Here’s a riddle to try on your colleagues: What do you call a doctor who takes on administrative responsibility in the age of value-based care? And it’s no fair answering “a damned fool.”
For Toledo-based physician executive recruiter Carson Dye, such titles matter. When a provider organization’s leaders recently hired him to find a chief medical officer, he gently set them straight. The areas of responsibility they envisioned for the new executive—including care management, population health, quality reporting, and strategic planning—meant that chief clinical officer was the better title, he explained. It was more accurate, suggesting team-based care rather than “doctors only.” And it was better catnip for candidate docs too.
“I told them there were a number of good prospects out there who would take a phone call from me about the CCO title, but not about CMO,” says Dye.
A chief clinical officer is one who also looks “sideways” across an integrated network says, Linda J. Komnick of Witt/Kieffer.
He isn’t the only executive searcher who’s been nudging clients toward the CCO title. “For some people this might be a matter of semantics,” concedes Linda J. Komnick, senior partner at the executive search firm Witt/Kieffer. But she says the CCO moniker better reflects an executive who oversees physicians but not just with a “top-down” mentality—one who also looks “sideways” across an integrated network to identify opportunities for performance improvement through the continuum of care, including postacute and outpatient settings.
Are we all agreed on what titles mean, then? No way. Many executives who are called CMOs—or something else—are also taking on the new duties of value-based care. Among physician execs in health plans and providers today, titling is far from consistent. “If you’ve seen one,” warns Komnick, “you’ve seen one.” Still, a few of the most common titles can be defined:
Associate medical director. “This may be a physician’s first step as a business leader,” says Atlanta-based recruiter Stephen J. Kratz, Komnick’s colleague and another senior partner at Witt/Kieffer, who works mostly with managed care and insurance industry searches. A few years in this role may lead to a medical director post, just as a few more years may turn a medical director into a senior medical director. At Philadelphia-based Independence Blue Cross, for example, “medical directors who manage staff have a senior medical director title,” says company spokeswoman Ruth Stoolman.
Medical director. This is the traditional title for a doctor, sometimes still practicing, who takes on administrative duties for a practice, provider, or plan. Medical directors vary from the volunteer part-timer for a group practice all the way to a highly paid C-suite executive with a major, say, in clinical policy. But in many organizations, the medical director position has morphed into a job with a grander-sounding title—or several posts that report to a more grandly titled boss.
“Twenty years ago I worked with health plans that had one medical director,” says A. John Blair III, MD, CEO of MedAllies, a Fishkill, N.Y.-based health IT vendor. Blair is past president of Taconic IPA, a nearly 5,000-member physician group. “Today they may have six medical directors, responsible for different areas such as care management or quality, all reporting to a CMO or CCO who’s part of the top executive team.”
The “director” part of the term “medical director” may understate the officer’s importance, says Robert Kuramoto of Quick Leonard Kieffer.
The medical director title has a special problem, notes Robert Kuramoto, MD, a Chicago-based managing partner of the health care executive search firm Quick Leonard Kieffer, and who was once medical director of a 100-physician multispecialty group practice. The word “director” risks confusion with the director level of management in an organization’s nonclinical sectors—HR, for example—and therefore may seem to understate the officer’s importance.
Despite that problem of appearances, recruiters agree that the profusion of new titles with which many organizations have replaced or supplemented medical directors represents not, with a few exceptions, mere “title inflation,” but actual growth. “More physicians are going into executive positions and these areas are expanding,” says Blair. “It’s not like banks, where everyone’s called a VP just to make them sound more impressive to customers.”
Vice president, medical affairs. Never in wide use among health plans, this title is now passing out of fashion even with providers. “It connotes a more old-fashioned role, from the days when you had a voluntary medical staff with elected officers,” says Dye. “It doesn’t mean anything to the large majority of physicians today, who are employed by providers.”
Komnick agrees: “VP–medical affairs doesn’t carry the same weight it did 10 or 15 years ago. We still see it, but mostly in smaller institutions.”
Chief medical officer. This is probably the most common top medical position in health plans and has replaced VPMA in many provider organizations, too. It usually describes the organization’s top physician, who likely has an MBA and/or another advanced degree in an area such as public health. He or she may or may not have decisive clout in making clinical calls on coverage or treatment issues.
“More physicians are going into executive positions, and these areas are expanding,” says A. John Blair III of MedAllies.
Sometimes the CMO title gets an extra dollop. “When Roy Beveridge, MD, joined Humana a few years ago,” says Kratz, “they called him the chief medical and well-being officer to reflect increased consumer involvement in health care decisions.” Titles are “getting sexier,” says Kratz, especially in health systems and health plans.
One recent client of Komnick’s, a 20-hospital system, has taken to calling its CMOs regional medical officers and having them report systemwide to a CCO, formerly known as the system CMO. And if that’s not complicated enough, some entities also have associate CMOs responsible for specific areas such as informatics or outpatient care.
Chief clinical officer. As Dye and Komnick say, this title has supplanted the CMO in many organizations; in others it defines a new, higher level to which a CMO, or a group of CMOs, reports. Conceding that the CCO and CMO labels are considered “somewhat interchangeable” by many, Komnick believes the CCO title is a better fit for the combination of hard business knowledge and soft relationship-building skills required to align care in today’s clinically integrated networks and ACOs.
Chief physician executive, sometimes called physician-in-chief. “This may be the most contemporary of all these titles,” says Dye. This individual often has responsibility for physician engagement and recruitment in a large health system. In theory it’s a different job than CCO, but there’s the usual overlap. A recent online job notice for a large Indiana multispecialty physician group, for example, called for a CPE to manage “the entire operations of a community health center,” drawing on previous experience “operating within a matrix reporting structure” and “developing a patient-centered medical home model.”
Chief integration officer or chief transformation officer. When an organization’s top doctor gets one of these new jobs, every glance at the business card is a reminder of roiling change. These titles don’t always go to physicians, but when they do they can be combined with lofty responsibilities. In May, for example, New York–Presbyterian (which includes a hospital, a regional hospital network, a physician services entity and a “community and population health” unit) appointed Peter M. Fleischut, MD, senior vice president and transformation officer, in charge of — among other things — overseeing implementation of “clinical technology operations” at a new center opening in 2018. A title that smacks of novelty is no novelty for Fleischut; he previously served as chief innovation officer.
“Finding candidates with the right balance of clinical and business credentials is getting harder,” says Stephen J. Kratz of Witt/Kieffer.
Out of the nomenclature thicket, one truth emerges: If you’re a doctor with leadership experience, a business or public health degree, and a penchant for helping to push care delivery toward the value-based approach that we all talk about—and that increasingly affects how providers are paid—you have opportunities.
“Finding candidates with the right balance of clinical and business credentials is getting harder,” says Kratz. “Where we used to be looking at slates of 10 candidates, today there’ll be four or five.”
Komnick adds that physician executives who leave acute-care positions to work for health plans are no longer seen as having passed through a one-way door, never to return. “These days,” she says, “providers love to hire someone who’s had experience with managed care.”