Thomas Hutchinson has more than 25 years of experience in both the private sector and in federal service implementing programs and policies directly affecting Medicare and Medicaid beneficiaries. Mr. Hutchinson advises clients on a wide range of payment policy and operations issues relating to the Centers for Medicare and Medicaid Services (CMS).
Prior to his joining EBG Advisors in this business advisory role, Tom served as the director of the Medicare Plan Payment Group at CMS, where he was responsible for all aspects of annual Medicare payments to Part C (Medicare Advantage) and Part D (drug) plans, totaling approximately $160 billion. This included all payment policy, systems development and implementation of the policies, validations of payments, and ensuring auditing compliance of these payments. The Part D risk adjustment model and the new (for 2012) Part C risk adjustment model were both developed under his leadership. Additionally, Tom was the driving force behind the design and implementation of the Medicare Risk Adjustment Data Validation (RADV) audits.
Tom spent 18 years working with CMS, where he held a variety of positions. Most of his experience was in the Medicare managed care area, where he was responsible for developing the policies and implementing the biggest changes to the Medicare Advantage program and the Part D Drug program after passage of the Medicare Modernization Act. He also worked in CMS’s budget group and the quality group and is highly respected by senior leadership and others throughout CMS and the U.S. Department of Health and Human Services (HHS).
Tom provided essential technical assistance to Congressional staff in drafting the Affordable Care Act (ACA) regarding changes in the Medicare Advantage payment methodology. His knowledge was sought by HHS executives responsible for implementing the ACA, particularly with regard to the various payment and plan design. His experience in designing and developing Medicare payment policies that utilize these same payment processes is invaluable.