One of the newest members of the Zelis Healthcare organization is Dr. Steven Wolinsky, MD., Chief Medical Officer. Dr. Wolinsky is board certified in Internal Medicine with 32 years of experience working with payers and providers to improve healthcare access, quality and cost. The Z Factor had the opportunity to sit with Dr. Wolinsky to obtain his insight on his new role at Zelis Healthcare.
What is the specific role of a CMO within an organization? And what does it mean to you to be the lead CMO at Zelis Healthcare?
A CMO is the clinical leader of an organization. I am excited to leverage my 32 years of combined career experience in clinical medicine in my own practice, and in managed care to lead Zelis as our CMO. I hope to drive clinical innovation for new and existing products, to represent and enhance Zelis’ reputation in the provider and payer communities, and to support business development across all parts of the Zelis organization, including Claims Integrity, Network Solutions, and Payments.
As you know, Zelis Healthcare formed from a merger of four companies (PHX, Stratose, Pay-Plus Solutions, and Globalcare) to form an end-to-end technology platform addressing the claims cost management and payments needs of healthcare payers, which is very exciting. How will this impact your approach to providing consistent leadership to the Claims Integrity team at Zelis?
My years of experience as a physician in my own practice, in addition to my many years of experience as a senior medical director for Blue Cross plans in the areas of medical cost management, program development, quality, network management, clinical innovations, medical policy and pharmacy, make me ideally suited to support all four Zelis divisions. I hope to take advantage of clinical and business synergies and opportunities across all divisions of the company. I have a long history of helping organizations to break down barriers and work together in teams which I hope will be helpful at Zelis.
What projects are you the most excited about on working on at Zelis? Why?
The opportunity to create synergies between our network solutions, claims integrity, and payment solutions divisions around clinical programs is extremely exciting. Zelis is providing me the unique opportunity to bring my value and experience along the entire claim continuum which is rare. My principal focus will be to bring new clinical capabilities and products to Zelis around clinical claim auditing, claims editing and specialty programs. Moreover, since my role will be two-fold and encompass both tactical and strategical components, it will be important for me leverage my expertise on all levels. For example I will have clinical oversight and support of our nurses, which will include reviewing all types of claims as well as aid in the development of new or improved products and services such as the creation of new clinical claims edits, and new bill review processes, among other projects.
How will your background as a Physician of Internal Medicine for over 32 years assist you in your role as CMO for Zelis?
My experience in my own practice, which I built and operated for 12 years early in my career, makes me credible to Zelis’ provider partners. My 20 years of experience on the payer side gives me ideas and credibility for our payer and employer clients.