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https://www.wittkieffer.com/position/21600-chief-population-health-officer/

SUMMARY OF RESPONSIBILITY:

The Chief Population Health Officer (CPHO) is a key member of SOHO's executive leadership team.  The executive leadership is responsible for improving value-based care and the sustainability of healthcare delivery through collaborative partnerships with physicians, Trinity Health Of New England (THOfNE), payers, community-based organizations, and preferred partners. New England is a competitive and rapidly evolving Health Care market. The CPHO will lead and drive population health efforts and programs, clinical and continuum integration, physician performance improvement and education, and the organization's strategic direction toward clinical and regional integration and superior value-based performance.

The CPHO is responsible for SOHO's provider network's clinical, quality and utilization performance and population health outcomes. S/he will lead and be accountable for the population health and clinical strategy, design, and maintenance.  Additionally, s/he will champion new physician alignment and performance incentive strategies to support the SOHO network's annual goals and objectives in the value-based environment.

Reporting directly to the CEO, the CPHO working with the Executive Leadership Team will participate in other critical strategic matters such as business development, strategic planning, technology, and clinical integration to deliver on improved quality and total medical expense (TME) outcomes. Lastly, the CPHO is responsible for ensuring that the clinical and medical management activities meet requirements of payor contracts, regulatory and delegated requirements, and provider performance standards.

JOB RESPONSIBILITIES:

STRATEGY/VALUE-BASED CARE/POPULATION HEALTH MANAGEMENT:

• Works with the CEO to identify key market drivers and develop plans and strategies to address clinical and cost trends.

• Define and promote the principles of population health and value-based care.

• Develops population health strategies and manages interventions, people, and programs that address the clinical and utilization needs of various risk-based populations.

• Fosters and develops physician alignment with the strategic priorities of the organization and the needs of the community.

• Advises on population health initiatives and care delivery innovations for our provider practices to reduce provider variation and improve cost and quality performance.

• Serves as one of the organization's critical spokespersons on value-based care, educating employees, physicians, business leaders, government officials, and other stakeholders on the expected changes in healthcare.

• Oversees the quality improvement, and medical management processes to improve care, reduce costs, and deliver evidence-based outcomes.

• Responsible for ensuring SOHO is operating with the up to date best clinical practices and evidence-based guidelines.

• Monitors performance indicators to ensure the delivery of exceptional quality outcomes.

• Monitors patient and provider satisfaction, and working with the CEO, THOfNE and practice leadership, recommends and implements changes to improve satisfaction levels.

• Reviews, aligns, and approves Quality metrics across our payor contracts.

• Responsible for the strategic direction and successful operation of SOHO's care management model, inclusive of personnel, technology, and support requirements.

• Drive the advancement of a unified care management model across the continuum of care received by SOHO's patients.

• Responsible for development, implementation, and review of SOHO's risk stratification and population segmentation models and supportive reporting.

• Leads prospective, concurrent, and retrospective review of medical services provided to SOHO covered lives.

• Approves the SOHO Care, Disease, and Utilization Management (UM) program, policies, and procedures.

• Leads the development and implementation of medical management initiatives including, Evidence-Based Guidelines Protocols, to achieve defined performance standards and/or targeted benchmarks.

• Develops and implements other medical review policies and guidelines as required.

• Provides leadership in the area of establishing, communicating, and executing models, structures, and strategies for physician integration and alignment consistent with SOHO's strategic plan and clinical program priorities.

• Work with member CMOs to implement systems of care that provide integrated, coordinated care across the entire continuum. Assure optimization of clinical performance and effective resource utilization across all systems of care. Assist member CMOs and other physician leaders in understanding physician practice patterns, data interpretation, identification of opportunities, and goal setting.

• Explores and establishes strategic alliances with physician organizations to enhance the delivery of services.

• Develop and administer accountability mechanisms for member physicians performing below the established standard. This will be achieved in coordination with member CMOs and the Clinical Integration Committee.

• Create an environment where physicians work together to establish clinical programs that improve the quality and efficiency of care and provide value to patients, physicians, THOfNE, and payors.

• Develops and implements physician communication strategies that inform, as well as promote SOHO strategies.

• Provides leadership in promoting network integrity through provider education, data review, and working with THOfNE and network leadership to identify and address network access opportunities.

• Participates in or leads/co-leads, where necessary, various committees (e.g., Credentialing, Incentive & Distribution). Supports Board Co-Chairs of the Clinical Integration and Medical Management & Policy Committees.

• Reviews, approves provider credentialing process, and ensures appropriate monitoring of provider qualifications.

• Ensures compliance with all federal and state regulations and accreditation standards where required.        

• Collaborates with CEO and other members of the Executive Leadership Team on the development of the annual and/or multi-year company and business plan, including the medical management strategy, TME, and quality goals and objectives.

• Serves as chief medical consultant to nurse care managers on complex clinical cases; attends case conferences with nurse care managers as needed.

