In this episode of the Clinicians in Leadership podcast, host Zach McConnell sits down with Karan Gill, a current medical student and the CEO of OneLine Health.
We dive deep into the paradox of modern medicine: while clinical treatments are highly advanced, physicians are drowning in administrative tasks, leading to massive burnout. Karan shares his unconventional journey from stem cell biology to health-tech leadership and explains how his company is changing the game.
OneLine Health acts as an AI physician copilot, aggregating fragmented patient data—from subjective histories to complex labs and imaging—before the patient even walks in the room. By automating these time-consuming tasks and generating precise clinical notes prior to consultations, providers can finally step away from the screen and get back to what matters most: face-to-face patient care.
Healthmap Solutions' CEO Eric Reimer and Chief Growth Officer Tom Gaffney return to The Strategy of Health for a 2025 year-in-review. They discuss how the company delivered record savings rates amid industry headwinds, the integration of the Carium, and why chronic care management is finally getting the scrutiny it deserves. The conversation covers their expanding comorbidity strategy, plans to grow spend under management by 30-40% in 2026, and how AI is making their clinical teams more effective without replacing them.
The narrative surrounding traditional healthcare systems is shifting from stability to precariousness. For decades, large health systems, the “incumbents”, have relied on a perceived moat of high capital costs, regulatory complexity, and geographic dominance to protect their market share. However, recent discourse, sparked by industry observers like Dr. Rashmee Shah, suggests this moat is drying up. As digital health disruptors and agile startups nibble away at the ambulatory market, hospital executives are left asking: Are we doomed?
The numbers lend credibility to this anxiety. Bain & Company projects that nontraditional providers will capture 30% of the U.S. primary care market by 2030, with payer-owned primary care alone reaching 20%. Optum now employs over 90,000 physicians—roughly 10% of the entire U.S. physician workforce—and manages 4.7 million patients in value-based care arrangements. CVS Health‘s $10.6 billion Oak Street Health, part of CVS Health acquisition added more than 200 primary care centers across 25 states, with plans for 50–60 new clinics annually. Yet 2024 delivered a plot twist that complicates the disruption narrative. Walmart shuttered all 51 health clinics. Walgreens wrote down $12.7 billion on VillageMD. Teladoc Health‘s stock fell 98% from its 2021 peak. The American Hospital Association captured this reversal with a pointed headline: “The Disruptors Are Getting Disrupted.”
In a recent discussion with Cole Lyons for the American Journal of Healthcare Strategy, Roger Kerzner, MD, MBA of Heartbeat Health argues that doom is not inevitable; but survival requires a radical shift in business modeling. The days of treating ambulatory care as merely a funnel for inpatient volume are over. To survive, incumbents must decouple their acute care excellence from their ambulatory strategy, embracing a transition from episodic visits to continuous, tech-enabled care. This episode explores Dr. Kerzner’s insights on why the old models are failing, the necessity of partnerships, and the leadership courage required to navigate this decade-long transformation.
Why the Incumbent “Moat” Is Evaporating
The incumbent moat is drying up because the traditional model of episodic ambulatory care is no longer the most effective or efficient way to manage patient health in a digital age. For years, health systems have operated on a premise where value is generated through office visits and subsequent hospitalizations. Dr. Kerzner points out that this structure is fundamentally misaligned with what modern technology now allows.
The breakdown is driven by a capability gap. Disruptors: tech-forward companies unburdened by legacy infrastructure are leveraging virtual care, remote monitoring, and continuous touchpoints to manage chronic conditions better than a quarterly fifteen-minute office visit ever could. Traditional systems rely on patients coming in every few months; disruptors monitor patients daily. Incumbents measure success by how quickly they can room a patient and turn over an exam room, while disruptors measure success by longitudinal health outcomes. The performance data from vertically integrated disruptors is striking. Optum reports its primary care practices achieve 33% more preventive cancer screenings, 23% fewer avoidable ER visits, and 30% lower hospitalizations compared to traditional hospital-based practices. Each Oak Street Health center is projected to generate $7 million in adjusted annual earnings—margins that traditional primary care clinics struggle to match.
As Dr. Kerzner notes, the current standard of care is becoming obsolete:
“Waiting every three months, four months, whatever the time interval—you see your doc and then everything happens there, and then you wait till the next one. It just doesn’t make sense. We can do so much better now.”
The Disruptor Shakeout: Lessons from 2024’s Failures
Before health system executives surrender to despair, however, they should examine why several high-profile disruptors failed spectacularly in 2024, and what those failures reveal about the durable advantages incumbents retain.
Walmart’s complete exit was the most dramatic collapse. On April 30, 2024, the world’s largest retailer announced closure of all 51 health centers and its MeMD telehealth platform, just weeks after announcing expansion to 75+ locations. Walmart’s official explanation cited a “challenging reimbursement environment and escalating operating costs,” but experts identified deeper structural issues. Dr. Zeev Neuwirth observed that when measuring revenue per square foot, “primary care does not cut it” for a retailer. Professor Robert Field at Drexel noted healthcare “is different from selling products, like toothpaste and breakfast cereal, and requires different kinds of expertise.”
Walgreens suffered even larger losses. The company closed 160 VillageMD clinics nearly triple the original 60 planned; recorded a $12.7 billion impairment charge, and saw full-year FY2024 operating losses reach $14.2 billion. CEO Tim Wentworth stated VillageMD is “not a crucial part of our future” a stunning admission given Walgreens invested over $6 billion in the venture.
Teladoc’s collapse illustrates virtual care’s profitability challenges without integration into broader care delivery. The stock has fallen 98% from its February 2021 peak, accompanied by a $790 million goodwill impairment, CEO departure, and multiple layoff rounds.
The common thread across these failures: companies lacking insurance integration struggled to make primary care economics work. As a Vizient, Inc analysis concluded, “Both Walmart and Walgreens lack a major component that can make a primary care business model more successful: neither owns an insurance company nor has real access to premium risk.” This distinction matters enormously. The disruptors that are succeeding: Optum, CVS/Oak Street, and to some extent Amazon, share vertical integration combining insurance risk-bearing with care delivery. Standalone retail health ventures cannot replicate these economics. For traditional health systems, this suggests the competitive threat is real but concentrated in a specific class of competitor, not a universal displacement.
The Bifurcation of Business Models: Acute vs. Ambulatory
Health systems must recognize that acute inpatient care and ambulatory services require two fundamentally different business models. A major error incumbents make is applying the same operational logic to a primary care clinic that they apply to an operating room. Dr. Kerzner emphasizes that hospitals are often excellent at acute care: managing the ICU, performing complex surgeries, and handling emergencies. This is high-stakes, episodic work that requires centralization. Ambulatory care, however, is evolving into a decentralized, continuous service that demands a different P&L approach and leadership mindset.
Many health systems have begun recognizing this reality. Northwell Health CEO Michael Dowlingnoted that “only about 46% of our business is from our hospital sector today. The more you expand ambulatory and grow in the right locations, the more you increase market share.” Health systems now account for 46% of medical office building leases and added 16,000 employed physicians between 2022 and 2023.
Major systems are investing accordingly. Hackensack Meridian Health committed $500 million to two dozen outpatient expansion projects. HCA Healthcare allocated approximately 25% of its $5+ billion capital budget to outpatient facilities. Sutter Health announced a $1 billion ambulatory expansion adding 27 ambulatory care sites, 27 urgent care centers, and 22 surgery centers. Joseph Cacchione MD CEO of Jefferson Healtharticulated the mindset shift required:
“We’ve got to get away from this idea of heads and beds and being a hospital system. That’s sick care. We need to truly be a health system.”
Incumbents that fail to separate these strategies risk losing their ambulatory volume to competitors who offer a superior user experience, leaving the hospital with only the highest-cost, highest-acuity cases without the supportive outpatient network. To succeed, executives must stop viewing ambulatory networks solely as feeder systems for the hospital and start viewing them as independent platforms for population health management.
The Strategic Pivot: Partnering with Disruptors
Rather than attempting to build competing proprietary technology stacks from scratch, incumbent systems should consider partnering with disruptors to handle specific segments of ambulatory care. This is a “buy vs. build” decision at the strategic level. If a startup has mastered virtual cardiology or remote diabetes management, an academic medical center might achieve better results by integrating that partner rather than trying to replicate their agility. The Amazon One Medical partnership model offers instructive lessons. Rather than positioning itself as a direct competitor to health systems, Amazon has established specialty care referral agreements with 19+ health systems including Cleveland Clinic, Duke Health, Baylor Scott & White, and Hartford HealthCare. The model treats One Medical as a primary care access point that feeds patients into traditional systems for complex care—co-opetition rather than pure disruption.
Early results are promising. Virginia Mason Franciscan Health’s partnership is yielding 350 net new patients monthly with minimal cannibalization. SVP Thomas Kruse described One Medical as a “growth engine” that increased Seattle primary care capacity by more than 25%. Hartford HealthCare operates three One Medical sites averaging 750 visits monthly across virtual and in-person care. Cleveland Clinic is opening hybrid primary care offices, with CEO Tom Mihaljevic calling it “a shared commitment to meet the needs of our patients.”
Dr. Kerzner suggests that mid-sized institutions and non-academic centers, in particular, should look to these partnerships as a lifeline. By offloading continuous monitoring and “low-end” disruption tasks to capable partners, the health system can double down on what it does best: complex acute care. Successful partnerships require defining excellence (identifying exactly where the health system struggles and finding a partner who excels there), avoiding ego (admitting that an external entity might provide better ambulatory experiences), and ensuring true integration so the partner becomes a seamless extension of the care team rather than just a vendor. Health Catalyst recommends an “80/20 approach”: partner for 80% of foundational digital capabilities, build 20% for differentiation. The average hospital now operates six patient apps simultaneously, creating integration complexity that favors platform consolidation over point-solution proliferation.
The Call for Leadership Courage
Modern healthcare executives must possess the courage to pursue a ten-year vision that may negatively impact financial performance for the first several years. This is perhaps the hardest pill to swallow for boards and C-suites beholden to quarterly or annual margins.
True transformation, moving from an episodic, fee-for-service-dependent hospital system to a continuous, value-driven health ecosystem is a long game. Dr. Kerzner estimates that this pivot could “hurt” for four to eight years before the vision fully matures. Leaders must be willing to weather the storm of initial investment and potential revenue dips to secure the institution’s relevance in the 2030s. Research on healthcare transformation reveals strikingly low success rates: only one in three top-down change efforts succeed versus four out of five collaborative approaches. McKinsey found 75% of health system executives report digital/AI investments falling short due to budget constraints and legacy systems, with only 13% having GenAI implementation plans established.
Successful transformations share common elements: clear strategic vision cascading from board to front line, early physician involvement in decision-making (cited by 47% of executives as the most effective tactic), integrated measurement dashboards providing comprehensive performance visibility, and governance structures that enable “generative thinking” rather than reactive oversight. The Chartis 2025 CEO/CSO survey reveals how executives are responding to competitive pressure. When asked how they would invest a hypothetical $1 billion, majorities prioritized expanding outpatient services and sites of care. The top challenge cited: physician recruitment reflecting both workforce constraints and the strategic imperative of building aligned ambulatory networks.
Conclusion: A Window of Opportunity, Not a Death Sentence
The competitive landscape between incumbents and disruptors has evolved beyond simple narratives. The evidence suggests traditional health systems face genuine competitive pressure but also possess durable advantages that retail and digital entrants have failed to replicate.The disruptor threat is real but concentrated. Vertically integrated payer-provider models (Optum, CVS/Oak Street) are gaining share, while standalone retail health ventures cannot make the economics work. By 2030, 30% of primary care may flow through nontraditional channels—but this leaves 70% with traditional systems that adapt effectively.
The incumbent moat has limits but substance. Complex care coordination, deep clinical networks, community trust, and payer relationships provide advantages that, as industry analysts note, “cannot be easily replicated by point solutions.” Health systems handling sicker, more complex patient populations perform functions disruptors have not demonstrated capacity to match. The strategic imperative is ambulatory expansion with digital integration. Health systems investing heavily in outpatient networks, partnering strategically with digital health companies, and building value-based care capabilities are positioning for a landscape where convenient primary care access determines downstream specialty and inpatient volumes.
Introduction
For many early-careerists, the Administrative Fellowship is viewed as a one-to-two-year crash course in hospital operations.1 But for Jeffrey Butler, it was the launching pad for a 17-year ascent to the top of one of the nation’s premier health systems. Starting as an Administrative Fellow at UCLA Health in 2008, Jeff has navigated the complex landscape of academic medicine to become the Chief of Operations for the Community Clinic Network, where he now oversees more than 280 clinics, 5,500 employees, and a budget exceeding $1.5 billion.
In this episode, we sit down with Jeff—now a dedicated preceptor himself—to discuss the evolution of healthcare leadership. We move beyond the resume to explore the mindset required to thrive in such a high-stakes environment. As Jeff reveals, the secret to longevity and innovation in healthcare isn’t just about mastering spreadsheets; it’s about maintaining a spirit of “continuous discovery” both inside the boardroom and out in the vibrant city of Los Angeles.
How does the location of a fellowship impact long-term career growth?
A dynamic city acts as a “secondary classroom,” preventing burnout and fostering the cultural agility required to lead diverse patient populations.
When choosing a fellowship, applicants often weigh prestige against geography. Jeff’s career trajectory proves that at UCLA, you don’t have to choose. The sheer variety of Los Angeles has kept him engaged for nearly two decades, fueling a career that has spanned everything from Radiation Oncology to the massive expansion of the Primary Care Network. Jeff emphasizes that the diversity of the environment is a critical tool for resilience. Even after 17 years, the capacity for surprise remains high, which mirrors the ever-changing nature of healthcare operations.
Cultural Immersion: Access to world-class museums and events keeps leaders intellectually stimulated.
Lifestyle Balance: The ability to take “day trips” to mountains or beaches offers vital decompression from high-pressure roles.
Professional Inspiration: Living in a city of innovation encourages leaders to think differently about care delivery.
Jeff notes, “My favorite thing is 17 years in, I am still discovering this city… It’s so interesting and so varied.” This sentiment is more than just appreciation for a city; it is the hallmark of a leader who refuses to stagnate.
Can a mindset of discovery lead to operational innovation?
Absolutely; leaders who actively explore their environment are more likely to pioneer innovative care models, such as retail clinics and integrated behavioral health services.
Jeff’s approach to his personal time—constantly seeking the unknown—directly correlates to his strategic successes. During his tenure, he has played a pivotal role in advancing innovative delivery models, including UCLA Health’s mall-based retail clinics and the expansion of mental health services through the Behavioral Health Associates program. These are not the ideas of a leader who stays inside the hospital walls:
When discussing his weekend plans, Jeff illustrates this enthusiasm for the unknown: “On Sunday night, I’m going this to this event at this museum with that I’ve never even heard of… I’m like, I, it’s amazing.”
For fellows, this is a crucial lesson. The transition from student to executive requires a willingness to venture into the unknown. Whether navigating a complex $1.5B budget or exploring a new neighborhood, the skill set is the same: curiosity, adaptability, and the confidence to say, “It’s so much to discover that you can never… fully know it, which I love about it.”
What is the unique value of the mentor-mentee relationship in this program?
A mentor who has “walked the path” provides invaluable context, bridging the gap between theoretical coursework and the political realities of a massive academic health system.
Jeff is uniquely positioned to mentor because he was in the fellow’s seat in 2008. He understands the pressure of the role and the intricacies of navigating a career at UCLA Health. Host Vrushangi Shah, MHA, reflects on this connection, noting, “I know that this, um, this episode is very special to me… being that you’re my mentor.” A mentor with Jeff’s experience helps the fellow:
See the Big Picture: Understanding how a single clinic decision fits into a system-wide ambulatory strategy.
Navigate Growth: Learning how to scale operations, as Jeff did when growing the Primary Care Networks.
Build Confidence: Providing a safe space to ask questions and fail forward.
Why is UCLA Health considered a premier destination for administrative fellows?
UCLA Health offers an unmatched combination of scale, prestige, and lifestyle, allowing fellows to train in a top-4 national health system without sacrificing personal well-being.
Candidates often fear that choosing a high-intensity fellowship means pausing their personal lives. Jeff argues that at UCLA, the environment supports the professional. The integration of a top-tier academic medical center within a world-class city creates a magnetic pull for top talent.
Jeff sums it up succinctly: “Absolutely LA and UCLA are the places to be.”
With a network that includes four hospitals and over 280 clinics, the operational playground for a fellow is vast.4 You might be working on a project for the Community Clinic Network one day and strategizing for Radiation Oncology the next. This scale, combined with the vibrant backdrop of Los Angeles, ensures that fellows are constantly growing, both as executives and as individuals.
Actionable Insight for Aspiring Healthcare Leaders:
Treat your curiosity as a professional asset. Jeff Butler didn’t become a Chief of Operations by doing the same thing every day. He embraced “continuous discovery.”
Next Step: In your current role or studies, identify one “museum you’ve never heard of”—metaphorically speaking. Is there a department, a technology, or a community partnership you know nothing about? Schedule a 30-minute coffee chat or site visit this week to learn about it. That habit of exploration is the seed of strategic innovation.
Healthcare organizations today are often described as “complex adaptive systems,” but for many executives and clinicians, they simply feel like chaotic tangles of disconnected processes. As hospitals merge into massive conglomerates and technology stacks grow increasingly unwieldy, the need for architectural clarity has never been more urgent. Enter Systems Engineering—a discipline born in the high-stakes worlds of aerospace and defense, now poised to revolutionize how we deliver care.
In a recent episode of the Strategy of Health podcast, host Cole Lyons sat down with Dr. Dr. Matthew Montoya , a distinguished professor of Systems Science at The Johns Hopkins University, to discuss this critical intersection. With a 40-year career spanning applied physics, defense, and public health, Dr. Montoya brings a unique, "Renaissance" perspective to the industry. His insights reveal why traditional management techniques often fail to solve healthcare’s wicked problems and how a systems mindset can turn organizational chaos into streamlined, patient-centered outcomes.
What value does Systems Engineering add to healthcare leadership?
