Brian Ellsworth has more than 30 years of experience in health care financing, delivery, and policy from both payor and provider perspectives. He has worked at Optum (UnitedHealth Group) and as a policymaker in New York’s Medicaid program. His extensive provider experience includes positions at the American Hospital Association (AHA) and senior leadership roles at statewide associations of home health, hospice, and long-term care providers. At HDG, Mr. Ellsworth leads efforts to develop value-based payment approaches for skilled nursing facilities and home- and community-based providers, including the development of continuing care networks and analysis of bundled payment opportunities. 

His expertise includes the following: development of cutting-edge episodic and value-based payment systems; managed care strategy development for providers and payors seeking to bring value to the health care delivery system; development of regulatory streamlining and cost-saving proposals through leveraging technology and programmatic change; and analysis of legislative and regulatory proposals affecting all post-acute sectors and dual eligible managed care plans.

At Optum, Mr. Ellsworth led efforts to develop a mobile technology solution to improve quality and program integrity for home care and medical transportation providers. His experience also includes federal and state demonstrations on home health pay for performance, Medicare capitation for the chronically ill, and dual eligible integration. At AHA, Mr. Ellsworth analyzed the impact of payment and quality monitoring policies for SNFs, hospital swing beds, IRFs, LTACHs, home health, and inpatient psychiatric facilities. Throughout his career, Mr. Ellsworth’s thought leadership has resulted in a number of important refinements to post-acute, long-term care, and inpatient payment and quality monitoring systems for both Medicare and Medicaid. As a policymaker in New York, he led early efforts to develop managed long-term care plans for the dually eligible. He has served on federal and state technical advisory panels on a wide range of topics, such as long-term care financing reform, episodic reimbursement, and development of process and outcome measures for home health.