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Strategic Payment Transformation Advisor at CareFirst BlueCross BlueShield in Washington, Washington DC

Posted in Other 30+ days ago.

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Type: Full Time

Job Description:

Resp & Qualifications

About CareFirst s Practice and Payment Transformation Initiative:

CareFirst launched its first Value-Based Payment Arrangement, the Patient Centered Medical Home (PCMH) Program in 2011 and currently has more than 4,000 participating primary care providers organized into over 400 Panels. With 8 full performance years complete, the Program has produced savings (actual cost vs. expected cost) every year.

Building on the foundation of its PCMH Program, in 2019 CareFirst is creating new pay-for-performance, episode and population-based models to drive targeted improvements in the health care delivery system, specifically focusing on cost, quality and the CareFirst Member experience.


This senior-level expert contributor role exists to study, develop, execute and monitor and continuously improve new models to finance health care for CareFirst Members. Those serving in this role will drive CareFirst s effort to transition from a fee-for-service payment system which incents health care providers to generate volume to a payment approach that rewards providers for the value they create.

The Value-Based Model Expert will be part of CareFirst s Payment and Practice Transformation team. The Payment Transformation Initiative consists of an internal team of experts focused on innovative and impactful payment models (this role), specialty practice benchmarking and operations, clinical support, legal support, pharmacy support and government program practice readiness.

The impact of this team of internal experts is informed and magnified by a team of geographically dispersed Practice Transformation Consultants who work directly with Primary Care and Specialty Care Practices to improve their performance on key cost, quality and patient experience measures.
The Value-Based Model Experts will collaborate with the stakeholders across the organization to effectively monitor, evaluate, coordinate and communicate the overall effectiveness of the value-based payment models.


Under the general supervision of a Vice President Payment and Practice Transformation, the incumbent s accountabilities may include, but are not limited to, the following:

1. Research, Market Awareness and Benchmarking

* Maintain a high level of awareness of provider performance and payment transformation efforts across the United States including BlueCross and BlueShield plans, other commercial insurers, Medicare Advantage plans, Medicaid Managed Care Organizations and provider-initiated programs.
* Participate in workgroups sponsored by the BlueCross and BlueShield Association related to payment transformation.
* Benchmark with the Organization for Economic Cooperation and Development (OECD) member countries health care system.
* Liaise with CareFirst s State and Federal Public Policy team regularly to stay abreast of policy changes that can impact CareFirst s payment transformation efforts.

2. Creation, Approval and Implementation of New Models to Finance Health Care

* Lead efforts to design and implement new payment models to drive improvements in the health care delivery system by introducing a thoughtful combination of incentives and risks to provider revenue.
* Analyze current cost, quality and utilization data to identify areas of opportunity that can be impacted by new payment models.
* New models will be informed by data on current and historical performance and will include quantifiable targets. Models will include:
* Population-based models
* Episode-based models
* Pay for performance incentive programs
* Prepare formal proposals for new payment models to communicate said models to CareFirst s Medical Affairs and Finance (Actuarial) executive teams to receive approval.
* Interface with CareFirst s dedicated provider contracting counsel to create thoughtful, innovative, measurable and enforceable contract terms to drive the provider performance and transformation we seek.
* Develop materials to brief Provider organizations, current and prospective Accounts and other stakeholders on the features of new models and their impact.
* Serve as a resource across the enterprise on issues related to value-based reimbursement.
* Work with the Practice Transformation Consulting team to launch models with the Providers in their respective markets, at times delivering presentations on the models to Provider organizations as needed.

3. Tracking/Monitoring and Reporting of Impact

* Interface with CareFirst s various data and Health Informatics teams to define and implement the mechanisms for measurement of the progress (or lack thereof) with the precision necessary to make payments to the providers.
* Prepare a quarterly report including qualitative and quantitative measures of progress, impact and outcomes.
* Represents CareFirst as needed as a thought leader on payment transformation in a variety of environments.
* Collaborate with the Practice Transformation Consulting team in a matrixed organization to assure Models are performing in their market areas and to inform adjustments to models going forward.


Required Experience/Skills/Abilities:

* Master s Degree in Public Health, Health Administration, Applied Economics, Business Administration, or related field. In lieu of a Master s Degree, must have 6 years of related experienced.
* In addition:
* 2+ years of experience developing and implementing value-based payment arrangements
* A minimum of 4 years experience with progressively increasing responsibility in health care environment, health insurance payer environment, or related industry
* Demonstrated ability to effectively analyze data and derive actionable information from said data
* Exceptional presentation skills and the ability to coach and deliver feedback to less experienced associates
* Proven ability to work collaboratively and effectively with others in a large, matrix organization
* Demonstrated leadership skills including the ability to: 1) train, coach and motivate the performance of others; 2) positively impact the performance of close colleagues as a trusted consultant
* Demonstrated ability to effectively influence and maintain composure with CxO level
* Must be able to work independently with minimal oversight and demonstrate attention to detail, accuracy and quality awareness
* Exceptional analytical and problem-solving skills
* Effective written and interpersonal communication skills, well organized, able to multi-task and work independently, promote flexibility and teamwork
* Able to travel throughout the region daily as needed
* Must have reliable transportation for travel between corporate offices, provider/panel offices and other locations as needed
* Advanced computer skills, Microsoft Word, Microsoft Outlook, PowerPoint, and Excel.
* Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.
* Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
* Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging


Department: Value Based Contracting

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

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