As SVP, Chief Medical Officer, Dr. Rajkumar leads healthcare program design and strategy, customer group consulting, medical expense management, care management, network provider contracting and relationships, health delivery redesign, plan and network quality initiatives, medical and reimbursement policy, and pharmacy for our health plan.
Dr. Rajkumar joined Blue Cross and Blue Shield of North Carolina in 2018. Prior to joining BCBSNC, Dr. Rajkumar was SVP and Chief Medical Office at CareFirst Blue Cross BlueShield, a multistate Blue Cross plan that serves members in Maryland, Virginia and the District of Columbia. Rahul has been a leader in the move toward value-based care, both at CareFirst and as a leader at the Centers for Medicare and Medicaid Services.
At CareFirst, Rahul led efforts to reduce medical costs and improve patient care. At the CMS Innovation Center, where he served as Deputy Director leading a staff of over 400 and an annual budget of over $1B, he led Medicare and Medicaid’s transition to new value-based payment models. He led the development of pioneering programs to promote Accountable Care Organizations, bolster primary care, implement bundled payments and increase patient safety. This resulted in thousands of agreements with doctors and hospitals worth billions of dollars. Cumulatively, these programs shift 30% of all Medicare payments into value-based models and contributed to an unprecedented slowing of per capita Medicare cost growth from 2012-2016.
Before joining CareFirst, Rahul served four years as Deputy Director of the Center for Medicare and Medicaid Innovation. In this role, he led many federal efforts to promote value-based payments for physicians and hospitals resulting in signing tens of thousands of agreements with providers worth billions of dollars. He oversaw programs promoting primary care, the initial federal pilots for Accountable Care Organizations (ACOs), bundled payments for health care procedures and patient safety initiatives.
As an attending physician in the Department of Internal Medicine at Brigham and Women’s Hospital, and Instructor at Harvard Medical School, he was responsible for patient care on an academic inpatient service, supervision and teaching of residents, interns and medical students. As a hospitalist physician at the Washington, DC VA Medical Center, Rahul continues to provide care to our nation’s veterans.
Dr. Rajkumar earned his MD from the Yale University School of Medicine, a JD from Yale College of Law. He completed his residency at Harvard Medical School/Brigham and Women’s Hospital and is board-certified in Internal Medicine.Back To Team