Southwestern Health Resources (SWHR) was formed in 2016 through a joint venture between UT Southwestern Medical Center - one of the premier academic medical centers in the country - and Texas Health Resources - among the largest faith-based care systems in the U.S. By blending the strengths of these two powerhouse healthcare systems, SWHR offers an unmatched ability to connect individuals with a full spectrum of nationally preeminent, clinical care. In 2018, SWHR expanded its reach to care for North Texas by becoming the parent of Care N' Care Insurance Co., a leading regional Medicare Advantage health plan.
Reporting to the Senior Executive Vice President / Chief Financial Officer of Texas Health Resources and the Executive Vice President for Business Affairs of UT Southwestern, the SVP Market & Payor Relations (SVP, MPR) will be responsible for developing a payer and direct-to-employer 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.
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 SVP, MPR 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 SVP, MPR 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.
Essential Functions:
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.
Professional Experience/Qualifications:
Individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individual with disabilities to perform the essential functions. This role requires the ability to solve problems, think outside-the-box, and be resourceful; must be result-oriented, a quick learner and self-starter. Comfortable working in complex and matrix organizations. The requirements listed below are representative of the knowledge, skill, and/or ability required to build SWHR's culture for action.
Bachelors' degree in business, health care administration, finance, or related fields required.
Masters' degree in business, health care administration, finance, or related fields preferred.
10 years' Experience negotiating complex managed care contracts involving value-based payments with payer organizations, preferably with an integrated health system which includes acute care, physician and sub-acute care operations and both academic and community hospitals required.
Experience working with consultants/brokers, employers and direct-to-employer products preferred.
Specific experience and strong track record in developing and executing innovative strategies to address market issues in healthcare including via payer arrangements.
Demonstrated ability to articulate a vision and generate necessary consensus behind implementation through exceptional influencing skills. Is results driven and comfortable implementing and driving change in a highly matrixed environment.
Strong industry knowledge related to value-based care, payment innovation, and provider collaboration.
Experience conducting significant negotiations.
Deep understanding of competitive landscape and industry trends in topics such as physician compensation redesign, patient-centered medical homes, full-risk capitation, bundled payments, and commercial and government ACO programs.
Ability to think critically, understand complex concepts and quantitative analyses, synthesize information and make good judgments. Deep understanding of the analysis of data and information, with the capability to support the design, execution and deployment of effective performance dashboards and metrics.
Excellent oral, written, and interpersonal communication and persuasion skills required.
Capable of functioning in ambiguous environments and handling multiple and diverse tasks simultaneously.
