This company is developing a leading team to stand-up a new and innovative healthcare services business. The start-up, Horizon 3 (“H3”) is a new Population Health business that will transform healthcare by addressing these needs of consumers through a personalized, physical and digital healthcare platform.
The team will create a business focused on a simple, delightful experience for users that ultimately will improve health outcomes and lower costs for the entire system. Backed by WBA and with the direct consumer access of this company, H3 has a head start on the typical technology startup and will provide a great opportunity for the candidate to shape and build a new and innovative healthcare services business for a Fortune 20 company.
The success of H3’s business plan relies on defining and executing a commercialization framework that enables H3 to take delegated risk on healthcare costs and share in the value H3 creates. The Head of Actuarial Sciences is critical to the success of this endeavor and will work closely with the Chief Financial Officer (CFO), Chief Clinical Officer (CCO), and Business Development Team, to oversee all aspects of H3’s Actuarial function.
• Oversees and manages a team in conducting complex analysis in support of H3’s pricing and total cost of care (TCOC) performance
• Conducts analysis, pricing and risk assessment, including understand cost of care for a population, calculating medical cost trend, to estimate financial outcomes across the portfolio of H3 offers under different fee arrangements (PMPM with performance guarantees, partial and full risk) .
• Develops and maintains the company's tools for measuring profitability and risk exposures related to medical cost
• Promotes best practices across the company and ensures the integrity of the organization's pricing and engages with clinical and care management functions to identify medical cost savings initiatives
• Supports the design and implementation of risk-based commercial arrangements by:
• Understanding the baseline cost drivers and clinical profile of potential target populations
• Understanding the opportunity for improvement in medical costs and healthcare outcomes for potential target populations
• Identifying and quantifying potential interventions and opportunity for H3 to establish programs, services, or solutions with potential target populations
• Modelling the impact of specific H3 programs on potential healthcare costs and outcomes of the target populations under different potential delegated risk model scenarios (e.g., shared savings, cap, sub-cap) in specific markets, with specific partners
• Recommending optimal delegated risk-arrangements that maximize potential value creation for H3 while appropriately managing risk of financial outcomes
• As H3 moves to risk-based arrangements with clients set up systems and processes to develop medical cost reserves.
• Supports the pricing of H3 solutions in other commercial arrangements by estimating the value created by H3 solutions for potential target populations on specific markets with specific partners
• Assesses the quality / impact of potential external parties (e.g., capability or enablement partners, M&A targets) against the medical costs based on empirical data provided by those partners
• Maintains awareness of enacted and proposed legislation at the federal and state level and uses this information in the completion of the above activities