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Job Description Summary :
Facilitates transformative change within primary and/or specialty care practice/organizations, providing generalized and specialized support aimed at building the practice/organization overall capacity for ongoing and sustainable change to high performing medical practices. Cultivates and leverages effective long-term relationships with practices/organizations to introduce and drive a culture of continuous quality improvement (QI) and learning in the practice/organization. Skillfully utilizes the QI framework to advance practice’s competency and capability in the five core functions of primary care: access and continuity, data-driven population health management, patient and caregiver engagement, comprehensive and coordinated care, and care management. The consultant will also use the QI framework to advance specialty practice’s competency and capability in coordinating and sharing information among primary care providers and specialists. Ensures that goals and measures set by Blue KC for monitoring and evaluating success of its various value based programs (ACOs, Medical Home, CPC+) and future programs are executed at the practice level while being inclusive of the health system, ultimately achieving the triple aim goals - better care, smarter spending, and healthier people.
Facilitates the progression of assigned practices from current state of care delivery to a highly functioning, transformed medical practice/system embracing and acting on the principles of patient-centered medical home (PCMH) in support of primary care practices entire Blue KC attributed members.
Effectively utilizes Appreciative Inquiry as the approach to organizational and practice improvement and the use of inquiry to elicit meaningful information foundational to initiate and drive change.
Leads the practice in mapping and redesigning of workflows and processes toward the goal of improving cost, quality and patient satisfaction outcomes.
Assesses and collects data and outcomes that support practices redesign efforts in the performance of Developmental Review Process reviews.
Provides training, technical assistance and consultative guidance to the practice related to Patient-Centered Primary and Specialty Care, Comprehensive Primary Care Plus (CPC+) performance. This training may be provided by this staff member directly or facilitated by engaging a content expert to bring resources to the initiative. Drives cross pollination of best practices/best approaches and collaboration among assigned practices/systems.
Interprets and presents analytic reports on cost, quality, utilization, patient experience and risk adjustment to support practices in their development and implementation of strategies and tactics to improve outcomes and results.
Accountable for introduction and educating on the value and use of reporting tools, registries and delivery of reports via Blue KC’s Physician Portal.
Build and effectively maintain relationship with the practice/organization leadership actively involved in transformation efforts. In order to drive and support integrated PCP led care for Blue KC members.
Packages organizational, practice and/or provider centric reports, talking points and any other supporting material as needed.
Works collaboratively with Blue KC’s internal practice engagement team members, to include Medical Directors, Pharmacists, Nurse Coordinators, Provider Business Partners, Provider Representatives, and other members of the team to provide comprehensive and coordinated support to practices as they transform. Drives external collaboration and an integrated practice facilitation approach with the CPC+ Regional Learning Vendor Practice Facilitator(s).
Assists and supports department leaders in summarizing and disseminating experiences and related learnings by way of team updates, written reports or presentations as called for by Blue KC leadership.
Identifies challenges and barriers that may prevent practices/systems from meeting desired outcomes and facilitates results-driven solution focused discussion, ultimately bridging Blue KC’s business objectives with the practices, bringing to bear solutions of mutual benefit.
Success factors for the Healthcare Transformation Consultant encompasses incremental and favorable movement by practices/organizations on specific cost and quality performance measures, practice satisfaction with the Healthcare Transformation Consultant’s engagement, and project based initiatives which may vary annually.
Bachelor’s degree in nursing, business administration, health care administration, organizational leadership or other relevant academic discipline with 10 years of experience in healthcare, preferably primary care, or any combination of education and experience providing the types and levels of knowledge, skills, and abilities required of the role, or the core competencies required are possessed and transferrable to the role.
Proficient understanding of PCMH and/or PCSC principles which include knowledge and techniques of how to effectively facilitate physician-led, team based, coordinated and holistic care.
Thorough understanding of value based care, alternative payment models and the role of primary and specialty care in directing care and delivering value within the healthcare ecosystem.
Possesses a command of cost of care, quality and outcomes framework, Consumer Assessment of Health Plan Survey (CAHPS) and Risk Adjustment (accurately capturing the illness burden of the patient/member population through medical coding).
Demonstrated proficiency in driving organizational and systemic change focusing on quality improvement opportunities surrounding people, process and technology.
Experience in interpreting analytic reports on cost, quality and utilization and developing and implementing strategies and tactics for improvement.
Ability to demonstrate strong communication and problem solving skills with the capacity to anticipate and identify needs from practices/systems.
Ability to demonstrate flexibility and adaptability in a rapidly changing environment.
Master’s degree or higher with previous experience performing practice facilitation and/or consulting. If a nurse, registered nurse in MO & KS.
Demonstrated proficiency in the use of health information technology (EHR’s, Clinical Registries, etc.) in clinical practice improvement and population health management.
Experience in integrating behavioral health into primary care settings
Experience implementing practice based Chronic Disease Self-Management Programs