The Mihalik Group was founded on the principle that we measure our success in terms of our clients’ results. Health care organizations that outperform the market prefer to work with us. We are as passionate about their results as they are. Our clients benefit from the combination of a global firm’s experience and a regional firm’s knowledge of local issues and techniques.
The Mihalik Group’s focus is on assisting health care organizations achieve compliance with regulatory requirements and accreditation standards. This has been the company’s major area of consulting since its founding in 1994.
The Mihalik Group is comprised of senior health care professionals with extensive high-level experience, educators, researchers, and data analysts. Principals and staff are knowledgeable about health care delivery, quality assessment and improvement, utilization management, accreditation, data warehousing, management consulting, development of preventive health programs, and utilization management. The Mihalik Group has extensive hands on experience in assisting government and private health care organizations achieve and maintain compliance with regulatory requirements and accreditation standards.
The principals combine their extensive experience in health care management and performance improvement with an unparalleled zest for precision and accuracy in all the company’s endeavors. Senior staff, with years of experience, manage all projects. Each one of our clients has come to trust that we will “do it right” the first time. This assurance rests on our years of experience. We pride ourselves on being a “Learning Organization”. The Mihalik Group’s commitment is that we will exceed your expectations.
Dr. Gary Mihalik is a founder and consultant of The Mihalik Group, LLC. He consults globally with an array of health care organizations including managed care organizations, managed behavioral health care organizations, hospitals, behavioral health facilities, integrated health care delivery systems, medical groups, and disease management organizations. His areas of expertise include performance measurement; quality assessment and improvement; utilization management; and compliance with the National Committee for Quality Assurance (NCQA) and Joint Commission (TJC) accreditation standards. Dr. Mihalik has served as an expert witness in numerous legal cases involving accreditation-related issues. Dr. Mihalik is a physician surveyor for NCQA and was a member of NCQA’s Behavioral Health Taskforce, which developed the MBHO standards, surveyor guidelines, and scoring guidelines. He currently surveys in NCQA’s accreditation programs for Health Plans, Managed Behavioral Health Care Organizations, Disease Management, and Case Management among others. He is a faculty member for NCQA’s education programs and surveyor training programs. Formerly Associate Director of the Department of Standards at The Joint Commission, Dr. Mihalik interpreted and developed standards for the hospital accreditation program, and developed standards for the behavioral health and long term care accreditation programs. He led the development of the Accreditation Manual for Healthcare Networks. He was on the faculty for hundreds of education programs and speaking engagements on a wide array of quality improvement and accreditation-related topics through The Joint Commission’s Department of Education Programs, Speakers’ Bureau, and Visitors’ Bureau. He was previously a surveyor in The Joint Commission’s Hospital Accreditation Program. Dr. Mihalik was the Medical Director of Green Spring of Illinois, a managed behavioral health care company with over 2 million covered lives, and the Northwestern Managed Mental Health Program affiliated with Northwestern University. He has held medical administrative positions in the public, private, and academic sectors. His clinical experience spans a wide array of treatment settings including inpatient, outpatient, long-term care, and partial hospital. Dr. Mihalik’s career led him to practice in Georgetown, Guyana for several months while conducting anthropological fieldwork. In addition to his current extensive consulting activities in the United States, Dr. Mihalik was head of The Mihalik Consultancy headquartered in Dubai and consulted extensively with the Ministry of Health of the United Arab Emirates. Dr. Mihalik has also consulted in Bulgaria, Hungary, and the Czech Republic. Active in several organizations, Dr. Mihalik is a Distinguished Fellow of the American Psychiatric Association, a Fellow of the College of Physicians of Philadelphia and a member of the Psychiatric Medical Association of New Mexico. He is board certified in General Psychiatry and is licensed to practice medicine in Arizona, California, Hawaii, Illinois, New Mexico, and Pennsylvania. Dr. Mihalik received his Bachelor’s Degree magna cum laude with distinction in an interdisciplinary major encompassing the biological and social sciences, his Master’s Degree in Anthropology, and his Medical Degree from the University of Pennsylvania. His Master’s Degree in Business Administration, with a concentration in international business, is from Loyola University of Chicago.
