Conversation With: Bill Lucia, CEO of HMS

Bill Lucia (Courtesy of: HMS)

Bill Lucia decided to switch lanes after 18 years as an executive in the life and health insurance industry. He chose to pursue a career in healthcare to test the leadership skills and business acumen he gained in a new and growing market.

Lucia joined HMS, a cost containment solutions provider to help payers and at-risk providers improve performance, in 1996, and climbed up in the ranks. He started as the IT director for an HMS subsidiary, then eventually was named HMS president in May 2005 and then CEO in March 2009, adding chairman to his title in 2015.

During his time as CEO, Lucia relocated HMS’s headquarters from New York City to Irving to “benefit from a large and educated workforce, a central location, and a business-friendly climate.” The company currently offers services in more than 40 states as well as 300 health plans for the federal government and employers. Lucia talked about the company’s finances and economic impact, its mission, and its future plans with D CEO Healthcare.

What economic impact does HMS have in North Texas?
“Our last full year reported revenue, for fiscal year 2016, was $489.7 million. We have 2,500 employees in 25 offices [and remote staff] across the country, with half of that staff in our Irving headquarters. So, we are a significant employer in North Texas.

“We have grown the company from our heritage business, Medicaid Coordination of Benefits, which still represents about 60 percent of our ongoing revenue. This is a service that assures that Medicaid, the U.S. healthcare program for the low-income population, remains the payor of last resort. That means that if someone on Medicaid has other coverage, HMS discovers that, helps our clients redirect these claims for services to the responsible party, and recovers when paid inappropriately.

“We also offer, through internal development and acquisition, payment integrity solutions. That’s focused on making sure claims are paid appropriately and that we’re using sophisticated data analytics to also identify and stop fraud and abuse in the system. … We also recently expanded into total population management, providing analytics, technology, and targeted consumer engagement services to make sure that the right people are getting the right services at the right time.”

What’s the company’s mission, and how does it serve North Texas?
“HMS’s mission is to improve the effectiveness of the healthcare system and help make it work better for everyone. We do this by helping eliminate fraud, waste, and abuse and assuring consumers are engaged to make appropriate healthcare decisions. The U.S. healthcare system is the most expensive in the world, with an annual spend of about $3 trillion, and an estimated one-third of that being fraud, waste or abuse.

“Since 2014, HMS has saved the state of Texas approximately $1.5 billion, including $275 million in savings for North Texas. These savings comprise both cash recoveries as well as avoidance of future costs, which can be used by the state to fund additional programs.”

What projects are you working on now, and how will this impact the North Texas healthcare economy?
“As healthcare costs continue to spiral upwards, we have to find ways to manage care and avoid expensive and traumatic emergency treatments and interventions. Also, about 5 percent of our nation costs us 50 percent of the healthcare spend, so focusing on engaging that population to take appropriate action is paramount to improving the system and controlling the rate of growth in healthcare costs. For our part, HMS has launched an analytics solution to help states and health plans identify high-risk consumers and proactively place them into treatment plans—before they incur unnecessary medical costs. This not only saves states like Texas money, but also contributes to a higher quality of life for its residents.

“And, of course, HMS continues to grow and continues to hire in Irving, supporting the local community.”

Any future plans coming in 2018?
“HMS is always looking to expand and improve the services we provide clients so they can enhance their financial performance and the health outcomes of the people they serve. We do this through data analytics, clinical expertise, and behavioral science—all supported by proprietary technology built over many years.

“Finally, we’ve publicly stated that our first use of capital is to acquire other companies to further expand the services we can provide our large and growing customer base. In the end, we continue to strive to help our clients save money and improve people’s health.”

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