Description
Vice President of Primary Care Operations
The Vice President of Primary Care Operations is a senior executive responsible for leading the transformation and performance of primary care services within a value-based care model. This role drives clinical, operational, and financial outcomes by aligning care delivery with population health strategies, risk-based contracts, and quality performance metrics. The VP ensures high-quality, cost-effective, patient-centered care while advancing the organization’s shift from volume-based to value-based reimbursement.
Key Responsibilities
Strategic Leadership (Value-Based Care)
- Lead the design and execution of a value-based care strategy across all primary care operations.
- Align primary care services with population health goals, including risk stratification, preventive care, and chronic disease management.
- Partner with payer organizations to optimize performance in risk-based and shared savings contracts.
- Drive growth in attributed lives and manage total cost of care (TCOC).
Operational Oversight
- Oversee multi-site primary care operations with a focus on care model transformation (team-based care, care coordination, integrated behavioral health).
- Standardize workflows that support value-based care delivery, including care gap closure and utilization management.
- Implement and scale care management programs for high-risk populations.
Financial & Risk Performance
- Manage financial performance under value-based arrangements, including shared savings, capitation, and bundled payments.
- Monitor key metrics such as total cost of care, medical loss ratio (MLR), and risk adjustment accuracy (RAF scoring).
- Collaborate with finance and analytics teams to ensure accurate forecasting and performance tracking.
Quality & Clinical Outcomes
- Drive performance on quality measures (e.g., HEDIS, STAR ratings, CMS quality programs).
- Partner with clinical leadership to improve outcomes in chronic disease management, preventive care, and care transitions.
- Ensure compliance with regulatory and payer-specific quality requirements.
Provider & Care Team Enablement
- Lead initiatives to align provider incentives with value-based performance.
- Support adoption of team-based care models including care managers, pharmacists, and social workers.
- Enhance provider engagement through education on value-based care principles and performance metrics.
Patient Experience & Access
- Improve patient access through advanced access scheduling, telehealth, and digital tools.
- Enhance patient engagement in preventive care and chronic disease self-management.
- Address social determinants of health (SDOH) impacting patient outcomes.
Data, Analytics & Technology
- Leverage data analytics to identify care gaps, manage population health, and drive decision-making.
- Oversee optimization of EHR and population health platforms to support value-based care workflows.
- Promote interoperability and data sharing across the care continuum.
Partnerships & Network Development
- Collaborate with payers, ACOs, and community partners to strengthen value-based care initiatives.
- Develop referral networks that support high-quality, cost-effective care.
- Represent primary care in contract negotiations and strategic partnerships.
Qualifications
Education
- Bachelor’s degree in Healthcare Administration, Business Administration, or related field (required)
- Master’s degree (MBA, MHA, MPH, or equivalent) strongly preferred
Experience
- 10+ years of healthcare leadership experience, with significant exposure to value-based care models
- 10+ years overseeing multi-site primary care or population health operations
- Demonstrated success managing risk-based contracts and improving cost and quality outcomes
Skills & Competencies
- Deep expertise in value-based care, population health, and risk adjustment methodologies
- Strong financial acumen related to capitation, shared savings, and cost-of-care management
- Experience with quality frameworks (HEDIS, CMS Stars, ACO metrics)
- Proven ability to lead care model transformation and change management
- Advanced data-driven decision-making capabilities
Key Performance Indicators (KPIs)
- Total Cost of Care (TCOC) reduction
- Quality scores (HEDIS, STAR ratings, CMS measures)
- Risk adjustment factor (RAF) accuracy and documentation
- Patient access and care gap closure rates
- Shared savings performance and margin under VBC contracts
- Hospital utilization (admissions, readmissions, ED visits)
- Patient and provider satisfaction