Melinda L. Orlando, RN, MA, CPHQ, CPCS Ms. Melinda Orlando, senior consultant at The Mihalik Group, LLC provides health care related consulting services. She is a Certified Professional in Healthcare Quality (CPHQ), Certified Provider Credentialing Specialist (CPCS), and Diplomate of the American Board of Quality Assurance and Utilization Review Physicians, with subspecialty certification in managed care. As Senior Quality Improvement Manager of Green Spring of Illinois, a managed behavioral health care company with over 2 million covered lives, Ms. Orlando was responsible for implementation of the Quality Improvement Program and the Credentialing and Privileging Program. She prepared the organization for the first managed behavioral healthcare organization (MBHO) survey the National Committee for Quality Assurance (NCQA) conducted to accredit MBHOs. The survey outcome was accreditation. Her prior position was Quality Improvement Manager of Northwestern Managed Mental Health Program affiliated with Northwestern University where she was responsible for all quality improvement and risk management activities. Ms. Orlando has held nursing administrative positions in the public and private sectors. She has extensive experience in developing and administering quality improvement and utilization management programs in a variety of settings. As Quality Improvement Director for Chicago Read Mental Health Center, with more than 600 inpatients and 6,000 admissions yearly, she was responsible for implementing the Quality Improvement Program and for all Joint Commission survey preparation activities. She took the facility through its first accreditation survey with a successful outcome followed by surveys every three years to maintain accreditation. Her clinical experience includes both inpatient and outpatient settings. Accreditation survey preparation is part of the consulting services Ms. Orlando provides to health plans, behavioral health organizations, hospitals, ambulatory care centers, and integrated health care delivery systems. Her areas of expertise include quality assessment and improvement; utilization management; credentialing and privileging; and compliance with accreditation standards including the National Committee for Quality Assurance standards for health plans, managed behavioral health care organizations and the Council on Accreditation of Services for Families and Children (COA) standards for continuous quality improvement processes. Ms. Orlando is a member of the National Association for Healthcare Quality (NAHQ), the National Association of Medical Staff Services (NAMSS), and the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP). She received her Diploma in Nursing from Chicago Wesley Memorial Hospital School of Nursing in Chicago. Her Bachelor’s Degree and Master’s Degree are from Loyola University of Chicago.
Our CONSULTING Team
Mr. Avishek Kumar is the Vice President and Executive Director for The Mihalik Group, LLC. He has more than fifteen years of extensive experience with Quality Assessment and Improvement, compliance with the National Committee for Quality Assurance (NCQA) accreditation standards and HEDIS. Mr. Kumar worked with numerous clients to successfully prepare them for NCQA accreditation and reaccreditation surveys, health care organizations including managed care organizations, managed behavioral health care organizations, integrated health care delivery systems. Mr. Kumar was a key presenter at the NCQA – Healthcare Effectiveness Data Information Set (HEDIS) Best Practices Seminar in 2008 and 2009. Mr. Avishek Kumar is the head of the HEDIS Improvement Practice and has worked with a number of clients to complete readiness assessments and develop improvement plans, he has a proven record of increasing HEDIS scores. Mr. Kumar frequently speaks on the national panels as it relates to HEDIS. As Director for HEDIS and Stars at Care1st Health Plan, Mr. Kumar was responsible for developing interventions to improve HEDIS rates. He was also responsible for developing the QI program, work plans, and completing the annual evaluations as per NCQA requirements. He was instrumental in developing interventions to improve encounter data collection that resulted in improvement in HEDIS rates and reduction in the need for medical record review. As National Director for Quality and Accreditation for AIDS Health Care Foundation, Mr. Kumar was responsible for quality improvement and accreditation activities including operations of the Quality Improvement, Credentialing and Health Education Departments; and ensuring successful preparation for audits required for DHCS, CMS (SNP and Overall Plan audits), AHCA (Florida State Agency), HEDIS, and oversight audits conducted by contracted organizations. One of his major successes in the organization was leading the organization to achieve successful Medicare deemed accreditation status for AAAHC within 12 months of joining the organization. During this time he ensured that the organization had adequate policies and procedures, program descriptions and work plans, annual evaluations, quality improvement projects and other required documents in place. He also conducted ongoing readiness assessment surveys to identify and address any gaps were addressed prior to the survey. Mr. Kumar also well worked with the surveyors at AAAHC to ensure that any potential gaps were resolved prior to the survey. Mr. Kumar was HEDIS Project Lead/Senior Clinical Data Analyst for L.A. Care, one of the largest Medicaid health plans in California. He was responsible for reporting HEDIS rates to NCQA and the California Department of Healthcare Services (CDHCS), directed all HEDIS activities, and managed a multidisciplinary team of over 30 individuals both internally and at external organizations. Mr. Kumar developed a strategic plan for HEDIS goals and improvement efforts for the next 3 years; directed L.A. Care and its contracted plan partners in collaborative efforts to identify and implement interventions; chaired internal and external committees to improve quality of care; developed educational webinars for providers promoting preventive health guidelines; designed and implemented real-time data reporting for health plans, physicians and provider groups; provided strategic support in developing plan-wide incentive programs for plan partners, PPGs, physicians, and members; and negotiated contracts with external vendors/auditors for annual HEDIS activities. By building collaborative partnerships to improve quality with four health plans and fifteen of the largest medical groups covering over 800,000 members, performance improved and cost savings of over $100,000 were realized. He succeeded in raising the 2008 quality measure scores above CDHCS’s Minimum Performance Level resulting in excellent status on the 2008 NCQA accreditation survey. Prior to coming to the United States, as a licensed physician in India and Nepal, Mr. Kumar provided primary care and supervised an intensive care unit in hospitals in Chennai, India. Mr. Kumar received his Bachelor’s in Medicine and Bachelor’s in Surgery (MBBS) degree from Manipal College of Medical Sciences in Pokhara, Nepal in 2001. His Master’s degree in Public Health received in 2005 is from The University of California. Among Mr. Kumar’s technical skills are proficiency with Tiermed (HEDIS software), GEO Networks, Access, SQL, and Visio. He also has Lean Sigma Training.
