NEQCA is a network of 1700+ affiliated community and academic physicians who refer patients to Tufts Medical Center & Floating Hospital for Children for complex care. The physician practices range in size from single physicians to multi-specialty groups with several hundred physicians. The practices are organized into groupings called Local Care Organizations (LCOs) which collaborate on practice improvement and collectively participate in risk-bearing commercial and government contracts. The LCOs are supported by a central organization (NEQCA Central) via contracting, reporting, informatics, and a variety of clinical programs including but not limited to Care Management, Clinical Pharmacy, Patient-Centered Medical Home, and Coding.
The Medical Director works closely with the Chief Medical Officer (CMO), NEQCA and its LCO Leaders to improve network performance in risk contracts and to realize the Quadruple Aim goals of better health, better care, lower costs, and higher clinician satisfaction. The role is comprised primarily of work with LCO Leaders, external stakeholders, and NEQCA Central staff. The Medical Director is a member of the clinical leadership team, currently comprised of the CMO and two other Medical Directors.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
- Maintains collaborative team relationships with peers and colleagues in order to effectively contribute to the achievement of goals, and to foster a positive work environment.
- Works to improve the quality of care provided within the LCOs to ensure that all patients receive the health care services they require at the right facility, in a timely fashion, and by the most appropriate provider.
- Builds relationships with internal and external partners through face to face meetings, conference calls, data sharing, and visits to practice sites and other locations.
Within NEQCA: The Medical Director plays an important role in creating and monitoring performance improvement programs to improve the NEQCA Network's quality and efficiency performance under all risk contracts. This is done in close partnership with NECQA Central staff in a dyad model on clinical and performance improvement strategies and tactics.
Examples of specific responsibilities include:
- Works with NEQCA Performance Management team to ensure successful achievement of relevant pay for performance measures and efficiency goals.
- Works collaboratively with NEQCA Data and Informatics team to develop/improve standard performance reporting, identify analytic requests to further understand performance and opportunities for improvement, and interprets data and reporting to take action on program development or interventions.
- Collaborates closely with NEQCA staff supporting LCO clinical performance, including but not limited to Care Managers, Clinical Pharmacists, Patient Centered medical Home Practice Consultants and Account Managers.
- Supports the NEQCA Coding team in the development and implementation of programs to help Physician practices improve the accuracy of coding.
- Works closely with NEQCA staff and others to develop informational tools and materials that support clinical quality and efficiency initiatives. Identifies and disseminates best practices.
- Plays an active role as assigned in relevant NEQCA committees.
- Is an integral member of the NEQCA clinical leadership team, and provides support and coverage for the CMO and other Medical Directors when needed.
Engagement with NEQCA LCOs: The Medical Director plays a critical role as the clinical liaison to and supporter of NEQCAs LCOs, including Physician and Administrative Leaders, frontline clinicians and others. As such, knowledge of contract performance measures and methods to improve contract performance is of central importance.
Examples of specific responsibilities include:
- Regularly participates in leadership meetings with LCO Medical Director, LCO Administrator, and NEQCA Account Manager as needed.
- Attends meetings of frontline physicians and works directly with these physicians when necessary.
- Works with LCO Medical Directors to set mutually acceptable annual goals, regularly provides feedback on their individual job performance, and formally evaluates their performance at least annually.
- Monitors LCO performance, identifies areas of concern and/or opportunity and works with LCO Leaders to address these and other issues and implement action plans to address suboptimal performance.
- Provides medical management and practice transformation support to LCO clinical leaders, and frontline clinicians as directed.
- Develops relationships with front-line physicians, supporting problem solving and improvement of quality and cost-effective practice.
- Works with LCO leadership to facilitate understanding of internal funds flow policies and financial aspects of payer agreements.
- Actively interfaces with hospitals, SNFs and other care partners to improve care outcomes, utilization and cost.
- Serves on committees, work groups, and projects as directed.
- Articulates NEQCA clinical strategy goals and plans to ensure effective implementation.
- Develops and communicates policies and procedures.
- Investigates selected cases where care is reported as deviating from accepted standards, and takes appropriate actions as indicated.
- Works to improve NEQCA Network clinical integration with Tufts Medical Center & Floating Hospital for Children.
Partnering with external stakeholders: The Medical Director, as assigned, helps to link NEQCA to important external stakeholders in order to assure the success and recognition of NEQCA programs.
Responsibilities in this area may include:
- Serves as liaison to health plans and other external groups, to promote effective collaboration and communication.
- Develops effective working relationships and communications with Tufts Medical Center & Floating Hospital for Children leadership, physicians and staff.
- Collaborates with community hospitals and community specialists to advance NEQCA’s goals, especially to support Network Integration with Tufts Medical Center & Floating Hospital for Children.
- Presents NEQCA programs and achievements and represents NEQCA at relevant local, regional and national meetings.
- Represents NEQCA on local, regional and national committees as needed.
- Advocates for the clinical appropriateness of performance measures with payers and national organizations.
Training, Research and Innovation: The Medical Director collaborates with NEQCA staff, physicians and administrators as needed to develop and implement strategies for education and training, research, and innovation to support NEQCA programs and initiatives.
- Evaluates new technologies to improve monitoring and management of chronic illnesses and recommends incorporation of new technologies when they will help to improve quality and/or reduce costs of care.
Performs other similar and related duties as required or directed.
Optional Clinical work: part-time clinical practice (no more than one half-day session/week) is encouraged but is not required.
JOB REQUIREMENTS: KNOWLEDGE AND SKILLS
Experience in primary care or multi-specialty practice management and managed care with strong understanding of core processes for high performance medical practice
- Demonstrated ability to work smoothly and effectively within a team of clinical and non-clinical colleagues. Experience with personnel management preferred.
- Self-motivated, goal-oriented and independent
- Creative thinking and problem solving skills
- Commitment to working in dyad relationship with operational leaders to facilitate all are “working to top of license”
- Knowledge of principles of high value health care including common quality and efficiency measures
- Strong quality improvement skills
- Experience in data analysis, e.g. to assess quality and efficiency of care, return on investment for medical management programs, etc.
- Superior leadership skills, especially relationship building and provider engagement skills, including the ability to influence without direct authority
- Superior written and verbal communication skills, including developing and giving clear and effective presentations, in both 1:1 and group settings
- Knowledge of integrated health network operations
- Knowledge of current clinical standards, guidelines and practices
- Project and resource management skills
- Ability to understand importance of and respect for the confidentiality of all patient information in accordance with applicable standards and regulations, and of payer and other contractual confidentiality requirements.
- Proficiency in Microsoft Office applications, including Excel, PowerPoint and Word
QUALIFICATIONS: MD or DO or equivalent degree. Board Certification in a specialty recognized by the American Board of Medical Specialties is required.
LICENSES, ETC.: Current unrestricted license to practice medicine in Massachusetts
EXPERIENCE: At least 5 years of clinical practice experience is required, ideally in a primary care or multispecialty group. Prior experience with population health management and managed care preferred