Jim Dalen

Background

About Jim Dalen

As a results-driven, collaborative chief health economist and entrepreneur, I lead data analytics solutions to drive excellence in healthcare delivery, quality, and equity with measurable impact for diverse populations. Throughout my longstanding career, I have worked in the full spectrum of managed care functions for health plans, including internal leadership roles, external business consulting, and strategic oversight of auditing and compliance activities. I currently partner to co-manage Qmetrics Inc, the sole nationwide validator for quality metrics reporting. I provide strategic guidance in advanced analytics and predictive models to support compliance and auditing functions with unbiased data for health equity initiatives, benchmarking, and performance metrics in quality practices. My career accomplishments include: Being selected by the National Committee for Quality Assurance (NCQA) to create the infrastructure, develop protocols, and pilot the Data Aggregator Validation (DAV) incubator audit program to increase interoperability for quality reporting. The program launched in July of 2021. Designing a proprietary predictive model for Change Healthcare’s core product with 94% accuracy to identify Medicare Advantage clients eligible for dual enrollment, increasing access to care for economically challenged beneficiaries. Co-developing and expanding QMetrics Inc. to consistently generate revenue increases by 50–100% YoY by building strategic partnerships with industry-leading quality organizations in tandem with the company’s outstanding reputation. Establishing multiple new analytics and health economics divisions. I developed Change Healthcare’s first performance analytics division and also launched and scaled Health Net of Arizona’s health economics division for commercial, Medicare +Choice, and Medicaid products with members. I am always open to expanding my professional network. If you would like to connect, please contact me at jimdalen@qmetrics.us. AREAS OF EXPERTISE Medicare Advantage & Medicaid Health Plans Value-Based Contract Process Improvements Risk Score Evaluation & Improvement Predictive Modeling & Data Analytics Managed Care Organizations (MCOs) Managed Care Network Adequacy HEDIS Auditing Readiness Stakeholder Management Acquisition Integrations Start-Up Enterprise