Mr. Robert Booth is a senior Environment of Care and Life Safety consultant with The Mihalik Group, LLC. He is a subject matter expert in the Joint Commission Standards for Environment of Care, Life Safety and Emergency Management and National Fire Protection Association (NFPA) 101 Life Safety Code as well as Infectious Disease and Infection Control. Mr. Booth has conducted numerous Environment of Care/Life Safety assessments, performed statement of condition assessments, and developed and implemented solutions to achieve compliance with TJC standards and regulatory requirements. He has presented many custom educational programs on TJC related topics for federal, state and private medical facilities. He has consulted with numerous VA and Military Medical Centers, Ambulatory Care Centers, CBOCs and Long Term Care facilities. Currently, Mr. Booth is faculty for the University of South Florida College of Medicine and Public Health risk management program. His instruction topics include health care compliance, administration, patient safety, and risk management. Previously, as Corporate Administrator-Health and Safety Program, Performance Improvement Division University Community Health, Inc. (a four-hospital system), Mr. Booth was responsible for all aspects of environmental and occupational regulatory compliance. He oversaw all activities related to patient, visitor and employee safety including disaster preparedness. His prior position was Industrial Hygienist/Federal Compliance Officer at the U.S. Department of Labor/Occupational Safety and Health Administration (OSHA). In this position, Mr. Booth’s responsibilities included conducting Federal safety and health inspections for compliance determination, hazard abatement assistance, public speaking engagements, regulation interpretation and enforcement of U.S. Department of Labor standards and inspection of the healthcare industry. Mr. Booth also held the position of Industrial Hygienist/Toxicologist for Gurr and Associates, Inc. He was responsible for employee training, program development, and review of hazardous waste clean-up sites throughout Florida. He was the project manager for audits and compliance studies, industrial hygiene services, indoor air quality, and asbestos surveys and abatement. Additionally, he developed an industrial health program and was a chemist for health compliance. Mr. Booth holds a Bachelor of Arts degree in Chemistry and a Masters of Public Health, Industrial Hygiene/Epidemiology degree from the University of South Florida in Tampa, Florida. He is a Licensed Healthcare Risk Manager and a Board Certified Industrial Hygienist. He is certified in numerous areas including hazardous waste operations supervisor, audiometric test technician, and firefighter: Florida State Fire Marshall. Mr. Booth is a member of the following Committees: NFPA Healthcare Committee, ASHRAE 170 Committee, and the FGI, Construction of Healthcare Facilities Committee. He is also a member of the American Industrial Hygiene Association; the Association for Professionals in Infection Control and Epidemiology.
Dr. Andrea Bradford is an NCQA physician consultant with The Mihalik Group, LLC. She conducts NCQA surveys for Health Plan, Managed Behavioral Health, and UM organizations. Dr. Bradford performs NCQA training, quality audits and consultation in preparation for accreditation surveys. Until recently, Dr. Bradford was Associate Medical Director for Optum Behavioral Solution where she provided clinical supervision to Care Advocates, conducted clinical rounds and staffs cases as needed; performed peer reviews and appeals reviews; interfaced with the Director of Clinical Operations and other internal and external customers to ensure optimal efficiency and quality of service. Dr. Bradford is a board certified in Psychiatry and Neurology and is licensed to practice medicine in Georgia. Dr. Bradfors holds a Bacholor’s Degree in Arts, Cum Laude from University of Alabama, a Medical Doctor degree from the University Of Alabama, in Birmingham, AL, her categorical internship in Psychiatry was completed at Eisenhower Army Medical Center, in Fort Gordon, GA. Dr. Andrea Bradford completed her Residency in Psychiatry, at Eisenhower Army Medical Center, in Fort Gordon. She holds a Certificate in Medical Management from American College of Physician Executives and Tulane University School of Public Health, in New Orleans, LA, and Masters of Medical Management (MMM), from Tulane University School of Public Health, in New Orleans, LA.
