Dave Prugh

Account Management Team
Expertise: Network contracting under value-based payment arrangements

Dave Prugh is a trusted executive and advisor with more than 20 years of experience in provider contracting and healthcare payment.

His areas of expertise include payer/provider relationships, contract development and negotiation, health care data analytics, value-based payment, payment integrity programs, and the identification of opportunities to improve healthcare cost and quality. He is also versed in payer/provider payment policies for both in-network and out-of-network providers.

Dave is the former national VP for reimbursement and contracting analytics for Anthem BCBS. In this role, he led a 240-person department that provided analytic insights for provider strategy development and provider/payer contract negotiations across Anthem’s 14 states. Additionally, he led the development and maintenance of provider payment policies and guidelines, and he was responsible for oversight of the Anthem’s program for detecting and preventing fraud, waste and abuse. He also served as the provider reimbursement expert on Anthem’s national Physician Advisory Council and he has served on “industry wide” expert technical panels focused on advancing innovations in payer/provider payment.

He is a certified public accountant and began his auditing career with Arthur Young & Company. He earned his B.B.A. in accounting from the University of Cincinnati College of Business, where he is currently an adjunct faculty instructor in Health Care Finance at the Lindner School of Business.