Patient Centered Clinical Integration (PCCI) Administrator
Participates in the successful development and implementation of TMCH Patient Centered Clinical Integration Administration (PCCI) for the communities served by TMCH. Facilitates PCCI in collaboration with the Chief Executive Officer and Executive Team, collaborating across TMCH with providers, other healthcare entities, stakeholders and the community in a unified health strategy to benefit patients and improve health outcomes. Consistently shares best practices across the organization in development of this strategy, standardizes population health information and shares resources with member PCCI partners. Infrastructure development, provider and payer integration strategy and implementation of patient cantered clinical integration strategy are the primary focus of this role. This includes leading and implementing strategy, tools, metrics and best practices that positions TMCH to achieve its integration strategy and continuity across the inpatient and outpatient care continuum from routine care - chronic disease management – homecare – to palliative care – and hospice.
Serves as a leader, principal communicator, and operational driver of the PCCI network. Works with the TMCH CEO, Executive Team, Physicians, Members and Committee, in a decision-making leadership and support role. Set goals and priorities of the PCCI, in collaboration with the overall direction for the network, and clearly articulates the values and goals of the PCCI.
Establishes PCCI operational and strategic goals in conjunction with the TMCH President and CEO.
Oversees recruitment and onboarding, in collaboration with physician leaders, of provider/physician practices to join the PCCI; including oversight of network development strategies, public relations/communications plans to promote the network. Develops and maintains protocols for follow-up/adherence to contract compliance and performance of providers, including referral management protocols, clinical pathways and data submission requirements.
In collaboration with Members, develops annual PCCI budget, operational priorities and strategic framework to support the network’s objective.
Explores existing and new business models, joint ventures, affiliations, structures and reimbursement methodologies in support of the PCCI’s mission and purpose. Facilitates the education, fiscal assessment, and operational and strategic implications of such methodologies.
As the network develops, engages leads and supports business development discussions with major employers about their healthcare needs, contracting/collaboration opportunities, and quality objectives.
Engages, leads and supports, in collaboration with Member contracting teams, PCCI contracting strategies and discussions with major health plans.score: N/A Establish and support people, process & structure to measure and improve quality, cost, patient experience and provider satisfaction across the network
Manages PCCI business operations; including finance, analytics, IT, provider relations, provider payment funds flow models.
- Oversee development and implementation of IT strategy and technical solutions in support of PCCI operations, including a must have robust population health analytics tool, care management/referral management functions and quality reporting tools. Partners with TMCH IS and with Member IS teams on vendor integration and development/selection of IT solutions around population management.
Collaborates with the PCCI Network Medical Directors to establish priorities for Network.
- Identify, develop, implement and maintain value added services for independent providers (e.g. medical malpractice, employee health benefit products, group purchasing arrangements, MSO services, agency staffing).
- Lead payer contracting strategy discussions and payer contracting negotiations with finance.
- Develop, implement and refresh PCCI quality metrics.
- Develop/maintain physician incentives distribution model.
- Provide PCCI education to the community, employers, payers, physicians and TMCH Executive Staff and Board Members.
- Develop and annually update a 3 year strategic plan.
Works collaboratively with TMCH CEO and leadership supporting the enterprise wide PCCI strategy and achieving and implementation goals.
Collaborates to assure medical staff leadership development is aligned with the TMCH concepts of integration and is able to socialize concepts, collaborate on creative solutions and broker relationships.
Is accountable for structure development, results reporting - including agreements, population health data repository, data mining for identification of system leakage and financial reporting.
As a subject matter expert supports efforts in the design and implementation of various PCCI programs across the enterprise.
Supports implementation of integration across TMCH with successful implementation marked by provider partnerships, population health collaborations, standardized processes, infrastructure development, quality initiatives and performance measurement and growth.
Integrates population health management software utilization across the organization and in collaboration with other partners assuring delivery of financial integration with partners and best practice standards to ensure TMCH achieves a high level of integration and targeted health outcomes. This includes collaborations with its practice support functions, providers, payers, other healthcare delivery systems, practices and patients.
In collaboration with the CEO, develops and implements partnerships, working with stakeholders to achieve best practices in management of populations for the TMCH communities,
Provides support in an effort to maximize collaboration with other health systems, primary and specialty care practices, healthcare payers and other health and community partners.
Adheres to TMC organizational and department-specific safety, confidentiality, values, policies and standards.
Performs related duties as assigned.
EDUCATION: MD/ DO with Master’s degree preferred.
EXPERIENCE: A minimum of five (5) years of progressively responsible related leadership experience that would demonstrate attainment of the requisite job knowledge / abilities.
LICENSURE OR CERTIFICATION: Current Arizona License to Practice Medicine.
KNOWLEDGE, SKILLS AND ABILITIES:
- Executes TMCH vision and mission in all initiatives.
- Understands the current health system and health payment structures.
- Experience with and understanding of primary care/specialty health integration and management.
- Knowledge of complex medical and health conditions and national standards of quality care.
- Capability to work collaboratively with people of diverse cultural backgrounds.
- Strong analytical, problem-solving and big-picture/conceptual skills.
- Capacity to embrace and understand the change process and effectively support change in the delivery and access to care which sometimes may move TMCH from a majority to a minority position in a new relationship.
- Understands and support population health and the analytics and necessity of a collaborative product to support this initiative.
- Understands provider practice patterns, levels of quality outcomes and data relative to patient leakage which can adversely affect outcomes.