Catherine Gitimu is an NCQA consultant with The Mihalik Group. She was previously Senior Manager of Accreditation Policy for the National Committee for Quality Assurance (NCQA). Ms. Gitimu has extensive knowledge of NCQA Accreditation standards and guidelines. Her areas of expertise include quality management and improvement, credentialing, delegation, multicultural health care, utilization management, physician and hospital quality and compliance with Accreditation standards, including NCQA standards for health plans, MBHOs, UM organizations and CVOs. While at NCQA, Ms. Gitimu managed the annual development and publication of NCQA Accreditation standards and guidelines for many of its products. In this role, she prepared and presented proposed standards' changes to NCQA's Standards committee, analyzed public comment feedback and incorporated changes to appropriate standards and guidelines. She resolved complex onsite file review issues from surveyors in real time, provided expert opinion on standards interpretation, and worked with NCQA's sales team to help prospective customers with the survey prequalification process and with the Accreditation Operations team to improve survey processes. She was faulty for NCQA seminars, NCQA surveyor training and the NCQA Speakers Bureau on Health Plan Accreditation, credentialing standards, UM standard and delegation standards, and was also an administrative surveyor. Ms. Gitimu earned her BS in Agricultural Science from the University of Nairobi, her MS in Information Management from Sheffield University and her MBA from The George Washington University.
Dr. Matthew Keats is an NCQA physician consultant, he has been an active NCQA surveyor since 1999 and is also a member of NCQA’s Review Oversight Committee (ROC) since 2006, the ROC group is entrusted by NCQA with the final decision on all accreditation and certification decisions. Dr. Keats is also a founding member of NCQA’s Patient-Centered Medical Home Recognition Program Review Oversight Committee Dr. Keats is a physician executive and psychiatrist with exemplary performance across a wide range of professional roles. His expertise spans 20 years in managed care and managed behavioral healthcare, quality improvement, and NCQA accreditation, with a particular interest in the integration of medical and behavioral care. Behavioral healthcare experience includes over four years in Medicaid, both in managed care and as BH Medical Director for a state Medicaid agency with additional areas of experience in the medical diagnostics industry, clinical research, forensic psychiatry, and teaching. He is adept in medical management, including utilization and formulary management, and recognized as a passionate advocate for clinical quality. Until recently, Dr. Keats was a Behavioral Health Medical Director for Virginia Medicaid/Department of Medical Assistance Services, his responsibilities included: clinical oversight of DMAS’s Addiction Recovery and Treatment Services program, where he authored a set of clinical measures to assess the quality of care provided to members with Opioid use disorder receiving medication-assisted treatment; assisted lead DMAS’s Behavioral Health Transformation effort, where he launched and chaired DMAS’s first Behavioral Health Quality Collaborative; provided psychiatric expertise and recommendations to DMAS’s pharmacy program, authoring the requirements and prior authorizations for multiple new forms of Medication Assisted Treatment; oversaw the development of DMAS’s BH quality measurement and improvement strategy; provided psychiatric expertise and consultation to DMAS’s Division of Developmental Disabilities and Behavioral Health; and Represented DMAS at the Governor’s Executive Leadership Team on Opioids and Addiction and the Department of Health Professions Prescription Monitoring Program committee. Dr. Keats holds a Bachelor’s Degree in Arts from Dartmouth College, a Medical Doctor degree from the University Of Virginia School Of Medicine, in Charlottesville, VA, his internship was completed at Tufts University Medical School, in Boston, MA. Dr. Matt Keats completed his Residency in Psychiatry, from Cornell Medical Center, in New York Hospital-Westchester Division, White Plains, NY. He holds a Certificate in Medical Management from American College of Physician Executives and Tulane University School of Public Health, in New Orleans, LA, and Masters of Medical Management (MMM), from Tulane University School of Public Health, in New Orleans, LA.
