Roundtables

Five CMOs Discuss the Biggest Challenges They Face, How Their Jobs Have Changed and What Tips They Would Share With Other CMOs Written by Helen Gregg Question: what is the biggest chal- lenge facing you right now? do you think it's the same challenge that is facing most CMOs around the country? H. David Arredondo, MD, CMO of Presbyterian Delivery System and Ex- ecutive Medical Director of Pres- byterian Medical Group (Presbyte- rian Healthcare Services, Albuquer- que, N.M.): Our biggest challenge is how to most rapidly and effectively implement the ever-increasing vol- ume of evi- dence-based practices and guidelines, and to do this in a way that does not overwhelm our physicians, providers and nurses. We need to make this easy for our clinicians, and we need to be able to track compli- ance. We will be challenged to sustain improvements and determine what care processes must be "highly reli- able" and achieve 100 percent compli- ance every time. Usamah Mossallam, MD, Associate CMO of Henry Ford Health System (Detroit): It's figuring out how to best place ourselves in an age of unknowns in healthcare. For us in particular, it's reimbursement challenges and changes. Everybody is interested in paying less for healthcare. We strug- gle with large numbers of under- and uninsured patients, and we wonder, as the [Patient Protection and Afford- able Care Act] takes effect, what that will do to those numbers… ere'll be an increase in Medicaid patients, but Medicaid isn't a great payer and doesn't cover our expenses, so we'll continue to have reim- bursements less than our costs. Jeremy Orr, MD, CMO of Humed- ica (Boston): One of the biggest is hav- ing a thorough understanding of the population. Many hospitals have grown by acquisition so they have disparate pieces — hospitals, clinics — that are on different IT systems and have different ways of billing clinical operations. at means they have islands of data and can't see across to get a sense of the population that moves between. is is the greatest challenge for them as they move into risk-based contracts. To make good, executive decisions they need access to this information, and right now they don't have it. M. Michael Shabot, MD, CMO of Memorial Hermann Health System (Houston): e greatest challenge is the conversation of our practice, both the inpatient and ambulatory sides, from volume to value, moving our goal from the number of procedures and tests we can do to doing what we can to improve the health and health- care of the patients we serve. It's a very differ- ent focus. We have spent a lot of time and energy here at Memori- al Hermann in reflection about this volume-to-value transition and how to optimize the value of the healthcare our patients receive. I think it's more of a cultural chal- lenge, and not a technical challenge. Some- times, the technical challenges are easier — setting up patient-cen- tered medi- cal homes, providing our ambulatory practices with electronic monitor- ing for high-risk patients at home. ose are specific things we can do, but changing the culture of the organization is more challenging. Anthony Slonim, MD, CMO of Barn- abas Health (West Orange, N.J.): e biggest challenge is trying to figure out how to integrate our organization with our physician colleagues while we attempt to understand the numer- ous relationships that can be formed in the process including employment, integration, joint ventures or simply IT integration. is is especially impor- tant as we transition from volume- to value-based healthcare. We have to be thinking more about how we work with our physicians to manage large pop- ulations of patients, reduce the clinical variation in care and the cost structure if we will be successful. No one quite has the skill set for that yet; but, one thing that is for sure is that we cannot do it without our physician partners. Q: what are the toughest clinical areas to maintain in terms of quality, and why? Dr. Arredondo: We have found that some of the surgical and medical spe- cialties are challenging with respect to tracking quality. Since evidence-based guidelines are less well-developed for these specialties than they are for pri- mary care, in many situations it can be difficult to determine how to measure quality. ough we can readily track Five CMOs Discuss Challenges, Changes and Advice 2

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