The Delaware Valley ACO Administrative Fellowship with Rachael Smith, MHA, RD

In today’s rapidly shifting healthcare landscape, administrative fellowships are more than just a springboard for rising leaders—they’re incubators for new ideas, cross-disciplinary collaboration, and the transformation of care delivery itself. Nowhere is this more evident than at the Delaware Valley Accountable Care Organization (ACO), where the next generation of healthcare administrators are getting hands-on experience in value-based care. In a recent episode of The American Journal of Healthcare Strategy podcast, Rachael Smith, MHA, RD, offered a candid look at her journey from bedside dietitian in a cardiac ICU to administrative fellow at the Delaware Valley ACO, sharing hard-won lessons, surprising challenges, and actionable insights for those considering a similar path.

Smith’s story is emblematic of a broader trend: clinically trained professionals increasingly stepping into administrative roles to bridge the gap between patient care and system leadership. Her reflections illuminate not just the value of diverse experience, but the urgent need for healthcare organizations to foster mentorship, welcome nontraditional candidates, and prepare for a value-driven future.

Why Make the Leap from Clinical Practice to Healthcare Administration?

What drives a clinician to leave patient care for administration? For Rachael Smith, the decision was rooted in a desire for impact—and a realization that her clinical vantage point, rather than being a disadvantage, could become her superpower.

“When I made the decision to go back to grad school and I had all of this clinical experience, my perspective was that I would be starting from behind,” she recalls. “I thought having mostly a clinical background would actually hinder me. Really quickly I learned…that may not be the case.”

Smith credits the faculty at Penn State for reframing her narrative: rather than seeing herself as lacking, she learned to position her clinical background as an asset. Her advice for other clinicians considering the leap?

• Recognize that clinical experience provides unique insight into patient needs and system gaps.

• Seek out programs and mentors who value your background, not just your potential.

• “It can really be an advantage and it really kind of uniquely sets you up for a career in administration.”

Smith’s journey echoes a national need: healthcare systems benefit when clinicians are part of the decision-making fabric. Yet, as she notes, not all clinical professions encourage or support this transition equally—a gap that educational and organizational leaders must address.

The Role of Education: What Makes a Graduate Program Welcoming for Clinical Professionals?

How can educational institutions help clinicians become leaders? According to Smith, the culture and support systems of graduate programs are critical.

“I think something that we can do as leaders…is just in the clinical space really encourage people to get that formal management leadership education,” she notes, contrasting her own experience as a dietitian with that of nurses. Nursing, she observes, has a well-worn pathway for clinicians to step into leadership and administration, often embedded in their training and visible in hospital hierarchies. Not so for dietitians, physical therapists, or other allied health professionals.

Smith’s experience at Penn State’s MHA program proved pivotal:

• Faculty took a personal interest in students’ holistic well-being and career trajectory.

• Cohorts included diverse early- to mid-career professionals, each valued for their unique perspective.

• Leadership training was explicit, intentional, and integrated from day one.

“From day one, they were thinking about how to uniquely position me in the field while also taking an interest in my emotional and educational health and well-being throughout the entire program,” Smith recalls.

Key takeaways for educational leaders:

• Make leadership pathways visible and accessible for all clinical backgrounds, not just nursing.

• Integrate mentorship and career coaching into curricula.

• Value prior clinical experience as a differentiator, not a deficiency.

Why Value-Based Care—and Why the Delaware Valley ACO?

What drew Smith to value-based care and the Delaware Valley ACO? Her answer is both personal and systemic.

“I really do just feel in my bones that [value-based care] is where the industry is headed…I was surprised that there was so little discussion of value-based care in my graduate degree program and I just felt like I had so much more to learn.”

Smith’s motivations for choosing the Delaware Valley ACO Fellowship included:

1. A strong belief in value-based care: She saw firsthand, in clinical settings, the limitations of fee-for-service and the potential of models focused on outcomes and prevention.

2. A desire for practical, on-the-ground learning: The ACO’s administrative fellowship provided a rare opportunity to be embedded in an organization making this transition real.

3. A steep, rewarding learning curve: “Everyone at the Delaware Valley ACO in the very beginning—whether it’s a fellow or a new mid or senior-level manager—describes it as drinking from the fire hose,” she laughs. “It’s just a lot of information, a lot of new language.”

What Does the Delaware Valley ACO Actually Do?

Smith boils it down: “We at the Delaware Valley ACO are one of the players trying to shift the industry from paying for volume to paying for value. We do that by just focusing on the patients in our network…keeping them healthy, keeping them out of the hospital, promoting their health to the best of our ability, and making sure that payment structures are set up so that we are paying their providers for the quality of care that they provide, rather than the volume.”

