Aligning Payer and Provider

The Increasing Role of Finance as a Strategic Partner in the Health Care System

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When Dan Chojnowski began his career in public accounting, organizations viewed the role of its finance department and, at its helm, the Chief Financial Officer significantly different than they do today. Gone are the days and the expectations of CFOs as merely number crunchers and budget guards, replaced by an increasing inclusion as strategic partners.

“What [organizations] want now is not somebody who reports the numbers,” Dan said. “They want somebody who can tell you why the numbers are telling us what they are and then, more importantly, help us with solutions on what we can do about it.”

Dan has experienced this evolution firsthand. Now the CFO at Johns Hopkins HealthCare (JHHC), he finds himself at an ideal intersection of shaping the future of an organization dedicated to improving the health of communities, while still leveraging the technical skills and financial acumen at the core of the position.

Still relatively new to JHHC himself, Dan is part of an executive team that has added a new Chief Executive Officer, Chief Medical Officer, and other key leadership positions since his arrival. He calls it a “reflection point” — a chance to build on the successes of JHHC’s former and long-serving leaders. “We view it as such an opportunity,” Dan said. “I couldn’t be more excited to be at the table with this new group of executives here at JHHC as we really take this organization to even higher heights.”

The ascent is characterized, in part, by transformations internally to the organization’s culture.

“For the organization to be successful, we’ve got to improve the financial results for sure, but probably more importantly, we have to make sure that we have an organization that our employees are engaged and can thrive in,” Dan said. “And, again, as executives, it’s our job to help create that work environment that we want people to come into every day.”

Surpassing 700,000 lives served between its health plans and health solution offerings, a strong organizational culture at JHHC contributes to the objective of creating healthier communities. A critical player in these conversations and decisions? Dan and the finance team.

“There’s a talent and skillset that lives within finance that, leveraged the right way, can just be unbelievably valuable to the organization,” Dan said.

Take JHHC’s nature as a provider-sponsored health plan (PSP). Owned by the Johns Hopkins Health System and the Johns Hopkins University School of Medicine, the integration of payer and provider yields unique advantages not accessible by non-PSPs. This model fosters greater collaboration with clinical care delivery partners, enhanced value-based care arrangements and population health management, with cost savings opportunities through reduced spending and achievement of quality goals.

Within the benefits of this arrangement exists what Dan acknowledges as a “healthy tension.” Building a strong payer-provider relationship helps find the common ground of health care utilization, ensuring the right services are provided at the right time and right cost, and in the right setting.

JHHC’s finance team is helping to find the alignment, creating the narrative behind the numbers to propose and implement solutions to affect the shared mission of improving the health of individuals and populations.

“It’s what attracts me to working in an integrated health care organization because I think the value proposition of bringing together payer and provider can be tremendous, but I don’t think a lot of organizations have got it figured out yet,” Dan said. “At the end of the day, we still have individual goals and objectives as the health plan, as do our provider partners at Hopkins. I think the improvement though is us sitting in the same room—I guess maybe not today, but sitting in the same Zoom—and having those types of conversations that I think weren’t happening between payer and provider.”

A more committed movement toward risk sharing and value-based contracting are significant factors in enhancing the alignment. These industry shifts are easier to achieve as a provider sponsored health plan. A payer organization is not just looking out for its own interests and the interests of its plan members, it’s considering the delivery side with every decision.

“As a health plan, that’s absolutely top of mind,” Dan said. “How are our provider partners going to view that? I think it leads to really great conversation.”

Dan specifically mentions curiosity, courage and compassion as vital tenants to progress. They are qualities he sees in JHHC’s new executive team that are precipitous to improved relationships with the organization’s provider partners and, ultimately, health outcomes.

“I want people that challenge the status quo,” he said. “This is the improvement mindset. I think that’s happening all across Johns Hopkins HealthCare now. Any time you get new people, new leaders, it’s the perfect opportunity to challenge the status quo. But there’s a courage to not just saying, ‘This is the way we’ve always done it.’

“When I think about courage, I refer to it as ‘respectful challenge.’ I think debates are what cause the best ideas to rise to the top. I think too many organizations get into groupthink and it’s very easy to fall into that trap. That’s why I used the word ‘courage,’ because having a different opinion than the group takes courage.”

Those new opinions lead to new ideas, which lead to improved care and better health. Especially over the last year, when the people served by JHHC endured so much, the organization was driven by compassion.

“Compassion, for me, comes from being motivated to work in a mission-driven, community-oriented organization,” Dan said. “There’s a compassion for the people that we’re trying to serve and trying to make their lives easier and healthier…Everybody’s been dealing with all kinds of different things between the pandemic, the racial inequities, the political unrest. Never more so than now [is it important] to have one of your core tenants be compassion, of how you work and support each other.”

Dan also has a front-row seat to the data and analytics collected by the health care economics and actuarial teams he oversees. That information—primarily collected through claims payments—helps JHHC create product offerings, design benefits, and customize care management programs.

“That, in and of itself, can lead to insights around care patterns,” Dan said. “But more importantly, as a health plan now, what we’re trying to do is gather more socio-economic information about our members and then combine that with the financial information and the claims information to paint a much more holistic picture of who our members are and what their care needs are.”

JHHC knows this work is not conducive in isolation. It all ties back to supporting and informing the delivery of care.

“How we share that data with our provider partners to provide insights to them in terms of opportunities for care improvements is one of the most critical things a health plan can do in their relationship with providers,” Dan said.

Leaning into its partnership with health care providers. Expanding the contributions of its finance team. These are ways JHHC is working to be stronger, easier and excellent.

“We really believe that we have such an opportunity to serve more of our communities,” Dan said. “I think that’s what excites us all is that we have an opportunity to have even bigger impacts in the communities we serve.”