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TITLE:
Director, Group Practice
THE
CLIENT:
HIP Health Plan of New York (HIP) and Group Health Incorporated
(GHI) are now affiliated companies operating under a common parent, EmblemHealth,
Inc.(www.emblemhealth.com/companies.html).
GHI and HIP announced their intention to merge in 2005, and affiliation was the
first step towards combining the two companies. The conversion of the combined
company to a for-profit and publicly traded company is currently working its
way through the regulatory approval process. With 5,400 employees, HIP and GHI
together are now the largest health insurer based in New York State serving
more than 4 million people with over 92,000 providers in 142,000 locations
across the Tri-State region.
In order to appreciate the scope and content of the
Director, Group Practice role, some history is important: Back in
the late 1940s, a number of physician group practices were formed throughout
the NYC area to provide medical services exclusively to HIP members. From 1950
- 1990, a number of affiliated HIP physician practices merged to achieve
economies of scale. HIP provided the medical facilities and directly paid for
all medical group operating expenses. They paid an agreed-upon amount each
month for physician and support personnel. In the 1990s, HIP’s enrollment and
the Medical Groups’ patients began to decline with the entry of new HMOs into
the NYC market. HIP formulated a corporate strategy to have its affiliated
group practices become free-standing, independent, and financially
self-sustaining entities. In June 1998, HIP and all the medical groups agreed
upon new contract terms: The MSA provided for capitated payments to the medical
groups and transferred to the Groups financial responsibility for facilities,
professional liability insurance, and other group practice expenses. Even
though these responsibilities were transferred, HIP still retained some control
over these aspects of the practice and cost structure. Also in 1998, in order
to better compete with Oxford , Empire, etc. HIP created its own independent
physician network option. Enrollees to HIP now had the choice of using a group
physician or a network non-medical group physician. Given the capitation
arrangement, the Medical Group is now financially responsible for physician
network claims for members who have chosen the medical group. In 2000, HIP
removed exclusivity from the medical groups who were now able to participate
with any other health plans.
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In 1990, two of the HIP medical
groups: Manhattan Medical Group, and Bronx Medical Group, merged into a single
corporate entity: New York Medical Group P.C. In the year 2000, HIP chose to
develop risk arrangements with hospital partners. In Manhattan, the partner was
Lenox Hill Hospital and Continuum (St. Luke’s Roosevelt, and Beth Israel). At
the end of that contract in 2006, HIP elected to contract with a newly formed
group: Manhattan’s Physician Group (MPG) which, in turn, contracted with the
same physicians that had been practicing at those former sites (8). The initial
governance of the newly formed professional corporation has been structured and
staffed by the healthcare consulting and management services firm: JHD Group.
Currently MPG serves over 39,500 HIP members as well as patients from other
health plans.
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In 1991, three of HIP’s affiliated
medical groups merged to become Queens Long Island Medical Group (QLIMG):
LaGuardia Medical Group, Nassau Queens Medical Group, and the East Nassau
Medical Group. While they were technically operating as a single corporate
entity, QLIMG continued to replicate prior day–to-day operating activities.
Thus, each former medical group became an operating region with its own Medical
Director and staff. Also, a number of shareholder voting rights remained at the
region level. The central/corporate office functions were to: negotiate and
manage the MSA with HIP; process payroll; centralize finance and accounting;
and coordinate activities among the regions. As HIP’s overall enrollment
increased and its IPA network continued to expand, the Medical Group’s
enrollment began to decline significantly. QLIMG enrollment decreased from
370,000 in mid-1996, to 234,600 in May 2001 (to now, 175,000). Needless to say,
these events caused corresponding decreases in capitation revenue.
Concurrently, the medical group reduced physician compensation and downsized
the number of physicians on staff. In 2005, HIP and QLIMG agreed to modify the
MSA. Among the new requirements were: Use a mutually agreed upon management
firm to assume responsibility for all operational and financial management of
the Group (except for certain clinical and compensation aspects left to the
QLIMG Board only. Overall, this change entailed a reaffirmation of a governance
structure wherein the Board would focus on strategy, and management would focus
on day–to–day operations. The consultant firm: PivotHealth LLC (www.pivothealth.com)
was engaged in March, 2005 with a several year management contract. Currently,
the Group has 22 medical offices throughout Queens, Nassau and Suffolk
counties.
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Staten Island Physician Practice
[SIPP] (www.si-pp.com) is a multispecialty
physician practice with approximately $50 million in revenues, 50 physicians,
290 FTEs, and 2 locations. Most of their revenues come from 30,000 HIP members;
however, they accept patients from twenty three other plans along with
Medicare. In 2005, HIP and SIPP agreed to modify the MSA. Among the new
requirements were: Use a mutually agreed upon consultant, PivotHealth LLC, to
perform operational and financial assessments of the Group and implement their
recommendations; purchase a practice management system and create
implementation plans; create a new management structure; and change the
governance structure so that the Board would focus on strategy, and management
would focus on day-to-day operations. Concurrently, in April 2006, the group
changed its name from the Staten Island Medical Group to the Staten Island
Physician Practice.
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Central Brooklyn Medical Group, now
known as Preferred Health Partners is the fourth medical
group falling under the aegis of EmblemHealth’s practice operations. It was
formed via a merger in 2001 of three separate medical groups in Brooklyn.
Currently, PHP serves about 98,500 HIP members as well as patients from other
health plans out of 10 medical office locations throughout Brooklyn.