For executive readers, the Delaware Valley ACO’s approach involves:

• Health outreach and preventative care

• Data-driven population health management

• Provider incentives aligned to outcomes, not procedures

• Reducing costly, high-acuity interventions by investing upstream

The Value—and Challenge—of Clinical Experience in Administration

How does clinical experience translate into administrative effectiveness? Smith is unequivocal: “My clinical experience has been invaluable when it comes to even the work that I’m doing now.”

She breaks down why:

• Clinicians-turned-administrators can speak the language of frontline staff, building trust and understanding.

• They bridge the communication gap between administration and clinical teams—crucial in implementing value-based care initiatives.

• They bring a ground-level perspective to policy and process change.

“I feel like I have a certain level of skill when it comes to connecting with clinical stakeholders because at one point I was a clinical stakeholder,” she says. “I can communicate certain needs that we have in the ACO to clinical staff because at one point I was a clinical staff member who was being told that I needed to do things that I didn’t understand why I had to do them.”

This dual fluency is vital as healthcare organizations pivot toward population health and integrated care models.

Will Value-Based Care Overtake Fee-for-Service? Smith’s Perspective

Is value-based care the future—or just a fad? Smith is realistic but hopeful.

“I would consider myself a hesitant optimist,” she says. “I wouldn’t say that value-based care is going to completely take over fee-for-service, at least not in my lifetime. There will always be those patients…and providers who prefer the fee-for-service model.”

But Smith’s vision is clear: “What I hope to see in my professional career before I retire is just that value-based care becomes more mainstream…I wish providers especially understood the benefits of it for both the health of a population and also just the health of individuals.”

For executives charting strategy:

• Don’t expect a complete replacement of fee-for-service, but prepare for increasing hybridization.

• Invest in education and outreach to ensure all stakeholders understand the benefits and mechanics of value-based models.

• Recognize the transition as cultural, not just contractual.

Practical Advice for Graduate Students and Young Professionals

How can new grads break into value-based care or secure a fellowship like Smith’s? Her guidance is concrete and refreshingly actionable.

“Just learn as much as you possibly can about all of the different ways things are done,” she urges. “Even though I fully believe that value-based care is where we’re headed…I’m still every day trying to learn all of the different small niches in fee-for-service medicine.”

Top recommendations from Smith:

• Diversify your knowledge. Don’t pigeonhole yourself—know both traditional and emerging models.

• Reach out proactively. “Cold call, cold call, cold call…now lucky for us it’s cold emailing not cold calling. But on those early days of my degree, I was cold emailing any person who I thought had a job title that I thought sounded interesting…nine times out of ten they would say yes.”

• Leverage networking for opportunity. One cold email led to a capstone project sponsor and a long-term mentor—proof that initiative pays off.

For graduate programs and employers, Smith’s story highlights the value of practical experience, diverse networks, and visible mentorship.

What Can Organizations Do to Attract and Retain Talent Like Smith?

How can organizations make themselves more attractive to top early-career talent? Smith highlights two priorities:

1. Flexible work arrangements. Remote or hybrid work isn’t just a perk; it’s a skillset many gained during COVID and want to continue leveraging.

2. Formal, well-structured mentorship programs. “If I were to interview with a company and they told me that they have formal mentorship—like structured mentorship programming—where they really invest in their young talent…that would be a huge gold star to me.”

This isn’t just window dressing. Smith notes that structured mentorship, especially for women and people of color, signals a genuine commitment to talent development and organizational diversity. It helps early-career professionals ask hard, career-defining questions and navigate their trajectory with support.

Key Takeaway: The Power of Perspective in Healthcare Leadership

The future of healthcare leadership lies at the intersection of clinical expertise and administrative vision. Rachael Smith’s story underscores that the most effective administrators are those who understand both the patient and the system, who aren’t afraid to keep learning, and who seek out opportunities to connect, mentor, and lead. As value-based care becomes more central to U.S. healthcare, organizations must prioritize not just technical skills, but the lived experience and adaptability that come from diverse, nontraditional backgrounds.

Actionable insight:
If you’re a healthcare organization, invest in pathways for clinicians to step into leadership. Build formal mentorship programs. Foster a culture where cold emails and bold questions are welcomed. And if you’re a clinician or early-career professional, don’t be afraid to reach across the aisle, ask for a seat at the table, and make your unique experience the cornerstone of your leadership journey.

As Smith puts it: “I always love an opportunity to talk about the industry and value-based care…I was more than happy to do it.” Let’s make space for more voices like hers—our healthcare future depends on it.