This role will work under the direction of the VP, ACO and will be responsible for leading both strategy and operational execution of value-based care initiatives including Dartmouth-Hitchcock’s ACO and Employee Health programs. This role will establish an evaluation framework to direct and assess performance improvement initiatives that drive high value care across the care continuum and operational excellence to support participation in current and/or future alternative payment models. This role will also oversee the development of a data analytics strategy to generate data-driven intelligence to support the business (ROI) case, process improvement efforts, the cost effectiveness of innovative PHM/ACO programs and advanced technologies (including but not limited to predictive risk modelling for care management programs, virtual care, remote monitoring, risk adjustment, network optimization and utilization management). Additionally, this role will support their clinical counterparts with the design/redesign, implementation and evaluation of programs that aim to improve outcomes while minimizing administrative burden.
Responsible for establishing a data analytics strategy for D-H attributed populations to outline financial and operational impacts to the organization due to participation in value-based care, alternative payment models.
Identifies and maps all data sources including claims, clinical, SDoH and other disparate data sources from payers, EDWs and EMRs to generate industry KPIs and performance dashboards, population risk stratification and program analysis.
Directs data analytics/science teams with standard and customized analysis plans to define cost and utilization benchmarks, conduct opportunity analysis and the development of predictive analytic algorithms to define patient populations.
Leads opportunity and exploration analysis of current and future state initiatives using established PHM/ACO strategy frameworks, gap analysis and business requirements, and synthesizes results into to support recommendations to key stakeholders.
Conducts readiness/needs assessments for process improvement efforts and application deployment of analytic accelerators and workflow tools (e.g., claims and clinical data, care management workflow tools) both internally (D-H Analytics Institute) and externally with solution based, third party vendors.
Partners with program sponsors (clinical & administration) across D-H to source relevant data for program proof of concept (ROI, feasibility, program design/redesign and effectiveness).
Represents the ACO in D-H operational, financial, and technical committees to ensure PHM/ACO strategies are aligned with systemwide goals and objectives.
Defines a network-wide framework for risk recapture and adjustment programs to ensure appropriate reimbursement; operationalizes HCC coding infrastructure to support ACO operations teams to assign appropriate HCCs.
Working with Vice Presidents and Regional Medical Director, builds and manages relationships with local site leadership and support ACO Operational Managers in building rapport, trust, and effective working relationships with local sites.
Develops program performance standards in conjunction with local site management teams. Monitors program performance regularly against those standards and implements steps to drive compliance with standards.
Partners with clinical leaders to continuously evolve and innovate on ACO program models; review data, test interventions, and define an improvement plan to ensure ACO programs can adapt and adjust as the ACO program evolves.
Hires, develops, and manages ACO operational and analytical team members. Manages to D-H policies for all employees; and establishes and communicates clear performance expectations for ACO staff and ACO programs.
Collaborates with external care partners, as well as external reviewing and paying agencies including Medicaid, Medicare fiscal intermediary and third-party payers and community agencies.
Develops centralized programs to support payer contractual obligations including ACO benefit enhancement programs, Telehealth, and waivers.
Performs other duties as required or assigned.
A Master’s degree in Business, Finance, Healthcare Administration or Public Health (or equivalent in education and experience).
Eight (8) or more years of healthcare management, operations, quality improvement, and/or clinical experience. HealthCare leadership preferred.
Prior experience in PHM/ACO and Health Information Technology
Track record of high-impact PHM/ACO strategy design and implementation support.
Demonstrated expertise in data analytics, data infrastructures (EDWs, EMRs) and hosting platforms and applications.
Advanced knowledge of complex policy and reimbursement methodologies, including budget-based, at-risk contracts and alternative payment models (e.g., ACOs, CINs, CPC+, BPCIs).
Demonstrated expertise and experience with measurement, reporting and improvement activities.
Experience with execution of complex legal structures.
Experience with contracts with quality and financial performance incentives.
Consultancy experience a plus
Demonstrated effectiveness in collaborating with diversified teams of health care providers, administrators, state agencies and legal partners.
A high degree of tact and discretion and excellent communication skills are essential.
Demonstrated leadership accomplishments in the overall improvement of financial, quality and operational performance of an organization.
Excellent written, verbal, and interpersonal communications skills
Substantive, working knowledge of healthcare finance, including the ability to translate the language of healthcare finance into practical and useful daily operations information.
Excellent presentation skills and the ability to facilitate diverse group discussions toward decisions.
Proactive and creative problem-solving skills.
Strong project management skills. Able to balance competing priorities, complex situations, and tight deadlines.
Strong computer skills
Experience developing and managing budgets.
Conducts oneself with integrity and the highest ethical behavior and role models this behavior.
Required Licensure/Certification Skills