SWHRCIN Chf Mkt Pyr Rl Fn Of SWHR

Southwestern Health Resources was established in April 2016 as a unique partnership between the founding entities, UT Southwestern Medical Center, a public academic medical center, and Texas Health Resources, a private faith-based non-profit health system, based on a shared commitment to create a highly differentiated value proposition in both quality and total cost of care for consumers, purchasers, patients and physicians. A cornerstone of Southwestern Health Resources is a clinically integrated network of independent and employed physicians, including the employed faculty physicians of UT Southwestern, the employed physicians of Texas Health Physician Group, and independent community primary care and specialty care physicians. The integrated network builds on more than 50 years of collaboration between the two institutions to improve the health of North Texans.

Southwestern Health Resources includes 29 hospital locations and more than 5,000 physicians located throughout North Texas in its network. With over 650 points of access to care, this provides for higher value and allows patients to access services across a full continuum of medical needs. The network serves people across 16 counties in North Texas. SWHR coordinates care for more than 700,000 patients, aligned with commercial health care plans and Medicare programs, along with more than 13,000 Medicare beneficiaries enrolled in its Care N’ Care health plan. It also provides Population Health Services through clinical and quality data along with analytic services necessary to support the physician-driven clinical decisions.

Position Summary:

Reporting to the Senior Executive Officer of Southwestern Health Resources, and in partnership with its parent organizations, the Chief Market, Payor Relations & Finance Officer SWHR will be responsible for developing a distribution strategy that is aligned with the companies' organizational goals and enables the organizations to succeed in a dynamic reimbursement environment. This executive will have oversight of the entirety of the managed care functions across both UT Southwestern and Texas Health Resources, representing $7.5 billion in base rate and at-risk contracted revenue through SWHR. Given the highly operational nature of value-based contracts, the Chief Market, Payor Relations & Finance Officer SWHR will oversee the financial aspects of SWHR operations (annual budget and actual P&L).

Reporting directly to the Senior Executive Officer, this position will lead the Finance function for the organization in coordination with the Chief Revenue Officer, THR. This position will also serve as a financial and strategic thought partner to the SEO, parent organizations, and the Board of Directors to shape the strategic direction and financial goals for the entity.

This leader will manage the relationships with and earn the respect of traditional managed care organizations as well as consultants/brokers, employers and governmental agencies. The Chief Market, Payor Relations & Finance Officer SWHR will be expected to coordinate efforts with the leaders and governance of hospitals, physician groups and population health services, which are part of the SWHR organization, and ensure that the best interests of both partners representing both community-based hospitals and academic medicine – are served in contracting functions on behalf of the whole. 

The Chief Market, Payor Relations & Finance Officer SWHR will interface with key leaders across the organization to effectively coordinate contracting for healthcare products and services. The successful candidate will be responsible for creating and leading a strategy that optimizes revenue while assessing both fee-for-service and value-based payment methods, ranging from upside-only risk to full capitation, evaluating new market offerings such as limited and tiered network products and considering new market opportunities like telehealth and national and international purchasers, as well as direct to employer relationships. This leader will incorporate feedback on payment design with the Physician Network, Care N' Care insurance company and Hospital Network, as well as the two parent organizations. The successful candidate will serve as a steward of fiscal resources, with the primary mission to achieve the revenue of SWHR and its affiliate organizations.

Responsibilities and Duties:

·        Partner with senior leadership to devise payer strategies that align with delivery system requirements and organizational goals and ensure market access, improved care quality and financial strength for SWHR, its parents and participating providers.

·        Advance the organizations’ value-based payment strategy through the optimization of existing programs and development of new risk-based reimbursement models and innovative insurance products featuring SWHR’s providers.

·        Develop and recommend negotiation plans, which will establish negotiating parameters that are aligned with the goals, strategies and objectives of SWHR and its parent organizations and optimize value in the care it delivers.

·        Partner with internal constituencies to develop strategies that increase competitiveness in the local market while leveraging volumes and strategic relationships.

·        Collaborate with clinical leaders to develop quality-based metrics and contractual incentives.

·        Serve as primary representative to the payer and healthcare purchaser market on behalf of SWHR and its affiliated hospitals, ancillary providers, independent practice associations and physician groups.

·        Build and maintain positive ongoing relationships with all healthcare purchasers, with the objective of maximizing market share for SWHR-affiliated members.

·        Develop managed care contracting and business implementation strategies with commercial insurance companies, consultants/brokers, employers and government agencies to include Medicare and Medicaid.

·        Ensure rigorous prospective modeling and routine financial reporting to ensure stakeholders have reliable information necessary to make informed decisions.

·        Work closely with parental business offices to ensure contractual arrangements support efficient collection efforts in all payer segments. Monthly review of payor performance to drive interim payor engagement for identified issues, as well as during contract negotiations.

·        Work cooperatively between the healthcare purchaser community and SWHR-affiliated organizations to provide market intelligence and customer feedback, as well as facilitate testing of new ideas, strategies and tactics with the healthcare purchaser community.

·        Work collaboratively with CIN operations to ensure alignment of SWHR and parental strategies are incorporated into agreements, in alignment with organizational goals and strengths.

·        Assess new and prospective regulations to determine impacts on contracts and reimbursement, and take appropriate action. Lead development and deployment of an enterprise alternative reimbursement platform to ensure financial payment integrity.

·        Understand and advance specialty and parental growth programs (in that, transplant, oncology, etc.) to ensure appropriate reimbursement, especially those programs that create unique value for the communities served.

·        Provide system-wide payer relations management in order to develop strategic and tactical operating plans that support the achievement of the financial and strategic objectives of SWHR.

·        Support the development of key indicators to monitor payer and healthcare purchaser relations activities. Manage all key indicators to ensure target compliance.

·        Oversee preparation of financial and statistical analysis and reporting for all payer and healthcare purchaser contracting.

·        Develop, motivate and mentor a management team with 20 staff to its highest performance. Work to effect positive change.

·        Instill accountability to create a high-performing team.

·        Create strategic alliances with key internal and external groups to maintain or create a competitive advantage for SWHR and its affiliates.

·        Directs the preparation of annual, quarterly and monthly financial statements in accordance with GAAP.

·        Drive predictable, consistent performance versus budget.

·        Oversee management short and long-term P&L and cash flow forecasting and capital allocation.

·        Ensure appropriate financial controls, infrastructures and processes are in place across the organization.

·        Acts as subject matter expert on financial reporting and technical accounting topics.