Systems Engineering provides the structural architecture and clarity necessary to solve complex, multi-stakeholder problems that traditional specialization cannot address. While medical education typically incentivizes deep specialization—focusing intensely on cardiology, neurology, or oncology—organizational problems rarely respect these boundaries. They spill across departments, technologies, and workflows. Dr. Montoya argues that the primary value of a systems engineer is the ability to stand in the middle of a "cloudy mess" and orchestrate a solution that accounts for every moving part, from the initial need to the final patient outcome. It is not about knowing everything about a specific medical niche, but about understanding how the pieces fit together.
"Part of my DNA is creating clarity out of chaos. And so systems engineering is a tool that allowed [me] to do that... bringing clarity to a problem and providing outcomes." — Dr. Matthew Montoya
In healthcare, where "clarity of communication" is often a struggle, this approach is transformative. By focusing on the entire lifecycle of a problem—defining the architecture, establishing metrics, and mapping the roadmap—leaders can bridge the gap between disjointed departments and ensure that the "widget" they are buying actually solves the underlying itch.
Systems Engineering vs. Project Management: What is the difference?
Systems Engineering focuses on the technical integrity and architectural validity of the solution, whereas Project Management focuses on the mechanics of execution, such as budget, schedule, and resource allocation.
This is a common point of confusion for executives. Many assume that a strong project manager can fix a broken system. However, while Project Management ensures a project lands on time and within budget, it does not inherently ensure that the solution is technically sound or that it will function harmoniously within the larger ecosystem. Dr. Montoya explains that while the two disciplines are inseparable and must link together, they serve different functions. The systems engineer is responsible for the "technical aspect," ensuring the inputs, outputs, and component interactions actually work.
"The project management, I view that as the, I'll say, process and product mechanics, which is budget, schedule, um maybe resource allocation, where the systems engineering is you're working on the technical aspect." — Dr. Matthew Montoya
For healthcare leaders, understanding this distinction is vital. If you are trying to integrate a new EHR across forty hospitals, a project manager will tell you when it will happen; a systems engineer will ensure the data architecture actually supports clinical workflows across those diverse sites.
How can large organizations avoid “eating the elephant” all at once?
The most effective way to implement systems engineering in large healthcare organizations is through "pilot efforts" that test the ecosystem on a small scale before attempting a system-wide rollout. Attempting to overhaul a massive health system’s operations in one fell swoop is a recipe for failure. Dr. Montoya warns against trying to "eat the whole elephant at once," noting that top-down mandates often generate significant resistance from the staff who actually have to do the work. instead, leaders should identify specific patient outcomes that involve two or three specialty areas and build a "systems ecosystem" around that smaller scope.
"If you can create these key principles... do it on a smaller pilot effort and check the outcomes... This allows you to create a more enduring ecosystem, try it [at] a smaller level, and then you know expand it to other areas as you're able to." — Dr. Matthew Montoya
This approach mirrors the scientific method: frame the problem, test the hypothesis (the new process) in a controlled environment, validate the metrics, and only then scale up. This "pilot" strategy not only mitigates risk but also creates internal champions. When a pilot works, "word of mouth from those folks can carry on to others," organic adoption often follows.
Is Artificial Intelligence the solution for system complexity?
Artificial Intelligence is a powerful tool for initiating collaboration and crowdsourcing potential solutions, but it is not a replacement for critical thinking or human architectural design.
As AI permeates healthcare, there is a temptation to view it as a magic bullet for efficiency. Dr. Montoya views AI fundamentally as a set of algorithms—tools for problem-solving that can handle complexity far better than manual analysis. However, he cautions that these tools can give "absolutely completely wrong answers" if not shepherded by human expertise. The true hidden value of AI in systems engineering may actually be social rather than purely technical. Dr. Montoya suggests using AI tools to bring disparate teams onto the "same sheet of paper".
"If you can have an AI tool that can bring people to better collaborate, you're able to solve the problem and start addressing the problem as a team." — Dr. Matthew Montoya
By using AI to generate initial scenarios or process maps, teams can stop arguing over blank whiteboards and start refining a shared starting point. It democratizes the problem-solving process, allowing for a "middle-out" approach where top-level architecture meets bottom-level "boots on the ground" reality.
Where should Systems Engineering be applied (and where should it not)?
Systems engineering is highly effective for device development and process improvement but should be applied with extreme caution in direct clinical, patient-provider interaction. There is a time and place for rigorous engineering logic. If you are designing a new medical device or optimizing the supply chain, the "needs/requirements" framework of systems engineering is indispensable. Similarly, general organizational processes—how a patient moves from admission to discharge—benefit greatly from this structural view.
However, the exam room is different. Dr. Montoya warns that the "personalization associated with working with patients" does not always fit neatly into an engineering schematic.
"You want to be very personal and make sure that you're clear on the outcomes of the patient... [Systems Engineering] is not as clear cut how you use it [in clinical interactions] as the other two areas." — Dr. Matthew Montoya
Executives must recognize this boundary. Over-engineering the human connection can lead to clinician burnout and patient dissatisfaction. The goal is to engineer the system to support the human, not to engineer the human out of the system.
How can organizations build a Systems Engineering culture?
Building a systems culture requires a blend of formal education and "on-the-job training" (OJT) within safe "design thinking" environments or sandboxes. You do not need to fire your staff and replace them with engineers. In fact, Dr. Montoya argues that the most effective change agents are often clinical staff—nurses and doctors—who are cross-trained in systems principles. These individuals already have credibility; they don't trigger the organizational "antibodies" that often attack outside consultants.
"If you have a clinical staff... and you can show them the systems principles, they can carry these things through... that really carries much more weight." — Dr. Matthew Montoya
To start this journey, Dr. Montoya recommends creating "design thinking workshops" where staff can practice these concepts away from the high-stakes pressure of the operating room. This allows teams to "build the bridge" mentally before they have to walk on it physically.
Actionable Takeaway
If you are a leader looking to introduce systems thinking to your organization, do not start by buying new software or hiring a fleet of engineers. Start with education and a single problem. Dr. Montoya explicitly recommends Peter Senge’s book, The Fifth Discipline, as a foundational resource to help your team understand the mindset of interconnectivity and dynamics.
Your Next Step: Identify one recurring "cloudy mess" in your organization—a specific friction point involving at least two different departments. Instead of applying a quick fix, form a small cross-functional team (a pilot). Have them map the inputs, outputs, and architecture of that single problem, focusing on clarity over speed. Use this pilot not just to fix the issue, but to prove the methodology to the rest of your organization.
In the complex ecosystem of modern healthcare, the most dangerous point in a patient’s journey is often the transition between diagnosis and action. For Angela Adams, RN, BSN, CEO of Inflo Health it is a matter of life and death that drove her from the bedside of a Cardiothoracic ICU to the helm of a technology company. Adams, a former nurse at Duke University Medical Center and a veteran of the medical device and startup worlds, sat down with host Cole Lyons to discuss a pervasive but solvable crisis: the "incidental findings" that slip through the cracks of our fragmented healthcare system.
Her journey highlights a critical pivot in health tech moving away from tools that simply generate more data and toward solutions that automate the actual work of care coordination. This discussion explores how specialized AI, high-reliability principles, and a "human at the top of the pyramid" philosophy are finally closing the loop on patient safety.
The Silent Crisis: Why Do Critical Findings Slip Through the Cracks?
The primary reason patients fall through the cracks is that health systems excel at acute, immediate treatment but often lack the infrastructure to track incidental findings across different care episodes.
This disconnect is best illustrated by the tragedy that inspired Inflo Health’s founding. Adams recounted the story of a colleague, Jill, who visited the ER for appendicitis. While the hospital successfully treated her acute surgical need, a CT scan revealed a suspicious breast lesion—an incidental finding unrelated to her appendix. Because there was no automated safety net to catch this detail, the finding was noted in a radiology report but never acted upon. Ten months later, a routine mammogram rediscovered the mass, but it was too late; the cancer had metastasized to her brain.
This is not an isolated anecdote, It is a systemic failure that Adams and her team validated with hard data:
50% of radiology follow-ups documented in reports are missed completely.
80% of follow-up volume (incidental findings outside of regulated breast and lung screening programs) is largely ignored by existing tools.
Reliance on "Heroic Effort": Systems currently depend on clinicians manually bridging gaps between departments, a method that is statistically destined to fail in a high-volume environment.
“It would've taken a heroic effort on behalf of the clinical teams, which is a lot of times what we expect out of our clinicians. We expect them to make a heroic effort to get work done every single day. And in this particular case, she just completely fell through the cracks.”
Why Traditional EHR "Worklists" Are Not the Solution
Current Electronic Health Records (EHRs) fail to solve this problem because they primarily generate static worklists that increase administrative burden rather than automating the closure of care loops.
For years, the industry assumed that if AI could detect a problem and put it on a list, the problem was solved. However, Adams argues that this approach fundamentally misunderstands clinical reality. A worklist does not schedule a patient. A worklist does not educate a frightened patient about what a "nodule" means. A worklist merely transfers the burden of action onto an already overwhelmed administrative staff who are forced to "dial for dollars" to track down patients.
Adams emphasizes that true reliability requires moving beyond identification and into orchestration.
Identification: AI finds the keyword in the report.
Orchestration: Automation routes the finding to the correct provider, initiates the order, tracks the scheduling, and educates the patient via text.
By focusing only on detection, many vendors are simply highlighting problems without offering the manpower to fix them.
“It irritates me... All we do by turning this on is increase our own liability. Increase the patient safety risk, increase the staff burden... Whereas a lot of companies are out there turning all of this on, and the data is just sitting there in piles with nobody to work on it.”
The "Human at the Top of the Pyramid" Philosophy
Inflo Health changes the clinician's role by automating routine administrative tasks, allowing providers to focus solely on complex cases that require human empathy and judgment.
One of the most compelling aspects of Adams’ strategy is her rejection of the idea that AI replaces clinicians. Instead, she advocates for a structure where automation handles the 80% to 90% of straightforward cases—scheduling, standard notifications, and tracking. This promotes the human clinician to the "top of the pyramid."
In this model, nurses and care navigators are no longer data entry clerks transferring information between spreadsheets. They are elevated to perform the work they were trained for: navigating complex patient emotions and managing difficult diagnoses.
The Impact on Clinical Staff:
Reduction in Burnout: Eliminating the "fishing" for information.
Return to Purpose: spending time on direct patient interaction rather than logistics.
Efficiency: Handling higher patient volumes without proportional staff increases.
“You're promoting the human to the top of the pyramid. So it's like AI at the bottom, automation second, and now we're using our clinicians and their knowledge and their wisdom... as the orchestrators of the AI and the automation so that it brings joy back into their day.”
Why Custom "Mini-Models" Beat Generic LLMs
Building a custom Small Language Model (SLM) is necessary for radiology because generic Large Language Models (LLMs) are cost-prohibitive at scale and prone to hallucinations regarding specific clinical nuances.
In the current tech hype cycle, the temptation to use off-the-shelf LLMs (like GPT-4) for every problem is high. However, Adams details why Inflo chose the harder path of building proprietary, domain-specific models.
Cost and Consumption: Health systems generate millions of imaging reports. Pinging a commercial API for every report is fiscally unsustainable and computationally heavy.
Accuracy and Hallucination: A generic model might identify a follow-up but struggle with the "logic tree" of clinical decision-making (e.g., identifying a nodule, checking the size, checking smoking history, and determining the specific guideline-based action).
Speed: "Mini-models" trained specifically on radiology ontologies are faster and easier to deploy within a hospital's secure environment.
This decision highlights a maturing of the AI market: the move away from "generalist" AI toward highly specialized, vertical-specific intelligence.
“If I build all of these like mini models and I build our own language structure, it's not gonna be considered a large language model, but it will be considered a radiology specifically language model.”
Beyond SaaS: The Necessity of "People, Process, Then Tech"
Implementing high-reliability change requires a partnership model that addresses people and processes before layering on technology, ensuring the underlying workflow is sound.
Perhaps the most critical lesson for healthcare leaders in this episode is the admission that technology alone cannot fix a broken system. Adams describes their partnership with the American College of Radiology (ACR) "Empower" program, which utilizes A3 problem-solving methodologies to identify failure points before software is even installed.
If a hospital does not have enough CT scanners to handle the influx of patients that the AI identifies, the software will fail. Inflo Health’s approach involves consulting on the operational roadmap—predicting volume surges and helping hospitals staff accordingly.
The Implementation Pillars:
People: Who is responsible for the finding?
Process: How does the data move from Radiology to the ordering provider?
Technology: The automation layer that enforces the process.
“Technology alone is never going to be able to fix everything in a health system. It has to be like people, process. Then it's all layered on tech that can do the automation.”
The Future: Agentic AI and Empathetic Automation
The next frontier involves "Agentic AI" capable of holding nuanced, empathetic voice conversations with patients to navigate complex diagnoses like cancer. Looking toward late 2024 and beyond, Adams predicts the rise of Agentic AI—autonomous agents that can handle bi-directional voice and text communication. However, the challenge in healthcare is vastly different from retail or customer service.
An agent calling a patient about a missed prescription is simple. An agent calling a patient about a suspicious lung nodule requires a high degree of "emotional intelligence" programmed into the bot. The system must be able to answer questions like "Do I have cancer?" or "What is a PET scan?" without causing panic or violating medical ethics.This evolution from text-based automation to voice-based agents represents the next leap in efficiency, allowing health systems to manage population health at scale without hiring armies of call center staff.
“It's not that it's easy... your bot has to be able to have really sensitive conversations about a PET scan that has maybe the opportunity that the patient has cancer, like teaching a bot to have that level of conversation.”
Actionable Insight
For healthcare executives and digital transformation leaders, Angela Adams’ journey underscores a pivotal shift in strategy: Stop buying detection; start buying closure.
When evaluating AI tools, look beyond the accuracy of the algorithm (the "detection") and interrogate the workflow (the "action"). Does the tool simply add rows to a spreadsheet, or does it autonomously advance the patient to the next step of care? Audit your current incidental finding workflows. If your process relies on a human to manually transfer data from a report to a registry, your system is vulnerable. The future belongs to platforms that treat the "finding" not as the end result, but as the trigger for an automated, high-reliability workflow.
Predictive analytics and artificial intelligence are no longer futuristic concepts in healthcare; they are active components of modern strategy. Yet, many sophisticated AI models fail at the "last mile." They can predict an adverse event with stunning accuracy but remain powerless to prevent it. Why? Because data alone doesn't change outcomes. People do.
In a recent Strategy of Health podcast episode, I spoke with Joseph Vattamattam, co-founder and president of Healthmap Solutions, a company that has built its entire model around this truth. They are proving that the true power of predictive AI is not just in its forecasts, but in its ability to be translated into actionable, human-centric interventions that empower both physicians and patients.
Building a Team Around a "Realistic" Mission
To build a program capable of tackling a problem as complex as chronic kidney disease (CKD), you first need to build an exceptional team. Healthmap Solutions has assembled a roster of industry leaders, and according to Joe Vattamattam, the "secret" is a culture built on an actionable and realistic mission.
This mission-driven culture is centered on aligning the company's financial incentives directly with patient well-being. “We have such a strong culture of mission here," Vattamattam shares. "...we align the money to the mission. Meaning the only way we get any revenue is by reducing the cost of care." This isn't just an altruistic talking point; it's a hard-wired business model. Healthmap only succeeds if patients stay healthier and out of the hospital. “The way we reduce the cost of care is by reducing, you know, the unnecessary admissions and visits to the emergency department," he explains.
This alignment creates a powerful sense of purpose that attracts and retains top talent. When a team's success is defined by measurable improvements in patient health, the work transcends the day-to-day and becomes a "noble cause." Furthermore, Vattamattam notes that great people want to work with other great people, and the company's leadership has leveraged past professional relationships to bring in proven, successful teams from prior ventures.
Using Analytics to See the Problem Differently
Before a single predictive model was built, Healthmap Solution's used its deep analytical expertise to challenge long-held assumptions about kidney care. Vattamattam, who has a background in mathematical finance and investment banking, brought a quantitative rigor to the company's initial strategy. They didn't just accept the industry's conventional wisdom; they let the data define the real problem.
This data-driven approach uncovered three critical, counter-intuitive insights:
Myth 1: Focus on the sickest patients. The assumption was to focus on End-Stage Renal Disease (ESRD) patients on dialysis, as they are the most expensive on a per-member basis.
Myth 2: Focus only on nephrologists. Kidney disease is a nephrologist's specialty, so they should be the only physicians to engage.
Myth 3: All CKD patients are high-cost.
This last finding, in particular, made the strategic path clear. To manage the cost and improve the outcomes for this population, they had to develop a sophisticated predictive model to identify that high-risk 30% before they became high-cost.
From "Black Box" to Actionable Insights
Healthmap Solution's predictive model is its "secret sauce," capable of forecasting adverse events 6 to 12 months in the future. But Vattamattam is quick to point out that a prediction is useless if it's trapped in a "black box." The challenge with many advanced AI models is that they can tell you what is likely to happen, but not why. To solve this, Healthmap solution's built a second, related model that functions as a "driver report."
Here’s how it works:
Prediction: The AI model analyzes a massive dataset (informed by over $30 billion in healthcare expenditures) and assigns a proprietary risk score to a patient.
Explanation: The "driver report" model then identifies the top clinical and non-clinical factors for that specific patient's risk. It translates the complex "why" into simple, actionable terms (e.g., "neurological and musculoskeletal issues," "running low on anti-convulsant medication," "recent ER visit").
Action: This simple, clear report is delivered directly into the workflow of a Healthmap solution's frontline clinician.
This transforms the entire care dynamic. Instead of a generic wellness call, the clinician can have a highly specific, high-value conversation. “They're able to converse... at a very meaningful way to say, ‘Hey, we noticed... you're running low on these drugs... We also know you have chronic kidney disease. Let us help you navigate the next 30 days...’," Vattamattam describes. This connectivity is where the true value is unlocked. “I think the connectivity between the AI ml stuff and the technology platform is where the magic really happens for Healthmap Solution's”
The Human Element: Analytics Are Useless Without Behavior Change
This brings us to the core thesis of Healthmap's success and the title of this article. All the data, analytics, and predictive models are ultimately just a means to an end. The real goal is changing human behavior.
