SVP, Health Plan Innovation, Services and Performance

The SVP, Health Plan Performance, Affordability and Innovation is responsible for driving a consistent level of high performance across the regions / markets by building nationally supported key capabilities within each region, spreading best practices and monitoring and managing results. This role will lead the enterprise initiative to improve the performance of our partnership and contracted network providers, including the development of policies and procedures that will drive consistency and performance across all regions.  Further, this role will be accountable for establishing, implementing and monitoring key health plan performance indicators for the regions / markets and coordinating with regional presidents to ensure consistent completion of national business strategic planning processes. Specifically, the position will focus on building and improving provider contracting and utilization management capabilities and resources and implementing cost structure improvements that will enable the Health Plan to compete nationally, at the scale and level of excellence required, to expand our business, grow existing share of total addressable market in the geographies we currently serve, and successfully expand into new geographies, business opportunities and partnerships. This will include partnering across Kaiser Permanente to establish clearly defined network contracting and staffing strategy for ALL regions with a rolling five (5) year view of execution. As part of this, the SVP will lead an initiative with leaders from National Health Plan, PMG, and others across KP to assess and develop capabilities that support the National Health Plan. This will include reviewing what capabilities and resources KP currently has, and what resources KP will need going forward. These capabilities are critical to the Kaiser Permanente National Health Plan-s success and most notably include building a consistent approach to contracting with out of area providers and a utilization management and clinical quality assurance approach for KP or non-KP providers. Today, these functions do not exist, or if they do, they reside outside of the National Health Plan and are carried out independently by each region (PMG, Health Plan and/or Hospital). As such, this role will require significant knowledge of not only health plan products, but also the matrixed organizational structures, and the dynamics of operating in a market in order to be able to transform these capabilities into nationally managed services.  This will include a deep understanding and thorough documentation of the roles and responsibilities for each function related to care delivery.  Including the Integrated Care and Coverage model for our managed care products, as well as, our choice based network products.

• Establish a new national network strategy, performance criteria and implementation plan to include:
  • Creation of a documented strategic plan for network strategy in each market. This will be co-created with regional leadership, National Strategy Team and the National Health Plan.
  • Best-in-class contracting methodology, 
  • Creation of network structure and language optimization, 
  • Creation of contract terms that are easy to administer,
  • Network design that supports product expansion opportunities, including selection and establishment of the right type of value-based contracts for 3^rd party providers, 
  • Creation of terms for value-based contracts which tie the payment for healthcare services provided to KP to patient outcomes, clinical circumstances, and other specified measures of effectiveness,
  • Creation of effective network compliance monitoring to ensure ongoing network adequacy and audit compliance,
  • Careful work around network affordability including medical policy language for performance and optimized contract language. 
• Represent the Health Plan perspective on decisions for clinical operations and medical policy to include:
  • Utilization Management of 3^rd party providers who provide services outside of KP PMGs, 
  • Raising awareness and driving to enterprise agreement on consistency for clinical operations policies (including Bed Day Management and Chronic Care Management policies) that drive the cost of KP-s Health Plan products, 
  • Responsibility for population health management engagement and alignment on program critical success factors and best practice alignment for clinical delivery in key segments such as Medicare Quality Programs, Medicaid State Quality Programs and Commercial Performance Guarantees, for providers outside of our ICC model. 
• Owning consistent application of clinical programs between internal delivery, external delivery and partnership with Risant. 
• Support Growth, Affordability and National/Regional Performance through oversight for region / market performance and results, to include: 
  • Partner with Regional Presidents on Operating Plans that maximize new and organic growth, affordability, and quality. Establish strategy documentation and consistency wherever possible (support differentiation where necessary), 
  • Support successful execution of new business growth opportunities nationally and within regions,
  • Actively pursue lifting and successful execution of best practices within the regions across all regions and nationally,
  • Develop, implement and monitor key health plan performance indicators, including clear and frequent two-way communication, required course corrections and reporting,
  • Liaise and coordinate among regional and national leadership to ensure regional interests are considered in the establishment of new products and growth initiatives, 
  • Provide support to each region / market to implement strategy and growth, affordability and quality initiatives to drive market success overall and growth in all Lines of Business.