Guy D’Andrea

“Payment reform offers huge potential to improve the health care system for both patients and providers. Our challenge is to design payment reform models that create the right incentives, are fair to providers, and are practical to implement.”

Guy D’Andrea is the Managing Partner at Discern Health where he oversees overall operations of the firm. Guy works with clients and staff to implement projects and position the firm for future growth and success. Guy’s recent work at Discern includes leading the development of a primary care incentives program for a Medicaid health plan and building quality standards for senior living. He has also directed a number of projects to develop quality measurement strategies across a range of clinical topics.

Before founding Discern in 2004, Guy spent seven years as Vice President at URAC, where he was responsible for the development of its accreditation programs, including quality standards for PPOs, utilization management organizations, case management organizations, and consumer-directed health care. Prior to URAC, he spent five years working on managed care regulatory and policy issues with the American Association of Health Plans (now AHIP) and the Maryland Association of HMOs.

Guy has co-authored several papers on health care reform, including “The Design and Application of Shared Savings Programs: Lessons From Early Adopters” and “Should Health Care Come with a Warranty?” in Health Affairs, “Physicians Respond to Pay-for-Performance Incentives: Larger Incentives Yield Greater Participation” in The American Journal of Managed Care, and “Sustaining The Medical Home: How Prometheus Payment Can Revitalize Primary Care” for the Robert Wood Johnson Foundation.

Areas of Expertise:

  • ACOs – Medicare Shared Savings Program
  • ACOs – payment models
  • ACOs – performance measures
  • Health system transformation
  • Major health quality stakeholders
  • MACRA- APMs
  • MACRA- MIPS
  • Medicare – payment to hospitals
  • Medicare – payment to physicians
  • PCMH – payment models
  • PCMH – performance measures
  • Performance-based payment models
  • Quality measures
  • State government policymaking and procedure
  • Value-based purchasing

Education:

  • MBA – Columbia University and London Business School
  • BA, Philosophy – Cornell University

Location:

  • Baltimore, MD

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