officer of Neighborhood Health Plan of Rhode Island.
As Director of Contracting, Cathy Rossi oversees managed care contracting and provider relations for UMass Memorial Medical Center, its member hospitals (Clinton Hospital, Health Alliance Hospitals, Marlborough Hospital, and Wing Memorial Hospital & Medical Center), behavioral health providers, ancillary providers, and affiliated physician practices. Prior to joining UMass Memorial, Cathy managed integrated delivery system and ancillary provider contracts for Tufts Health Plan. Her prior healthcare experience also includes contract development and referral and admission management for rehabilitation and extended care facilities and paralegal work for a Boston-based personal injury law practice.
Erin Mandile currently serves as the Manager of Provider Relations for UMass Memorial Health Care, Inc. Drawing on her twelve years health plan provider relations experience, Erin has led the UMass Memorial Provider Relations Department for the past three years. The Provider Relations Department acts as a resource for physicians affiliated with UMass Memorial and UMass Memorial Medical Center staff, assisting with questions or issues pertaining to managed care plan policies and procedures as well as communicating contractual obligations under the various health plan agreements. As part of this effort, Erin works closely with many physicians, office staff, and hospital departments on operational issues that may arise with contracted health plans and participates in many internal work groups and external payer forums.
Alan Krinsky, PhD, MPH, is the Medical Management Interventions Manager. Alan completed his Master of Public Health degree in 2006 at Brown University, with an MPH thesis addressing the measurement of comprehensive diabetes quality care. He has previously worked in healthcare quality improvement and in quality assurance for the clinic cancer trials process. His doctorate (University of Wisconsin-Madison, 2001) is in History and the History of Science, with a focus on the history of nutrition and diet. His work with the UMass Memorial Managed Care Network will center on the analysis of healthcare data and systems, the development of intervention materials, and ongoing monitoring for the network's quality improvement and Pay for Performance projects.
Christine Cernak, RN, BBA, has over twenty years of health care experience. Her background includes direct patient care, NIH funded internal medicine/information systems research in an academic Medical Center and the Maryland Hospital Association Quality Indicator Project®. It is her belief that Diabetes Care requires a continuous improvement focus by the patient and the health care team. She joined UMass Memorial in 2005 as a patient educator in the Memorial Campus Diabetes Center.
Managed Care Operations Contact Information
- Medical Management
Telephone: 508-793-6067
Fax: 508-793-6086
Email: Medman@ummhc.org - Provider Relations
Telephone: 508-334-5509
Fax: 508-334-6291
Email: ProviderRelations@ummhc.org - Contracting
Telephone: 508-334-6185
Fax: 508-334-6291