ACO, Chief Medical Officer

ACO, CHIEF MEDICAL OFFICER

POSITION SUMMARY

As health care payment reform advances, ACOs must deliver meaningful innovation that improves population health, enhances patient experience, and reduces cost. As ACOs and integrated systems assume increasing quality and financial functions it is necessary to have executive leadership with the operational experience to manage utilization, unit cost, and quality improvement, and the judgment to lead organizational change fostering innovation across people, process, and technology that payment reform and financial risk demand.

The ACO Chief Medical Officer carries enterprise accountability for that agenda: the strategy, growth, external partnerships, payer economics, and data and analytics platform on which Atlantic ACOs performance depends. The CMO works collaboratively across the entire ACO team, partnering especially with the Associate CMO to lead execution across the operational and clinical program portfolio.

STANDING ACCOUNTABILITIES

ACO Operations

Provide leadership, direction, and support in the development and management of ACO daily operations, including utilization management, care management, credentialing, and network development.

• Lead the development and implementation of the utilization management program.

• Provide leadership and support to all operational committees and task forces of the ACO.

• Participate in executive management business and clinical strategy development and implementation.

• Build and leverage cross-functional collaborative relationships with key stakeholders to achieve shared ACO goals.

• Develop and implement strategic goals related to quality improvement.

• Oversee outcomes for the ACO's beneficiary population.

• Remain informed about political, government, insurance, and local practice developments affecting physicians and the ACO.

• Maintain awareness and understanding of emerging models in health care delivery; identify and define new and innovative strategies to achieve the business goals and objectives of the ACO.

• Work collaboratively with Integrated Care to support complex case management, rising risk, and post-acute care initiatives.

Utilization Management Program

Ensure physicians and providers have the tools and education they need to understand financial risk, and that physician and ACO leaders have metrics to identify and react quickly to outlier activity including data to promote preventive care, manage chronic disease, identify ambulatory-sensitive conditions, and achieve payer utilization requirements.

Management of Post-Acute Care

Post-acute cost is a growing concern among payers and a significant opportunity for our ACOs to affect cost and quality. Apply thoughtful approaches to prior authorization, concurrent review, and medical necessity criteria; equip ACO physicians and providers with the tools and education to manage post-acute admissions and length of stay; and support and optimize the post-acute care network strategy.

• 2027 focus: post-acute care utilization, outcomes, and costs

Practice/Network Relations

Lead the ACO's efforts to partner with healthcare teams and providers to improve population health, enhance the patient experience, and reduce cost.

• Promote collaboration among internal and external healthcare team members.

• Identify opportunities to collaborate and develop clinical integration opportunities that achieve best-practice outcomes.

• Educate and appropriately manage interactions across and between Atlantic ACO participants.

• Serve as a liaison for the ACO to the community.

• Communicate consistently and routinely with all participants.

• Train physicians and others to foster effective leadership within the ACO system.

• Meet 1:1 with ACO physicians, providers and staff, review pertinent data points, make recommendations, and develop and communicate performance improvement action plans with outlier participants. Shared responsibility with Associate ACO CMO.

MA Risk Scoring

Risk scoring is a key opportunity to increase revenue for ACO and for individual practices. Support practices to ensure proper coding of complex conditions and close gaps in care supporting value-based contract goals. Maintain a strong command of risk score metrics and communicate them clearly to physicians and providers.

Payer Relations and Contracting

Provide direction and support for the ACO's arrangements with payers.

• Assist with analytics and the development of quality measures for new value-based and risk-based payment models.

• Work collaboratively with executive leadership to design, negotiate, and monitor payment arrangements with payers.

• Participate in payer joint operating committee meetings and other clinical and financial review sessions.

2027 PRIORITIES

Priority 1 - Unburden: technology, AI, and workflow re-engineering

• Patient empowerment and engagement tech-stack - evaluation, partnerships, implementation, and impact analytics.

• Generative AI agent design empowering patients and the primary care provider and care team.

• Key vendor partners: Medical Brain, FeelBetter, Innovaccer

Priority 2 - Growth: strategy, branding, and incentive design

• CIN strategic actions - value proposition, differentiator, convener, disruptor.

• Professional targeted marketing and patient targeted marketing.

• Shared savings distribution formula; incentive model; evaluation of new and existing CMS models.

Priority 3 - Performance: accountability, payers, and care delivery

• ACO Performance Improvement Committee and ACO Boards - practice selections, messaging, and accountability parameters for performance year.

• Review of the Atlantic Health risk readiness assessment.

• Payer negotiations - terms, strategies, carve-outs, opportunities, and proforma design.

• Remediation and remuneration discussions with Innovaccer; ACO EHR vendor quality reporting.

• Integrated Care Team

• ACO Clinical Pharmacist oversight

• Assist ACO President and COO with identifying needed ACO positions and roles, and budget considerations

Priority 4 - Data, analytics, partnerships, and ventures

• AHS-EDAP resources; population health data aggregation and mastering within EDAP - analytics, report generation, and QA.

• Data flow diagrams and integration of vendor data; data governance, access, and security management.

• Additional data sources - Quest and other laboratories.

• Vendor resources - Innovaccer analysts, AI, and contract performance modeling; AWS Insights services and generative AI tooling.

• Atlantic Health partnerships - evaluation and management; HTC services, Garner, and other partnership and product due diligence, integration, and impact analytics.