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Pamela Ballou-Nelson, RN, CMPE, MA, MSPH, PhD, Principal Consultant

Pamela Ballou-Nelson, RN, CMPE, MA, MSPH, PhD,  has over 30 years of experience across the continuum of care in healthcare management focusing on practice process transformation; PCMH; workflow analysis; quality measures, including PQRS, HRSA, Medicaid and CMS outcome measures; care management; population health; and patient activation. Dr. Nelson has worked with both provider and payer organizations working toward alternative care and payment models.

As Clinical Quality Director for Adventist Health Network in Chicago, Dr. Nelson was responsible for leading physicians and hospital directors in their clinical integration process. This work involved over 600 physicians, four hospitals and an IT vendor in developing evidence-based clinical practice guidelines and in collecting and measuring outcomes from inpatient, outpatient, emergency room, and ancillary services to meet MU and PQRS programs. Dr. Nelson developed and trained staff to implement a PCMH NCQA program for 53 practices within the PHO, achieving Level 2 and Level 3 recognition. The PCMH program trained selected staff in PCMH transformation and mentored and assisted employed and independent practices to implement process improvement to achieve PCMH recognition. Dr. Nelson has also worked with numerous commercial payers on quality outcomes and effectiveness measures, including compliance for Medicaid care management programs and Medicaid insurance contracts, as well as high-risk and dual-eligible patient programs. 


More recently, Dr. Nelson has provided practice with education, training, and implementation for MACRA QPP MIPS and APM, in addition to implementing Patient Activation programs in practices or health systems using PAM® in partnership with Insignia Health.

Dr. Nelson has a BSN from University of Utah, an MA from Wheaton College, and an MS and PhD in Public Health from Walden University. In addition, she frequently speaks on Patient Activation, PCMH transformation for ACO and population health initiatives, as well as MACRA QPP MIPS and APM programs.

AREAS OF EXPERTISE: 

  • Population health management
  • PCMH, PCSP transformation process
  • MACRA QPP: MIPS and APM programs
  • Clinical integration
  • ACO development
  • Practice compliance standards
  • Patient Activation using PAM®
  • Cultural assessment and implications for change
  • Care management and care coordination
  • Quality measurement reporting for outcomes
  • Clinical improvement activities
  • Practice start-up
Contact Pamela
Phone: 877.275.6462, ext. 1877
Email: pballounelson@mgma.com
 
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