“They [analytics] don't really make any difference unless you can change some human behavior," Vattamattam states definitively. “At the end of the day, we need a patient to change their behavior, potentially a provider to change their behavior.”
This is why Healthmap Solution's refused to create a data-only solution. They knew from the beginning that a "pure data model" that bypasses clinicians would fail. These patients are complex, often seeing three to four different providers and taking 15-20 different medications. You cannot effectively manage their care without becoming a trusted partner to their physicians.
This philosophy is what drove Healthmap Solution's acquisition of Careium, a technology platform designed to operate at the "healthcare delivery edge." This platform acts as the final-mile conduit, connecting Healthmap's insights, the patient, and the provider's care team. It's the tool that facilitates the behavior change.
This integration also opens the door to new data streams, such as remote patient monitoring (RPM) and wearables. While Vattamattam says it's still early, the company is excited about the promise of integrating biometric data from weight scales, blood pressure cuffs, and glucometers to provide even earlier leading indicators of risk.
The Future: A Replicable Model for Chronic Care
When asked what's next, Vattamattam sees a clear path forward: replicating this model for other complex, multi-chronic conditions.
The Healthmap program, while focused on kidney disease as the "ticket of entry," is already a comprehensive, whole-person care model. “Once you're in, we're working on everything with that member," he says. “We're working on their cardiac issues, you know, COPD, behavioral health, social determinants of health.”
Because they have already built the clinical programs and predictive models for these comorbidities (like heart failure), expanding to new disease states is a natural evolution. The core asset is the replicable process: a technology platform that combines powerful predictive analytics with a human-driven, clinician-integrated workflow. This model, Vattamattam believes, could be a game-changer for population health across the industry.
The Takeaway
The Healthmap Solution's story provides a vital blueprint for healthcare leaders navigating the AI revolution. The value of predictive technology is not in its computational power, but in its application. True transformation doesn't happen when a server flags a risk; it happens when that insight is demystified, translated, and placed in the hands of a clinician as a tool to build trust and guide a patient toward a better action. This isn't about artificial intelligence replacing human judgment; it's about augmented intelligence supporting the critical human-to-human relationships that are, and always will be, at the center of healing.
Beyond the Bedside: How Synthetic Data is Arming Clinicians for Healthcare’s Next Frontier
Healthcare is drowning in data yet starving for insight. In an industry that generates an estimated 30% of the world's data volume, frontline clinicians—the very individuals trained to synthesize complex information and make life-or-death decisions—are often the last to gain meaningful access to the operational and population-level data generated by their own work. This paradox creates a frustrating chasm between the clinical teams at the bedside and the administrative leaders in the boardroom, hindering innovation, perpetuating inefficiencies, and ultimately impacting patient care. The traditional pathways to data, guarded by overwhelmed analyst teams and months-long regulatory approvals, are no longer sufficient for a system demanding agility and precision.
Bridging this chasm requires more than just new technology; it demands a new philosophy. It requires leaders who can speak the languages of both patient care and data science. Trushar Dungarani, DO, SFHM, Director of Clinical and Data Science at MDClone, embodies this new archetype of clinician leader. With a journey that has taken him from the front lines of hospital medicine at Northwell Health and Johns Hopkins Medicine to the forefront of data innovation, Dr. Dungarani has witnessed firsthand the "beauty and the dysfunction" of modern health systems. His work now focuses on empowering organizations with a transformative tool that promises to democratize data, protect patient privacy, and unlock the insights trapped within the electronic health record (EHR): synthetic data.
The Clinician’s Dilemma: A Culture of Data Distrust
For many healthcare professionals, the relationship with organizational data is fraught with frustration. Clinicians are trained to be masters of data interpretation for a single patient, but when it comes to system-level performance, they are often handed reports and directives with little context or ability to investigate the source. Dr. Dungarani explains that this top-down approach, combined with a lack of access, breeds a natural skepticism.
"These clinicians aren't getting access to data, so they're being told something without that ability to see, see the data," Dungarani notes. "There's always a kind of a defensiveness to it… we have to teach our providers and our clinical team members about data, give them access and, and let them make changes for themselves."
This challenge is rooted in several systemic issues that Dr. Dungarani identifies from his experience in quality, operations, and health information management:
Fragmented Systems: Health systems often consist of patchworks of technology. Data from a previous EHR may not be integrated into the current one, making longitudinal studies nearly impossible without significant manual effort.
Workflow Silos: Data is often trapped within departmental workflows. An emergency department physician may have no visibility into inpatient bed capacity, even though the two are inextricably linked. This makes it difficult for teams to understand and solve cross-functional problems like patient throughput.
The Bottleneck of Access: The traditional process for obtaining data is fundamentally broken. A clinician with a research idea or an operational question must submit a request to a small team of data analysts, who often have a backlog of projects from across a 30,000-person organization. The wait can be weeks or months, extinguishing the spark of curiosity and innovation before it can even ignite.
This environment not only stifles quality improvement but also contributes to clinician burnout. Being held accountable to metrics without the tools to understand or influence them is a recipe for disengagement. Empowering clinicians means giving them the agency to solve the problems they see every day, and that agency begins with access to data.
Forging a New Path: The Intersection of Leadership, Culture, and Technology
Solving the data access problem is not merely a technical challenge; it is a leadership and cultural one. According to Dr. Dungarani, effective change requires clinician leaders who can act as translators, bridging the gap between administrators, data scientists, and frontline caregivers.
Bridging the Great Divide
Administrators, clinicians, and data analysts often look at the same problem through vastly different lenses. The CFO sees cost, the pharmacy team sees medication adherence, and the physician sees a patient's clinical journey. A successful data-driven culture requires a "common language" to align these perspectives.
This alignment is crucial because the narrative told by the data and the one experienced by the clinician can often diverge. "A clinical workflow and a clinical story can be very different from a data journey," Dr. Dungarani explains. "The assumptions and the expectations of how data flows with a patient story need a lot of communication… you need that same type of multidisciplinary team to really communicate how that data is telling that story."
For example, a report might show a delay in administering a specific medication. The data simply shows a timestamp. The clinical story, however, might involve a patient who was temporarily off the floor for a procedure, a pharmacy delay, or a nurse attending to a more critical emergency. Without the ability for clinical teams to easily explore the associated data points themselves, incorrect assumptions are made, and ineffective solutions are implemented. Clinician leaders are essential in facilitating this dialogue, ensuring that data insights are grounded in clinical reality.
The Leadership Mandate
Ultimately, fostering this culture starts at the top. Leadership must transition from a compliance-oriented mindset—"Your throughput times are terrible, fix it"—to an empowerment-oriented one: "Here are the tools to explore the data. Find the bottlenecks and tell us what you need to solve them." When teams are given the tools to identify problems themselves, they become far more invested in creating and sustaining the solution. This shift democratizes problem-solving and builds a true learning health system, where improvement is a continuous, collaborative effort rather than a series of top-down directives.
Demystifying Synthetic Data: A New Frontier for Privacy and Innovation
If the goal is to provide widespread access to data, the primary obstacle has always been patient privacy. The Health Insurance Portability and Accountability Act (HIPAA) and other regulations rightly place strict controls on the use of protected health information (PHI). The traditional method for creating "safe" data for research has been de-identification, a process of stripping 18 specific identifiers like name, address, and Social Security number. However, this method is increasingly seen as inadequate. In a world of big data, re-identifying an individual from a "de-identified" dataset can be surprisingly easy with enough external information. Furthermore, to be safe, de-identification often requires removing or aggregating key variables—like zip codes or specific dates—that are critical for studying health equity or disease progression.
What is Synthetic Data?
Synthetic data offers a far more robust solution. Instead of simply removing identifiers, a synthetic data generation process studies the entire original dataset to learn its statistical patterns, correlations, and distributions. It then generates a brand-new, artificial dataset that mirrors these statistical properties but contains no one-to-one mapping back to any real patient. Imagine it as creating a statistically identical "twin" population. One row of synthetic data does not represent a real person, but an analysis of 10,000 rows will yield the same conclusions—the same rates of diabetes, the same average length of stay, the same correlation between a lab value and an outcome—as an analysis of the original 10,000 patients.
This approach offers the best of both worlds: it provides a high-fidelity dataset for exploration and analysis while completely severing the link to individual identities, thus protecting patient privacy at its core.
Accelerating the Pace of Discovery
The operational impact of this technology is immense. It effectively removes the regulatory and logistical logjams that plague healthcare research and operations.
"The benefits of synthetic data right now in the healthcare system is a, I don't have to jump through a million hoops to look at whether my study is feasible," says Dr. Dungarani. "It may take weeks or months to get a data set to even see if your project is viable. Do I have a magnitude of patients to do this research project?"
With a self-service platform built on synthetic data, a clinician can test that hypothesis in minutes. They can explore the data, refine their research question, and confirm the viability of a study before ever applying for Institutional Review Board (IRB) approval to use the original patient data. This dramatically speeds up the innovation cycle, allowing teams to fail fast on ten ideas to find the one that warrants the time and resources of a full-scale study. It transforms the data analyst from a gatekeeper into a strategic partner, freed from routine data pulls to focus on more complex, high-value projects.
Synthetic Data in Action: From Predictive Models to Health Equity
The applications of this approach are not theoretical. Health systems are already using synthetic data to drive meaningful improvements in patient care and operational efficiency.
Predicting Chronic Disease Progression
Dr. Dungarani shares the example of a health system working to predict which patients with chronic kidney disease (CKD) are most likely to progress to dialysis—an outcome that profoundly impacts a patient's quality of life and represents a significant cost to the system. Using synthetic data, their teams could rapidly build and test machine learning models to identify the key predictors of progression. This allows them to create targeted interventions for high-risk patients, potentially delaying or preventing the need for dialysis and improving long-term outcomes. Similar work is being done to predict which cardiac patients will develop severe heart failure, enabling proactive care management.
Closing Gaps in Healthcare Equity
Perhaps one of the most powerful uses of synthetic data is in the study of healthcare disparities. Analyzing sensitive demographic variables like race, ethnicity, language, and geographic location is essential for identifying and addressing inequities, but it also carries the highest risk for patient re-identification. Synthetic data provides a safe harbor for this critical work.
Dr. Dungarani describes clients using synthetic data to examine geographic "heat maps" for correlations between environmental factors and chronic disease or to analyze whether a patient's primary language or ethnicity impacts the time it takes to get to the operating room for a common procedure like a hip fracture. This type of exploration is vital for ensuring equitable care delivery for all populations. The self-service nature of these tools fosters an iterative, curiosity-driven process that is fundamental to discovery.
"We can ask a question, find an insight, and with anything in healthcare, there are 10 more questions or are 20 more questions," he remarks. "Having that self-service ability to look at synthetic data and ask more questions and really have this dialogue with data is really the power."
Key Takeaways for Healthcare Leaders
For clinician leaders who want to champion a new era of data-driven healthcare in their organizations, Dr. Dungarani's insights distill into several actionable principles:
Champion Data Literacy: Acknowledge that healthcare has one of the lowest rates of data literacy among all industries. Invest in training that creates a common language and understanding of data workflows between clinical, analytical, and administrative teams.
Democratize Data Access (Safely): Move beyond the gatekeeper model. Explore and invest in technologies like synthetic data platforms that can empower your teams with self-service analytics without compromising patient privacy or overwhelming your existing data infrastructure.
Cultivate Curiosity, Not Compliance: Foster a culture where data is a tool for exploration, not just a report card for compliance. Encourage teams to ask questions, test hypotheses, and follow their curiosity to uncover the root causes of systemic challenges.
Embrace the AI Frontier: The rise of AI and machine learning in healthcare is inevitable. Clinicians must be active participants in shaping how these tools are developed and deployed. This requires a willingness to learn, experiment, and engage with new technologies.
Conclusion: Be a Part of the Change
The future of healthcare will be defined by how well organizations can leverage their data to deliver more personalized, efficient, and equitable care. Achieving this vision requires more than just algorithms and dashboards; it requires a profound cultural shift that places the power of data into the hands of those on the front lines. Synthetic data is a key enabling technology for this shift, providing a safe and agile framework for innovation.
As Dr. Dungarani passionately concludes, skepticism in the face of new technology is natural, but inaction is a choice. The path forward demands engagement and a proactive spirit from today's and tomorrow's healthcare leaders.
"Without trying, without learning and, and, and being curious, you know, we aren't gonna move forward," he urges. "So I would say if you doubt it, study it, learn it, and, and figure out where the gaps are and be a part of the change."
In the sprawling landscape of American healthcare, a quiet crisis is unfolding in plain sight. It doesn’t involve a new pathogen or a breakthrough drug, but rather a patient population that is both revered and routinely misunderstood: military veterans. While the U.S. Department of Veterans Affairs (VA) health system looms large in the public imagination, the reality is starkly different. The vast majority of the nation’s 18 million veterans receive their care not in specialized VA hospitals, but in the same community clinics and civilian medical centers that serve the general public. And according to Dr. Ali R. Tayyeb, a U.S. Navy veteran, registered nurse, and founder of RN-Mentor Consulting, LLC, these systems are fundamentally unprepared to meet their unique needs.
This isn't a failure of intention, but one of awareness, education, and strategic priority. Civilian health systems, from the C-suite to the exam room, often lack the cultural competency and clinical protocols to effectively care for those who have served.1 The result is a dangerous gap where veterans’ service-related health risks go unscreened, their invaluable skills are overlooked in the workplace, and their transition back to civilian life is made harder by a system that fails to see them for who they are. Drawing from his profound personal and professional experience, Dr. Tayyeb offers a compelling diagnosis of this systemic failure and a clear prescription for how healthcare leaders can—and must—do better.
The Cultural Chasm: From Military Unit to Civilian Life
To understand the challenges veterans face in healthcare, one must first appreciate the profound cultural shift they navigate upon leaving the military. It’s a transition that goes far beyond simply changing jobs or moving to a new city. It’s a complete rewiring of identity, communication, and community. Dr. Tayyeb, who served for a decade as a Navy Corpsman before building a career in nursing leadership, explains that the military is an all-encompassing culture.
“There's a whole indoctrination that happens for individuals going into the military,” he notes. For an average of four years or more, service members are immersed in a world with its own language, hierarchies, and codes of conduct. They build their identities, networks, and a deep sense of camaraderie within this structured environment.
The Shock of Re-entry
The problem arises when it’s time to leave. Unlike the structured process of joining the military, the exit is often abrupt and lacks a meaningful process for reintegration. “When it's time to leave that environment that's been reinforced over a number of years, there is really no enculturation back into the civilian community,” Dr. Tayyeb explains. “We have maybe a couple of weeks that we go through some classes... but not enough for us to say, ‘Okay, now I have taken, I have put aside my 4 years, 8 years, 20 years of service, and now I can easily reintegrate back because it's a completely culture shift.’”
This cultural whiplash leaves many veterans feeling isolated and misunderstood. The very traits that were assets in the military—directness, a mission-focused mindset, a dark sense of humor forged in high-stress environments—can be misinterpreted in a civilian workplace. This disconnect is exacerbated by what experts call the "civilian-military divide." With less than one percent of the U.S. population currently serving on active duty, the number of civilians with direct exposure to military life is at an all-time low. As Dr. Tayyeb points out, this isn't about a lack of respect; it’s a profound lack of familiarity that breeds misunderstanding and allows stereotypes to flourish.
The Veteran in the Workplace: An Untapped Asset
This cultural divide manifests acutely within the walls of healthcare organizations. While many systems proudly proclaim they hire veterans—and often receive incentives for doing so—the support frequently ends at the point of hire. Dr. Tayyeb identifies this superficial engagement with a poignant term: the "badge buddy effect."
Beyond the Badge Buddy Effect
A badge buddy is a small card that hangs behind an employee's ID, often used to display their role (RN, MD) or special certifications.2 Some hospitals give veterans badge buddies that identify their branch of service. While a well-intentioned gesture of recognition, Dr. Tayyeb argues it often represents the beginning and end of an organization’s veteran support strategy.
“I call it the badge buddy effect,” he says. “You get that veteran into organizations, you slap on a badge buddy. Thank you for your service. And that's the extent of where they stop engaging with the veteran, right? They've hired them. They've done their good deed... But what do you do with the veterans afterwards? How are you investing in them?”
This failure to invest is a massive missed opportunity. Veterans bring a portfolio of skills tailor-made for the pressures of healthcare: discipline, resilience under pressure, advanced technical training, and proven leadership experience. Yet, instead of cultivating this talent, organizations often leave veteran employees to navigate a foreign culture on their own.
Dr. Tayyeb shares a personal story of being called into an HR meeting after a colleague felt uncomfortable with his description of his military experience—a conversation the colleague had initiated. His communication style, honed in a predominantly male, high-stakes military environment, was perceived as aggressive in the predominantly female, civilian nursing world. The burden was placed on him to change, to make others feel "safe" from his experience. This scenario highlights a crucial point: without organizational efforts to bridge the cultural gap through education, the onus of adaptation falls unfairly on the veteran, leading to alienation and stifling their potential contributions.
The Clinical Gap: Failing to Ask the Right Questions
The consequences of this systemic ignorance extend beyond employee relations and into the very core of patient care. The single most significant clinical failure, according to Dr. Tayyeb, is a remarkably simple one: health systems are not consistently asking patients if they have served in the military.
“Most veterans do not receive their healthcare within the veteran's health system,” he emphasizes. “They're not getting their care at the VA, they're getting their care in the civilian communities. However, most of our civilian communities... are not asking the right questions.”
Invisible Wounds and Unseen Exposures
That one unasked question—"Have you ever served in the military?"—is a gateway to a host of critical follow-up assessments. Without it, clinicians are practicing with a blind spot, potentially missing diagnoses directly linked to a patient's service history. These can include:
Mental and Behavioral Health: Post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), military sexual trauma (MST), depression, and suicide risk are all significantly more prevalent in the veteran population.
