What to Look for in a Healthcare Executive Who Understands Clinical Operations and Value Based Care
Boards and investors in post acute care often hire for one of two profiles. One is the operator who knows how to grow census, manage margins, and open new markets. The other is the clinician who knows what good care looks like at the bedside. Value based care asks for someone who can do both, and that person is harder to find than most job descriptions admit.
I have been on the clinical side of that table and the executive side of it. I started in bedside hospice nursing and eventually built the clinical and compliance infrastructure for a hospice organization operating across five states. Along the way I learned that the leaders who succeed under value based arrangements are the ones who can translate between the care team and the contract.
Here is what I would look for if I were hiring that person.
Why the stakes are rising
In 2021, the CMS Innovation Center set a goal of having every person with Traditional Medicare in an accountable care relationship by 2030, meaning their providers answer for both the quality and the total cost of their care (CMS, 2025). As of January 2025, CMS reported that 53.4 percent of people with Traditional Medicare were already in one of those relationships (CMS, 2025).
For post acute providers, that shift shows up in referral conversations with ACOs, health systems, and Medicare Advantage plans. Partners increasingly want to know your outcomes, not just your capacity.
Quality data is also getting more detailed. In hospice, CMS replaced the Hospice Item Set with the Hospice Outcomes and Patient Evaluation tool on October 1, 2025. HOPE collects patient level assessment data at admission, at update visits during the first 30 days, and at discharge (CMS, n.d.). An executive who does not understand how that data is generated at the bedside cannot manage what it will show.
Six capabilities to look for
Each of these comes with a question I would ask in the interview. The answers tell you far more than a résumé does.
1. Fluency in both clinical and financial language
The right leader can explain to a CFO why a visit frequency matters clinically, and explain to a nurse manager why length of stay matters financially. Neither audience should feel talked down to.
Ask: Tell me about a time a clinical decision and a financial target pulled in different directions. What did you do?
2. Command of quality data at the source
A strong candidate knows how measures like the HOPE assessment and CAHPS Hospice survey results are produced, which documentation habits drive them, and where the data can mislead. They do not treat quality scores as a report that arrives from somewhere else.
Ask: Pick one quality measure you have been accountable for. Walk me through how the data was created and what you changed to improve it.
3. Compliance judgment that holds under growth pressure
Value based arrangements do not suspend eligibility rules, documentation requirements, or referral laws. Look for someone who has grown an organization and kept it defensible at the same time. This is the core of my ALIGN framework for compliant hospice growth.
Ask: Describe a growth opportunity you turned down or reshaped because of compliance risk.
4. Experience building infrastructure, not just running it
Many leaders can operate a system that already works. Fewer can build one. Ask about EMR implementations, standardized training programs, and new market launches. Those projects reveal whether someone can design processes that hold up when they are not in the room.
Ask: What is something you built that still runs well without you?
5. The ability to partner across the continuum
Value based care depends on handoffs between hospitals, physician groups, home health, palliative care, and hospice. The right executive has relationships across those settings and understands each partner's pressures.
Ask: Which outside partner relationship are you proudest of, and what did both sides get from it?
6. Respect for the bedside
I put this last, but I weigh it heavily. Leaders who have never carried a caseload, or who have forgotten what it was like, tend to design workflows that look efficient and fail in a patient's living room. The best executives I know still ask frontline staff what is not working, and they listen.
Ask: When was the last time frontline staff changed your mind about something?
A final thought
If you find someone who scores well on all six, hire them quickly. If you cannot, I would prioritize compliance judgment and respect for the bedside. Financial and partnership skills can be supported by a strong team. Those two are much harder to teach after the fact.
I work with hospice and post acute organizations through PAC Leadership Solutions on clinical operations, compliance, and fractional leadership. If you are weighing a leadership hire or need interim clinical leadership while you search, you can reach me through the contact page on this site.
About the author
Tonia Barrier, MSN, RN, is the Founder and Principal Consultant of PAC Leadership Solutions and a DNP Executive Leadership candidate at Walden University. She is the former CCO & Compliance Officer of a multistate hospice organization, a trained End of Life Doula, and an HPNA Tennessee State Ambassador. She developed the ALIGN framework to help hospice organizations grow without trading away clinical integrity.
References
Centers for Medicare & Medicaid Services. (2025). CMS Moves Closer to Accountable Care Goals with 2025 Accountable Care Organization Initiatives. Fact sheet.
Centers for Medicare & Medicaid Services. (n.d.). Hospice Outcomes and Patient Evaluation (HOPE).
