KPMG US

As a Principal at KPMG, my role revolves around using my management consulting skills to provide financial analysis and strategic business planning guidance. I work closely with healthcare executives, empowering them to navigate the complexities of budgeting within the evolving landscape of healthcare payments. By cultivating leadership development and leveraging my analytical skills, I help these professionals sustain and grow their organizations effectively.

Principal

Managing Director

Director

American Heart Association

As a member of the executive leadership team for the American Heart Association's Heart Walk, I leverage my skills in management consulting and leadership development to drive fundraising efforts, community engagement, and awareness campaigns. I am deeply involved in budgeting and financial planning for fundraising activities, utilizing my analytical skills to maximize efficiency and reach. My role is focused on raising awareness about the impact of heart disease and stroke in Maryland, forging strong connections with the community, and providing strategic guidance to optimize our mission's impact.

Heart Walk Executive Leadership Team Member

Healthcare Financial Management Association (HFMA)

In my previous role as President of the Maryland Chapter of the Healthcare Financial Management Association (HFMA), I led a professional network of financial executives in the healthcare sector. I applied my management consulting expertise and financial analysis skills to oversee educational development and foster leadership development within the organization. A significant part of my work involved guiding members in comprehending and navigating the intricacies of healthcare payments, budgeting, and analytical techniques, thus contributing to their individual growth and the overall advancement of the chapter.

President of Maryland Chapter of HFMA

I am a Principal at KPMG, where I use my management consulting skills to provide financial analysis and strategic business planning guidance to healthcare executives. With a Masters of Health Science from The Johns Hopkins University, I have a strong background in health finance and management, which enables me to navigate the complexities of budgeting within the evolving landscape of healthcare payments.

My role is focused on empowering healthcare professionals to sustain and grow their organizations effectively, by cultivating leadership development and leveraging my analytical skills. I have delivered keynote speeches at healthcare conferences, trained professionals at Johns Hopkins Bloomberg School of Public Health, and advised executives on payment policy design for maximum community impact. I am also a member of the executive leadership team for the American Heart Association's Heart Walk, where I drive fundraising efforts, community engagement, and awareness campaigns. I am passionate about collaborating for a sustainable future.

James Case

A versatile and strategic executive in the healthcare industry. Proven innovator with unique expertise at the intersection of operations, finance, technology, and clinical management. Experience includes companies ranging from start-ups to industry giants.

Clear strategic vision and sense of urgency. Substantial P&L experience. Talent for completing rapid and comprehensive assessment of complex situations, and leading teams to create and implement effective solutions. Results-driven, customer-focused, financially, and technically savvy. 

Brings a broad and deep subject matter expertise in managed care from a payer and a provider perspective and across all industry segments including Medicare, Medicaid, Commercial and Self-Funded lines. 

CORPORATE LEADERSHIP
◆ EVP of Healthcare Delivery, Capital Blue Cross, Harrisburg, PA 
◆ COO, PreferredOne, Golden Valley, MN (sold to United Healthcare)
◆ COO, UNC Health Alliance, UNC Healthcare, Chapel Hill, NC
◆ President, North American Medical Management, Chicago, IL (sold to Optum)
◆ Founder/CEO Dynamic Grape Companies, Mequon, WI 

BOARD SERVICE / ADVISORY / OPERATING PARTNER
◆ Advisory Board Member, Stellar Health
◆ Advisory Board Member, Guardiant Health
◆ Board Member, HC Systems, Bathroom Appliance Innovation
◆ Board Secretary, Minnesota Spay and Neuter Assistance Program 
◆ Commissioner, Minnesota Combat Sports Commission
◆ Former Board Member, Minnesota Council of Health Plans

WOMEN BUSINESS LEADERS of HEALTHCARE | www.wbl.org
◆ Member of the premier network of women executives across the healthcare industry. Members are able to move their companies forward, advance their careers, and make a true impact on the healthcare industry.

Board of Directors Level Leadership |Industry Innovator | Financial & Operational Turnarounds | Growth & Profitability Driver | Financial, IT & Clinical Integration | Strategic & Operational Development | Business Transformation | Consultative Sales & Marketing | Technology Commercialization | New Business Development | Compensation & Contracting Strategies | Value Based Care | Advisor | Product Design | Population Health | Pharmacy | Analytics | Care Management | Coaching | Mentoring

Stacy Mays

Imagine receiving a call that puts an employee’s life in your hands.

A prior authorization for their treatment has just been denied.

They have cancer.

And the treatment their doctor believes might give them a chance has just been denied by the plan administrator your company hired to manage your self-funded health plan.