Environmental Exposures: Service history can reveal exposure to harmful substances like Agent Orange in Vietnam, contaminated water at Camp Lejeune, or toxic burn pits in Iraq and Afghanistan, which are linked to specific cancers and respiratory illnesses.3
Musculoskeletal Injuries: The physical demands of military service often lead to chronic pain, joint issues, and other long-term orthopedic problems.4
Hearing and Vision Loss: Exposure to high-decibel noise from machinery, aircraft, and weaponry is common, leading to tinnitus and hearing loss.5
When a clinician doesn't know to screen for these conditions, they miss the opportunity for early intervention and targeted treatment. This clinical gap is widened by an educational deficit in medical and nursing schools, which rarely include veteran-specific health in their core curricula.6 Clinicians enter the workforce without the knowledge base to understand what to ask or, critically, what to do with the information once they have it.
A Path Forward: From Afterthought to Priority
For healthcare leaders feeling overwhelmed by the scope of the problem, Dr. Tayyeb offers a single, powerful directive that reframes the entire approach. It’s not about launching a dozen disparate initiatives, but about making one fundamental strategic shift.
“Make the veteran community a priority within your organization,” he urges. “Not a competing topic with everything else within the healthcare system, but making them a priority... The veteran community can't be the flavor of the month.”
This means moving beyond Veterans Day platitudes and embedding veteran support into the operational DNA of the organization. It requires treating veteran care and employment not as a niche interest or a DEI checkbox, but as a core component of quality, safety, and workforce strategy.
What Priority Looks Like in Practice
Translating this mandate into action involves a multi-pronged approach:
At the Bedside: Mandate the inclusion of military service history in all patient intake processes, both in the EHR and in direct conversation. Train clinical staff on evidence-based screening tools for PTSD, TBI, and exposure-related conditions.
In the Workforce: Go beyond the "badge buddy" by creating robust support systems. This includes establishing empowered Veteran Employee Resource Groups (ERGs), offering cultural competency training for all managers and staff, and developing mentorship programs that pair newly hired veterans with established leaders.
In Leadership Development: Actively recognize the leadership experience veterans bring. Create clear pathways for them to advance into management roles, translating their military leadership skills into the civilian healthcare context.
Crucially, this work also acknowledges that not all veterans even qualify for VA healthcare services. Many who served for a single term or did not sustain a service-connected disability are entirely reliant on the civilian system. By making veterans a priority, health systems fulfill a societal obligation while simultaneously improving care quality and strengthening their own workforce.
Key Takeaways for Healthcare Leaders
Dr. Tayyeb’s insights provide a clear roadmap for any healthcare leader committed to better serving the veteran community. The journey begins with these actionable steps:
Mandate the Screen: Implement a universal, mandatory screening question—"Have you or have you ever served in the military?"—at all patient access points. Ensure this data point triggers appropriate clinical decision support and follow-up assessments within the EHR.
Invest Beyond the Hire: Develop a comprehensive veteran employee strategy that includes cultural competency training for non-veteran staff, mentorship programs, and leadership pipelines designed to leverage the unique skills veterans possess. Move from passive appreciation to active investment.
Educate and Empower Your Teams: Provide ongoing education (CMEs/CEUs) for clinical staff on veteran-specific health concerns. Equip them not only to ask the right questions but to know how to act on the answers with confidence and empathy.
Make Veterans a Strategic Priority: Weave veteran care and workforce initiatives into the fabric of your organization’s strategic plan. When veterans are a stated priority from the C-suite, resources and attention will follow, ensuring the effort is sustained rather than temporary.
Conclusion
The failure of civilian healthcare to adequately care for its veterans is not a partisan issue or a niche concern; it is a fundamental gap in the quality and equity of our health system. It is a failure to honor the unique sacrifices of a population that has given so much. Dr. Ali Tayyeb’s message is both a stark warning and a call to action. By shifting veterans from an afterthought to a priority, healthcare leaders can begin to bridge the cultural and clinical divide. It is a complex challenge, but it starts with a simple question and a profound commitment: to see, hear, and serve the veterans who walk through our doors, not just as patients or employees, but as the valued and respected members of our community they have always been.
In the complex and often contentious world of healthcare policy, the voices of those on the front lines can feel distant from the legislative chambers where decisions are made. Yet, who better to diagnose the ailments of our healthcare system than those who treat its patients every day? This is the central conviction of Representative Arvind Venkat, a practicing emergency physician who also serves in the Pennsylvania House of Representatives. In a recent discussion, Rep. Venkat shared his unique journey from the ER to the statehouse, arguing that clinicians are not just well-suited but essential leaders in the fight for a more accessible, affordable, and effective healthcare system. His dual perspective offers a powerful diagnosis of our systemic challenges and a clear prescription for how to begin healing them.
From the Emergency Room to the State House: A Physicians Call to Service
For Representative Arvind Venkat, the decision to enter politics was a direct extension of his work as an emergency physician. He views the role not as a career change, but as a broadening of his commitment to public service. An ER doctor has a unique window into a community's well-being, witnessing firsthand the downstream effects of policy failures, economic strain, and social inequities. This daily exposure to the "strengths and the challenges in your community" provides an unparalleled, real-world education in public health.
The catalyst for his campaign was the COVID-19 pandemic. While serving as president of the state's emergency physicians' organization, he saw the deep societal divisions over science and medicine threaten the health of his community. "The combination of understanding the challenges in my community and also knowing that we needed more people with scientific and healthcare backgrounds, in politics, in policymaking because of the challenges we're facing—that's what motivated me to run for office," he explains. Elected in 2022, he became the first physician to serve in the Pennsylvania legislature in nearly 60 years, bringing a perspective grounded in clinical reality to a body often dominated by other professions.
Identifying the Core Crises: Access and Affordability
When asked about the most pressing healthcare issues facing his constituents and the nation, Rep. Venkat points to two intertwined crises: access and affordability. These problems, exacerbated by the pandemic, now threaten the stability of the entire healthcare ecosystem. The challenges manifest in several critical ways:
Workforce Shortages: Clinician burnout has led to a mass exodus from the bedside, creating significant gaps in care availability.
Financial Strain: Patients face mounting costs for insurance and treatment, while hospitals and clinics struggle with their own financial viability.
Poor Outcomes: Despite spending more per capita than any other nation, the United States continues to lag behind other industrialized countries in key health outcomes.
Rep. Venkat’s diagnosis is informed by a constant flow of information. He listens to constituents in his suburban Pittsburgh district, consults with healthcare professionals and stakeholders from across Pennsylvania, and closely monitors federal policy shifts. The persistent threats to programs like Medicaid and the Affordable Care Act, for example, directly impact the legislative priorities he champions, as federal decisions have profound local consequences for patients and providers alike.
Why a Broken System Produces Broken Results
A central paradox in a state like Pennsylvania is how it can host a high concentration of world-class medical schools and training programs yet still suffer from significant care access issues. According to Rep. Venkat, the problem isn't a lack of talent but a flawed system that fails to create a sustainable practice environment. He invokes a powerful axiom of systems thinking: "Every system is perfectly designed to get the results that it wants, and the problem is, is that we are incentivizing results that are not of benefit to our fellow Pennsylvanians."
He identifies two primary systemic flaws driving these poor results:
Unchecked Healthcare Consolidation: The relentless trend of mergers and acquisitions has created massive health systems that dominate regional markets.6 In Western Pennsylvania, the healthcare landscape is a "two horse town" controlled by UPMC and Allegheny Health Network. This lack of competition, he argues, leads to an environment where "many health professionals feel that they are widgets, they're not respected as the professionals that they are."
A Flawed Reimbursement Model: The prevailing fee-for-service model rewards volume over value. This incentivizes providers to push patients through the system quickly and encourages organizations to staff at the most minimal levels possible. It creates a "just-in-time warehouse" approach to care that is fundamentally at odds with the unpredictable nature of human health, especially in areas like emergency medicine that must maintain readiness at all times.
A Prescription for Reform: Antitrust Action and Value-Based Care
To fix a system designed for the wrong results, Rep. Venkat advocates for fundamental structural reforms aimed at promoting competition and realigning financial incentives with patient outcomes. He proposes a two-part legislative prescription to address the core problems of consolidation and reimbursement.
First, to counter unchecked market consolidation, he calls for a strong state-level antitrust statute. Pennsylvania is one of only two states lacking such a law, effectively abdicating its responsibility to regulate competition. A robust antitrust framework would empower the state to scrutinize mergers, prevent monopolies, and ensure a healthier, more competitive marketplace that serves patients and respects clinicians.
Second, he argues for an accelerated transition away from fee-for-service and toward value-based care. This means moving to a reimbursement system "based on a global basis of healthcare and outcomes." Instead of paying for each individual test or procedure, this model would reward providers for keeping populations healthy, managing chronic diseases effectively, and delivering high-quality, efficient care. This shift would fundamentally change the economic drivers of the healthcare industry, prioritizing patient well-being over sheer volume.8
Defending Progress in a Shifting Political Landscape
Meaningful reform is impossible if existing foundations of care are dismantled. Rep. Venkat identifies the most immediate danger to the nation's health as the persistent political threats to Medicaid and the Affordable Care Act (ACA). He sees proposals to gut these programs as a direct assault on access and affordability. While acknowledging the ACA didn't fully solve the problem of high prices, he views it as the essential "American vehicle for making sure that everyone that we possibly can is covered by health insurance."
An erosion of Medicaid and the ACA would not only strip coverage from millions but also trigger a cascade of negative consequences. Uncompensated care costs would soar, shifting the financial burden to insured individuals and threatening the stability of hospitals, particularly in rural and underserved areas. For Rep. Venkat, the first principle of healthcare policy must be to not go backwards. Protecting and strengthening existing coverage is the necessary prerequisite for building a better system.
Advice for the Aspiring Clinician-Advocate
For other clinicians inspired to get involved in advocacy or even run for office, Rep. Venkat offers pragmatic advice rooted in his own experience. He stresses the importance of navigating potential conflicts of interest with employers by establishing clear boundaries from the outset. While he maintains a strict separation—"you don't do politics when you're caring for patients actively"—he notes there is a long and proud history of health professionals advocating for public health outside the clinical setting.
Aspiring clinician-leaders must also confront the personal and financial realities of such a commitment. His own journey required a shift to part-time clinical work and a significant pay cut. However, he affirms that the impact is well worth the sacrifice. As the only physician in the legislature, his voice carries unique weight on healthcare issues, allowing him to champion legislation on medical debt relief, hold insurance companies accountable, and defend reproductive rights.
The Power of Coalition: A Final Word for Early-Career Professionals
For residents, fellows, and other early-career professionals eager to make a difference, Rep. Venkat’s most crucial piece of advice is to start by building community. The challenges in healthcare and policy are too large to tackle alone. "It's very hard in our system of government and policy, and really in society as a single individual to make a profound difference," he advises. "You need to build coalitions. You need to build alliances." He points to the recent success of physician unionization efforts, which have been championed by a younger generation of doctors who organized to advance a collective agenda. By finding like-minded individuals and uniting around a shared priority, you can amplify your voice and drive meaningful change.
Rep. Arvind Venkat's career embodies a new model of healthcare leadership—one that bridges the gap between the exam room and the legislative floor. His work serves as a powerful reminder that the insights gained on the front lines of care are not just relevant but essential to crafting sound public policy. The path forward requires more clinicians to step beyond their traditional roles, lend their expertise to the public square, and lead the charge in building a healthcare system that truly serves the health and well-being of all.
The journey from graduate student to healthcare executive is rarely a straight line. It’s a path paved with pivotal decisions, calculated risks, and the deliberate cultivation of a strong professional network. For aspiring leaders, navigating this landscape requires a blend of ambition, self-awareness, and a willingness to step outside one’s comfort zone. Mahee Patel, MSHA, MBA, an Administrative Fellow at Apex Health Solutions, embodies this modern trajectory. Her story, from leaving her home state of Wisconsin for the University of Alabama at Birmingham’s (UAB) renowned MHA program to securing a coveted internship at the Mayo Clinic and ultimately landing in the dynamic world of value-based care in Houston, offers a masterclass in strategic career development. In a recent conversation on The Fellowship Review, Mahee shared the insights that shaped her path, offering actionable advice for the next generation of healthcare leaders.
Why did you choose UAB for your graduate studies?
The decision to attend the University of Alabama at Birmingham for graduate school was primarily driven by the program's culture and its emphasis on in-person connection. While many programs were still operating virtually in the wake of the COVID-19 pandemic, UAB’s decision to host an in-person interview weekend made all the difference for Mahee. This approach allowed her to experience the campus environment firsthand and assess her compatibility with the faculty and future classmates—a critical factor for a field as relationship-driven as healthcare administration.
She recalls the experience vividly, noting how it immediately set the program apart. “The MHA world as we know, is pretty small and culture means everything,” Mahee explains. “And I thought that if I was going to be spending upwards of every day with a group of around 30 people I'd really wanna fit in. And my interview at UAB was just so much fun, it didn't even feel like an interview.” This focus on cultural fit over pure prestige underscores a vital lesson for prospective students: the environment you learn in is just as important as the curriculum. The right program should not only challenge you academically but also provide a supportive community where you can build lasting professional and personal relationships.
Navigating the Transition from North to South
Moving from Wisconsin to Alabama was a significant personal and cultural leap that required courage and a focus on the long-term career goal. Mahee admits the decision was daunting, especially as it meant leaving a close-knit family network for the first time. The fear of the unknown—making new friends, adapting to a different culture, and the simple "what if it's the wrong decision?"—was very real.
However, she didn't let those doubts dictate her future. “My future, my career was worth it,” she reflects. “I'm so glad that I didn't let those little doubts of what if I make no friends or what if I hate it...play too much importance on my decision making.” Her experience serves as a powerful reminder that career growth often demands stepping into uncomfortable territory. Ultimately, the people she met at UAB made the transition seamless. The strong bonds she formed with her classmates created a new "family," proving that the quality of the people around you can make any location feel like home. Her advice to others facing a similar move is to recognize that while regional differences exist (she confirms Southern charm is real), people are fundamentally the same everywhere.
How did you secure an internship at the Mayo Clinic?
Mahee secured her internship at the Mayo Clinic by strategically leveraging her university's alumni network and demonstrating a keen interest in innovative academic medical centers. While in her graduate program, she was drawn to high-acuity, research-driven organizations like the Cleveland Clinic and its peer, the Mayo Clinic. To transform this interest into an opportunity, she took a crucial step that every student should emulate: she connected with a UAB alum who had previously completed the Mayo internship.
This conversation provided an authentic, inside perspective that a website or job description could never offer. Hearing firsthand about the alum's positive experience solidified her decision to apply. This highlights the immense value of networking; alumni have walked the path you're on and can provide candid insights that demystify the application process and help you gauge cultural fit. The Mayo Clinic’s application process involves applying to the system as a whole, with location assignments made upon offer. By a stroke of luck, Mahee was placed at the health system in her home state of Wisconsin, allowing her to gain experience at a world-class institution while being close to home.
Why Pursue a Fellowship Over Other Career Paths?
For Mahee, a first-generation American and first-generation student, the decision to pursue a fellowship was rooted in the unparalleled mentorship and accelerated career exposure it provides. A fellowship offers a structured pathway to gain high-level experiences that are often inaccessible through a traditional entry-level job. It’s an intensive, year-long immersion into the inner workings of a health system, designed to mold promising graduates into future leaders.
The core appeal was the guarantee of mentorship and guidance from seasoned executives. Mahee saw it as an invaluable opportunity to build a robust professional network and learn directly from leaders at the top of their field. “Build that professional and personal connection with a mentor that can not only guide you in your career, but propel you and…speak about you at tables that you know, you don't have a seat at yet, I think is invaluable,” she states. This sponsorship—having a champion who advocates for you in rooms you aren't in—is one of the most powerful career accelerators a young professional can have. For anyone who identifies as a lifelong learner, a fellowship extends the educational journey beyond the classroom, allowing you to explore curiosities and transition from student to leader under the guidance of experts.
Strategies for a Successful Fellowship Application Cycle
A successful fellowship application cycle requires meticulous organization, intentionality, and a focus on quality over quantity. Mahee managed her applications with a master Excel spreadsheet that she updated almost daily, a practice many successful applicants swear by. Given that her UAB program required a fellowship, she had significant institutional support, including a "Preceptors Conference" where dozens of organizations came to recruit.
However, she didn't limit her search to the organizations that came to her. She proactively researched other programs to ensure she was casting a wide but deliberate net. Her strategy offers a clear blueprint for applicants:
Be Intentional: Rather than applying to dozens of programs, Mahee applied to around 10. This allowed her to tailor each application and truly invest in learning about the organizations that interested her most.
Connect with Current Fellows: This was a game-changer. Speaking with individuals currently in the role provides the most authentic gauge of an organization’s culture and the day-to-day reality of the fellowship. If you can see yourself in the current fellow’s shoes, it’s a strong indicator of a good fit.
Trust Your Gut: As Mahee notes, “The best way to gauge if you yourself are a cultural fit is if you can get along with the person that is doing the role currently.”
Ultimately, overwhelming yourself with too many options can lead to decision fatigue. A focused, well-researched approach yields better results and ensures you land in a place where you can truly thrive.
Mastering the Fellowship Interview
The key to mastering the fellowship interview is to reframe it as a mutual assessment of cultural fit rather than a one-sided evaluation. Mahee’s experience demonstrates that by the time you reach the final, on-site interview, your qualifications are no longer in question. At that stage, the organization has already determined you have the technical skills and academic background to succeed. The real question becomes: Do your personality, values, and working style align with the organization’s culture?
This realization helped her approach the process with confidence and authenticity. “Once you make it to the onsite interview, you can believe that you're qualified for the job,” she advises. “At that point it is down to what's a cultural fit.” This mindset shift is empowering. It transforms the interview from a nerve-wracking test into a conversation where you are interviewing the organization just as much as they are interviewing you. By showing up as your most authentic self, you not only stand out but also ensure you land in an environment where you can be successful and happy.
A Look Inside the Apex Health Solutions Fellowship
The Administrative Fellowship at Apex Health Solutions offers a uniquely flexible and entrepreneurial experience tailored to the individual, set within a fast-growing value-based care organization. As a managed service organization (MSO) founded in 2019, Apex provides partners with the people, processes, and technology to succeed in value-based arrangements. This is a step beyond traditional consulting; it’s about hands-on implementation and partnership.
