Job Details

Vice President Of Accountable Care Organization Strategy And Transformation

Company name

Champlain Valley Physicians Hospital

Organization Type

Public Interest

Job Type

Non-practicing Attorney

Valid Through

Dec 21,2019

Posted on

Sep 07,2019

Years of Experience

Min 10 yrs required


Plattsburgh, NY, United States

Employment Type



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Vice President of Accountable Care Organization Strategy and Transformation
Responsibilities: Leads new ACO programs (government, self-insured). Serves as the main point of contact for all program/contract negotiations and/or amendments. Serves as the main liaison with legal counsel and Chief Compliance Officer to assure program compliance. Proactively identifies any barriers in the ACO programs and ensures changes/amendments are well designed for ACO success. Acts as the primary contact for legal counsel and the Chief Compliance Officer to develop and execute on participant contracts that are in compliance with state and federal laws. Identifies and develop contingency plans to mitigate and address contract risks Acts to influences health care reform activities that impact ACO program design. Stays up to date on current industry, market and policy landscapes including trends and features of commercial and government ACO programs nationally. Oversees Alignment of ACO Financial Budgets and Policies and Procedures. Oversee development of annual ACO budgets for ACO programs for the CEO, Finance Committee, and Board of Managers. Monitors results against budget, proactively identifying issues and proposing actions and recommendations for program performance to budget targets. Ensures budgets and related information necessary for ACO compliance is provide to regulatory bodies as required. Develops models and forecasts for ACO Programs to generate expected total cost of care targets as part of annual budget process. Develops and maintains models for operational support revenue as a combination of founder/owner contributions, network contributions/fees, grant income, payer program revenue, contracted services and other revenue. Ensures ACO payer program budgets and revenue models comply with financial, program and contractual requirements. Builds or buys financial performance monitoring infrastructure and/or services required to successfully implement approved strategies and achieve high performance. Oversees ACO approaches to risk sharing/management including participating in reinsurance program review with CEO and Finance Committee. Lead ACO program Strategic/Financial Planning and Implementation. Maintain significant industry knowledge of ACO programs and value-based reform including financial elements, program structures, best practice trends, and performance benchmarks. Create and maintain multi-year plans and economic models for assigned ACOs. Assesses all market opportunities that align with provider-led, population-based reform and innovative revenue models to providers. Develop and sells to payers a proactive vision and strategy for aligned ACO models and contracts based on unified incentives and common population health management approach. Develops strategies for self-funded accounts/lives through commercial carriers or direct contracts. Oversees ACO Finance Leaders in negotiation of financial elements of ACO program contracts with payers and employers. Reviews all opportunities and options for Medicare and Medicaid ACO program offerings to incorporate in product portfolio and strategic plans under guidance of CEO and ACO Boards. Assesses government program managed care options such as Medicare Supplemental Plans, Medicare Advantage, and Medicaid Managed Care which could drive premium-based revenue and more flexible ACO programs. Identifies and implements approved strategic partnerships and ventures with existing payers/insurers to implement strategies. Implements a data-driven approach to monitor and improve ACO program performance. Drives significant focus on numeric performance against targets and benchmarks for cost, utilization, best practice adherence, and network use patterns. Develops and publishes quarterly program performance reports for all major ACO programs/contracts. Presents monthly updates to ACO Boards and Committees on program performance and opportunities. Meets with payers and network providers on a regular basis to review program performance and opportunities. Assesses and quantifies opportunities for improvement on total cost of care performance on an ACO-wide basis as well as for specific service areas or providers. Develops approach for program performance monitoring and forecasting which allows risk-based provider accruals of losses/gains. Leads Assigned ACO’s efforts on value-based provider payment model. Maintains knowledge of revenue-driven health reform and payment reform efforts at both state and national levels. Ensures payer negotiation or ACO program flexibility allows for provider-led payment reform designs. Leads development of non-fee for service provider payment and incentive models which may include fixed prospective payments, full or partial capitation, withholds bundled payments, and value-based incentive payments. Drives internal consensus on clear, actionable payment reform approaches and supports efforts to communicate and promote participation to network providers. Analyzes and recommends action/inaction on optional reform participation such as demonstrations, waivers, and payment reform pilots which include alternate models of reimbursement which can either stand alone or coexist with ACO programs. Develops desired details, added elements, and/or alternative models for health reform which can be used in advocacy efforts. Builds and Maintains Important Government/Stakeholder Relationships. Maintains knowledge of stakeholders and their communication and input needs regarding ACO finance, programs, and payment reform. Maintains senior stakeholder relationships in a highly transparent and collaborative manner. Develops general government relations strategies across executive branch, legislatives, and regulatory bodies in collaboration with ACO senior team, Boards, and ACO equity partners. Focuses heavily on strategies and relationships with the state and federal regulators including Centers for Medicare and Medicaid Innovation and the Department of Health in New York. Develops strategies to provide ongoing and ad hoc engagement and communications with stakeholders regarding finance and strategy. Serves with the ACO CEOs, VPs/AVPs Operations (COOs) as a public face of the ACO and shares duties of presenting at conferences, provider association meetings, providing testimony when asked by the legislature, serving on task forces and committees. Maintains strong ongoing relationships with the ACO’s major partners Adirondack Health institute (AHI), Hudson Headwaters Health Network, UVMHN Programs and others.

Qualification and Experience

Qualifications: Bachelor’s of Science in Health Care Administration, Business, or Finance is required. Graduate Degree in Master’s of Public Health, Master’s of Business Administration, Master’s of Science in Nursing, Medical Degree, Doctor of Osteopathic Medicine, JD Degree, or other related field is preferred. Must have knowledge and passion for complex payment reform models, population and community health programs, federal and state health reform programs and all financial, clinical, and technologic aspects of healthcare reform within an ACO Program and partnership with federal and state healthcare purchasers. Specifically the candidate requires breadth of knowledge and which span multiple functions and areas of health care reform efforts. Advanced knowledge of national and local health care industry practices and trends. Federal and state regulation, health care industry economics, provider network building, shared risk arrangements, reimbursement strategies and methods, contract and proposal design and development, negotiation theory and practice, strategic work planning, project management and human resource management is required. Working knowledge of various payment methodologies to help transform incentives for paying for health care differently including capitation, pay for performance, bundled payments, gain sharing and other risk strategies is required. Comprehensive understanding of hospital and physician financial issues and how to leverage technology to achieve quality and cost improvements for both payers and providers is required. High proficiency in analyzing and synthesizing complex financial information and funds flows is required. Functional knowledge and ability to effectively apply knowledge in the course of fulfilling the duties of the position - management care products, health policy, marketing, principles of entrepreneurship and organizational development is required. Project Management Skills – A strong ability to lead a project team to assess, design, tests, and/or implements new systems, policies, or standards are required. Process Improvement Knowledge and Abilities – Strong demonstrated knowledge and experience with business process improvement cycles. 10+ years of health care experience in general health reform strategy, health care financial programs and operational management with a specific focus in population health care programs development inclusive of financials, informatics, network development, and payer/provider relations required. Previous experience at the Director, VP, or CEO/CFO/CIO levels is highly desirable and experience in network-based organizations under popular economic incentives is highly valued. Experience in one of more of the following areas: public or private insurance/health plans, provider-side managed care, health care provider operational/clinic leadership/ or practicing physician/clinician with material administrative or financial leadership duties is required.

Additional info

ID: 2019-25045

Company info

Hiring Coordinator
Champlain Valley Physicians Hospital
75 Beekman Street
Plattsburgh, NY 12901