Peter Kelly, MBA, executive director and business development leader at CareMount Medical, Mount Kisco, New York
Kelly, 36, feels fortunate to have spent six years in his early career as an Avalere Health consultant. The firm grew from 45 staff to more than 200 during his tenure. There, he gained specialized knowledge in U.S. healthcare reimbursement and finance, especially for governmental programs. After business school, he joined Universal American as director of strategy and then served as executive director of the New York Medicare Advantage and accountable care organization market. In this capacity, he helped launch the Mount Kisco Medical Group ACO. In 2016, he joined MKMG, which became CareMount in his current capacity. In 2018, the company launched the CareMount Next Generation ACO. The ACO currently manages 35,000 Medicare patients in full alignment with CareMount physicians. He serves as executive director and oversees key areas including strategy, finance, recruiting, risk contracting, data analytics, delivery system performance, and preferred network.
MHE: Why did you choose your profession?
Kelly: I was interested in helping to solve the high cost of healthcare as an undergraduate. Learning more about governmental programs and fee-for-service reimbursement led me to focus on managed care. Then, at Universal American, I spent time with the market leadership of a successful and innovative Medicare Advantage plan in the Houston market, named TexanPlus. This opened my eyes to the possibility and inherent leverage of physician-led delivery systems in managing the medical premium.
MHE: What has been your biggest learning experience in the industry? What did it teach you?
Kelly: The importance of building a team. Integrating the healthcare provider and managed care operations spans so many critical functions— finance, clinical operations, contracting, data analytics, quality, med management, and pharmacy. To do it well, you need leaders or rising managers across these areas. Experience has taught me the importance of organizing people and aligning them with a core mission and narrative. For my team at CareMount, the goal is to achieve total quality outcomes for our patients.
MHE: What change would you like to see in healthcare in the next five to 10 years?
Kelly: I think a responsible expansion of Medicare Advantage is good public policy. Along with it, we need a regulatory framework that creates a transparent and credible glide path for providers to take delegated premium risk under the plans.
MHE: If you could sit down to dinner with anyone involved in healthcare who would it be?
Kelly: I would ask Jeff Bezos how he views patients as customers and how to streamline the customer experience in healthcare. We probably could go to a good restaurant, too.