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
• 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
• 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.

Attribution & Risk Adjustment Accuracy Analytics: 

• Within the ACO, use claims data to identify potentially attributable patients, patients at-risk of losing attribution
• Work with performance management teams to identify strategies to maintain and/or grow membership
• Create ACO and Medical Group-level reporting showing attribution opportunities and risks
• Create and model impact of risk adjustment accuracy efforts; assist with setting targets where relevant 
• Identify areas of potential risk adjustment inaccuracy for Performance & Operations teams

Manage and Direct Core Actuarial Analyses and Forecasting:

Vbc Contracting And Growth:

• 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 contracts
• Support 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 trends
• Quantify and manage financial risk using mathematical and financial theories

Forecasting 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 forecasting
• Identify key cost trends and any potential fraud/waste for deeper medical economic investigation
• Support evaluation/analysis of financial reserving and reinsurance

As Senior Director Medical Economics, you should have:  

• 10+ years experience working in an Medical Economics role with internal stakeholders to answer business questions
• Actuarial designation preferred, but not required
• Experience analyzing and summarizing medical claims data (inclusive of utilization and cost) 
• Experience with Value-based contracting design 
• Deep understanding of Medical economic cost modeling, reporting/trending, and identification of opportunities
• Risk adjustment (MA/MSSP) knowledge
• Strong working knowledge of scripting or data mining tools like R, Python and SQL
• Strong proficiency with one or more BI tools (Tableau, Looker, PowerBI, SAP/Business Objects, SAS, etc.) )for data analysis and visualization
• Experience working in a cloud-based data warehouse environment like Snowflake or Databricks
• Must be able to turn Excel and SQL analyses into usable presentations and memos for consumption across different teams/audiences
• Track record of driving performance in value-based risk contracts
• Value-based performance strategy and contracting experience
• Experience/understanding of quality and risk adjustment programs
• You have strong analytic skills and can make informed business recommendations based on statistical inferences
• You are an exceptional communicator, and are able to crisply articulate problems and solutions even when operating under uncertainty

Who 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 uncertainty
• Individuals 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 success
• Individuals 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 environment
• You care about care delivery and improving patient outcomes
• You are excited about and have experience building infrastructure from the ground up in a fast-paced environment
• You get things done and you love working in a dynamic environment

Pay:

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 Benefits
• Flexible PTO
• Universal Paid Family Leave
• Company sponsored One Medical memberships and Citibike memberships
• Medical Travel Benefits 
• A 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 donations
• Stock Options & a 401k matching program
• Career development opportunities like Manager Training, coaching, and an internal mobility program
• A broad calendar of company sponsored social events that for our in-office and remote employees

Diversity is the key to our success. Stellar Health is an equal opportunity employer and we are open to all qualified applicants regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or expression, veteran status, or any other legally protected status.  

We believe that diverse teams -and the different identities, cultures, and life experiences our team members bring to the table- enable us to create amazing products, find creative solutions to interesting problems, and build an inclusive working environment. 

Stellar Health Employment Privacy Notice

At Stellar Health, your privacy and security as a job seeker is a priority no matter where you are in the interview process. As recruiting scams have become more prevalent, please take note of the following practices to ensure the legitimacy of any interaction with our team. 

• Please note that any communication from our recruiters and hiring managers at Stellar Health about a job opportunity will only be made by a Stellar Health employee with an @stellar.health email address. 
• Stellar Health does not utilize third-party agencies for recruitment services and does not conduct text message or chat-based interviews. Any other email addresses, agencies, or forums may be phishing scams designed to obtain your personal information. 
• We will not ask you to provide personal or financial information, including, but not limited to, your social security number, online account passwords, credit card numbers, passport information, and other related banking information until we begin onboarding activities, which will be coordinated by a member of the Stellar Health People Ops Team with an @stellar.health email address.  

If you are ever unsure whether you are in contact with a legitimate Stellar Health teammate, please contact people-team@stellar.health. If you believe you've been a victim of a phishing attack, please mark the communication as “spam” and immediately report it by contacting the U.S. Federal Trade Commission.