A key differentiator of the Apex fellowship is its adaptability. Fellows can choose whether their year-long experience will be rotational or project-based, a level of autonomy rarely seen in more established programs. “The previous fellow had a more project-based, uh, fellowship, but I think that's a unique opportunity and privilege of the fellowship is that you get to make it your experience,” Mahee notes. As the sole fellow, she has had the opportunity to rotate through each of the company's functional pillars, gaining a holistic understanding of the business while building deep relationships across the organization. This model is ideal for self-starters who want to customize their learning journey and make a tangible impact in a growth-stage company at the forefront of healthcare innovation.
The Transition from Learner to Leader
A fellowship is designed to accelerate the transition from student to leader, and Mahee’s experience on a complex regulatory project exemplifies this perfectly. Tasked with helping build the clinical policy for Apex’s utilization management team, she was pushed far outside her comfort zone. The project required her to develop a project plan and delegate tasks to senior leaders, including Vice Presidents.
This experience was initially intimidating but proved to be a critical developmental milestone. It forced her to shift her mindset from being the "doer" to being the "delegator" and to cultivate her executive presence. Learning to manage up and guide team members who are more senior is a vital leadership skill. As she notes, while intimidating, it's a necessary step for anyone on a leadership track. Good fellowship programs create a safe space for this growth. As one of her own mentors advised, the goal is to be challenged but not allowed to drown. This project provided the perfect opportunity to develop high-level project management and communication skills while delivering significant value to the organization.
The Power of a Dual-Mentorship Model
Effective mentorship is the cornerstone of a successful fellowship, and Apex provides a robust structure with both a preceptor and an executive sponsor. This dual-mentorship model ensures the fellow receives comprehensive support covering both day-to-day execution and long-term career strategy.
The Preceptor: Mahee meets with her preceptor weekly. This relationship serves as her primary, day-to-day support system. The preceptor is her "safe space to fail," someone she can bounce ideas off of, ask any question without judgment, and turn to when feeling overwhelmed. This person is essential for navigating daily challenges and ensuring the fellow stays on track.
The Executive Sponsor: Meetings with her executive sponsor occur bi-weekly and are focused on the bigger picture. These conversations revolve around future planning, post-fellowship career goals, and identifying the experiences needed to become a successful early careerist.
Beyond this formal structure, Mahee has found a wealth of informal mentors through her rotations. The learning-oriented culture at Apex means that leaders across the organization are invested in her success, not just as a fellow but as a person.
Takeaway: Trust the Process
Reflecting on her journey, Mahee’s most resonant piece of advice is simple yet profound: relax and trust the process. The path through graduate school and the fellowship search is filled with uncertainty and "what if" scenarios that can generate significant anxiety. It’s easy to get caught up in worrying about outcomes you can’t control. However, looking back, it becomes clear that life often guides you in the right direction, even if the path isn’t what you originally envisioned. “Take a step back and look back at all you've accomplished thus far,” she advises. “This is just one more step...it's not gonna be easy, but it's not impossible.” By staying true to yourself, remaining confident in your abilities, and trusting that things will work out, you can navigate the challenges of an early career with greater calm and focus, ultimately landing right where you need to be.
The Clinician’s Instinct Meets the Enterprise Stack
Healthcare’s most stubborn operational problems rarely begin in the boardroom. They surface at 1:00 a.m., during a staffing-capacity huddle, when a nurse has to decide between staying late to cover a shift or going home to feed a newborn. They show up in a supply closet when a frontline clinician opens a packet and discovers the cap needed to safely “scrub the hub” isn’t actually there. And they accumulate in the thousands of small, invisible frictions—extra clicks, workarounds, missing data—that quietly burn out clinicians and erode value.
Catherine Robison, MBA, BSN, RN has lived every layer of that reality. A former bedside nurse and nursing administrator in southeastern Virginia, she crossed the aisle into technology and now serves as Director of Healthcare Strategy at Oracle Health. Her mission sits at the intersection of leadership, wellness, and community collaboration: translate clinicians’ lived experience into data models and enterprise tools that organizations will actually use—and that actually change outcomes.
As Robison puts it, “we need better tools to do our job in healthcare.” But she’s equally clear-eyed about the core challenge: “Everyone wants to change the world… The trick isn’t having the idea. The trick is figuring out how to scale the idea.” This feature traces Robison’s journey from med–surg to tech, why she believes quantifying clinical work is a precondition for better care and better jobs, and how to build innovations that genuinely move the needle for patients, clinicians, and communities.
From Med–Surg to “Innovation Scientist”: A Journey Shaped by Real-World Pain Points
The night shift epiphany
Early in her career, Robison found herself on yet another winter capacity call—those familiar late-night huddles that stretch staff to their limits. She had already returned from maternity leave early because her unit was short. The call ended; the baby woke. The dissonance was clarifying. “We need better tools to do our job in healthcare,” she concluded. The issue wasn’t a lack of commitment; it was a lack of systems that respected time, energy, and reality.
Asking the right “naïve” questions
From the beginning, Robison’s approach to leadership was operationally grounded. “Why do I have to click so many buttons to transport the patient off the floor for a simple procedure?” That deceptively simple question nudged her into process improvement, professional practice, Magnet program work, and nurse management. She learned a pattern: frontline challenges often persist because they’re expressed in a language leaders can’t easily invest in—then solved with point solutions that sit outside core systems.
Crossing the aisle into tech
Robison joined Oracle a few months before the Cerner acquisition, working on a broad innovation portfolio that spanned epidemiology, public health, and life sciences. She loved the R&D but discovered her deepest interest was operational: the plumbing of healthcare. She now works inside Oracle’s North American applications team, where “back-office” data—human capital management (HCM), finance, supply chain, and scheduling—meets clinical reality. In plain terms: the people, money, and materials that make care possible.
Jargon check HCM (Human Capital Management): enterprise systems for workforce data (hiring, scheduling, payroll, career progression). EHR (Electronic Health Record): clinical system of record for patient care. “Point solution”: a narrow tool solving one problem in isolation rather than integrating with core platforms. “Scrub the hub”: disinfecting the access port of a central line to prevent bloodstream infections.
The Unifying Hypothesis: If We Can Quantify the Work, We Can Improve It
Robison’s north star is both simple and radical: healthcare can’t optimize what it can’t see. “Our work isn’t very well quantified,” she says of nursing. The result: clinicians ask for reasonable support (“We need more staff”), but leaders—especially those far from the bedside—can’t draw a clean line from workload to outcomes to dollars. Without that line, investments stall.
So Robison built a model early in her career to quantify time with patients and correlate it to cost. It worked—but only partially. It lived outside the health system’s core stack and demanded manual effort. The lesson? Good ideas die when they’re not embedded into existing workflows and data flows. At Oracle, her definition of success is different: co-create with customers and product teams so these measures live inside scheduling, HCM, finance, and the EHR—so leaders and clinicians both see the same truth and act on it.
“If we can create… leverage the technology that already exists, so that we can deliver joy back into healthcare,” she says, then we can track what matters—like two‑year RN turnover or the true cost of care—and change those numbers.
Leadership as Translation: Turning Clinical Truth into Business Cases
Healthcare has two valid but often incompatible dialects: the clinical language of outcomes, safety, and staffing—and the enterprise language of return on investment. Robison learned to connect them. A mentor’s advice stuck: talking only about patient outcomes won’t unlock budget; leaders also need to hear how this makes or saves money. That framing is not a betrayal of the mission; it’s the bridge that funds it.
A practical script emerges from her approach:
Name the micro‑problem precisely. (e.g., the missing central-line cap in the “cleaning packet.”)
Show its frequency and cost. (Delays, rework, infections averted, staff minutes lost, morale impact.)
Embed the fix in existing systems. (Supply chain templates, EHR order sets, scheduling rules.)
Translate to dollars and outcomes. (Retention, avoided agency spend, CLABSI reduction, HCAHPS improvements.)
This is leadership as stewardship. It’s also wellness strategy: fewer frictions and clearer priorities reduce cognitive load. The payoff compounds across teams and, ultimately, communities.
The Data Reality: Messy, Fragmented, and Full of Hidden Assumptions
Robison doesn’t sugarcoat the current state. “The data in healthcare is messy. It’s very, very messy.” Part of the mess stems from a naïve assumption that “if something is in the chart, then it’s true.” Clinicians know that documentation can be wrong, incomplete, or context-blind. Meanwhile, enterprise data lives in silos—HR here, the EHR there, supply chain elsewhere.
Every interface extracts a tax. “Every time you have an integration point… it’s one more spot where AI is going to become less efficient,” Robison notes. That’s a sobering counterpoint to breathless AI promises. Machine learning trained on flawed, disjointed data won’t magically repair upstream process problems; at best, it obscures them.
Jargon check Integration point: the handshake where two systems exchange data. Each handshake adds potential error and latency. AI vs. “agentic AI”: traditional AI models predict; agentic AI chains tools and steps to autonomously accomplish tasks. Both degrade when the underlying data is inconsistent or incomplete.
Begin with the End in Mind: Designing for Scalability, Not Heroics
Asked whether fragmentation is simply “the way healthcare is,” Robison refuses fatalism. “Oh, I refuse to believe that this is just the way that healthcare is. I’m an idealist at heart, and I believe that we’re going to change.” The route to change, however, isn’t another quick fix layered onto brittle workflows. It’s systems thinking.
Her advice: start with a precise description of the outcome you want, then work backward to the smallest measurable units of work that drive it. “We do not understand at scale the granular work that people do,” she says. But that’s exactly what we can measure—without “chasing people around with timers”—if we embed well‑designed telemetry into everyday tools: staffing rules that reflect real workload, supply chain templates aligned to infection prevention, and schedules that adapt to census and acuity without punishing staff.
Case in point: the central‑line cap A unit assumed compliance failure—nurses “not scrubbing the hub.” Robison walked to the closet, opened the packet, and discovered the needed cap wasn’t included. The fix wasn’t more training. It was a supply chain update, embedded in the kit build and verified in the EHR’s preference lists. The ROI? Fewer infections, less rework, safer care—and less moral injury for staff blamed for a system error.
Where Wellness, Leadership, and Community Collaboration Converge
Wellness is a systems property
Wellness initiatives often focus on resilience courses and meditation apps. Useful, yes, but insufficient if the work remains chaotic. Robison’s framing is refreshingly direct: wellness flows from sane workflows. Reducing clicks, interruptions, and scavenger hunts is a wellness intervention because it returns time to clinicians and reduces cortisol spikes. The nurse who gets to go home on time is a community health asset—the professional who returns tomorrow.
Leadership that listens like a clinician
Clinical training teaches pattern recognition under pressure: sense, prioritize, act, reassess. Robison argues those skills are portable—and powerful—in enterprise settings. “Your ability to communicate effectively over a short amount of time… your ability to walk into a room and know how someone is feeling both emotionally and physically and respond to that immediately… [and] assess a situation using limited… information and make a decision to act—that is a unique skill set.” Bring that to budgeting and product design, and the culture changes.
Community as co‑designer
Robison’s current role puts her in constant dialogue with customers and product teams. The most durable solutions, she argues, are “co‑authored”: frontline nurses, respiratory therapists, transport, infection prevention, schedulers, finance, and IT all shaping the same tool. That’s community collaboration at an enterprise scale—less a town hall than a product sprint.
Programs and Practices: What This Looks Like in the Real World
Advanced scheduling that respects real workload
Oracle’s applications work includes “some really cool stuff in advanced scheduling,” Robison says—an area where clinician well‑being and operational efficiency align. The idea: translate imprecise staffing ratios into dynamic workload models that consider patient acuity, care tasks, and team composition. When embedded in HCM and the EHR, schedules flex to demand without defaulting to mandatory overtime. The measurable outcomes leaders care about—turnover, recruitment costs, agency hours—move in the right direction.
Supply chain aligned to care
The central‑line example is a teachable pattern. Inventory templates should reflect infection‑prevention standards; picking lists should be validated against real‑world use; the EHR should nudge ordering toward the right bundle. The “program” here isn’t a standalone app; it’s a governance loop: frontline feedback → supply build → EHR preference → audit data → improvement. The win shows up in CLABSI rates and in trust.
Quantifying care time without a stopwatch
Robison’s early time‑with‑patients model illustrates how to operationalize “invisible” work. Today, that logic can be embedded across systems: task lists, documentation timestamps, transport metrics, and messaging data combine to approximate true workload by shift and role. Leaders get a defensible business case; teams get relief before burnout escalates to attrition.
Translating outcomes to enterprise value
Robison is blunt about the language shift. A friend once told her she needed to connect the dots to dollars. That sparked a durable habit: present improvements with dual currencies—lives and line items. The deck that lands investment is the one that shows a million‑dollar annual savings and a safer, calmer unit.
What AI Can—and Cannot—Fix
The last few years have seen AI framed as healthcare’s universal solvent. Robison is optimistic but pragmatic. AI amplifies whatever system it touches. If the substrate is disjointed, AI becomes a glossy veneer over entropy. If the substrate is integrated, the same AI unlocks deeper insights and more humane workflows.
Hence the emphasis on platform consolidation. When EHR, HCM, finance, and supply chain speak the same data language, leaders can ask—and answer—questions that actually matter: Where are we spending per patient per nurse? Which micro‑bottlenecks cost the most morale? Which schedule patterns predict resignations? That’s how AI gets pointed at the right problems.
The Moral of the Story: Clinicians Belong in the Design Studio
Robison’s closing advice to nurses and other clinicians is part affirmation, part call to action:
“Don’t lose sight of the fact that you are uniquely skilled and gifted to drive the change that you want.”
“Technology is going to change the way that we deliver care. We need to be the ones that are directing and driving and defining how care is delivered.”
Learn the enterprise dialect—how to describe value in terms of both outcomes and dollars.
Cultivate curiosity about platforms and data models; know enough to shape roadmaps.
Start small, measure precisely, and embed fixes where the work already happens.
In the end, Robison’s north star is personal. “I have been around death and I know what people say on their death bed,” she reflects. Success, for her, is moving the numbers that actually change lives: “if we can change that number of how many nurses are leaving the profession, if we can change the number associated with cost of care, that will feel like success.”
Actionable Key Takeaways
Quantify the invisible. Inventory the “micro‑frictions” on a unit (extra clicks, missing supplies, avoidable trips). Use timestamps, task lists, and message metadata to model workload without clipboards.
Translate to dollars and outcomes. Pair each improvement with both a clinical metric (e.g., CLABSI, falls, HCAHPS, turnover) and an economic metric (agency hours avoided, vacancy days reduced, overtime cut).
Embed, don’t bolt on. Prioritize solutions that live inside existing platforms (EHR, HCM, supply chain, finance). Point solutions raise integration costs and die on the vine.
Design for the smallest unit of work. Begin with end outcomes, then work backward to measurable, granular tasks. Fix what staff actually touch.
Staffing: move beyond ratios. Pilot demand‑aware scheduling that accounts for acuity and task complexity. Protect off‑time; measure the impact on retention.
Tighten the supply loop. Validate kits against real‑world use (e.g., central‑line caps). Align EHR defaults with supply builds; audit exceptions.
Build a common language. Use “bridging artifacts” (one‑page problem statements, costed user stories) that clinicians and executives can both sign off on.
Aim AI at good data. Consolidate around fewer integration points. Let AI summarize, predict, and orchestrate on top of reconciled, governance‑backed data.
Treat wellness as design. Reduce interruptions and rework; protect predictable schedules; measure emotional labor alongside throughput.
Make it a community project. Co‑design with nurses, transport, environmental services, infection prevention, finance, and IT. Durable change is a team sport.
Conclusion: Changing the System by Respecting the Shift
Healthcare transformation doesn’t start with a moonshot. It starts with the humble decision to respect a clinician’s time, attention, and judgment—and then to encode that respect into the systems that run the enterprise. Robison sums up the ethos with characteristic clarity: “I refuse to believe that this is just the way that healthcare is.” The path forward is not mysterious: listen like a clinician, measure what matters, embed fixes where work happens, and speak in a language that funds the mission. Do that consistently and the outcomes change—on the unit, at the balance sheet, and across the community.
Along the way, we should protect and celebrate the uniquely clinical superpower Robison named at the outset: “your ability to walk into a room and know how someone is feeling both emotionally and physically and respond to that immediately.” That skill—paired with data and design—may be the single most important engine of healthcare innovation we have.
Michigan Medicine’s Administrative Fellowship is designed for ambitious early-careerists who want both breadth and depth—real projects, real mentors, and real exposure to system-level decision-making. In this conversation with first-year fellow Trent Garrett, MSHA, MBA, we unpack how a dual-degree path led him to Ann Arbor, why an atypical internship at Press Ganey paid off, and what day-to-day life looks like inside a two-year, project-driven fellowship that culminates in an “immersion” year. Expect candid advice on choosing programs, surviving interviews, and building a network that lasts. As Trent puts it, “there are going to be opportunities for you to learn and grow… based off of what you are looking for post-fellowship.” If you’re exploring administrative fellowships—or you lead one and want to sharpen it—this is your insider’s guide.
Who is Trent Garrett—and what uniquely prepared him for fellowship?
Trent is a first-year administrative fellow at Michigan Medicine whose nontraditional path (animal sciences → MBA/MSHA) gives him a distinctive systems lens.
Trent grew up in Panama City Beach, Florida, earned a bachelor’s in animal sciences at the University of Florida , and then made what he calls a “hard pivot” to health administration at University of Alabama at Birmingham, completing a dual MBA/MSHA. That shift was informed by hands-on clinical work during the pandemic, where he witnessed both the resilience of teams and the friction of fragmented processes. The experience sharpened his purpose: understand the clinical environment deeply, then use management training to remove barriers to great care.
Leaders consistently favor fellows who can translate clinical realities into operational solutions. Trent’s journey maps to that ideal: frontline exposure, analytic training, and the humility to learn in complex environments.
How did UAB’s dual-degree program set him up for success?
UAB’s three-year MBA/MSHA sequence (two didactic years + required fellowship year) provided both foundational business fluency and leadership development
For Trent—who came in without prior finance or business coursework—the dual program mattered. It layered core finance, strategy, and operations on top of healthcare management, with structured professional development baked in. He emphasizes the intentionality of UAB’s design: two years of classroom rigor, followed by a required fellowship year to apply it in practice. Even though Michigan Medicine’s fellowship spans two years, the habit of integrating theory with applied learning traveled with him.
