David Wedemeyer is an established data expert and a seasoned consultant with expertise developing Healthcare Effectiveness Data and Information Set (HEDIS) and risk programs, process improvements, and software tools.
In the medical management field, he has experience with quality improvement and has provided subject matter expertise in building software tools to auto-code service and diagnosis codes for electronic medical records (EMR) systems. This included working with certified vendors and health plans. In addition, he has developed processes for standardized data pulls from electronic medical records databases and supplemental sources.
David has significant accreditation expertise, specifically National Committee for Quality Assurance (NCQA) Accreditation and has been a featured speaker on this topic at numerous conferences including the Medicare Advantage Congress conference. At HMA, he will assist clients with a wide range of NCQA needs while helping them navigate process improvement, risk adjustment, Medicare Stars programs, and requests for procurement of new state and federal programs.
He has prepared, audited, and submitted all requirements for NCQA Accreditation. With a focus on improvement and return on investment, he also developed HEDIS, Consumer Assessment of Healthcare Providers and Systems, and Health Outcomes Survey and Starts proactive programs to save organizations efforts and resources.
David has extensive experience writing responses to request for proposal (RFP) questions pertaining to all medical management areas for state and federal business including Medicaid and Medicare programs in California and Arizona.
Before joining HMA, David served as senior director of quality improvement with LA Care Health Plan where he directed and developed workgroups and quality projects focused for improvement in Model of Care and Medicare Stars programs, and oversaw all annual credentialing, quality review, and evaluations including HEDIS, NCQA, Medicare and Medicaid programs.
A former vice president of quality improvement with Care1st Health Plan, he developed Special Needs Plan (SNP) programs and the SNP model of care as well as the plan’s Medicare Risk Assessment and Adjustment process, consistently leading the plan to improvements in HEDIS rates and reaching High Performance Levels. He also developed a web portal for data exchange and group dashboards aimed at improving ratings and outcomes to streamline efforts. Under his leadership, the plan secured a commendable NCQA rating.
With a background in direct patient care, David began his career in nursing, serving as a registered nurse, nurse coordinator, urgent care staff nurse and staff development coordinator. He received a Bachelor of Science in Nursing degree from the University of Phoenix. He also completed certifications as an emergency medical technician and licensed vocational nurse.