Demos › Operating Model Designer

Module 06 · Operating Model Designer

Decision rights, org design,
and the build-buy-partner map.

Sherlock designs Meridian's AI operating model in three artifacts a CEO can act on: the target org chart with named roles, the RACI-backed decision rights, and the capability heatmap that decides what to build, what to buy, and what to partner for.

Archetype selected

Federated hub-and-spoke

Total AI FTE (Y1 → Y3)

14 → 38

CoE structure

Central + 4 domain pods

Reports to

CEO (dotted to COO)

Operating model archetype

Sherlock recommends based on scale, regulation, cultural fit

Centralized

Recommended

One central AI CoE owns all initiatives. Domains submit intake. Fastest to stand up. Bottlenecks at scale.

Fit: Small orgs, single BU, < 5 initiatives / year.

Federated hub & spoke

Recommended for Meridian

Central CoE sets standards, tooling, and governance. Domain AI pods (Clinical, Ops, Rev-cycle, MA plan) execute against them. Best balance of scale and speed.

Fit: Multi-BU health systems & captive plans, 15+ initiatives, regulated environment.

Fully distributed

Not recommended

Each BU builds its own AI capability with light central oversight. Fastest local delivery, weakest governance, risk of duplicative spend.

Fit: Loose federations, low regulatory burden, mature engineering culture.

Target org chart · Year 2

Federated hub-and-spoke · CEO-sponsored · 38 AI FTE at steady state

Executive sponsor

Chief Executive Officer

Chairs AI Steering · sets envelope

Owner

Chief AI Officer

Direct report to CEO · dotted line to COO

Hub

AI Center of Excellence

8 FTE · standards, tooling, MLOps

Hub

Model Risk & Governance

4 FTE · validation, monitoring, audit

Hub

AI Data Platform

6 FTE · feature store, RAG stack, PHI

Spoke

Clinical AI Pod

6 FTE · CMO reporting

Spoke

Ops & Rev-Cycle Pod

5 FTE · COO reporting

Spoke

MA Plan Pod

5 FTE · Plan President reporting

Spoke

Member Experience Pod

4 FTE · CMO + CCO

Executive

Central hub

Domain pod (spoke)

Role dictionary · hiring waves

Sherlock generates JDs + comp bands · your recruiters can start Monday · 4 waves · 14 hires → 38 FTE steady state

Wave 1 · Q3 2026

Executive spine. Nothing else moves until these two are seated.

Hire #1

CAIO

Chief AI Officer · reports to CEO. Comp band $520–680K TCC. External hire from payer-scale AI org.

Hire #2

HoMR

Head of Model Risk · MRM background from FS or life-sci. Comp band $340–420K. Reports to CAIO.

Wave 2 · Q4 2026

Clinical credibility & engineering backbone. Unlocks Tier 3 build-out.

Hire #3

CMIO+

Clinical AI Medical Director · practicing MD with informatics background. 0.6 FTE clinical + AI lead. Comp band $420–560K.

Hire #4

Prin

Principal ML Engineer · leads CoE stack & hires. Comp band $340–420K + equity if avail. Reports to CAIO.

Wave 3 · Q1 2027

Domain pod leadership · spokes get their operators.

Hire #5

ClinPod

Clinical AI Pod Lead · owns bedside & ambulatory AI initiatives. Comp band $280–340K. Reports to CMIO+ (solid) & CAIO (dotted).

Hire #6

MAPod

MA Plan AI Pod Lead · STARS, Risk Adj, PA. Comp band $280–340K. Reports to Plan President (solid) & CAIO (dotted).

Hire #7

OpsPod

Ops & Rev-Cycle Pod Lead · contact center, coding, billing AI. Comp band $260–320K. Reports to COO (solid) & CAIO (dotted).

Hire #8

MxPod

Member Experience Pod Lead · navigation, digital front door, personalization. Comp band $260–320K. Reports to CMO+CCO.

Wave 4 · Q2–Q3 2027

Platform & governance scale · the hub crosses 15 FTE.

Hire #9

HoDP

Head of AI Data Platform · PHI feature store, RAG stack, MLOps. Comp band $320–400K. Reports to CAIO.

Hire #10

Ethics

Chief AI Ethicist · chairs Clinical AI Ethics Board mechanics, member consent frameworks. 0.5 FTE clinical bioethicist. Comp band $260–320K.

Hire #11

HoVal

Head of Model Validation · owns bias, fairness, drift monitoring under HoMR. Comp band $240–300K. Reports to HoMR.

Hire #12

AIPMs

AI Product Managers (×2) · embedded in Clinical + MA Plan pods. Comp band $200–260K each. Report to pod leads.

Decision rights · who decides what

Single owner per decision · no committee tie-breaks · consulted parties named

Decision	Single owner	Consulted / Informed
Annual AI investment envelope	CEO	Steering Cmte, CFO, Board Finance
Which initiatives get funded this quarter	AI Steering (majority)	CAIO recommends · CMO/COO consulted
Approve model for production release	Model Risk Committee	CAIO accountable · Domain owner informed
Build vs. buy vs. partner	CAIO	Domain owner, CFO, CIO consulted
Tier assignment (risk classification)	Head of Model Risk	Compliance consulted · CAIO informed
Domain roadmap sequencing	Domain Pod Lead	CAIO consulted for cross-pod dependencies
AI incident containment	CAIO	Compliance accountable to Board · CMO/COO informed
Board attestation content	CAIO	Compliance consulted · CEO informed

Capability heatmap · build vs. buy vs. partner

12 capabilities scored · gap-to-target & strategic move

Model risk mgmt & validation

Now 3 / 10Target 8 / 10

● Build (hub)

Feature store & PHI data platform

Now 4 / 10Target 8 / 10

● Build (hub)

Prior auth AI decisioning

Now 5 / 10Target 9 / 10

◆ Partner (vendor)

Ambient scribe & documentation

Now 6 / 10Target 9 / 10

■ Buy (mature market)

Risk adjustment coder assist

Now 5 / 10Target 8 / 10

◆ Partner

Clinical decision support

Now 3 / 10Target 7 / 10

◆ Partner (EHR-native)

STARS gap-closure agent

Now 2 / 10Target 8 / 10

● Build (differentiator)

Contact-center summarization

Now 7 / 10Target 9 / 10

■ Buy

Bias & fairness testing

Now 2 / 10Target 8 / 10

◆ Partner (audit firm)

MLOps & deployment

Now 4 / 10Target 8 / 10

● Build (hub)

Genomic & imaging AI

Now 2 / 10Target 5 / 10

◆ Partner (academic)

Executive AI literacy

Now 4 / 10Target 9 / 10

● Build (Sherlock)

"Explain the operating model in one paragraph"

Auto-generated CEO memo · one click

“Meridian will operate AI in a federated hub-and-spoke model: a central AI Center of Excellence (hub) owns standards, tooling, model risk, and the PHI data platform; four domain pods (Clinical, Ops & Rev-Cycle, MA Plan, Member Experience) execute against them. The Chief AI Officer reports to the CEO with a dotted line to the COO. Steady-state headcount is 38 AI FTE at Year 2, hired in four hiring waves starting with the CAIO in Q3-2026 and reaching pod-lead coverage by Q1-2027. The capability heatmap identifies 6 build, 4 partner, and 2 buy priorities — the differentiators (STARS gap-closure, PHI platform, model risk) are built in-house; commodities (ambient scribe, contact-center summarization) are bought; regulated clinical workflows are partnered with EHR-native vendors.”

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Decision rights, org design,and the build-buy-partner map.

Decision rights, org design,
and the build-buy-partner map.