Which internships shaped his lens—and why did Press Ganey matter?
A PCA role during COVID gave Trent empathy for clinical burdens; a consulting internship with Press Ganey gave him a cross-market vantage. Together, they grounded his administrative approach.
Trent started as a Patient Care Assistant at UF Health to “understand the scope of each role,” from nursing to medicine. Working through the pandemic surfaced “systemic issues” and sparked his drive to catalyze change. He then took an internship with Press Ganey Consulting, which became a high-leverage bridge between analytics and improvement. Over that summer and school year, he supported clients across:
Academic medical centers
Rural health centers
Safety-net hospitals
The common thread: learning to see patterns across settings and connect survey insights, operational redesign, and change management. Cross-site exposure accelerates judgment. Seek experiences that mix clinical empathy with systems-level consulting or improvement work.
How should candidates choose where to apply—and stay sane doing it?
Be ruthlessly selective. Apply only where you’d say “yes” immediately, and cap your list to avoid burnout. “It is not easy… that was a very stressful time.”
Trent distilled his approach to three moves:
Define the must-haves. He prioritized continuous learning and the academic tripartite mission (clinical care, research, education).
Do the homework. Summer webinars, outreach to current fellows, and a living spreadsheet for deadlines, rankings, and fit signals.
Limit the spread. “If you apply to more than 15 places, I’m going to fly to you and we’re going to have a serious conversation,” a mentor warned—and Trent listened.
Practical toolkit:
Build a single source of truth (webinar dates, contacts, deadlines, interview status).
Color-code for fit (mission, mentorship, project model, geography).
Pre-decide your no-go criteria (e.g., limited exposure to senior leadership, no defined preceptor model).
What actually wins interviews?
Preparation and authenticity—in that order. “Come prepared, but also be your authentic self.”
Michigan Medicine clicked for Trent during the onsite: “All of the current fellows were just phenomenal… so personable, so intelligent and brilliant… I just fell in love with the institution and how detailed and intentional everyone was.” He also sanity-checked fit by asking: Are these people I want to work with?
Simple prep stack for candidates:
Know your three stories that demonstrate learning agility, stakeholder management, and impact.
Practice the why-us/why-you answer linking your values to the program’s structure.
Bring thoughtful questions about mentorship cadence, project scoping, and exposure to system priorities.
Leader insight: Authentically signal your culture during finalist days—fellows are interviewing you, too.
How is Michigan Medicine’s fellowship structured?
It’s a two-year program: Year 1 is project-based breadth; Year 2 is a deep-dive immersion in a specific area. “The Michigan Medicine Administrative Fellowship Program is a two year program.”
Year 1—Project-Based Breadth In the first two weeks, fellows receive a curated list of vetted project proposals. Each entry outlines the background, scope, preceptor, and mentorship plan. “The first two weeks… you get a list of submitted project proposals… and then who your preceptor for that project would be and how they would mentor you.” Areas span clinic operations, faculty affairs, graduate medical education, and more. Fellows choose to build range.
Year 2—Immersion (Depth) “We call it the immersion year… embedded as a full-time resource within one area or departments within Michigan Medicine.” That can mean an interim clinic manager role, a seat in Strategy, or another high-impact placement—designed to convert first-year range into second-year mastery.
Cohort Model & Culture Michigan Medicine accepts up to three fellows per year, emphasizing peer support and shared learning. Alumni remain visible, projects have demand (“leaders submit requests before fellows even start”), and the program’s decades-long history means stakeholders understand how to integrate fellows.
Bottom line for executives: This breadth-then-depth architecture de-risks early-career placement and creates versatile leaders who understand the enterprise.
What mentorship and leadership access do fellows actually get?
Monthly 1:1s with two executive preceptors, quarterly with an executive sponsor, frequent touchpoints with the program director, and weekly exposure to C-suite meetings.
The structure is unusually explicit:
Two Executive Preceptors: the Chief Operating Officer of the Medical School and the Chief Operations and Integration Officer of the health system—each meeting monthly with fellows.
Executive Sponsor: the Chief Governance Officer (a former health system president) meets quarterly.
Program Director: a fellowship alumna who meets biweekly, ensuring momentum and support.
Fellows staff weekly upper-leadership meetings, seeing how enterprise priorities are debated and decided. They’re also encouraged to network upward: “We can cold call or cold email senior leaders just to have coffee chats or one-on-ones… and because we’re fellows, they’re more than open to it.”
What kinds of projects define the experience? (A real example.)
High-priority, system-visible work with measurable impact. Trent helped Michigan Medicine roll out ambient AI documentation for providers—300 initial licenses—on an accelerated timeline.
“We had implemented ambient AI documentation for providers. We had 300 initial licenses… first proposed… as six weeks, and then… asked, can we cut this in half? And… we said yeah.” Why it mattered: reducing “pajama time” by offloading documentation burden so clinicians can finish notes during the day, not at night.
What success looked like:
Rapid deployment: Licenses installed and ready within a week in early cohorts.
Positive adoption signals: Immediate, unsolicited feedback from providers.
Human-centered value: “I get to go home and have a date night with my partner… I get to read to my kids before bed.”
What the project teaches fellows:
How to shepherd technology with clinical partners, not at them.
How to compress timelines without losing stakeholder trust.
How to measure impact in both operational and human terms.
How does Ann Arbor—and Michigan Medicine’s locale—support fellows?
Inclusive, vibrant, and livable. “Ann Arbor is just a welcoming community.” Yes, winters are real, but even Trent’s co-fellow from Hawaii is thriving.
Trent was deliberate about choosing not just an organization, but a place aligned with his values. He found Ann Arbor to be:
Inclusive and community-oriented, with easy friend-making beyond work.
Rich in food and culture—from the college-town scene to nearby Detroit’s dynamic dining and music.
Logistically smooth: Ann Arbor offers a mellow daily rhythm, while Detroit (≈40–45 minutes) adds big-city optionality.
Leader takeaway: Selling your city matters. Programs win when they help candidates imagine life outside the hospital—community, culture, and support systems.
What advice does Trent have for applicants (and for programs)?
Prioritize fit, cap the list, and be kind to yourself. “You are likely going to be told no… so be kind to yourself.”
Trent’s go-to guidance:
Limit applications to places you’d say “yes” to immediately. (He kept it to about 15.)
Curate your bandwidth—you’re running a marathon of deadlines, webinars, and interviews.
Protect your peace: “After your interviews, de-stress… do what you need to do to maintain your peace.”
Trust the match: “Everything truly happens for a reason. You will end up at the organization that… you belong to.”
For programs: Make fit discoverable. Show candidates your mentorship model, project pipeline, and leadership access—and let them meet the fellows they’ll stand beside.
Why Michigan Medicine—and what makes the fellowship durable?
Short answer: A decades-long track record, a “build-your-own-path” culture, and enterprise-level buy-in. Projects are requested by leaders—often before fellows even start.
Trent highlights the institutional memory and demand signal: stakeholders know how to use fellows. That maturity produces four reinforcing benefits:
Project Gravity: Leaders submit meaningful work with clear sponsorship.
Mentorship Muscle: Preceptors understand how to coach and escalate.
Network Density: Alumni stick around, creating a living ladder of support.
Career Optionality: “There are going to be opportunities for you to learn and grow… a lot of times it’s within Michigan Medicine too.”
The Bottom Line: Build range, then go deep
Michigan Medicine’s Administrative Fellowship blends intentional project design with access to decision-makers—and it asks fellows to own their journey. Year 1 maximizes range through a curated portfolio; Year 2 transforms that range into depth via immersion. Along the way, the program’s mentorship architecture and culture of executive access build the confidence and relationships fellows need to lead.
Actionable next step—whether you’re a candidate or a program lead:
Candidates: Draft your must-have matrix (learning culture, mentorship cadence, leadership access, project model, geography). Use it to prune your list to a focused 10–15, then prepare authentically.
Program leaders: Publish your mentorship cadence, list sample projects with sponsors, and invite candidates to shadow a leadership meeting. Make fit obvious.
As Trent’s experience shows, when structure and support align, fellows deliver outsized impact quickly—sometimes in as little as a week—while building the kind of careers that keep them in the system, paying it forward to the next cohort.
In the U.S., millions of adults have CKD, yet identification, follow-up, and day-to-day self-management remain uneven across communities and health plans. In this episode of the The Strategy of Health podcast, we spoke with Howard Shaps, MD, MBA , Chief Medical Officer at Healthmap Solutions, about why patients slip through the system and how Healthmap’s care navigators help close the gap.
Dr. Shaps’ perspective spans the emergency department, plan leadership at national insurers, and population health operations. His central point is disarmingly pragmatic: “We need to have patients see their doctors, take the right medications, stay on their medications—and if you do that, as well as diet and lifestyle, you go a long way.”
Why do CKD patients fall through the cracks?
They fall through the cracks because complexity meets limited bandwidth. CKD coexists with diabetes, hypertension, and cardiovascular disease, and the clinical plan is only as strong as what happens after the visit. As Dr. Shaps explained, “The docs are really good… what they don’t have are eyes and ears outside their four walls.” Patients may mishear instructions, lack transportation, skip refills, or face food insecurity and behavioral challenges that derail adherence.
Key reasons patients slip
Late recognition: Many patients aren’t identified until Stage 3–5, when risk escalates.
Fragmented accountability: PCPs, nephrologists, cardiologists, and pharmacies operate in parallel, not as a coordinated system.
SDOH headwinds: Transportation, literacy, and affordability issues hinder execution of even the best care plans.
Short clinical touchpoints: Fifteen minutes can’t compete with daily habits; as Shaps put it, “It’s hard to change behavior overnight.”
What makes CKD management uniquely hard for community physicians and health plans?
It’s uniquely hard because CKD isn’t a single disease—it's a risk multiplier woven through multiple specialties and settings. Community physicians can write the right prescription; the challenge is what happens next. Plans can see claims, but not always the nuance of readiness, knowledge, or barriers at the member level.
From Dr. Shaps: “Patients may forget to fill prescriptions or they don’t have transportation… I can’t tell you how many times we’ve talked to patients who said, ‘I didn’t understand anything that was told to me.’” For health plans, the difficulty is prioritization and timing: Who is most likely to decompensate in the next 12 months, and what intervention—clinical, social, behavioral—will matter most right now?
The practical pain points
Polypharmacy and contraindications across cardiometabolic conditions.
Variable nephrology access amid perceived specialist shortages.
Data latency—claims arrive after the fact; clinical data is siloed.
Benefit design complexity—members struggle to navigate referrals, surgeries (e.g., dialysis access), and cost-sharing.
How does Healthmaps' navigator model actually work?
Healthmaps' navigator model identifies high-risk members early, activates support outside clinic walls, and closes loops with providers. In Dr. Shaps’ words, “We’ve looked at millions and millions of lines of claims data, clinical data, and other data points… our risk-stratification engine shows who is higher or medium risk for an acute event in the next 12 months.” Technology spots the signal; people move the needle.
A simple, repeatable flow:
Detect: AI-driven risk stratification flags members by event risk and care opportunities (labs due, missed refills, ED use).
Engage: Nurse navigators call, text, and educate—clarifying meds, scheduling visits, solving transport issues.
Coordinate: Navigators share timely insights with PCPs, nephrologists, cardiologists, and endocrinologists.
Escalate: For Stage 4–5, navigators initiate transplant-first conversations and early dialysis education.
Reassess: Knowledge checks and outcome tracking refine the plan.
The “secret sauce” is an operating system that blends analytics and human connection. As Shaps put it, “The secret sauce is technology—but there’s a people component as well, and a clinical operations component.”
Why partner with Healthmap Solutions instead of building in-house?
Because time, talent, and tight execution matter more than theory. Plans can build, but accruing the data science, protocols, clinical operations, and feedback loops that work at scale takes years. “Can payers do it or can other companies do it? Yes—we think we do it really well,” Shaps noted, pointing to a decade of iteration.
Build vs. Partner—what usually decides it:
Speed to value: Ready-made models and workflows compress the learning curve.
Operational depth: Hiring, training, and supervising navigators at scale is nontrivial.
Provider trust: A vendor that acts as an extension of the clinic earns access and attention.
Governance and economics: Risk arrangements reward those with proven reduction in avoidable utilization.
Which outcomes matter most—and how do navigators move them?
The outcomes that matter most are preventable ED visits, unnecessary admissions, avoidable readmissions, and slowed CKD progression. Healthmap orients interventions squarely around these. “We reduce unnecessary hospitalizations, reduce emergency department visits, reduce readmissions… we slow CKD progression,” Shaps said. Why these? Because they reflect both quality and cost, show up in Medicare Stars, and align incentives across member, provider, and plan.
Navigator levers tied to outcomes:
Medication optimization: Reconcile meds; escalate cardiometabolic therapy opportunities.
Timely specialty care: Ensure nephrology and cardiovascular follow-up happens on time.
Lab vigilance: Close gaps in eGFR, UACR, and other required tests for risk staging.
Barrier removal: Ride coordination, refill reminders, caregiver education.
Behavioral activation: Brief motivational coaching that sticks after the call.
When navigators act as “eyes and ears,” physicians can practice at the top of their license—and members arrive prepared.
Why is early identification (Stage 3) the tipping point?
Because Stage 3 is where trajectory becomes malleable at scale. Shaps emphasized, “We try to identify patients that have Stage 3 CKD… identifying them early is really important because sometimes it’s not identified.” Many Stage 3 patients can be managed expertly in primary care with selective nephrology referral, but someone must orchestrate labs, meds, and comorbidities consistently.
He added a stark reminder: “There’s a lot of kidney disease out there—15% of all U.S. adults, about 37 million people.” For leaders, that prevalence means a broad early-stage strategy beats a narrow late-stage rescue. Early detection paired with navigation also nudges upstream screening—catching Stage 1–2 among patients with diabetes or hypertension.
Your early-stage checklist:
Standardize CKD risk flagging inside primary care registries.
Embed navigator outreach on missed labs and med lapses.
Stand up rapid nephrology tele-consults for “gray zone” cases.
Track conversion from identification → first nephrology visit.
What happens when acuity rises—how do navigators bridge the hardest moments?
They prepare, guide, and prevent “crashes.” For Stage 4–5, Healthmap’s navigators begin with readiness assessments, then move quickly to key decisions. “We’ll start the conversations early about transplant—and transplant first, because that’s always the best alternative,” Shaps said. In parallel, they demystify dialysis—options, home modalities, and lifestyle impacts—and ensure vascular access is planned before a crisis hits.
High-acuity playbook:
Transplant-first counseling and referral workflows.
Home dialysis education (peritoneal or home hemodialysis).
Access surgery coordination with reminders and transportation.
Symptom monitoring and early escalation to avoid ED spirals.
The aim is a planned start rather than a chaotic, on-the-floor initiation. “We’ve seen our planned start rate go up, the crash rate go down, and home dialysis go up,” Shaps reported. That sequence protects quality of life and bends the cost curve.
Does it work—and how do you know?
Yes—when navigation is systematic, measured, and relentlessly iterated. Healthmaps solutions uses knowledge assessments and repeats them post-education to confirm progress. As Shaps summarized, results show movement in the metrics that matter: “Planned starts up… crash rate down… home dialysis up.” Equally important, feedback loops with providers reinforce adoption: navigators bring back specific med and visit opportunities, not generic advice.
What to measure (and show your board):
Avoidable utilization: ED rates, admissions, readmissions per 1,000, risk-adjusted.
Progression markers: eGFR slope, albuminuria control, time to nephrology follow-up.
Treatment readiness: Access placement lead time, transplant referral rates.
Engagement: Answer/connect rates, refill persistence, kept-appointment rates.
Experience: Provider satisfaction with navigator touchpoints; member sentiment.
Report these quarterly, with trend lines and dollar translation—linking clinical wins to financial performance.
Why do behavior and culture matter as much as analytics?
Because daily choices compound more powerfully than any single prescription. “It’s hard to change behavior in a 15-minute conversation. Repetition goes a long way, and having a caring nurse goes a long way,” Shaps said. And yes, culture is candid: “Pizza and cheeseburgers taste really good—it's hard to get somebody to stop.” Navigators add the repetition, empathy, and problem-solving that clinical teams can’t sustain between visits.
Build the culture that sticks:
Normalize micro-touches: Short, frequent check-ins beat quarterly lectures.
Design for frictions: Transportation, refills, copays—remove them one by one.
Coach, don’t scold: Celebrate small wins; anchor progress to personal goals.
Close the loop: Always bring insights back to the physician to reinforce trust.
This is where analytics becomes outcomes: when it is delivered through a human who knows the member’s name, context, and next best step.
What’s next for Healthmap—and for CKD care more broadly?
On Healthmap’s trajectory, Shaps is intentionally modest: “We’ve got our heads down—bringing on new clients, keeping clinically sound programs, staying current when new literature comes out.” Expect steady iteration, not hype cycles. For CKD broadly, Shaps points to therapy and technology tailwinds—new medications that may slow progression and improving options in dialysis access and home tech. The counter-currents are familiar: “There’s a lot of diabetes and hypertension out there… the ability to get healthy food can be a challenge.”
Watchlist for leaders:
Medication adoption across SGLT2i/GLP-1 pathways in appropriate patients.
Tele-nephrology and remote monitoring integrated with primary care.
Home dialysis enablement with training and caregiver support.
Food-as-medicine and transportation benefits that tackle SDOH directly.
Outcome-based contracting aligned to avoidable utilization and CKD progression.
The strategic mandate is clear: keep the programs clinically rigorous and relentlessly practical.
What should payers and providers do now?
Start by focusing on avoidable acute care and readiness for the next stage. “We want patients to get the right care at the right place at the right time,” Shaps stressed. Partnering where it accelerates impact—and resisting the urge to reinvent every wheel—delivers faster gains. As he added, “The unnecessary care is where there’s a lot of opportunity.” That’s where quality, cost, and member experience converge.
An executive action plan for the next 90 days:
Name the metrics: Choose 3–5 outcome targets (e.g., avoidable ED, planned starts, refill persistence).
Stand up navigation for CKD: If partnering, pick a high-value market and launch; if building, pilot with a contained panel.
