Practice Facilitator

Overview

The Practice Facilitator is a healthcare professional essential for guiding, coaching, and supporting Value-Based Payment Programs within medical practices. This role manages relationships with practice leadership and drives transformation in quality improvement and patient-centered care models. The Practice Facilitator focuses on improving clinical outcomes, streamlining operational workflows, and enhancing the total cost of care for populations by promoting best practices and integrating supportive care delivery models.

Frequent travel to healthcare practices and community sites is required to ensure direct collaboration and on-site implementation support.

• Facilitate understanding of value-based payment programs, such as ACOs, HEDIS, and Risk Scores.
• Present payor performance scorecards to review benchmarks and develop improvement strategies.
• Develop and provide quality improvement plans with tailored data, tools, and resources to support value-based care models.
• Obtain EMR access and provide support to close gaps in care and identify high-risk patients.
• Review high risk patients with providers, engage in high risk case management as needed, complete transitions of care as needed, and close quality gaps.

• Facilitate performance-based interventions with internal SMEs for HEDIS/STAR and risk adjustment benchmarks.
• Analyze practice-specific scorecards to identify trends and gaps and recommend improvements.
• Deliver education on ICD-10/CPT coding accuracy, risk adjustment, and population health management (e.g., TOC, AWVs, Diagnostic Attestation).
• Guide action plans using models like Plan-Do-Study-Act (PDSA) to drive care transformation and workflow efficiency.
• Monitor key performance indicators (KPIs) and medical loss ratio (MLR) to drive improvements in quality measures and total cost of care (TCOT).

• Build trust-based relationships with practices and care teams.
• Collaborate cross-functionally with internal departments and external stakeholders (e.g., IPAs, Providers, Payors).
• Act as a liaison between Care at Home and healthcare practices to ensure coordinated efforts.

• Act as an SME, supporting activities such as Transitions of Care (TOC), Pre-visit Planning, and Annual Wellness Visits (AWVs).
• Update and maintain internal and practice facing health data portals for quality tracking and reporting.
• Identify drivers of medical expenses and recommend remediation strategies.

• General Duties:

• Develop and maintain detailed project plans, tracking milestones, deadlines, and outcomes to ensure successful implementation of practice transformation strategies.
• Coordinate multiple projects simultaneously, managing priorities and resources effectively to meet the needs of diverse practices and stakeholders.
• Conduct scorecard analyses and develop action plans to enhance KPIs, including Quality, Risk Adjustment, Utilization, and practice growth metrics.
• Conduct regular check-ins with practices to ensure alignment with value-based care goals and identify emerging needs.
• Coordinate logistics for practice engagement meetings, including scheduling, agenda creation, and follow-up communications.
• Maintain up-to-date knowledge of healthcare regulations and value-based care models to provide relevant guidance to practices.
• Foster a culture of continuous improvement by encouraging regular feedback and promoting best practices across practices.
• Collaborate with leadership to identify opportunities for program enhancements and report on successes or challenges.
• Document workflows and processes to ensure standardization and facilitate onboarding or training for new staff.
• Actively participate in professional development opportunities to enhance skills related to quality improvement and practice transformation.
• Establish rapport with practice teams to facilitate effective communication and engagement.
• Provide regular updates to healthcare practices and Care at Home leadership on progress and challenges.
• Act as a resource for best practices in workflow optimization and care transformation.
• Participate in leadership meetings to share…