Angela Michael

Reporting to the VP of Clinical Integration and Payor Contracting and working directly with a dedicated team of Medical Directors, Practice Leads, Care Management, Clinical Professionals, Data Scientists and Analysts to develop strategy, assess and analyze operations, financial impact, and quality outcomes within Value Based Care Programs.

· Director of Operations: Oversee, implement, and maintain the administrative, clinical, and operational aspects of the Enterprise Network in alignment with the mission, vision, and strategy outlined in the Operating Agreement of the Network and Frederick Health, as well as the Network Participation Agreement. Executive lead operations for clinically integrated network of over 500 primary and specialty care providers. Assisted care transformation organization in participation with Maryland primary care program for 8 hospital and 8 independent community practices. Executive primary oversight of 16 practices participating within Total Cost of Care (TCOC) All Payer Model to optimize patient care across various settings and promote cost-effective healthcare solutions. Administer VBC Programs for the CIN for participation Medicaid, Medicare and Commercial Value Based Care Relationships

· Board and Committee Governance: Direct, implement, and sustain the operations of the Board and Governance Committees as specified in the Operating Agreement. (Board of Managers, CI/IT, Finance, Credentials and Membership, and Nominations and Governance). Facilitate collaboration across the network through committees and work groups. Utilize experience, knowledge, and trust within Network to achieve common goals and objectives.

· Network Partnerships: Direct, implement, and maintain relationships with essential stakeholders, including physicians, staff, patients, community leaders, and regulatory authorities. Collaborate with hospital leaders across operations, strategy, transformation, marketing, IT, and ancillary business lines to improve patient continuity of care and reinforce partnerships within the Enterprise Network, Community, and Frederick Health.

· Value Based Care Business Partnerships / Advocacy: Direct, implement, and maintain strong relationships with Value Based Care Payor Partners within Practice/Providers and the Enterprise Network to ensure compliance and successful performance.

· Network Management: Manage and update the Network Participant Roster. Ensure regular audits and compliance in accordance with the Network Participation Agreement and VBC Payor Program requirements. Leading and coordinating Practice recruitment efforts based on Network Adequacy standards and goals for growth.

· Network Adequacy: Manage and oversee the Network Participant Roster along with conducting annual audits for Network Adequacy. Spearhead initiatives to maintain Network Adequacy and address vacancies as necessary.

· Policies and Procedures: Supervise the creation and execution of policies, procedures, and quality standards for Network Enterprise to ensure adherence to regulatory mandates and industry best practices, including the Enterprise Network Operating Agreement and Participant Provider Agreement. Conduct a comprehensive review of all policies and procedures, making necessary additions or revisions, and communicate updates with the Enterprise Network at least once a year.

· Funds Flow: Provide administrative direction, design, manage, and sustain the funds flow model for the Enterprise Network. Conduct an annual analysis and review of the funds flow model, incentive payment structure, and distribution processes within the Enterprise Network.

· Quality Performance Goal Setting: Annually lead, identify, and manage the establishment of quality performance goals, overseeing the matrix for quality metrics that cover a wide array of focus areas, including adult primary care, pediatrics, specialty care, and other outcome-based measures.

· Financial Performance Goal Setting: Annually lead, identify, and manage the establishment of financial goals, overseeing the matrix for financial metrics that encompass a broad spectrum of focus areas, including adult primary care, pediatrics, specialty care, and other outcome-based measures.

· Enterprise Network Engagement Opportunities: Lead, plan, and implement engagement opportunities within the Enterprise Network that promote growth, learning, and networking in relation to Total Cost of Care and Value-Based Care.

· Health Equity Innovation and Performance: Organize and implement health equity initiatives within the Enterprise Network that align with the goals and health equity objectives in the Value-Based Care landscape.

· Population Health Program Development: Collaborate with clinical and administrative leaders to pinpoint areas for process enhancement, cost savings, and revenue growth. This may involve initiatives aimed at decreasing patient utilization and enhancing care transitions to tackle readmissions, out-of-network usage, and primary care access solutions, as well as efforts to facilitate screening and services related to social determinants of health.

· Data Analytics and Practice Transformation Performance Efforts: Partner with Information Technology, Population Health, and Data Analysts to create, execute, and oversee actionable data reports that can be used collectively as an Enterprise Network and individually by Practices for improvement initiatives. Continuously monitor and evaluate key performance metrics (quality and utilization) and financial indicators to determine the effectiveness and efficiency of network operations.