Embed provider loops: Send actionable member-level insights weekly, not dashboards monthly.
Operationalize SDOH: Budget for rides, refills, and food supports where ROI is proven.
Publish results: Share wins with clinicians and members—momentum compounds.
Administrative fellowships are often portrayed as linear ladders—grad school, fellowship, promotion, and permanence. Rachel Gerhardt, MPH’s path is proof that great careers are rarely straight lines. She began on the phones and at the front desk of Boston Children's Hospital neurology clinic, earned her MPH at night, jumped into a Johns Hopkins Medicine fellowship, took an interim leadership role earlier than planned, chose exploration over early title, led operations at UPMC through COVID, and now steers system integration strategy at Beth Israel Lahey Health in Boston. Along the way, she kept coming back to one north star: values. As she puts it, “the MPH…aligned with my values,” and later, “the value of the fellowship is…you do get to experience every area.” This is the story—and the playbook—behind her rise from patient services to system strategy.
Who is Rachel Gerhardt, and how did she get started?
Rachel Gerhardt is a Boston-area native who launched her career at Boston Children’s Hospital as a patient service representative in the neurology clinic; that frontline role—and the people she met—set everything in motion. In her words, “I ended up…starting at Boston Children’s…in June of 2013…doing a lot of scheduling…answering the phone…that first point of contact for patients.” She didn’t know healthcare administration was a career. “I had no idea what I was getting into,” she admits, but proximity to patients, nurses, and physicians gave her a panoramic view of access, quality, and cost.
That day-to-day exposure did two things:
-It revealed how much administrative work shapes the care experience.
-It showed her leaders’ typical educational paths, nudging her toward graduate school.
Crucially, a supportive preceptor opened doors: “My preceptor…said, oh, you should apply to these entry level positions at the hospital.” If you’re early in your journey, emulate that: shadow operations, ask naïve questions, and notice which degrees and roles keep appearing in the org chart.
Why an MPH at Boston University—while working full-time?
Because it aligned with her values and practical reality. Rachel chose BU’s part-time MPH to keep earning, keep learning, and build toward leadership. “I needed to keep working full-time, so I was looking for a program that I could do part-time,” she explains. The content matched her interests—child development, community health, the social determinants, and the (still relevant) Triple Aim. “The MPH…aligned with my values…what I was interested in,” she says.
The cadence was gritty and sustainable:
-One class at a time → then two → then three when possible.
-Commuting from clinic to campus: “I would take the bus from Children’s over to BU…sometimes I would walk…[and] slowly chipped away at my MPH.”
-Three years of persistence, plus relationships with faculty she still keeps today.
For rising leaders, the lesson is simple: choose a credential that fits your life and mission. Value alignment beats brand-chasing. And don’t underestimate the compounding power of steady progress.
How did she discover administrative fellowships—and why pursue one?
She found fellowships the unglamorous way: by searching. “Honestly, I came across fellowships by just doing my own research…on the BU Public Health website,” she says. What sealed it was access and breadth. “There was just an opportunity to explore so much as part of a fellowship and to interact with the executives of a hospital…mind-blowing.”
Her “why” mixed ambition with curiosity:
-Accelerate development through rotations across operations and strategy.
-Build executive visibility and mentorship.
-Pressure-test passions before specializing.
Rachel compiled a national list—academic medical centers, children’s hospitals, coast to coast. If your program isn’t hands-on with fellowship prep, adopt her approach:
-Mine your school’s career site and alumni networks.
-Identify faculty champions (Rachel later found Prof. Chris Lewis at BU).
-Cold-reach programs early; track deadlines, formats, and criteria.
-Practice telling your story—values first, résumé second.
What was the Johns Hopkins fellowship like—and why take an interim role so early?
It was rotational, relationship-rich, and—by chance—accelerated. She began with exposure to Hopkins’ Children’s Center because of her background. Then timing created an opportunity: “Toward the end of my first year, the assistant administrator…was leaving…[and] I was approached about stepping in interim to that role.” She said yes.
That meant true accountability: inpatient operations for a 205-bed children’s hospital, leading director-level teams, and learning at the steepest possible slope: “I jumped into that role as the interim assistant administrator…overseeing the day-to-day operations…[and] I learned so much.”
Should you take an interim step-up if it truncates rotations? Rachel’s answer is nuanced:
-Yes, if it gives first-line leadership experience you don’t yet have.
-Yes, if the window won’t open again soon.
-But… keep checking against your original “why.”
Which leads directly to her next move.
Why did she choose to step back from that interim position?
Because her “why” demanded exploration, not early anchoring. “I decided to pursue a fellowship to really get exposure to the full health system,” she says. “The value of the fellowship is not just that you get a job…it’s that you do get to experience every area…if you take advantage of it.” She recognized the risk of being typecast as “pediatrics ops,” however prestigious.
So she pivoted—intentionally—toward enterprise strategy. “I met with [Dr.] Lisa Ishi…a newly SVP of health system operations…working directly with [the] president of the health system…And I said…‘I want to work with you.’” That choice—hard in the moment—maximized learning, diversified her network, and broadened her brand.
Takeaway: When an early title conflicts with long-term range, you’re allowed to choose range. You can be loyal to your organization and still loyal to your development.
What did life outside work in Baltimore teach her?
That community accelerates growth and resilience. Rachel says it plainly: “It was the best decision I ever made… I loved Baltimore.” Her small class (three fellows) became an immediate support system—dinners, scooters (it was the year they hit the city), and rec-league sports. The point wasn’t nightlife; it was belonging. “We really just created this great network of people…you have to put yourself out there.”
If you’re relocating for a fellowship:
-Treat social planning like project planning—make the list, set the cadence.
-Join a league, meetup, or volunteer shift within 30 days.
-Cross-pollinate with other fellowship programs at conferences; the national network is real.
-Remember Baltimore’s nickname: Charm City—and go find its charm blocks.
Geography isn’t destiny, but choosing to build community is a leadership act. The relational capital you bank outside work pays dividends inside it.
Why leave Hopkins after fellowship—and what’s the right way to navigate mentors?
COVID’s timing, a cross-city relationship, and a compelling role at UPMC all converged. “Turning [Hopkins offers] down was the hardest decision…,” Rachel says. But the method mattered as much as the outcome: “Talk to your people about it…be open…you don’t really want anyone to be shocked.” Her mentors modeled healthy sponsorship—supportive even when her path diverged.
Her rubric for good mentors is worth copying:
-They can be disappointed and still champion you.
-They separate institutional preferences from your best interests.
-They stay in your corner after you leave.
And if someone weaponizes your choice? That’s data. “Those aren’t the mentors that you want in your life.”
What did UPMC teach her about operations, management, and the ops–strategy myth?
UPMC gave her scope and stewardship. She entered as a director of operations with direct reports—through the chaos of early COVID—and later became division administrator for General Internal Medicine. The people side was the crucible: “Managing people…is the most challenging thing.” That’s why early management reps matter for future executives.
She also rejects a false dichotomy: “You don’t have to pick [ops or strategy] and you can go back and forth.” Operations is strategy-in-action; strategy without operational empathy is theater. For fellows and early leaders:
-Seek roles where you own a P&L slice and contribute to system priorities.
-Ask for projects that tie capacity, access, and patient experience to growth and quality.
-Measure your success by changed outcomes, not just completed tasks.
In short, become bilingual. Speak both Gemba and boardroom.
Why return to Boston—and what does system strategy look like at Beth Israel Lahey Health?
Family, mental health, and timing drove the move; professional fit sealed it. “It was really a personal reason,” Rachel shares. With a young son, no nearby family in Pittsburgh, and the pull of home (and Baltimore as a close second), she and her spouse chose proximity over continuity. The happy complexity: “I married that fellow…we now have two children.”
Professionally, Beth Israel Lahey Health offered enterprise strategy during a pivotal phase. “I am now more in a strategy role…working across the health system,” she explains of her Director of Integration remit within a relatively new, 14-hospital system that merged just before COVID. Like a mini-fellowship, she works with senior leaders on “where we’re going, how we’re getting there, and what it looks like.”
For executives, that translates to:
-Post-merger integration: governance, operating model, and service line alignment.
-Access and growth: site-of-care strategy, capacity management, and referral pathways.
-Outcomes and experience: standardization that respects local realities.
The throughline remains values and relationships—plus the humility to let life stage influence strategy stage.
What one piece of advice would she give fellows and rising leaders?
Be authentic, be curious, and do the work. “People just at the end of the day wanna connect with like a real person…so just like be yourself,” she says. That doesn’t mean passivity; it means initiative with humanity. “Make an effort to get to know people. Make an effort to get to know your organization and put yourself out there.” Authenticity earns trust; effort earns opportunity.
Practical ways to operationalize that:
-In interviews/personal statements: share what you value and why.
-In rotations: ask for feedback, volunteer for the messy projects, close loops.
-With executives: come with a point of view and a question—not just a calendar invite.
-With peers: build the dinner list, organize the run club, be the glue.
And when choices get hard? Return to your “why,” as Rachel did—repeatedly.
Key moments and lessons you can use tomorrow
Here’s a quick checklist distilled from Rachel’s journey:
-Frontline first. If you haven’t worked in access, ambulatory, or inpatient flow, find a way to get close. It sharpens your empathy and your strategy.
-School–work fit. Choose programs that match your life and values; part-time doesn’t mean part-quality.
-Research like it matters. Fellowships won’t find you. Build a tracker; start early.
-Titles aren’t trajectories. Take interim roles for reps, not résumé lines—and be willing to pivot back to your plan.
-Mentors who stay. Be transparent with sponsors; retain the ones who honor your goals.
-Ops ↔ Strategy fluency. Learn to toggle; seek roles with both execution and design.
-Community is a competency. Your off-hours network sustains on-hours performance.
-Life stages count. Family, health, and place are strategic variables, not afterthoughts.
As Rachel reflects, “It’s not that easy…there’s definitely hard moments,” but alignment beats autopilot.
Final Takeaway
If you remember only one thing, make it this: careers compound when values lead and curiosity drives. Start where patients are; study what aligns; use fellowships to widen—not narrow—your horizon; say yes to reps, no to boxes; and keep choosing the mentors, moves, and cities that let you be both human and high-performing. Or, as Rachel puts it, “be yourself…work hard…put yourself out there.” Do that consistently, and the path from patient services to strategy becomes less a leap and more a series of intentional, values-backed steps.
Why this conversation matters now
In an era when clinician burnout and patient distrust can feel like permanent fixtures of the healthcare landscape, the most effective leaders are the ones returning the system to first principles: humanity, humility, and shared purpose. The COVID-19 pandemic didn’t invent the cracks between bedside and boardroom—it widened them. Today, rebuilding trust demands more than new dashboards or staffing models; it calls for leaders who can translate across cultures, listen deeply, and act with courage.
That’s the work of Gwendolyn Williams MD, FHM—a hospitalist and associate professor of medicine at VCU Health and a long-time physician leader who served as President of the Medical Executive Committee (a role akin to Chief of Staff) at Sentara CarePlex Hospital in Hampton Roads. Across roles in governance, wellness, and chapter leadership with the Society of Hospital Medicine (SHM), Williams has built bridges between clinicians and executives while keeping the patient—and the person providing the care—squarely at the center.
Her core thesis is deceptively simple: “Healthcare is a business, medicine is an art, and the two do not necessarily marry well — but they must respect each other.” Respect, she argues, is the shortest path to common ground, the precondition for trust, and the first step in shifting cultures that can drift into toxicity under stress.
What follows is a synthesis of Williams’s journey and playbook—equal parts narrative and analysis—on how to lead with presence, rebuild trust after collective trauma, and transform cultures through listening, compassion, and shared accountability.
From Bedside to Boardroom: A Clinician’s Path to System Impact
The throughline: advocacy and early leadership
Williams doesn’t pinpoint a single moment when she “became” a leader. “It happened very early,” she says—well before medical school—through advocacy, community work, and a long string of student leadership roles. That early experience became a throughline in her clinical career as a hospitalist: the discipline of caring for acutely ill, hospitalized patients while navigating the complexity, pace, and uncertainty of inpatient medicine.
As she moved into formal leadership, Williams served as Vice President of the medical staff and later as President of the Medical Executive Committee at Sentara CarePlex Hospital, the physician governance body where bylaws are stewarded, quality is debated, and peer review and professionalism are addressed in direct collaboration with the C‑suite. In parallel, she led the SHM Hampton Roads chapter—“a role that brings me absolute joy”—and under her leadership the chapter earned national recognition.
Pandemic pivot: wellness as a strategic imperative
In January 2020, Williams co‑founded and then chaired a wellness and engagement team. Within weeks, COVID-19 transformed that agenda from a “nice-to-have” to a survival strategy. The focus expanded from patient safety to psychological safety—“really looking at our, not just our patients, but the people who provide care equally and everyone’s wellbeing being collectively important.” The group pivoted quickly, helping clinicians surf the emotional whiplash of the unknown while partnering with administrative leaders to translate risk, resources, and reality in real time.
The lesson: wellness cannot be episodic or ornamental. It must be built into the operating fabric, with governance attention and clinician voice. And it requires leaders comfortable advocating in both directions—explaining the operational constraints that administrators face and, just as importantly, making the human case for frontline needs.
Closing the Distance Between Clinicians and Executives
The gap is real—and relative
Williams refuses to romanticize the divide. “The gap is subjective,” she notes. “It’s relative to the group you’re a part of and who’s around you.” What widens the space, she argues, is less malice than misunderstanding: executives don’t always grasp how decisions land at the bedside; clinicians don’t always appreciate the constraints of capital, regulation, or system tradeoffs. The work is to translate.
Translation starts with posture. “The goal is not to win,” Williams says. “The goal is to find common ground.” In practice, that means entering discussions not as combatants but as collaborators serving a single team: patients and community. That shift of frame—from sides to shared purpose—invites curiosity and opens room for solutions.
Listening as leadership muscle
If translation is the work, listening is the muscle that powers it. Williams is candid about how hard it is: “In healthcare, we think we’re the best listeners. We are the worst listeners.” Her humbling moment came not in a boardroom but at home. Lost in mental to‑dos, she missed her three‑year‑old’s words until her daughter grabbed her face: “Mommy, you are not listening to me. I need you to hear me.” That, Williams says, is the daily corrective leaders need: hold space before making a point; reflect before reacting; hear the person, not just the problem.
This is not soft-skills garnish; it’s operational strategy. Leaders who listen surface constraints earlier, defuse conflict sooner, and design systems people can actually use. Listening is also the wellspring of dignity at work—the experience of being seen and taken seriously—which becomes fuel for effort in high‑stress environments.
Power and humility
Williams’s theory of power is as much ethical as it is practical. “Power is something to be respected,” she says. “If you do not have the humility to bend down and pick up power that someone has laid at your feet, you should not have it.” Exercised well, power invites participation; misused, it breeds fear and disengagement. Her meetings model belonging: kids’ voices in the background are okay; contributions are welcomed in their own time; the culture prizes candor without bullying. When leaders normalize humanity, people take risks on behalf of patients.
Kindness, accountability, and the courage to be better
Williams is blunt about cultural drift in parts of healthcare: “The culture of healthcare is extremely abusive. It’s extremely toxic because people don’t take the time to think about what they’re going to say and how they’re going to say it.” Her remedy is not performative niceness but principled kindness. “Kindness is not weakness. It’s a great strength.” Coupled with accountability, it changes trajectories: apologize and mean it, then improve the behavior. “Don’t be sorry. Be better.”
Rebuilding Trust After Collective Trauma
Two fronts of trust: communities and the workforce
Trust “takes seconds to break and a lifetime to repair.” Williams argues that healthcare must rebuild on two fronts at once. The first is trust with patients and communities—especially those long underserved. The second is trust with the workforce itself, frayed by the pandemic and its aftermath.
On the community side, trust grows when the system engages with people as whole humans. “Focus on our patients and our communities beyond their medical illnesses,” Williams urges, naming food insecurity, housing, education, and health literacy as practical starting points for cross‑sector collaboration.
On the workforce side, acknowledging trauma is non‑negotiable. “We need trauma‑informed leaders,” she says, those who know that a “keep calm and carry on” message after mass loss and prolonged moral distress is not only unrealistic—it’s harmful. In Williams’s practice, that looks like debriefs after code events, moments of silence, and explicit permission for clinicians to experience and process big emotions. Safety lives not just in personal protective equipment but in psychological safety: the shared belief a team can speak up, ask for help, and be human.
Policy levers matter: Lorna Breen and beyond
Culture and policy must move together. Williams points to the Dr. Lorna Breen Heroes’ Foundation as a model for changing the structural incentives that punish vulnerability, particularly invasive mental‑health questions on credentialing forms. Removing those barriers, she argues, is a concrete step toward treating clinician mental health as a safety issue, not a stigma.
And, she cautions, symbolic efforts won’t cut it: “As much as I like pizza—I’m a New Yorker—a pizza party is not going to fix this.” Real rebuilding requires investment, measurement, and hard choices about what gets deprioritized so that people can recover.
Programs, Practices, and Stories That Move Cultures
Wellness and engagement as an engine for change
Williams’s wellness and engagement team, launched in early 2020, is a case study in making wellbeing actionable. The team’s anchor ideas—psychological safety, bidirectional communication, and parity between patient and caregiver wellbeing—helped leaders justify time for debriefs, normalize asking for help, and keep executives close to the frontline signal in the most chaotic moments of the pandemic. The pivot was not about perks; it was about codifying humane practice under pressure.
The SHM chapter as a micro‑culture of belonging
As President of SHM’s Hampton Roads chapter, Williams emphasizes culture-setting as core work: celebrating contributions, modeling inclusive meetings, and protecting autonomy so leaders can grow without micromanagement. The results—recognition at the national conference and a pipeline of energized leaders—flow from design choices that prioritize belonging. In Williams’s telling, joy is not a by‑product of a healthy chapter; it’s a leading indicator of future impact.
Translating needs: from home visits to medication access
On any given day, the bridge work is granular: making the case for affordable medications, explaining why timely home health visits post‑discharge matter for frail elders, or advocating for collaboration across specialties and even across systems so that a patient’s care plan is coherent. Williams names these not as abstractions but as the daily content of translation: clinician stories that help administrators see the “why,” and administrator context that helps clinicians understand the “how.”
