Practice Transformation Coach

Job Summary: The Practice Transformation Coach supports Clinical Services and Operations Team in their effort to monitor outcomes and create ongoing performance improvement initiatives at DVACO. Will be working across DVACO and with multiple CINs and ACO Members, and multiple EMRs. Work as a member of the DVACO Team to study and monitor care processes in a quality infrastructure and use data to drive ongoing performance improvement throughout DVACO. Must be able to coordinate, interpret, and translate performance data, and critically review metrics; data should permit evaluation of opportunities to implement change and monitor ongoing results of clinical quality outcomes. Collaborate with DVACO Leadership team on ongoing opportunities for improvement in Clinical Operations, Quality, Risk Reduction, Patient Outcomes; this may be in response to regulatory, payer, entity & health system requests as it relates to clinical quality. Education: Bachelors degree in related field with prior applicable experience strongly preferred. In lieu of degree, at least 5 to 7 years of relevant experience is required. Working knowledge of ambulatory care service delivery, clinical operations/ workflows, and clinical data analysis and reporting desired. Licensures & Certifications: PCMH CCE preferred but not required Experience: Excellent communication skills, approachable work style and a willingness to take on complex organizational and clinical project management activities. Demonstrate strong/solid knowledge and skill with computers, spreadsheets and databases. Proficiency in software applications that include, but are not limited to Microsoft Word, Excel, and PowerPoint. Working knowledge of EMR and report development would be helpful, but not required. Must be highly organized with the ability to work well with people. Must have ability to work with highly sensitive...

Quality Improvement Specialist

JOB SUMMARY: The QI Specialist will operationalize the performance measurement Quality Improvement initiatives and Patient Experience data. Together with QI team, is responsible for determining measures, targets for QI/organizational goals, developing analytic methodologies and helping DVACO partners and internal leadership/staff to identify opportunities for clinical/process improvement. The Specialists role will also include researching data benchmarks (national and regional), transforming data into actionable insights, and engaging DVACO leadership as needed in QI improvement efforts. QI leadership contributes to activities for diverse projects and provides mentorship and guidance to internal/external team members and organizational leaders. The QI Specialist will work with Quality Director to provide administrative support and develop presentations, meetings, and communications. Education: Bachelors degree in Nursing, Masters degree in Quality Improvement, Healthcare, Public Health, Population Health or related field strongly preferred. Advanced education or experience in Information Technology, or related field required a plus. Licensures & Certifications: If RN must be from an accredited institution with a current Pennsylvania license. Experience: Minimum of three years working in Quality Improvement environment that includes managing data and implementing quality interventions. Experience translating data into meaningful information and actions driving improvement, presenting to senior leadership. Excellent organizational, oral and written communication skills. Effective collaboration and interpersonal skills are necessary. Demonstrated expertise in facilitating diverse teams required. Demonstrated ability to work with inter-professional teams and with physicians and clinical teams in particular. Experience in providing reports and data analysis to various departments, services, and leadership members. Knowledge of statistics, data analysis and other analysis techniques strongly desired. Strong organizational skills and ability to manage multiple and complex projects. Ability to prioritize projects for...

Care Coordinator

JOB SUMMARY: The Care Coordinator is a Social Worker who facilitates patient continuity of care with the healthcare team. Under the clinical direction and oversight of the Primary Care Physician, the Care Coordinator coordinates care for high risk/complex patients by collaborating with the patient, family, physician, nurses, and other members of the healthcare team to identify needs and expedite appropriate, cost effective care. The Social Worker partners with the RN Care Coordinator to facilitate the care models of DVACO by coordinating services and community resources and meeting member socioeconomic needs to support the quality of life. S/he assists in the development of the patient’s care plan and collaborates with the Primary Care Physician to provide leadership in issues of outcomes management, disease management and prevention, and development of improved strategies to benefit high risk patients. The Care Coordinator may serve as the patient’s primary conduit to the primary care provider as they help coordinate necessary services both within and outside the practice, coordinating care from a variety of sources – physicians, specialists, home care providers, rehab centers, pharmacists, etc. They will engage patients and encourage them to take an active role in their health by providing them with the tools necessary to make healthy lifestyle choices and adopt life-long healthy behaviors. The social worker will serve as an advisor to the clinical team for health and human services resources as well as guardianship and behavioral health issues. ESSENTIAL ACCOUNTABILITY: Patient and Family Empowers and engages patients and families to represent themselves and advocates the patient’s perspective. Recognizes the holistic interrelationship that exists within and across the health system and...

Welcoming DVACO’s New Chief Medical Officer, Dr. Mark Angelo.

Delaware Valley ACO is fortunate to have Mark Angelo, M.D. joining us as Chief Medical Officer and his timing could not be better. With the Centers for Medicare and Medicaid (“CMS”) announcing challenging new models for its Medicare Shared Savings Program (“MSSP”) and deeper engagement with commercial payers in our future, Mark is taking the clinical reins of the organization at a pivotal point. Fortunately, he comes well prepared for the tasks ahead. He joins DVACO from Cooper University Health Care where he served in many roles, including Medical Director for Population Health and as Chief Executive Officer of the AllCare Health Alliance ACO. He will manage all activities of the DVACO clinical team including quality, care coordination, population health pharmacy, post-acute strategy, clinical integration and practice transformation. For more from Dr. Angelo, including a blog post about practice transformation and the Medicare Annual Wellness Visit (“AWV”), click...

Delaware Valley Accountable Care Organization recipient of the National Association of ACOs Innovation Award

The Delaware Valley Accountable Care Organization (DVACO) has been presented with an Innovation Award by the National Association of ACOs for post-acute strategy. The award recognizes accountable care organizations that develop innovative ways to transform the real world care model. Beth Souder, PT, director, Post-Acute Network, DVACO, presented the strategy at NAACOS’ fall conference on October 4, 2018 in Washington, DC. A large percentage of patients’ care occurs in post-acute environments such as nursing facilities, home health and hospice and outpatient rehab therapy. The care provided in these environments demonstrates high variability in both quality and cost outcomes. The DVACO developed methods to measure both quality and cost outcomes (value) in post-acute care, and then defined high-value partners and effective strategies, which is a critical factor to success for any population health/value-based care endeavor. “We were proud to receive this award which recognized our use of data to develop post-acute strategy and ultimately improve outcomes for our patients,” said Souder. Katherine Schneider, MD, president, DVACO added, “We are honored to have been recognized by NAACOS for the broad and deep changes implemented by our physicians and hospitals, supported by data, that over the past four years have improved quality and safety while reducing the total cost of skilled nursing facility spending by 25% in our Medicare population. We are excited to continue to strengthen these collaborations as more and more emphasis is placed on excellent care coordination across the continuum and the community.” The NAACO allows ACOs to work together to increase quality of care, lower costs and improve the health of their communities. Determined to create an environment...