Sometimes the therapy is new.
Sometimes it’s rare.
Sometimes it’s simply expensive.

But in that moment, the employee knows one thing:

This may be their last real chance.

They might not survive either way.

But without access to the treatment, the outcome feels almost certain.

The formal appeal process exists for a reason.

But it can take a month or more.

Sometimes people don’t have that kind of time.

When I ran health plans, employers occasionally called me directly about cases like this.

Those calls were rare.
But they mattered.

And when they did, after discussing precedent and cost, the denial was reversed.

The fiduciary can do that.

One phone call saved months of agony for that employee and their family.

Most employees don’t think about escalating an issue like this to their CEO.

Many hesitate to raise it internally at all.

They worry about being labeled difficult or problematic.

Sometimes escalation is exactly what’s needed.

Not because CEOs should be making medical decisions.

But because in a self-funded plan, the responsibility ultimately sits with the employer funding the coverage.

Legally, that employer is the fiduciary.

Some executives have told me,

“CEOs didn’t sign up for this.”

I understand the sentiment.

But in a self-funded plan, the employer is the fiduciary.

And the authority to act ultimately sits with the CEO — just as it does for the company’s 401(k) plan and its tax filings.

The plan administrator is a vendor the employer hired to administer the plan.

No company would allow a vendor responsible for one of its largest expenditures to operate without oversight.

So why is healthcare the exception?

Architect of Market Innovation | Catalyst for Culture & Value Creation | Senior Executive| Board Member

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We Built Our Healthcare System — On Purpose.

It’s 1943.

He’s in the Army.
She goes to work while wages are frozen under wartime controls.

Since employers can’t raise pay,
they offer something else:

Health insurance.

It feels temporary.
Practical.
Patriotic.

No one thinks they’re reshaping American healthcare.

But they are.

⸻

In 1954, employer health benefits become tax-free.

Insurance through work becomes structurally advantaged.

The link between job and coverage hardens.

⸻

In 1965, Medicare and Medicaid expand third-party payment nationwide.

Security increases.

So does distance from price.

⸻

In the 1970s, managed care is encouraged.

In the 80s and 90s, PBMs expand.
Hospitals consolidate.
Insurance markets consolidate.

More intermediaries.
More contracts.
Less direct competition.

⸻

In 2010, the ACA standardizes coverage.

Lifetime caps are removed.
Pre-existing conditions must be covered.
Plans become richer and more comprehensive.

The intent was protection.

The structural effect was different.

When insurance has no lifetime ceiling,
and coverage is mandatory,
there is no natural boundary to what the system will finance.

If a therapy costs $2 million…
or $3 million…

The system absorbs it.

Drug pricing behavior changes.
Medical pricing behavior follows.

Insurance shifts further from risk management
to unlimited cost financing.

⸻

Fast forward eight decades.

Their grandchildren don’t ask:

“What does it cost?”

They ask:

“Is it covered?”

Routine care flows through insurance.
Employers and government control most healthcare dollars.
Liability has no clear ceiling.

This isn’t accidental.

It’s cumulative.
It’s structural.
And it was built — on purpose.

We built it — on purpose.

Now we need the courage to rebuild it.

Durably.
Intentionally.
In a way that improves our health as a nation
and resets the growth curve.

Health insurance in the U.S. is mostly tied to two things.

Your job.
And a 12-month contract.

Those design choices quietly shape what the system optimizes for.

Price the risk.
Manage the claims.
Reset the contract next year.

But imagine a different structure.

Insurance that wasn’t tied to employment.

And instead covered you — and your family — for 10 years.

Not 12 months.

A decade.

The math of healthcare would start to look very different.

Short horizons favor short-term management.

Extend the horizon and different investments begin to make sense.

Food.
Sleep.
Exercise.
Stress reduction.

Not because the system suddenly becomes philosophical about health.

Because the math changes.

Prevention becomes financially rational when the return doesn’t disappear at renewal.

Longer insurance horizons could support:

• prevention investments that actually pay off
• more stable pricing
• less churn between plans
• care models built around long-term health trajectories

Meanwhile much of the healthcare system is organized around managing disease after it appears.

Hospitals depend on high-margin procedures.
Specialty care expands with chronic illness.
Drug spending grows as disease progresses.

Revenue is still tied to utilization.

And utilization is disproportionately driven by chronic disease.

That’s the engine.

Change the time horizon, and the incentives around that engine begin to shift.

Long-term catastrophic insurance doesn’t just change coverage terms.

It changes what the system is capable of optimizing for.

Structural reform in healthcare isn’t only about who pays.

Sometimes it’s about how long the system expects to care.

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The Battle

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