This position has overall accountability for development and implementation of Medicare VBC strategy and related program management across Providence Health & Services. By partnering with regional and system leaders, this role will identify key regulatory opportunities for growth and operational performance and will lead development of specific recommendations and tactics to address the opportunities. This role will develop a proactive relationship with internal advocacy teams, and policy leaders in government and industry to position Providence as an industry leader in improving outcomes for their patient populations. The VP of Medicare Strategy will develop a multi-year roadmap for this program. This role will also be responsible for building and mentoring the Medicare VBC team, consisting of Program Leaders and analysts who manage and administer Medicare value based reimbursement programs across the system.
The Vice President, Medicare Strategy will have the following accountabilities:
- Team Development and Executive Leadership
- Project executive presence and represent PSJH’s thought leadership position in value based care programs as part of senior leadership interactions internally and with industry peers.
- Build consensus on Medicare Strategy across system and regional executive teams
- Lead a geographically distributed team of Program Leaders and Analysts
- Set clear goals and performance expectations, function as a coach and mentor the team to lead in a matrixed organization
- Lead staff development processes including career progression planning, education
- Develop collaborative operating mechanisms that ensure alignment with other departments and teams internally within Population Health and with the rest of shared services and the system such as regional leadership teams, Physician Enterprise, Information Services, Healthcare Intelligence, and Clinical Analytics.
- Serve as a domain expert on Regulatory provisions and related changes in Value Based payment policy:
- Create and lead methodical approach to monitoring external environment, developing summaries and implications and sharing findings across Providence and affiliates.
- Develop and maintain in-depth knowledge of Medicare programs’ requirements and needs, market solutions and competitor analysis.
- Serve as key business contact for Government affairs team and lead evaluations / analysis to understand business implications of any proposed policy changes.
- Understand regulatory framework and implications for business strategy and operations.
- Develop and nurture industry relationships to understand regional and national trends and solutions and incorporate into Providence strategy.
- Develop Medicare Strategy:
- Executive responsible for developing system wide strategy and roadmap for Medicare programs. Focus areas include: MSSP, MACRA, MU/ACI, CPC and other value-based programs initiated by CMS.
- Engage leaders from Physicians services, payer contracting, ACOs, Operations, marketing, clinical institutes, innovation, finance, regional teams, and shared services as required to develop and finalize strategy.
- Working with Regional Chief Executives, develop market specific strategies to achieve overall system strategy and growth goals.
- Develop metrics and other success measures and monitor performance.
- Build Strategic Partnerships:
- Identify and build potential partnerships with external organizations such as payers that support overall strategy.
- Serve as key executive in developing and nurturing relationships to develop alignment.
- Partner with Contracting, Legal and other departments to ensure proportional contractual obligations in risk based arrangements
- Implementation & Operations:
- Lead development of implementation plans.
- Lead and/or coordinate execution of implementation plans.
- Identify and resolve any issues that arise during implementation.
- Provide ongoing leadership and consultation for regional operations to ensure achievement of regional and system strategies.
Required experience/education for this position include:
- Master’s degree in Business Administration, Health Sciences, or other relevant discipline
- Ten years of progressively increasing responsibility in managed care/ health economics as part of a payer or healthcare delivery system.
- Expertise in Medicare Payment reform policies and demonstrated experience in implementing Medicare APMs such as MACRA/MIPS, CPC , PCF, MSSP, DC.
- Knowledge of CMS and ONC Health IT policy making and fluent in policies related to adoption of Health IT interoperability standards
- Demonstrated experience in developing successful working relationships with other organizations.
Preferred experience/education for this position include:
- Expertise in Population Health strategies and operational model strongly preferred.
- Training and background in implementation of change management initiatives at enterprise scale.