• Serves as SOHO's senior medical liaison to internal and external entities, including the medical, state, and national organizations.

• Maintains a strong working knowledge of current best administrative and clinical practices, and national & state health policy and health care law. 

• Participates in Board meetings and Retreats

• Board Certified medical doctor in Primary Care preferred or doubled boarded Specialist; MBA/MPH desirable.

• Active in medical practice for a minimum of ten years.

• Prior experience as a Senior Medical Leader and/or medical leadership role in a Clinically Integrated Network (CIN), Independent Practice Associate (IPA), Physician-Hospital Organization (PHO), or Accountable Care Organization (ACO) health plan required.

• Knowledge about the healthcare utilization, industry, and experience with population health. Experience with medical utilization management and quality assurance.

• Certification in Lean or other performance improvement methodologies preferred.

• Experience in a Clinically Integrated Network required including demonstrated success within the capitated/risk-sharing environment

• Strong interpersonal and negotiation skills.

• Analytical, systematic, and positive approach to problem-solving.

• Ability to interpret utilization and financial data/reports.

• Excellent organizational and priority setting skills.

• Capable team player, demonstrating initiative, leadership, and adaptability.

• Excels in effective teaching, coaching, and mentoring.

• Must be highly mobile, able to access all areas of the premises, ability to travel outside of work premises through the state, and outside the state as needed.

• Ability to work long hours – over eight in a workday, and over 40 in a workweek as necessary;

• Regularly required to use hands to finger, handle or feel objects, tools, or controls; reach with hands and arms; and talk or hear. 

• Frequently is required to walk and sit. 

• Occasionally required to stand; climb or balance; stoop, kneel, crouch or crawl. 

• Ability to lift and/or move up to 20 pounds. 

• Vision abilities required by this job include close vision, color vision, peripheral vision, depth perception and ability to adjust focus. 

• The dexterity necessary to utilize a computer keyboard regularly is essential.

• Actively designs and implements innovative physician alignment and clinical integration strategies across the SOHO Network to achieve plan goals and objectives.

• Leads the medical management and clinical integration planning processes to evaluate utilization, quality, total cost of care, patient satisfaction, and overall marketplace competitiveness.

• Reviews quality, utilization, and cost performance for all areas of medical care delivery and develop interventions and strategies to improve performance.

• Advises and develops performance reporting to support operational goals and organizational strategies.

QUALITY/BEST PRACTICES:

• Develops provider and clinical cost of care performance standards and where appropriate utilizes the medical review process to address inappropriate or poor performance, up to and including removal of poorer performing providers/practices from SOHO's network.
• Develops and implements chronic disease programs and evidence-based guidelines to address less than satisfactory clinical performance and to reduce disparities.
• Collaborates with SOHO's Network affiliate members' executive leadership, medical staffs' leadership, nursing leaders, as well as other clinical professionals to improve integration, quality, and safety of care utilizing national best practices and benchmarks to measure excellence.
• Works with community-based physicians and organizations to create an integrated approach to health and care management for patients.

UTILIZATION REVIEW/CARE MANAGEMENT:

• Works collaboratively with hospitalists, intensivists, palliative care, SNF-ists, primary care, medical home coaches/coordinators, hospital nursing, and multi-specialty medical groups to ensure the seamless transitions in care across the care continuum.

PHYSICIAN INTEGRATION AND NETWORK ALIGNMENT:

ADMINISTRATION/OVERSIGHT:

QUALIFICATIONS AND COMPETENCIES:

PHYSICAL AND MENTAL REQUIREMENTS:

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to perform the essential functions of the job successfully.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

MENTAL REQUIREMENTS:

• An energetic, passionate leader and true champion for healthcare quality, patient safety, and continuous process improvement. Strong clinical acumen, with a solid track record in health care quality management, development, and implementation of evidence-based protocols and guidelines. Ability and desire to integrate CQI principles and tools into clinical inpatient and ambulatory work processes, guidelines, measurement, and reporting.
• A visionary and transformational leader, with entrepreneurial business skills, to partner with physicians and administrative leaders to implement a value-based Accountable Care Organization delivery network across the eastern SOHO region.
• Highly developed and effective interpersonal, communication, and listening skills to interact tactfully and persuasively with parties internal and external to the SOHO Health Network organization. Ability to adequately express and sell new concepts and ideas through influence and persuasion.
• Diplomatic as well as organizationally savvy, able to relate to and open to differences; maneuvers well to get things done; presents views and arguments well; able to drive change management initiatives and build diverse networks that align and support the SOHO Network's mission and vision.
• Collaborative team player with high integrity and ethical standards. Possesses strong problem-solving skills with the ability to facilitate the resolution of conflicts and grievances, handling highly charged problems and situations calmly and objectively.

The duties listed above are intended only as illustrative of the various types of work that may be performed.  The omission of specific statements of duties does not exclude them from the position if the work is similar or a logical assignment to the position.