Medical Economics and Contract Performance
As Vice President of Medical Economics and Contract Performance, Christy Cawthon oversees the organization’s actuarial services, provider compensation, regulatory administration and medical economics.
Bringing 20+ years of advanced analytics experience to her role, she laid the foundation for informatics and strategy at SWHR, leading interactions with regulatory value-based contracting with government agencies such as Centers for Medicare and Medicaid Services (CMS), providing critical feedback related to risks and concerns connected to ACO model performance and process improvement opportunities.
Responsible for the strategic design and administration of physician compensation programs, she oversees overall performance of operational clinical and quality outcomes and the financial success of delegated contracts. Within her role, she oversees medical loss ratio (MLR) and forecasting revenue projections, including:
Development of efficiency models using actuarial concepts to compare physicians, network and facilities for ACO utilization.
Creation and management of payment mechanisms for incentive awards to the provider population.
Designing employer dashboards to facilitate monitoring of utilization and expense trends.
Leading teams responsible for data integrity, customer service and support for population health management.
Her achievements include implementation of the first regulatory program for SWHR as part of 2014 Medicare Shared Savings, as well as subsequent ACO transitions, maintaining SWHR as a top-performing ACO with over $158 million in shared savings since 2017. In addition, Cawthon developed strategic recruitment models for the extended network with ancillary providers and physician specialists.
She is a graduate of Texas A&M University, earning a bachelor’s degree for applied mathematics in actuarial science.