Senior Director, Medical Economics
About Stellar Health :
Historically, US Healthcare has relied on a fee-for-service reimbursement system where providers are paid based on the quantity of patient visits and procedures, rather than the quality of health outcomes. At Stellar Health, we help primary care providers put patient health first. Our platform a mix of technology, people, and analytics supports providers at the point of care, delivering real-time patient information, activating practice staff, and empowering providers and care teams with incentives that reward the work they are already doing to keep patients healthy. Using the Stellar App, our web-based, point-of-care tool; practices receive a simple checklist of recommended actions that support the best quality care. Providers and care teams are then paid monthly for each action they complete, and Payors save money in reduced healthcare costs along the way. Stellar is a US-based Health-tech backed by Top VCs (General Atlantic, Point72, & Primary Venture Partners) with an established product & proven operating model. We've shown that we make a real difference for physician practices and their patients.
About the position :
The Senior Director of Medical Economics will help drive overall surplus performance in Stellar's ACO and Payor Risk Contracts by utilizing standardized medical economics tools and analyses to determine performance needs in major functional areas (contract performance, trends, specific high areas of utilization), drilling down to understand provider / region specific opportunities as well as trends and communicating with key stakeholders to support their generation of performance management strategies and measurement of impact.
This role is critical to creating the underlying business intelligence, performance measurement and target setting for Stellar Health's ACO and all total cost of care risk contracts.
This hire will serve as the leader of this functional Medical Economics Organization, building and managing a team of Actuaries and Medical Economic Analysts, reporting directly into the VBC Organizational Leader who owns performance for all total cost of care risk contracts.
What you'll do :
Individually contribute and Manage core Medical Economics Analyses and Outputs :
Medical Economics :
Using standardized medical claims data & industry-standard tooling :
- Identify & report on cost and utilization trends
- Develop standardized views and complete ad hoc analyses to identify high cost patients, disease states, or provider-level views
- Lead Stellar cross-functional Medical Economics committee meeting, inclusive of Product and Tech teams to review findings and discuss intervention opportunities
Create standardized Revenue & Cost of Care reporting for Medical Groups, including development & identification of a standard set of "key opportunities" for medical groups
Conduct Impact Assessment :
Analyze clinical interventions to evaluate their impact on patient utilization and cost of care.Develop and apply methodologies to isolate the effects of interventions, attributing changes in utilization and cost to specific programs or initiatives.Advise on study design set-up in order to enable sound impact assessments (e.g. preferred method (pre / post vs control / treatment), target sample size, target experiment period, etc.Collaborate with Stellar's Enterprise Analytics to build new enterprise data tools, techniques and standards
Attribution & Risk Adjustment Accuracy Analytics :
Within the ACO, use claims data to identify potentially attributable patients, patients at-risk of losing attributionWork with performance management teams to identify strategies to maintain and / or grow membershipCreate ACO and Medical Group-level reporting showing attribution opportunities and risksCreate and model impact of risk adjustment accuracy efforts; assist with setting targets where relevantIdentify areas of potential risk adjustment inaccuracy for Performance & Operations teamsManage and Direct Core Actuarial Analyses and Forecasting :
Using Stellar data, CMS publicly available data and / or purchased data - identify Medical groups that are good targets for Stellar to grow with in our ACO or via other total cost of care risk contractsSupport negotiations with health plans and provider partners by identifying key levers of Stellar performance within the contract and creating models to show range of opportunity or risk, using statistical methods as well as strong grasp of premium rates, plan design and industry wide trendsQuantify and manage financial risk using mathematical and financial theoriesForecasting and Risk Management :
Creating regular financial forecasting for surplus performance for each contract, as well as portfolio views - inclusive of specific trends and any key deviations from prior forecastingIdentify key cost trends and any potential fraud / waste for deeper medical economic investigationSupport evaluation / analysis of financial reserving and reinsuranceAs Senior Director Medical Economics, you should have :
10+ years experience working in an Medical Economics role with internal stakeholders to answer business questionsActuarial designation preferred, but not requiredExperience analyzing and summarizing medical claims data (inclusive of utilization and cost)Experience with Value-based contracting designDeep understanding of Medical economic cost modeling, reporting / trending, and identification of opportunitiesRisk adjustment (MA / MSSP) knowledgeStrong working knowledge of scripting or data mining tools like R, Python and SQLStrong proficiency with one or more BI tools (Tableau, Looker, PowerBI, SAP / Business Objects, SAS, etc.) )for data analysis and visualizationExperience working in a cloud-based data warehouse environment like Snowflake or DatabricksMust be able to turn Excel and SQL analyses into usable presentations and memos for consumption across different teams / audiencesTrack record of driving performance in value-based risk contractsValue-based performance strategy and contracting experienceExperience / understanding of quality and risk adjustment programsYou have strong analytic skills and can make informed business recommendations based on statistical inferencesYou are an exceptional communicator, and are able to crisply articulate problems and solutions even when operating under uncertaintyWho will love this job :
Individuals who love the entire journey of problem solving; embracing unstructured problems, developing a path forward, and executing against the plan, and measuring outcomes.You are highly analytical, can structure unstructured problems and work messy data effectively, and can push consistently toward an answer under uncertaintyIndividuals who are curious by nature, and who have a deep desire to learn more about value-based care and about how a healthcare technology startup drives towards successIndividuals who enjoy a high degree of autonomy and are unafraid to voice opinions in pursuit of finding a better way of doing things.You have a deep passion for empowering the goals of value-based care in the primary care environmentYou care about care delivery and improving patient outcomesYou are excited about and have experience building infrastructure from the ground up in a fast-paced environmentYou get things done and you love working in a dynamic environmentPay :
The salary range for this role is $200,000 - $240,000 + an annual performance based bonus. Where a new hire falls within this range will be based on their individual skills and experience, and how these competencies compare across other employees in the same role. Stellar's bands are designed to allow for individual compensation growth within the role. As such, new hires typically start at the lower end of the range. Stellar rewards performance and outcomes - should you join the company, you will have the opportunity to grow your salary over time.
Perks & Benefits :
Stellar offers a carefully curated selection of wellness benefits and perks to our employees :
Medical, Dental and Vision BenefitsFlexible PTOUniversal Paid Family LeaveCompany sponsored One Medical memberships and Citibike membershipsMedical Travel BenefitsA monthly wellness stipend that gives employees the freedom to choose where they spend their cash, whether it be on wellness, pet care, childcare, WFH items, or charitable donationsStock Options & a 401k matching programCareer development opportunities like Manager Training, coaching, and an internal mobility program