Reporting to the VP of Integrated Care and Payor Contracting, this roles directs the Frederick Integrated Healthcare Network (FIHN) and Frederick Health Medical Group (FHMG) Value-Based payment models including implementation and maintenance of programs aligned with strategic planning to key initiatives to meet organizational and financial goals.

Senior Operational Value Based Care Leader

o Manages various functional areas and cross-departmental workstreams, coordinating clinical, operational, financial, analytics, compliance, and contracting resources to guarantee adherence to program participation and delivery.

o Acts as the main organizational representative for senior-level internal and external stakeholders, including health systems, payers, providers, employers, and community partners, in achieving the Total Cost of Care and Value Based Care objectives of the Enterprise.

o Provides administrative direction, leadership, and oversight for the management of the Network and VBC Governance Committees and Board as directed by the VP of Integrated Care.

o Provides administrative direction, leadership, and oversight for the management and administration of the Network Operating Agreement, Participating Provider Agreement, Policies and Procedures, and Funds Flow of the Enterprise.

o Develops, interprets, implements, and suggests changes to organizational policies and procedures that facilitate Value-Based care transformation and ensure regulatory compliance.

o Promotes the organizational adoption of Value-Based care principles through education, change management strategies, and collaboration across functions.

o Fosters a culture of accountability, continuous improvement, innovation, and alignment with the organization’s mission, vision, and core values.

o Holds operational responsibility for defining and measuring clinical performance outcomes and affordability impact across Value-Based care and Network clinical programs.

o Oversee clinical pilots and improvement initiatives from implementation to evaluation, including established success metrics and performance monitoring.

o Stays informed about policy and regulatory influences on cost and quality measurement to ensure compliance.

o Ensures that effective clinical programs are integrated into routine performance monitoring, forecasting, and financial evaluation processes.

· Administration, Management, Monitoring, and Performance in VBC Programs

o Administer and Maintain Enterprise and Network VBC Contracts

o Direct strategy and operations for involvement in VBC Contract Programs

o Contract Negotiations and Strategy - Identifies VBC opportunities, conducts regular market analysis, performs assessments, and develops strategic models for program involvement. Guides negotiations and contractual strategies for payer-provider partnerships and risk-based agreements, ensuring they align with the organization's financial and quality objectives.

o Creates and implements thorough, annual and multi-year Value-Based care strategies that correspond with Enterprise objectives and enhance clinical outcomes, patient experience, equity, and financial performance.

o Performance Dashboards and Outcomes - Establishes and supervises performance management frameworks, dashboards, and reporting systems to track quality, utilization, risk adjustment, costs, and compliance outcomes.

o Converts enterprise strategy into operational plans with clear milestones, KPIs, governance structures, and accountability mechanisms across various departments and divisions.

· Financial Responsibilities and Management

o Funds Flow - Directs the design, execution, and enhancement of Value-Based Funds Flow and payment models (such as CINs, ACOs, shared savings, bundled payments, capitation, and risk-based arrangements) to meet quality, utilization, and financial goals.

o Performance Dashboards and Outcomes - Develops and supervises performance management frameworks, dashboards, and reporting systems to track quality, utilization, risk adjustment, cost, and compliance outcomes.

o Budget - Creates and oversees departmental budgets and cost centers, ensuring responsible management of financial and operational resources.

o Network Risk Management - Recognizes enterprise-level risks, implements mitigation strategies, and appropriately escalates significant issues to safeguard strategic, operational, and financial objectives.

• Organized and optimized program design by utilizing comprehensive data on payor and performance metrics.
• Collaborated in shaping strategic and operational initiatives related to programmatic surgical services and organizational systems.
• Collaborated with stakeholders to create and establish comprehensive training initiatives for surgical care teams, enhancing knowledge of preventative practices.
• Achieved seamless collaboration with C-suite physicians and medical directors, resulting in improved project outcomes. Cultivated relationships with independent payers and contractors to enhance service delivery and consumer satisfaction.
• Directed strategic operational design and maintenance of special programs for surgery, including bariatric, orthopedics, and spine surgery.
• Established strategic partnerships with external organizations, expanding program reach and impact.
• Organized events and workshops to engage participants, enhancing their learning experience within the program framework.

• Led team in delivering high-quality patient care through effective communication and collaboration.
• Oversaw daily operations, ensuring compliance with healthcare regulations and hospital policies.
• Developed operational strategies that aligned with hospital goals, driving quality outcomes across departments.
• Collaborated with other department leaders to establish shared goals and ensure alignment across teams.