Administrative burden & provider experience
Expose manual work, rework, appeals, delay, escalation, and provider touchpoints—then determine which controls are necessary and which work can change.
Healthcare practice
The pressure is rising. The controls still matter.
I help health plans, healthcare services organizations, managed-care organizations, provider platforms, and large provider organizations redesign complex workflows without increasing clinical, compliance, financial, or operational risk.
The transformation problem
Administrative burden is a control-design problem.
Eliminating a step is easy. Determining what purpose it served, what risk it controlled, and what operating mechanism should replace it is the real work.
Healthcare workflows evolved through regulation, product variation, local exceptions, platform constraints, and organizational handoffs. The burden appears in one department. The cause often sits somewhere else.
I map the work, evidence, decisions, controls, dependencies, exception paths, and outcomes as one system—then turn that model into a practical sequence for change.
Reduce the burden. Preserve the control. Redesign the system.
Where TKO works
Problem domains, not narrow product categories.
Utilization management & prior authorization
Redesign review tiers, evidence requirements, decision rights, exceptions, escalation, auditability, and differentiated controls before automating.
Enterprise workflow modernization
Connect claims, provider, clinical, product, data, integration, and release dependencies into one executable operating model.
Governed AI-enabled operations
Define where models assist, where humans decide, how low-confidence work routes, what is audited, and how outcomes improve future decisions.
Domain and capability
Prior authorization is evidence. Operating-model transformation is the capability.
Prior authorization, utilization management, provider experience, and interoperability are where I have the depth. The transferable capability is redesigning and executing complex regulated operating models.
- Payer and provider operations
- Utilization management and prior authorization
- Claims-related and clinical-administrative workflows
- FHIR, APIs, data flows, and interoperability
- Rules, decisioning, analytics, and automation
- Human-in-the-loop and fail-closed controls
- Governance, dependencies, testing, and readiness
- Transformation execution and recovery
I have led governance, delivery orchestration, dependency management, reporting, readiness, testing coordination, escalation, and cross-team alignment on enterprise healthcare programs—prior-authorization and provider initiatives, large governance environments, dozens of interdependent applications and workstreams, CMS/FHIR interoperability product ownership, and a governed decision system I built and run. I influenced design and implementation choices; strategy, architecture, and funding sat with others.
When to engage
Signals that an operating model is under pressure.
I am most useful when an external or internal signal implies a deeper workflow, control, dependency, or execution problem.
- Prior-authorization reform or Gold Card legislation
- CMS or interoperability implementation requirements
- Provider dissatisfaction or relations pressure
- Operating-cost or administrative-burden mandates
- AI, workflow, or platform modernization
- Vendor replacement or major enterprise transformation
- Acquisition, integration, or new executive leadership
Principal-led healthcare advisory
What is changing—and where is the operating model starting to break?
Bring one bounded transformation, workflow, or decision under pressure.