Horizon Healthcare Innovations (HHI)
Head of Clinical Innovation
Newark, NJ

Client Snapshot:
As part of their commitment to Making Healthcare Work, HBCBSNJ is continually exploring innovative ways to improve the quality and value of health care for their members. In order to accelerate these efforts, they made a significant organizational change and commitment. Specifically, they formed a new subsidiary company, Healthcare Innovations Inc., whose purpose is to develop and pilot innovative, quality enhancing care delivery models with health care providers.

They decided to create a new company to provide a focus on innovation and the development of new models. This will also ensure that the company’s existing efforts to work with health care providers continues to receive the focus required.  

The need for new approaches is evident from the unsustainable health care situation facing our nation. As a nation we now spend 17% of our gross domestic product (GDP) on health care, and this spending is growing two-three times faster than overall inflation, as measured by the consumer price index (CPI). Despite spending more than twice as much per capita on health care than any other nation, the United States lags behind in many health measures including life expectancy and infant mortality.

Search Overview:
Given the complexity of the health care system today, the organization sees an opportunity to change the payment and delivery of care to include; improvements in the financing arrangements for physicians and hospitals to better align incentives among all stakeholders (i.e., physicians, hospitals, insurers); greater focus on primary care and care coordination; greater adoption of electronic medical records (RMRs); emphasis on quality, clinical outcomes and the practice of evidence-based medicine in reimbursement; and broader engagement of patients and plan sponsors in programs for preventative health and managing chronic conditions. The payment models are expected to create rewards for value rather than volume-driven approaches – an important factor in improving clinical outcomes and reducing costs.

The position reports to the President of the company.

Top Search Requirements

The Director Clinical Innovations provides overall direction and leadership for the vision of the new relationship model design and piloting, including developing and effectively implementing provider, customer, consumer (e.g., benefit design and adherence), community (e.g., wellness) pilots. These strategies should reflect the needs of the organization as well as leading industry standards.

• Progressive experience in multiple facets of a healthcare delivery system, including managing projects and programs in a health plan environment.
• Significant experience with provider negotiations and care delivery
• Demonstrated leadership, management, and execution experience.
• Development and implementation of health care policy.
• Knowledge of all facets of healthcare delivery systems.
• Extensive knowledge of Plan products, applications, policies, procedures and systems.
• In-depth knowledge in the principles of performance improvement.
• Knowledge of all regulatory requirements and standards as they apply to Health Care Plans.

BNG Placement – Kevin Maher, MHA, BS, RN

Horizon Healthcare Innovations Inc. (HBCBSNJ)
Director, Clinical Innovations.

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