Mr. Frank Stelling is a senior consultant and part of TMG’s NCQA consulting team, he was an Assistant Director of Policy at NCQA. Mr. Stelling’s areas of expertise include quality improvement, credentialing, case management, disease management and all aspects of compliance with the National Committee for Quality Assurance (NCQA) Accreditation and Certification Standards and Guidelines. Mr. Stelling has worked for over 13 years at NCQA. In addition to his position as Assistant Director of Accreditation Policy, he has served NCQA as faculty for NCQA seminars and NCQA surveyor training, and the NCQA Speakers Bureau on Health Plan Accreditation, NCQA Credentialing Standards, Case Management Accreditation, and Disease Management Accreditation. He is also an NCQA surveyor and has surveyed Health Plans, Managed Behavioral Health Organizations, Disease Management Organizations, and other organizations for over 12 years. Mr. Stelling’s responsibilities at NCQA, have included managing the publication of the Standards and Guidelines for Health Plan Accreditation; overseeing the Policy Clarification Support System, the customer portal for questions about standards; coordinating the transition of new products from development to production; and training and development of staff. He was a member of the Policy Development Group, an interdepartmental workgroup charged with resolving policy issues. He also was responsible for working with the Centers for Medicare and Medicaid Services (CMS) and state governments in ensuring NCQA met regulatory requirements. He was the lead in developing the NCQA Medicare Advantage Deeming program. Mr. Stelling has over 40 years of experience in health care with a focus on preventive services, disease management, and quality improvement. Before joining NCQA in 2001, Mr. Stelling held management positions with state and county health departments, hospitals, voluntary health organizations and, for 14 years, with a managed care organization. Mr. Stelling holds a Bachelor’s Degree in Exercise Science from Wake Forest University, a Master of Education in Health and Exercise Science from the University of South Carolina and a Master of Public Health from the University of California, Berkeley.
Dr. Thomas Zastowny is a psychologist consultant with The Mihalik Group, LLC. He was a surveyor for the Behavioral Health, Hospitals and Ambulatory Care Accreditation Programs for The Joint Commission. Additionally, he surveyed Methadone and Opiate Treatment Programs and free-standing drug and alcohol facilities. Dr. Zastowny has extensive experience in interpreting standards, suggesting strategies to improve compliance, preparing for accreditation and education, and providing the expertise that makes quality happen. During his fifteen-year work experience as a surveyor at TJC, he had experience in a variety of settings including private and public and civilian and military. He was faculty for numerous educational programs on the TJC standards and quality improvement including Lean Six Sigma in Health Care. He was special projects consultant for the Joint Commission and was the author for A Guide to Performance Improvement in Behavioral Health Care Organizations. Dr. Zastowny held the following positions at facilities located in Rochester, New York: Director of Performance Improvement at Coordinated Care Services, Inc.; Director of Occupational and Ergonomics Center at the University of Rochester; Director of Ambulatory Programs and Director of Quality and Total Quality Management Initiatives at Park Ridge Health Systems. He is affiliated with the University of Rochester Medical Center and The Robert Wood Johnson Foundation. He taught many national and international programs on topics such as performance improvement, outcome measurement, and assessment, program design, treatment planning, evaluation of health care systems and statistics. Dr. Zastowny has published over 100 scientific articles and book chapters in these areas as well as contributed to complex evaluation reports for the Substance Abuse and Mental Health Services Organization (SAMHSA), Center for Substance Abuse Treatment (CSAT), Center for Substance Abuse Prevention (CSAP), The International Society for Quality in Health Care Ltd. (ISQUA) and the United Nations (UN). Consulting, teaching, and development activities have taken him to Italy, Germany, Argentina, Mexico, Korea, Canada, and the UK. A significant portion of Dr. Zastowny’s clinical career was to provide services and consultations in inpatient psychiatric settings-for both acute illness and long-term hospitalization. He provided consultation to over 20 psychiatric facilities for TJC readiness, and corrective action. About half of these facilities were seeking initial accreditation. All of the health care organizations received accreditation. Dr. Zastowny’s areas of specialization include (1) treatment planning and documentation, (2) performance improvement, outcome measurement, and quality assurance, and (3) special methodologies such as Root Cause Analysis, sentinel events reviews and special case reviews. Other types of consultation have been program design, evaluation, clinical materials-such as evidence-based practices, and community and facility need assessments. His professional affiliations have included the American Psychological Association, American Public Health Association, American Sociological Association, Association for the Advancement of Behavioral Therapy, American Group Therapy Association, Association for Marriage and Family Therapy and American Board of Medical Psychotherapists. Dr. Zastowny received his Bachelor of Arts Degree in Psychology the State University New York, Brockport, New York, and his Masters and Doctorate Degrees in Psychology from the University of Rochester, Rochester, New York. He is licensed to practice in New York and has been in private practice for over twenty years.
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