SUMMARY OF RESPONSIBILITY:

The Chief Population Health Officer (CPHO) is a key member of Southern New England Healthcare Organization's (SoNE HEALTH) 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 SoNE HEALTH'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 SoNE HEALTH's 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 trends and future business development efforts.
• Develop programs that meet the patients’ needs in the organization’s population health management initiatives, promoting wellness through intervention and care coordination. Critical to this is the CPHO's ability to foster physician alignment with the strategic priorities of the organization and the needs of the community.
• Drive population health management, care delivery innovation, payor relations, provider variation, and management of medical expenses, areas that are central to SoNE and its accountable care capabilities.
• Serves as one of the organization’s key spokespersons on value-based care, educating employees, physicians, business leaders, government officials, and other stakeholders on the expected changes in healthcare. 
•  Actively design and implement innovative physician alignment and clinical integration strategies across the SoNE Network to achieve plan goals and objectives.
• Lead the medical management and clinical integration planning processes to evaluate the utilization, quality, total cost of care, patient satisfaction, and overall marketplace competitiveness.
• Review quality, utilization, and cost performance for all areas of medical care delivery and develop interventions and strategies to improve performance.

QUALITY/BEST PRACTICES:

• Oversees the quality improvement, and medical management processes to improve care, reduce costs, and demonstrate evidence-based outcomes.
•  Ensures SoNE HEALTH is compliant with best clinical practices.
• Monitors performance indicators to ensure the delivery of cost-effective care within quality standards.
• Monitors patient and provider satisfaction, and working with the CEO, Trinity Health of New England, and practice leadership, recommends and implements changes to improve satisfaction levels.
• Reviews, aligns and approves quality metrics.
• 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 from SoNE’s network.
• Provides medical expertise and leadership in the development and implementation of Clinical Disease and Population Health Management programs.
• Collaborates with SoNE’s Network affiliate members’ executive leadership, medical staff leadership, nursing leaders, as well as other clinical professionals to improve integration and quality and safety of care, utilizing national best practices and benchmarks to measure excellence.

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.

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

• Reviews the SoNE HEALTH Care 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. 

• Provides leadership and expertise in the development, implementation and interpretation of medical review policies and guidelines.

• Works collaboratively with hospitalists, intensivists, palliative care, SNFist’s, 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:

• Provides leadership in establishing, communicating, and executing models, structures and strategies for physician integration and alignment consistent with SoNE’s strategic plan and clinical program priorities.
• Explores and establishes strategic alliances with physician organizations to enhance delivery of services.
• Creates environment where physicians work together to establish clinical programs that improve the quality and efficiency of care and provide value to patients, physicians, Trinity Health of New England, and payors.
• Develops and implements physician communication strategies that inform, as well as promote SoNE strategies.
• Provides leadership in promoting network integrity through provider education, data review, and working with Trinity Health of New England and network leadership to identify and address network access opportunities.

ADMINISTRATION/OVERSIGHT:

• Participates and leads, where necessary, various committees (e.g., Clinical Integration).
• Supervises the Regional Medical Directors (RMD) program and performance of Regional Medical Directors.
• Supervisors the Clinical Pharmacist program to help increase the quality of patient care and lower pharmaceutical spending.
• 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 the company’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.
• Supports SoNE HEALTH Board Committees for Clinical Integration, Medical Management & Policy, Credentialing, and Incentive & Distribution.

Compliance:

• Oversees quality improvement and UM compliance to ensure all federal and state regulation accreditation standards are met.

QUALIFICATIONS:

• MD or DO from a an accredited medical school
• Appropriate board certification
• Eligibility for permanent, unrestricted licensure in Connecticut
• An advanced degree in healthcare administration, business administration or a related field is desirable

 KNOWLEDGE AND WORK EXPERIENCE:

• A minimum of ten years of progressive experience in clinical practice, preferably in a group practice setting, including a background in quality management, performance improvement, and/or care redesign.

• Knowledge and application of performance improvement techniques/methodology, LEAN/SIX SIGMA, utilization management, patient flow, and the principles of the clinical redesign.

• Demonstrated success working within a risk/shared savings model for defined populations. A deep understanding of bundled payments, direct-to-employer arrangements, and Medicaid risk models.

• Experience within a managed care/health plan environment would be a plus.

• Experience working in partnership with multiple constituents throughout an organization. This includes achieving consensus through presentations, thought leadership, partnership, and relationship-building throughout the organization.

• Progressive experience as a senior-level leader that includes experience in clinical integration, performance improvement, and population health management.

• A leadership role with demonstrable success in an integrated delivery system that has successfully managed risk, an IPA, an ACO, a CIN, or in a managed care setting.

• Experience in successfully leading quality, and performance improvement across the full continuum, including the inpatient and ambulatory environments.

• Proven ability to collaborate and build relationships. Demonstrated ability to engage and align community physicians in private practice.

• Demonstrated understanding of general principles of healthcare management and the complexities of alternative payment models and value-based financing systems, both in Commercial and government payor environments.

• Experience in an operations-related setting with health informatics, analytics, and program development.

•  Knowledge of national trends and key issues related to quality, performance improvement, and patient safety.

• A change agent who thrives on innovation and can adapt to a highly dynamic environment and look at problems and solutions from a creative standpoint.

• A highly personable, approachable person who can promote and maintain the momentum and enthusiasm to drive quality, performance improvement, patient safety, and service excellence.

• Energized, enthusiastic, resilient, and engaged leader with a strong intellect and creativity.

• An inclusive leader with outstanding interpersonal skills, who empowers, motivates, and challenges staff while holding them accountable. A team player who has an open and non-competitive leadership style that promotes partnerships and builds trust and strong relationships.

• Excellent written and verbal communication skills, including the ability to listen effectively and be open to the ideas of others. Can present data and translate complex issues into comprehensible ideas in a concise and easily understood manner.

• Is innovative, creative, and “thinks outside the box.”

• Sound financial acumen