Baylor Scott & White Value-Based Care
BSWH Value-based Care oversees resources and initiatives dedicated to improving healthcare cost and outcomes throughout BSWH, including Baylor Scott & White Quality Alliance and services delegated from Scott & White Health Plan.
Baylor Scott & White Quality Alliance (BSWQA) is the clinically integrated network (CIN) affiliated with Baylor Scott & White Health. It is comprised of more than 6,600+ primary and specialty care physician members, 50+ hospitals, 95+ post-acute care facilities and other healthcare stakeholders all agreeing to be jointly accountable for improving quality, enhancing the patient experience, and reducing healthcare costs for the 850,000+ commercial, medicare, and Medicaid lives it serves. BSWQA has been a national leader in MSSP performance for the past 2 years and has several direct-to-employer arrangements with local and national employers.
Vice President, Chief Medical Officer
The VP, CMO for Value-based Care reports to the Vice President of Value-based Care/Executive Administrator of BSWQA, with dotted line reporting to the BSWH System Chief Medical Officer. The VP CMO provides leadership, direction, and management to medical leaders and quality improvement initiatives. This individual will be responsible for identifying utilization and quality opportunities and standardizing value based clinical intervention.
Leads the creation of clinical programs including vendor evaluation, internal build, and/or performance improvement programs. Develops, leads, and provides oversight to provider performance management, contract and regulatory quality reporting, and care/case/disease management.
Collaborates closely with the Value-based Care and System executive leadership team and senior administration. Collaborates closely with medical, operational, and quality leadership, to improve transitions of care and support related System goals. Facilitates awareness and alignment with System leadership, key employer groups, key physician groups, and individual physicians across the System.
Drives communication and performance strategies for physicians to maintain cooperative working relationships and ensure achievement of strategic goals and objectives.
RESPONSIBILITIES:
- Provides clinical direction to care management, quality improvement, clinical performance, and provider performance management. Provides reports to internal and external stakeholders on the progress and success of the organization as it pertains to the quality, cost of care, and clinical integration for the patients served.
- Relentless focus on the optimization value-based care initiatives, to include leading with emphasis on execution, outcomes, continual improvement, and performance enhancement. Ensures consistent and continual monitoring of quality of care delivered. Develops and oversees a communication strategy to the physicians regarding measures and current performance to include supportive process improvement guidance to physicians at all levels of performance. Promotes quality improvement programs to ensure that members receive timely, appropriate, and accessible healthcare.
- Provides planning, leadership, and ongoing direction of clinical intervention and program strategies. Supports comprehensive care management in protocol creation, communication strategy, and engagement of physicians. Oversees evaluation and management of clinical practices.
- Sets strategy and leads initiatives to improve System and Value-based Care performance measures, shared savings opportunities, and contract measures through partnership with regional, division, and System leadership.
- Ensures clinical considerations are fully weighted when the organization makes strategic decisions. Solicits input from stakeholders to ensure appropriate representation. Exercises clinical expertise in the determination of when to consult with outside experts or resources. Establishes self as a credible, engaged and supportive provider representative. Actively engaged in provider operations, to include proactive action to address challenges faced by providers across the spectrum of specialties, settings and payment arrangements.
- Integrates BSWH/Value-Based Care/Health Plan health initiatives to ensure that overlapping processes are consolidated within the Value-based Care activities, avoiding redundancy and optimizing in the most efficient and cost-effective manner.
- Articulates and establishes plan policies and procedures to providers and organizations and ensures effective implementation of policy guidelines and programs.
- Oversees, facilitates, and integrates Value-based Care governance and committee work, including the Value-based Care Quality Improvement Committee and Sub-Committees. Committee outputs include developing order sets, care paths, and protocols for both inpatient and outpatient processes of care. Integrates Value-based Care initiatives with the operational quality improvement and population health committees of the employed medical group practices in the divisions, BSWH service lines, and the BSWH Clinical Leadership Council.
- Ensures full awareness and alignment with System executive leadership regarding overall performance on value-based contract arrangements as well as any challenges, successes, or needs.
- Promotes the role of the BSWH Value-based Care to the public, health care organizations, professional associations, and purchasers of healthcare services. Develops cooperative relationships with external physicians, hospitals, community organizations and other healthcare facilities to collaborate and exchange information. Promotes relationship building with key employer groups, physician groups, individual physicians, managed care organizations, and state medical associations and societies.
- Drives quality and compliance to ensure that Value-based Care meets and exceeds medical management, regulatory, agency, and quality standards. Supports state regulatory relationships and may serve as the lead physician for state and federal medical management regulatory audits.
- Collaborates with Pharmacy Director and Pharmacy Operations to design and execute a Prior Authorization program/Drug Utilization Review process that is both clinically sound and cost effective.
- Oversees the administration of medical management programs to ensure that network providers deliver appropriate, high quality, cost effective care. Advises patients and members in methods that facilitate a capacity for self-care and a move toward a healthcare partnership between providers, customers, and their families.
24-month Goals and Objectives:
- Create & execute plan to support achievement of system VB lives growth
- Lead clinical strategy to optimize network performance including components like tiering, COEs, membership strategies for specialists
- Support transition to PCP cap as program availability permits
- Develop physician leader succession plan
- Develop value-based digital and home clinical strategies
- Identify key investments and partnerships to support success
REQUIRED EXPERIENCE:
- Doctorate required. Candidates may be Physician MD or DO with at least five years of experience in a similar role.
- Experience as a leader in a large matrixed organization strongly preferred.
- Strategic thinking and business acumen with the demonstrated ability to align clinical strategies with business objectives.
- Operational focus with demonstrated data analysis/interpretation acumen, project management, change management, and execution skills.
- Extensive knowledge of payor operations, managed healthcare systems, medical quality assurance, quality improvement and risk management.
- Track record of successful leadership of case management, disease management, and population health programs.
- Adaptable and flexible style of collaborating with key stakeholders in setting direction.
- Experience in the development of hospital and physician compensation programs.
- Advanced leadership and communication skills to effectively operate in the complex, matrixed environment of an integrated health system.
- Appreciation of cultural diversity and sensitivity towards target population.
- Excellent presentation skills for both clinical and non-clinical audiences.
