CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S.,from clinics and hospitals to home-based care and virtual care services,CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources, CommonSpirit is committed to building healthy communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen, both inside our hospitals and out in the community.
Job Summary / Purpose
The System VP, Payer Strategy Innovation is responsible for leading initiatives on behalf of the Payer Strategy & Relationships (PSR) function to create innovative and transformative payer strategies, relationships and agreements that drive the future of CommonSpirit Health by optimizing revenue and increasing the number of people we serve. This role will lead the Payer Strategy Innovation team in developing payer strategies to advance strategic partnerships, merger/acquisition activities, new care delivery/service reimbursement models, enterprise business line integration, value-based agreement strategy and growth, and overall efforts to innovative payer strategies to maximize value for CommonSpirit Health. This role positions CommonSpirit Health for sustainable financial performance through sophistication and innovation in payer strategies and the translation of provider/system value into payer reimbursement strategies.
The System VP of Payer Strategy Innovation is a key member of the CommonSpirit Health leadership team, directly interacting with executive leaders across the organization and contributing to the ministry becoming a system of choice through an integrated operating organization with a healthy culture built on relationships, trust, & teamwork. This role will make significant contributions to the development and implementation of system and local strategy, transformation to a clinical enterprise, successful physician alignment strategies, achievement of patient experience & employee engagement goals, and achieving budgets. This position is responsible for innovative payer strategies that impact payer agreements with over $13B of annual net revenue and over 2M people attributed to value-based agreements.
Essential Key Job Responsibilities
1. CommonSpirit Health System leader responsible for payer strategy innovation to advance strategic partnerships, merger/acquisition activities, new care delivery/service reimbursement models, enterprise business line integration, value-based agreement strategy and growth, and overall efforts to maximize the value of strategic payer partnerships.
2. Directly engages with the senior leadership team across CommonSpirit Health to design strategic initiatives that influence payer and employer strategies for the entire ministry.
3. Leads, manages, mentors and develops Payer Strategy Innovation team.
4. Engages in cross-functional initiatives to drive integration and alignment across CommonSpirit Health to improve operational and financial performance, increase employee engagement, and deliver on our ministry’s commitment to improving the health of those we serve.
5. Evaluates innovative payer partnership opportunities to ensure alignment with CommonSpirit Health’s transformative strategies and PSR’s National/Divisional strategic plans (JOA/JV, co-branded/white labeled payer products, preferred network partnership, narrow/tiered network partnerships, etc.).
6. Develops, implements and monitors success of innovative national and local payer partnership strategies to drive sustainable financial performance.
7. Acts as the System PSR lead for all payer-related merger, acquisition and divestiture activities.
8. Translates value generated from CommonSpirit Health providers, Clinically Integrated Networks/ACOs, and population health management programs into payer contracts and reimbursement models.
9. Designs strategy and manages system participation and performance in novel innovative care models to ensure appropriate reimbursement models accompany program participation.
10. Designs and implements reimbursement strategies for new services/care delivery models to optimize revenue and margin (telehealth, hospital at home, etc.).
11. Collaborates with System and Division Finance, Legal, Enterprise Business Line, Strategy and Business Development, and Clinically Integrated Network Operations areas to advance the alignment and accountability model in order to maximize the value of CommonSpirit Health payer contracts.
12. Stays current with emerging payer trends, new reimbursement methodologies, payer activity, products and delivery channels.
12-18 month expectations
Success in this role will be evident in revenue generation and contribution margins achieved through fee-for service and value-based reimbursement effectiveness, and the organization's ability to translate provider/CIN/system value into effective value-based models that reward CommonSpirit Health for improving the health of defined populations while delivering affordable access and service excellence.
Key initial success indicators for this role include:
Design and implement a high quality, integrated and aligned Payer Strategy Innovation structure that delivers value across the System.
Develop reimbursement strategies and contracting guidelines for new services/care delivery models to optimize revenue and margin (telehealth, hospital at home, etc.).
Deliver effective support across the System to advance payer-related merger, acquisition and divestiture activities.
Demonstrate concrete and relevant operating income and contribution margin linkages between payer contracts and provider/CIN/system value generation.
Non-essential Job Responsibilities
1. Educate key stakeholders on PSR initiatives and objectives
2. Coordinate system reporting to address internal and external requests
3. Other duties as required by PSR Leadership
Required Minimum Experience
· 15+ years industry experience
Required Minimum Knowledge, Skills and Abilities
· 10+ years progressive leadership responsibility and experience in large healthcare organizations and/or integrated healthcare delivery systems
· 5-10 years strategic management of healthcare pricing, contract negotiation, and healthcare economics in a complex, national or multi-regional healthcare system or health insurance environment
· Experience in value-based reimbursement model development
· Experience with healthcare merger & acquisition transactions
· Demonstrated success in leading, implementing, and managing financial performance of payer contracts
· Demonstrated ability to work effectively in a matrix organization
· Demonstrated ability to effectively drive strategic transformation work
Preferred Education and/or Experience
Bachelor’s degree is required; Master’s in Business or Healthcare Administration or related field is preferred