Resp & Qualifications
CareFirst is a not-for-profit corporation which is the largest health insurer in the mid-Atlantic region with more than 3 million Members, 5,000 associates and more than $8 billion in annual revenue. The company is regarded as a top employer in many surveys and offers competitive salary and benefits.
Much different from other such programs, CareFirst launched its Patient-Centered Medical Home (PCMH) Program in 2011 and currently has more than 4,000 participating primary care providers organized into over 400 Panels. More than $5 billion in global healthcare cost is managed by the Program on an annual basis. With eight full performance years complete, the Program has produced savings (actual cost vs. expected cost) every year.
In 2019, CareFirst expanded the scope of PCMH outside of primary care to include value-based contracts that support a broader array of healthcare services delivered to our members.
The Practice and Payment Transformation Consulting Team consists of over 40 individuals with varying educational and work backgrounds. We have individuals who hold MPHs, MBAs, MHAs, and MPAs from a variety of leading universities. Successful candidates come to CareFirst from provider organizations, government, advocacy organizations and other payers.
Given CareFirst’s presence in the region, the sophistication of the PCMH model and the substantial experience gained since 2011, this is the best opportunity in the market for individuals seeking to pioneer the development of the population health management field and value-based payment models.
ROLE OF SPECIALTY PRACTICE CONSULTANT- SPECIALIST PERFORMANCE:
The Specialty Practice Consultant, Specialist Performance measures and tracks performance of all providers in order to achieve organization goals of improved quality and reduced global health care costs. This includes but is not limited to:
· Oversee/lead development and execution of Provider Profile Score
· Collaborate with various departments to appropriately measure providers for network curation
· Oversee/lead annual release of specialist cost rankings including updates to methodology and resources developed
· Regularly meet with physicians to review utilization across cost, quality and relationship health relative to peers
· Review and baseline provider performance relative to peers
· Provide ongoing support to internal practice consulting team on all work related to specialist rankings and provider profile score
· Utilize claims and EMR data to conduct a thorough analysis of Physicians’ utilization patterns, opportunities and outcomes relative to peers
· Minimize variability in cost effectiveness by bringing high cost specialists into alignment with more cost-effective peers
· Connect Primary Care Providers with Specialty practices to direct referral volume. Assist with the organization and execution of Clinical Compacts in defined catchment areas throughout Maryland, Washington D.C., and Northern Virginia
· Share best practices and support other Practice Consultants during training as requested
Under the general supervision of a Manager, Practice and Payment Transformation the incumbent’s accountabilities may include, but are not limited to, the following:
Market Analysis and Development
• Builds and manages relationships within the local healthcare market
• Understands community health and wellness needs and identifies opportunities to improve the access, quality and efficiency of patient care and provider communication between patient, PCP, specialist and hospital
• Recruits providers and health systems and promotes participation and success in new innovative value-based contracts
• Facilitates relationships between primary care providers and specialists, creating medical neighborhoods that facilitate optimal patient care and communication
• Negotiates terms of clinical compacts between primary care providers and specialists, and facilitates the execution and success of the compact throughout the year
• Manages aggregate performance of all value-based contracts across the market and develops/adjusts plan as needed
Panel Data and Workflow Analysis
• Becomes the expert in the portfolio of Providers assigned, keenly attuned to current outcomes and areas of opportunity
• Using CareFirst’s proprietary, purpose-built analytic system (known as SearchLight) with a variety of reports for Providers, conducts a thorough review of Panel’s opportunities, utilization patterns, and outcomes on a regular basis
• Acts as a subject matter expert for SearchLight reporting, effectively articulates data sources, data structures, data integrity
• Tracks Providers’ progress to performance targets, develops plan to support maximum outcomes and adjusts as necessary
• Researches any variances and seeks resolution
• Demonstrates the ability to identify through the data, the practice patterns which if modified yield the biggest impact
• Prepares findings in a format designed to tell a compelling story through the data and create the appropriate “call to action” from the target audience of Panel providers
• Models the financial impact of proposed changes in practice patterns
• Prioritizes Providers with greatest impact on cost curve
• Participates in practice workflow analysis to identify and improve inefficiencies
• Provides clinical decision-making support tools
• Assesses practice capabilities and economics in order to make recommendations that optimize cost-efficient, high quality care
• Articulates the basic tenets of value-based programs and successfully presents to providers, administrators, and other key stakeholders
• Schedules, prepares for, and facilitates customized presentations, articulating the call to action based on Provider data
• Maintains a strong relationship, a high level of contact and program direction with value-based Providers in order to implement practice transformation strategies indicated by the data analysis
• Employs consulting skills to overcome objections and resistance to change from Providers, influencing a Provider Group to make a mutual decision to act on proposed practice transformation strategies
• Develops deep relationships with management and key influencers in the Provider Group that enable the Practice Consultant to be the catalyst for practice transformation
• Motivates and inspires providers and their Panels to change behavior and improve overall cost savings and quality through data analysis and consulting
• Focuses providers on findings with the greatest impact on overall cost and quality – directs conversation to avoid low impact pursuits
• Thoughtfully implements processes and technologies in practices to assure the highest state of provider readiness to participate in various CareFirst networks, government programs and other opportunities that may emerge
• Understands other models practices are involved in and aligns practice transformation focus to maximize results in all programs, including ACOs and the Maryland Primary Care Program.
Active Participant in Best Practice Sharing, Practice Consultant Team Activities and Administrative Functions
• Shares best practices and supports other Practice Consultants during training as requested
• Tracks key metrics for practices in a dashboard and meets regularly with Managers and internal subject matter experts to assess progress
• Summarizes provider interactions in a Client Relationship Management System each week
• Participates in ongoing Practice Consultant training and professional development courses
• Master’s Degree in Public Health, Health Administration, Business Administration, or related field.
• At least two years of experience in the healthcare field
• Demonstrated ability to effectively comprehend complex data analysis
• Solution development
• Executive presentation skills
• Effective written and interpersonal communication skills
• Must be able to work independently with minimal oversight and demonstrate attention to detail, accuracy and quality awareness
• Well organized, able to multi-task and exhibit flexibility
• Proven analytical and problem solving skills
• General understanding of Operations, Finance, Health Care Systems
• Ability to work in a matrixed organization, promoting collaboration and teamwork
• Effective at building relationships with various levels of business professionals and/or clinicians
• Drive to establish new relationships within healthcare provider community and be creative in coordinating meetings, overcoming obstacles to scheduling, etc.
• Strong computer skills including Microsoft Excel, PowerPoint, Word, and Outlook.
• Able to travel through assigned region on a daily basis and work in the field the majority of work days (75% of role is in the field).
• Must have reliable transportation for travel between Corporate offices, provider/Panel offices and other locations as needed.
• 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
• Must demonstrate resilience and 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
• Four to five years of work experience, in one or more of the following areas:
o Consulting skills and/or direct experience in a consulting role
o Experience in a clinical setting or knowledge in a clinically related field
o Project management experience
• Experience using Client Relationship Management (CRM) System(s)
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.
Please apply before: 2.10.2021
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship