The Medical Director provides clinical leadership and direction for ANI’s Clinical Integration Program (CIP), Accountable Care/Population Health and Value-Based Care initiatives as established by the ANI Board of Directors and aligned with Aspirus, Inc.This position will work collaboratively with the ANI Team to yield optimal decision-making, alignment and efficiencies related to all ANI provider members, payor, management, and implementation strategies. This position will also work collaboratively with Aspirus System operations leaders to assure CIP, Accountable Care/Population Health and payor strategies are implemented to yield optimal performance.
- Develops and maintains physician relationships that promote a culture of trust, collaboration, and transparency embedded in the principles of the Aspirus Compact.
- Assures provider performance incentives are aligned with payor value-based contract strategies and provider compensation models.
- Defines levels of physician engagement, alignment and involvement in CIP and its relationship to commercial and government payor value-based contract arrangements.
- Serves as a representative voice of physicians across ANI, Aspirus System and broader organizations to promote ANI clinical strategies and interventions designed to efficiently produce the optimal value proposition.
Clinical Integration Program (CIP)
- Leads and directs CIP development, alignment, and implementation.
- Leads and directs ANI Physician Leadership Council (PLC) - PLC oversees the implementation of the Clinical Value Program (CVP).
- Leads and directs clinical business informatics reporting, internal or external tool, for tracking, evaluating, communicating, and improving CVP performance; interacts with Aspirus IT leadership team to assure optimal functionality and connectivity.
- Leads and directs best practice clinical benchmark analytics of CVP performance to identify opportunities for recognition and improvement.
- Facilitates transparent communication to ANI individual providers on CVP metric performance and provides support and remediation efforts with a provider to achieve optimal performance.
- Leads and directs continuous improvement and transparency efforts to achieve the best clinical quality outcomes and improves quality metrics, in collaboration with system medical directors, by analyzing and monitoring internal data and various external benchmark data sources, e.g., WCHQ, WHIO, and other clinical report cards.
- Leads and directs continuous improvement and transparency efforts to achieve the best patient satisfaction metrics with inventions when necessary designed to produce optimal performance.
- Leads and directs collaboration with system medical directors with standardization of care by selecting evidence-based practice guidelines where applicable.
- Facilitates transparent communication of ANI’s strategic clinical direction to ANI providers, practice administrators, and system leaders.
- Supports Aspirus System Quality & Patient Council to ensure alignment with PLC strategies.
Accountable Care/Population Health
- Leads and directs, with Aspirus System CMO, the development, management and implementation of Accountable Care/Population Health strategies that influence care management efforts with the goal to be a well-managed, clinically integrated system of care capable of delivering Accountable Care.
- Leads and directs Accountable Care informatics reporting that support ANI and Aspirus System needs for actionable and meaningful clinical and financial reporting capabilities related to per member per month costs of a defined patient population.
- Leads and directs an annual care management improvement plan that demonstrates an improvement in ANI efficiencies and improves quality outcomes for a defined population.
- Leads and directs development of patient registries for Aspirus System care management team to create directional care management intervention plans for a defined patient population.
- Leads and directs utilization improvement and clinical care redirection from variances of unnecessary care based on defined set of key clinical performance indicators.
- Leads and directs further development of care management capabilities in collaboration with system medical directors and executive leadership with the goal to deliver such capabilities to payors and external purchasers.
- Facilitates transparent communication of Accountable Care/Population Health strategies to ANI providers, practice administrators, and system leaders.
- Leads and directs ANI Credentialing Committee to ensure the highest standards of provider participation/eligibility and credentialing payor requirements are met.
- Develops and fosters strong, positive working relationships with existing and future payors to maximize opportunities to promote ANI’s clinical quality outcomes value proposition.
- Provides clinical knowledge that supports payor negotiations and network management to achieve transition from volume-based to value-based reimbursement strategies.
- Collaborates with payor clinical leaders to assure alignment of payor quality initiatives with CVP quality metrics.
- Participates in development of payor value-based reimbursement strategies.
- Participates in development and implementation of payor value-based distribution model that aligns with System provider compensation model.
- Direct report to ANI Executive Director with matrix reporting to Aspirus System CMO.
- Meets regularly with ANI leadership team and Board Chair for preparation of Board meetings and to maintain an ongoing, positive working relationship and transparent communication.
- May attend ANI Board meetings as administrative staff member.
- Works effectively with ANI Board of Directors, ANI Team, Aspirus executive leaders, and BU CMO’s/System Medical Directors.
- Is responsible for understanding federal compliance standards as a clinically integrated network.
- Ensures climate of collaboration and fosters an environment of teamwork.
- Leads, manages and coaches the ANI quality and reporting team, as applicable (including performance appraisals, time management and project direction).
- Perform other duties as assigned.
Department Specific Accountabilities
- Provides direction to Credentialing Services and Health Resource Team.
- Maintains department specific accountabilities as determined, maintained, and housed within each unit’s Scope of Service.
- Knowledge of healthcare standards and practices normally acquired through completion of a Doctor of Medicine Degree (M.D. or D.O.) required.
- Minimum of 10 years professional clinical practice experience preferred.
- A minimum of 3 years of healthcare management/quality/population health leadership experience preferred.
- Board certification in a clinical specialty.
- Is, or becomes, licensed by the State of Wisconsin to practice medicine.
- Demonstrates strong leadership capabilities with proven ability to make tough decisions yet be influential.
- Demonstrates strong leadership capabilities with proven ability to energize staff.
- Possesses excellent interpersonal skills, including written and verbal communication skills.
- Possesses excellent internal management skills evidenced by exercising a high degree of initiative, judgment, discretion, organization, and time management.
- Possesses a strong interest to grow knowledge base and understanding of the managed care environment/conditions/trends, value-based payor contracts, health insurance industry, provider networks and associated legal issues.
- Possesses a strong understanding of finance and health care reimbursement.
- Possesses strong analytical and presentation skills.
- Functions under pressure and is an expert at managing multiple priorities.
- Annual competencies as required by Aspirus and/or various regulatory agencies based on entity and/or job position.