VP Payor Strategy

Location: Cambridge, MA
Job ID: 176403-1A
Date Posted: May 18, 2022
Category: Professional

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Job Description

Welcome To

Beth Israel Lahey Health (“BILH”) is a comprehensive, integrated healthcare system, dedicated to delivering extraordinary care to residents throughout New England. We are anchored by academic and teaching hospitals, community and specialty hospitals, and a full continuum of services spanning specialty and primary care, behavioral health, ambulatory care, and home health services in shared mission to expand access to extraordinary care and advance the science and practice of medicine through groundbreaking research and education.

About the Job

Beth Israel Lahey Health (BILH) is seeking a leader to work with BILH in structuring and negotiating managed care and value-based care contracts and to drive strategy for Beth Israel Lahey Health including Beth Israel Lahey Health Performance Network (BILHPN), behavioral health, ancillary services and continuing care companies. The Vice President of Payor Strategy is a key member of the BILH leadership team, responsible for conceptualizing, developing and executing commercial, Medicare, MassHealth, and direct to employer contracts that support the systems' business objectives and meet the goals of all stakeholders. This executive leads contract negotiations, payer market review and analysis, identifying and summarizing provider competitive intelligence, managing the legal and operational, and contract finance aspects of all system payer arrangements.

The Vice President of Payor Strategy will oversee strategy development to enable payer alignment with system strategic goals and lead key payer negotiations that need to include value-based models as well as FFS models for referral business. The position will have significant revenue responsibilities and will require a detailed understanding of healthcare financing and delivery as well as the ability to think strategically and offer innovative solutions to complex challenges.

The Vice President will jointly report to the Executive Vice President and Chief Financial Officer of BILH and the President of the BILH Performance Network.

Duties & Responsibility:

  • The position provides strategic thought leadership and partnership to all constituent entities of BILH and BILHPN. These responsibilities need to be carried out with a high value placed on process buy-in and the needs of constituents.
  • Develop annual and multi-year payer strategic plans aligned with changing health reform landscape in the context of the BILH/BILHPN's overall strategic direction and mission.
  • Oversee negotiations with third party payers on behalf of the enterprise to ensure the results meet enterprise goals.
  • Pursue and develop relationships with employers with regard to narrow network plan design, and new payment and relationship models.
  • Provide input to senior management relative to business development and strategic positioning as it relates to payer strategy.
  • Serve as a liaison to the payer community on payment issues.
  • Pursue and develop relationships with payers with regard to new payment methods that support the strategic goals of the enterprise.
  • Be an effective partner to BILHPN and support its business objectives.
  • Monitor relevant policy at a state and national level and assess opportunities and threats related to emerging and evolving issues.
  • Integrate and develop the existing contracting, finance and analytic teams to support the payer strategy efforts.
  • Propose enhancements to operational processes to improve efficiency and/or effectiveness.
  • Ensures that all departments meet service level agreements, quality standards, and performance goals based on the development and monitoring of cost and process metrics.
  • Acts as a key participant in the strategic and long-range planning of the organization. Integrates long ranges plans with operational plans and capital priorities.
  • Analyze operations to evaluate performance of the team in meeting objectives or to determine areas of potential cost reduction, program improvement, or policy change.

Experience:

  • 10+ years related work experience in managed care; payer and provider experience desirable.
  • Experience with and understanding of health care reimbursement methods, health care payment reform both locally and nationally.
  • Experience working with cross-functional teams in complex organizations.
  • Experience hiring, training and managing small teams and matrixed staff.
  • Successful experience managing population health, including clinical considerations.

Business Acumen:

  • Proven ability to successfully build relationships with key stakeholders; CEOs and Executive Leadership team and leaders across the system.
  • Ability to think on his/her feet and offer creative insights and constructive responses when face with difficult concerns and issues raised by payers, executives and Board-level and management level stakeholders.
  • Proven success working under extreme pressure where consequences of error could result in material negative financial outcomes that have high impact on the organization or members of BILHPN.
  • Errors in accuracy, judgement, tact, or communication could result in significant loss of credibility with Network stakeholders, payers or regulators. Individual must have a track record that demonstrates mastery of these characteristics within a complex, fast-moving environment.
  • Demonstrated ability to manage varied and competing interests of current stakeholders, other potential stakeholders, and future concerns in order to preserve the mission and long-term vision of a fast-growing, deadline-focused organization operating in a rapidly changing environment.
  • Advocates for the desired culture in high-level planning and decision making, with a focus on performance accountability and achieving greater operational efficiencies.
  • Excellent staff leadership, operations development and oversight, program supervision and management skills of a diverse team ensuring that succession and development plans are in place to achieve the company's goals.

 Goals and Objectives:

  • Develop the payer contracting governance structure to support BILH entities and ensure stakeholder engagement and BILHPN.
  • Develop a payer and employer strategy that incorporates innovative models for value based care.
  • Develop a plan for the transition of contracts from entity based to Beth Israel Lahey Health and BILHPN system wide agreements.
  • Develop the infrastructure needed to support the activities.
  • Model leadership behaviors and lead as a unified team to drive system alignment.

Education:

  • 10+ years related experience in a senior level position dealing with managed care strategies, contracting, finance, and operations support within a complex healthcare system, integrated delivery system, payer or other managed health care environment.

About Us

Beth Israel Lahey Health is dedicated to improving health and wellness and making a difference in the lives of our patients, their families and all members of the communities we serve.  Formed in March 2019, Beth Israel Lahey Health is a patient-centered, integrated care delivery system providing a continuum of services spanning academic, tertiary and community hospitals, dedicated orthopedic and psychiatric hospitals, primary and specialty care, community acute care, ambulatory care, behavioral services and home health.  Beth Israel Lahey Health Performance Network is a unified joint contracting and population health management organization, jointly governed by participating physicians and hospitals.

Equal Opportunity Employer/Minorities/Females/Disabled/Veterans.