THE
POSITION:
The
Director, Group Practice reports to the Vice President, Group
Practice and is responsible to oversee
the strategy, restructuring initiatives and business relationships
as they relate to HIP and the traditional medical groups (as
identified above). The
interaction includes the Medical Groups, Medical Group Practice
Management Firms (also identified above) and Downstream Provider
networks. The incumbent
will supervise an Assistant Director and various Relationship
Managers who are charged with managing the respective medical group
relationships. Specific
responsibilities
include the following (which are listed in descending order of
importance):
·
Negotiate
and implement various Medical Group medical services agreements
(MSAs).
·
Administer
Medical Group contracts and reconciliations.
·
Recommend
and implement strategies and tactics to improve the business
relationship with medical groups for both the Plan and its
members.
·
Recommend
and implement pay for performance incentive programs for the medical
groups.
·
Develop
practice improvement programs and tools for the Medical
Groups.
·
Manage
and monitor HIP’s investment in the Medical Group’s Electronic
Medical Record.
·
Manage
HIP’s relationship and contracts with all Medical Group Downstream
Networks.
·
Oversee
and implement HIP’s Traditional Medical Group medical office real
estate strategy including the design, upgrade and replacement of
medical office facilities.
·
Implement
and manage the CMS Severity Adjustment Hierarchical Care Categories
(HCC) documentation improvement strategies throughout all Medical
Groups.
·
Implement
and manage HEDIS improvement projects within HIP and the Medical
Groups.
·
Negotiate
and manage HIP’s relationship/contract with the Medical Group’s
practice management partners.
·
Manage
Medical Group compensation/capitation within
budget/forecast.
·
Oversee
production of HIP produced Medical Group management
reports.
·
Assure
medical group compliance with HIP, regulatory, and NCQA
standards.
Commensurate
with the above responsibilities, the incumbent will have
delegated decision-making authority, in coordination with the
Vice President, Group Practice, to negotiate Medical group MSAs,
Practice Management Agreements and Reconciliations, while directly
interfacing with the various Medical Group leaders as they jointly
seek to promote performance improvements and solve business
problems. Furthermore,
s/he will lead efforts, internally, (within EmblemHealth) to effect
system changes as they might impact on existing or new contract
requirements, as well as lead appropriate departments in their
efforts to implement Medical Office Facility plans. Additionally, s/he must
effectively interact with Downstream Partners (viz: large
hospital networks and individual physician offices) as well as,
axiomatically, all levels of EmblemHealth and the Medical Group
leadership. Finally,
s/he will also manage all aspects of the Medical Group arrangements
within agreed upon budgets.
In
sum, then, the incumbent interacts with, and serves various
constituencies. S/he is
the key liaison between EmblemHealth and: all levels of the Medical
Groups; the Downstream Networks; and with the Practice Management
Partners. Furthermore,
s/he interacts continuously with the Medical Management Leadership;
facilitates issues relating to Care Management and Quality while
also interacting with Claims, Enrollment, Finance, Member Services,
Marketing, Information Services, Facilities, and Grievances and
Appeals, as these relates to, and have an impact upon all issues
involving the medical groups.
QUALIFICATIONS:
The
selected candidate will be able to demonstrate a record of five to
ten years of progressive healthcare experience including four or
five years in leadership roles. Given the fact that the position
requires truly a comprehensive knowledge, understanding, and interest in medical service
agreements, practice management agreements and downstream
agreements, the emphasis will be placed on finding someone who
possesses: practice management experience, an understanding of
capitation and how it is implemented, along with the problem solving
skills to influence-with-integrity among so many different
constituencies. These sets of experiences might have come from
working in Medical Group Practice management, IPAs, or from managing
capitation. The key,
clearly, relates to communication style. This person is someone who
understands interdependency: standing on their own yet inviting
information, criticism, and cooperation from others. They know how to leverage
themselves (and others) such that they can welcome the dual role of
leading others, yet have a subset of “hands on” responsibilities
that are their own personally.
They will know how to affect, motivate, cajole, and advocate
while still remaining credible. Axiomatically, then, this is
someone who thrives on the dynamism of change implicit in
multi-specialty groups today, and has the personal vigor/stamina,
perseverance, organizational skills, integrity, and sense of
humor to make-a-difference without the need to
grandstand.
To
assure the necessary analytical and business skills are extant, the
selected candidate should most likely possess an MBA, MPH or MHA.
Clearly, however, the important emphasis will be placed on this
individual's record of effectiveness. The intellectual premium here
is on quantitative (business) and demonstrated analytical
skills. The specific
personal style that will succeed here is one that is
“balanced”: a superb listener (someone who knows the important
difference between acceptance and judgment), calm, mature,
thoughtful and articulate, able to manage "up" and down, with grace,
tact, diplomacy and authority. To get this job done, s/he must be an
effective time manager so as to instill into his/her team awareness
of the difference between activity and productivity.
Also, this role involves frequently visiting and interacting with
the sites. Therefore,
the incumbent must like to get away from the corporate offices and
mix-and-mingle with the various
constituencies.
COMPENSATION:
The
total compensation package for this position will becompetitive with the
market for such levels of experience matched to the scope and
complexity of the job.
EmblemHealth is a major employer in New York and intends to
hire someone for a long term position. As such, the compensation
will be structured to meet the needs of the final candidate.
CONTACT INFORMATION:
Peter A. Rabinowitz, President
P • A • R • Associates, Inc.
23 West Bay Road
Osterville, MA 02655
(508) 420-2372 (phone)
(508) 420-9268 (fax)
E-mail: peter@parassoc.com
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