Alan Krumholz MD, FAAP, DFACMQ
Vice President MCHS-FH, MCHS Director of Quality Outcomes, Medical Director Health Tradition Health Plan
Dr Krumholz has been in the Mayo Health System for the last twelve years as VP of Practice Development at Franciscan Healthcare (FH), and Medical Director of Health Tradition Health Plan. He has successfully implemented many programs to significantly improve the utilization and productivity at FH. His MCHS roles include the physician lead for Quality Outcomes and the project informaticist on the Humedica database project. He was both the FH lead physician and a key leader in the Mayo Health System’s Electronic Medical Record Project. He has just finished serving as the president of the American College of Medical Quality.
Prior to joining the FSH, Dr. Krumholz was a consultant and instructor in healthcare informatics for Ruffin Informatics and Medical Decision Networks. Prior to his consultant positions, he served as the Chief Medical Officer for QualChoice of Virginia, a Managed Care plan sponsored by the University of Virginia Health System. While at QualCoice he implemented the use of clinical database reporting and severity adjusting, and trained all of the network physicians to interpret their own data. He worked directly with the vendor to redesign many of the standard reports for increased interpretability and ease of use. He also re-engineered the processes of the medical services department to facilitate a 30% increase in productivity and a 20% decrease in utilization with no increase in staffing.
Previously, Dr. Krumholz served as the Medical Director of Regional Partnerships at Blue Cross-Blue Shield of Massachusetts where he was responsible for managing three Regional Medical Directors and introducing a medical management delivery strategy for 800,000 covered lives across the state. He redesigned their provider-reporting package to be rated as “best in class” by the network physicians. He also totally reorganized the credentialing and the provider profiling departments and designed BCBSMA’s first provider report cards. He also served on the original HEDIS reporting design team. Earlier, as Regional Medical Director for the Central-Western Region of Massachusetts for HMO Blue, he led the regional provider team with the highest provider satisfaction scores in the state while lowering Admits and Days /1000 by 20%.
Earlier in his career, Dr. Krumholz served as a Medical Director for a Hospital PHO and their associated IPA, and for a peer review organization. He was responsible for the design of a Utilization review program for a local hospital, as well as the Maine Medical Foundation, utilizing Wennberg’s SAV data. He also was one of the original authors of the Pediatric SI/IS criteria for Interqual. Concomitantly, he was a full time Pediatric Practitioner for 15 years, in a 4-6-physician group. While in practice, he also invested to maximize the efficiency of his staff with automated systems as early as 1982.
Dr. Krumholz was an Associate Professor at the University of Virginia in the Department of Health Evaluation Sciences, in that capacity he worked directly with residents to help them understand biostatistics and prepare them for entering the medical practice environment. In another prior role as an Assistant Professor of Pediatrics at the University of Massachusetts Medical Center, he has developed curricula for training practitioners to teach residents. Additionally he was one of the creators of a program to move Pediatric residents out into the community to do their outpatient continuity experience. In this role he mentored 2 residents through their three year outpatient experience, mentored numerous other physicians entering this role, and spoke at conferences and academic centers on the benefits and costs of this program. He has published articles on Emergency Room Utilization and Training the Trainer.
Dr. Krumholz is a Distinguished Fellow and President Elect of the American College of Medical Quality and a Fellow of the American Academy of Pediatrics. He is Board Certified in Pediatrics and Quality Assurance and Utilization Review. Dr. Krumholz holds a BS degree in Physics, from SUNY Stony Brook; and a MD degree from SUNY at Downstate Medical Center, Brooklyn, NY. He completed his Pediatric Internship at Boston City Hospital and Residency at the U of Mass. Medical Center in Worcester, MA.
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