Choosing peace over chaos in moments that matter
Williams tells a domestic story with professional implications. After an exhausted morning, she lashed out over unwashed bottles and later apologized. Her husband asked a single question: “Why did you choose chaos over peace?” The question landed. In hospital dynamics—an undrawn lab, a delayed study, a scarce resource—the reflex to escalate is powerful. Choosing peace is not avoidance; it’s a strategy to “funnel passion,” to invite people into a calmer space where problem‑solving becomes possible. It takes time, she admits, and “time is the thing we always feel we don’t have,” but embracing that time is how change sticks.
Leadership, Wellness, and Community Collaboration: The Intersection
A round table with no head
Williams’s metaphor for the future is a round table with no head: clinicians, executives, patients, and community partners approaching problems with equal dignity and voice. “If I’m in the room where it’s going to happen, I need to not only have a voice, but champion other voices that are in the room—and the voices that can’t be in the room.” That’s what it means to keep “the human in healthcare.”
The practical implications are many: bring community organizations into care planning; align on shared outcomes beyond volume and RVUs; publish staffing and safety metrics alongside patient‑experience data; build feedback loops that reach the people who can act. Respect the art and the business—and make them respect each other.
Compassion as operational design
Compassion, for Williams, is not the impulse to fix everything immediately. It’s “the desire to be there, understand, be mindfully present, and then ask: How can I help?” That stance helps leaders avoid two traps: dismissiveness (which erodes trust) and over‑promising (which breeds cynicism). Compassionate leadership aligns expectations with resources while making it unmistakable that people’s experiences matter.
Redefining success: excellence over perfection
Perfection, especially in complex systems, is a mirage. Williams reframes success as excellence pursued together: agreeing on goals, iterating in the open, and measuring progress with humility. When teams internalize that frame, they are more likely to surface problems early, learn quickly, and persist through the messy middle of change.
Actionable Takeaways for Health System Leaders
Build the bridge on purpose
Start with respect, not righteousness. Enter tough conversations assuming the other party is acting in good faith within real constraints. Name the shared goal—healthy patients and a healthy community—at the outset.
Translate relentlessly. Ask clinicians for the story behind a request (the patient, the risk, the workflow). Ask administrators for the tradeoffs behind a decision (financial, regulatory, operational). Publish those explanations.
Institutionalize listening. Design meetings where listening is a discrete step: reflection rounds, structured “hold space” practices, and real pauses before decisions. Reward leaders for listening behaviors.
Make wellness structural. Treat psychological safety like hand hygiene: expected, measured, and led from the top. Normalize debriefs after adverse events, invest in peer support, and make time for recovery part of the schedule, not after-hours charity.
Adopt trauma‑informed policies. Remove stigmatizing mental‑health questions from credentialing, simplify access to counseling, and train managers on recognizing moral injury and responding without punishment.
Model kindness and accountability. Coach leaders on giving critical feedback without humiliation. Replace “I’m sorry” cycles with concrete improvement commitments. Track whether behavior changes.
Share power. Build round‑table structures—co‑chaired councils, clinician‑administrator dyads, patient/community representatives with real votes—so that decisions travel on more than one rail.
Choose peace in the moment. In escalation-prone settings, equip leaders with language and tactics to downshift the temperature (acknowledge emotion, restate goals, propose a next step). Protect the time that calm requires.
Measure trust. Don’t guess. Use pulse surveys, focus groups, and exit interviews to quantify trust among clinicians and staff. Share results transparently and act visibly on what you learn.
Aim beyond the diagnosis. Partner with community organizations on food, housing, education, and health literacy. Build shared dashboards to track impact outside hospital walls.
Conclusion: Respect as Strategy
Williams’s leadership philosophy is not theoretical—it is hard‑won at the intersection of human vulnerability and system constraint. The prescription is clear: honor the art and the business; design for listening and psychological safety; lead with compassion and accountability; build a table where every voice matters. Do these things, and the distance between bedside and boardroom begins to shrink.
“Take away titles, take away white coats,” Williams says. “We’re all human beings and we have a shared humanity.” In a system that has survived crisis after crisis, that reminder is not sentimentality. It’s strategy—one that just might rebuild trust where it matters most: between people who heal and the people they serve.
Introduction: Urgent Care’s Tipping Point
Urgent care in the U.S. is at a crossroads. Patient expectations have soared, staffing is volatile, and traditional “assembly line” models are buckling under demand. The industry’s average door-to-door visit time hovers near an hour hardly consumer-friendly when retail and tech sectors have trained Americans to expect speed, convenience, and personalization. But what if urgent care could reliably deliver a five-star experience in half the time, without sacrificing quality or compliance?
Enter Brandon J. Robertson, founder & president of UCP Merchant Medicine and Intellivisit Solutions, whose “clinical concierge” approach and data-driven lean design are upending decades-old workflows. In a recent interview, Brandon outlined not only how his team has cut door-to-door times in half, but why eliminating handoffs and embedding AI-driven protocols at the front lines are key to the urgent care revolution. Below, we break down the conversation, answer executive-level questions, and pull practical lessons for leaders navigating the future of on-demand care.
What Inspired the Reinvention of Urgent Care?
Robertson’s journey from Johns Hopkins finance intern to urgent care disruptor was shaped by firsthand experience with bottlenecks and waste.
Asked what led him to focus on this niche, Brandon explained: “So when I was at Johns Hopkins, I had the opportunity to learn about how finance and healthcare actually work. … I didn’t understand the revenue cycle, and rate regulation is a nightmare unto itself.”
But the real turning point came during his administrative fellowship, where he realized, “I got into urgent care at AdventHealth in Florida. That’s where I started to figure out why I love consumer-centric retail medicine models and how to make the experience just better.”
The insight: Healthcare’s “provider bottleneck” isn’t a criticism. It is a solvable design challenge. Robertson saw that eliminating unnecessary steps and handoffs could fundamentally transform speed, satisfaction, and outcomes.
How Do Clinical Concierge and Lean Design Slash Door-to-Door Time?
Clinical concierge and lean, Six Sigma-driven workflows reduce urgent care visit time from a U.S. average of 58–68 minutes to as low as 28 minutes.
To answer directly: This is accomplished by radically streamlining patient flow and embedding diagnostic and administrative tasks into a single role, guided by AI and standing orders. Robertson details: “We rewired the whole process. There’s a person that greets you at the door—they’re called the clinical concierge… I register you, I collect your payment, I run all your insurance, I do your vitals, I ask you a series of AI-assisted medical interview questions… all the tests are run in the room.”
Here’s the typical old workflow:
-Registration (10 minutes)
-Wait/handoff (7 minutes)
-Rooming/vitals (5 minutes)
-Wait/handoff (7 minutes)
-Provider visit (10 minutes)
-Provider orders tests, more handoffs/waits (7+ minutes)
-Discharge (5 minutes)
Total: approximately 58–68 minutes (with 30–40 minutes spent just waiting between handoffs).
Robertson’s “clinical concierge” model:
One person handles registration, payment, insurance, vitals, history, and most testing—with AI recommending diagnostics based on standing orders.
The provider enters once, reviews AI-compiled findings and documentation, confirms or adjusts the plan, and signs off.
No redundant handoffs; no waiting between steps.
As Robertson puts it: “All these little handoff times have gone away. … When you chop all that down, you end up reducing from 58 minutes down to 28 minutes.”
Key takeaways:
-Each “handoff” adds about 7 minutes on average.
-Cutting handoffs slashes wasted time, cognitive load, and errors.
-Door-to-door time is halved—from a national average of 58 minutes to 28 minutes in the best models.
Why Haven’t Larger Consulting Firms or Health Systems Done This Already?
Despite evidence and ROI, entrenched habits and mental models have kept the “assembly line” urgent care model alive.
Why not sooner? According to Robertson: “If you always heard the Toyota way is the way to do things, then you would think…you would never even try it because you’d think Toyota is the way to do it. The reality is assembly line models are fantastic if you’re going to make 2 million of exactly the same car. … If you’re trying to be hyper-efficient at seeing one unique case at a time, you’ve got to do it more like Rolls Royce.”
Barriers have included:
-Reluctance to challenge accepted process-improvement dogma (“batching” vs. “single-piece flow”).
-Lack of integrated IT systems and AI-driven decision support.
-Inertia: “We’ve always done it this way.”
-Skepticism about cross-training and role expansion.
The inflection point: As AI and EMR integration matured, standing orders could finally be executed accurately and compliantly at scale, removing the last operational and clinical hurdle.
How Does AI-Powered Clinical Decision Support Change the Game?
AI enables standing orders to be executed consistently, safely, and efficiently, transforming care team roles and compliance.
Robertson is blunt about the limitations before AI: “Before we built the AI platform, we were using basically human memories to figure out when it would or would not make sense. … We found out that they were only doing it in about 4% of appropriate cases.”
Now, with AI:
-Clinical concierges get real-time prompts (for example, “Run a strep test if CENTOR score is met”).
-Medical leadership signs off on standing orders—not case by case.
-AI reviews intake answers, SDOH risk, and symptoms, then triggers appropriate diagnostics instantly.
Robertson shares a cautionary tale: “You’ll figure out real fast how bad your standing orders actually are when you have AI reminding people on every single case. … We had a client that increased their glucose testing from about two a week to about 30 a day.”
This forces organizations to re-examine sensitivity and specificity, and continually refine protocols—an unexpected but valuable side effect.
What Are the Staffing and Productivity Implications?
Clinical concierge models can double provider productivity, improve satisfaction, and shrink clinic square footage by 40 percent, all while maintaining quality.
Direct answer: By redesigning workflow, each provider can now see up to 60 patients a day, supported by three clinical concierges each handling one patient at a time.
Robertson spells it out: “If a provider is going to spend even 10 minutes with a patient, how many 10 minute blocks are there in an hour? Six. So if you have three clinical concierges and one provider…that puts you at a level of basically them seeing somewhere between one and three patients at any given time throughout a 12-hour shift, one patient at a time under the responsibility of each one of those concierge.”
Operational impacts:
-Dramatic reduction in provider “room-hopping” and task-switching.
-Clinics operate profitably at just 15.7 visits per day (versus industry average break-even of approximately 43).
-Average urgent care site size shrinks from 3,500 sq ft to approximately 2,000 sq ft, slashing fixed costs.
This is not theoretical: “Our centers are about 2,000 [square feet] … you can chop that way down because of, again, consolidation of productivity methods.”
Can This Model Work for Both Large Systems and Rural Clinics?
Yes. AI-powered, handoff-free urgent care models are deployed across both multi-hospital giants and single-site rural settings.
Robertson emphasizes scalability: “We’ve used it in the most densely packed urban environments of America to…a location with a population of 5,000 right now. … It’s total ends of the spectrum. All payer mixes, all levels of social determinants of health.”
-Works in multi-state, 30-hospital systems (think CommonSpirit, Advocate Health/Atrium Health).
-Already operating in rural clinics with as few as 5,000 residents.
-AI normalizes intake, testing, and risk assessment—regardless of geography or patient mix.
Bonus: AI can highlight SDOH needs and ensure unbiased, guideline-concordant care, helping underserved populations get the right tests and referrals.
Why Invest in Urgent Care Instead of Primary Care or the ED?
Urgent care is the “gateway” to long-term patient relationships, especially for healthy, commercially insured patients.
“Urgent care has a very unusual patient population. Specifically, the people that utilize urgent care are healthy people. Health systems are highly adept at connecting with patients that are 65+ or pregnant, but if you don’t fall into those buckets, health systems don’t really have a great way to connect with patients directly,” Robertson explains.
-Urgent care is often the only “touch point” for young adults, families, and university students.
-Profitability: Primary care usually runs at a loss; urgent care can break even at low volume and drive margin.
-Each visit becomes a “primer” for future health system loyalty.
-Downstream value is enormous:
ROI is measured in three phases:
Income statement: Immediate profitability by right-sizing sites and workflow.
Downstream referrals: Specialty care, imaging, surgery, etc.
Lifetime value: Multi-year NPV based on capturing young, healthy patients who later require complex care.
How Does the Implementation Process Work for Health Systems?
UCP Merchant Medicine customizes urgent care transformation “soup to nuts”—from strategy to site selection, rollout, and ongoing support.
Robertson lays it out: “We get brought in to do things soup to nuts. So we start all the way from ‘what is the purpose of urgent care? Why are you doing this?’ … Then we figure out markets, do site selection, design the model, build it for every health system partner, roll it out, and then we teach them how to run it and step away.”
Key steps include:
Define the strategic purpose for urgent care in the system.
Market prioritization and data-driven site selection.
Model customization based on local strengths, needs, and patient mix.
Operational rollout, staff training, and real-time performance metrics.
Handoff and ongoing support for optimization.
What Leadership Skills Are Needed to Build Transformative Systems?
Robertson credits “individualization”—the ability to quickly identify and nurture top talent—as his core leadership strength.
He’s matter-of-fact: “I’m not saying I have such a superpower, but what I am good at is I reliably pick the best people and it doesn’t take a lot of time for me to engage with somebody to figure out whether or not they’re a rockstar.”
He continues: “This individualization…has allowed me to have just great people—the best people that know exactly what they’re doing, and as such, they’ve been able to build a lot of capabilities within our organization, which have allowed us to achieve key performance indicators that no one else achieves.”
For leaders looking to replicate these results:
-Invest in team selection, not just process.
-Cross-train staff for multi-functional roles.
-Cultivate a culture that adapts, iterates, and measures relentlessly.
Takeaway: The Path Forward for Urgent Care Leaders
The reinvention of urgent care is not theoretical. Robertson’s team has proven that eliminating handoffs, embedding clinical concierge roles, and leveraging AI can halve visit times, delight patients, and drive new ROI for health systems. But success is not just about technology or process. It is about rethinking assumptions, breaking away from batch-process dogma, and investing in people who can deliver on the promise of healthcare’s next chapter.
Actionable Insight: If you are a health system executive, challenge your team to map every handoff, measure every wait, and pilot a clinical concierge model—even in a single site. The results will speak for themselves: shorter visits, higher Net Promoter Scores, less staff burnout, and a real competitive edge in America’s changing care landscape.
“We get to have massive impact. It’s just so much fun. We’re at the best time.” – Brandon J. Robertson
Want to hear more from leaders transforming healthcare delivery? Subscribe to The American Journal of Healthcare Strategy for fresh stories, evidence, and strategies every week.
Food insecurity is more than a social issue—it’s a daily crisis for millions of Americans, especially in rural states like Oklahoma, where access to healthy food is often as much about infrastructure as economics. But a quiet transformation is underway. Across central and western Oklahoma, clinics, hospitals, and food banks are redefining how and where patients access nutritious food. At the heart of this movement is Keeley White, MPH, PMP, Director of Community Health Programs at the Regional Food Bank of Oklahoma, who brings a deeply personal commitment and public health expertise to the fight against hunger.
In this interview, White shares how her team partners with medical providers to screen for food insecurity, overcome transportation and funding barriers, and ensure that every Oklahoman regardless of zip code can access not just calories, but health.
Why Are Oklahoma Clinics Addressing Food Insecurity?
Oklahoma’s medical clinics are tackling food insecurity because they see first-hand how nutrition impacts patient outcomes. “Food insecurity isn’t just about missing meals. It’s about chronic health crises, expensive diets, and the stress that comes with illness,” says White. Her own experience battling childhood cancer made clear that “maintaining a healthy diet while going through treatment was a struggle—not just physically, but financially for my family.”
Clinics are motivated to act for several reasons:
Food as medicine is gaining traction: More providers recognize that a patient’s ability to follow a treatment plan often hinges on whether they can afford nutritious food.
Public health research is clear: Poor nutrition worsens chronic conditions, increases healthcare costs, and prolongs recovery.
Equity matters: Oklahoma’s rural landscape makes equitable food access a logistical puzzle. “We really focus on equity and trying to make sure we’re filling all the gaps, we’re identifying all the barriers, and trying to find ways to alleviate those barriers for the Oklahomans that we work with,” White emphasizes.
By integrating food support into clinical care, Oklahoma clinics aim to break the cycle of poor health and poverty.
What Are the Biggest Barriers to Feeding Patients in Oklahoma?
The primary barriers are geography, infrastructure, and community resources. As White notes, “Oklahoma is a very rural state… we cover 53 counties of central and Western Oklahoma, and so it’s really important to us that we really focus on equity.” Rural areas struggle with:
Distance and transportation: Many patients live far from clinics or food pantries, sometimes with inadequate roads or no public transit.
Limited local partners: Some small towns lack any food pantry or volunteer infrastructure.
Resource scarcity: Clinics and partners often operate with minimal financial or volunteer support.
Urban clinics, while better resourced, face other issues: “In the urban areas, we deal with issues… like crime or general safety of some of our members,” White says, which can discourage patients from seeking food or healthcare.
Solutions to Rural Access Challenges
No two communities are alike. White’s team tailors solutions, including:
Partnering with local transit or developing door-to-door delivery for seniors and those without transportation.
Building community-specific programs: “You have to kind of find a solution for that specific community,” White advises.
Launching state-supported transportation projects for older adults to ensure access to clinics, pantries, and essential services.
These solutions require not only creativity but deep trust and collaboration with community members.
How Do Clinics Identify and Address Food Insecurity?
Clinics start by screening patients for food insecurity and then act quickly to provide resources. The Regional Food Bank’s model begins with direct partnerships:
Leadership Buy-In: “We just meet with the leadership, and hopefully the individuals or staff at the clinic who will be involved in the program and give an overview.”
EMR Integration: Clinics add food insecurity screening questions to their Electronic Medical Records (EMR) systems to systematically identify patients in need.
Staff Training: White’s team provides hands-on training so clinic staff can have sensitive conversations about food insecurity and understand available resources.
Immediate Food Assistance: When a patient screens positive, “we actually implement a food pantry within the clinic setting so that when a patient is identified as at risk… they are provided with immediate access to healthy food assistance.”
Sustainable Support: Patients are referred to local pantries, SNAP (food stamps) application assistance, and other federal programs for ongoing help.
This process ensures that food insecurity is not just identified but directly addressed—without burdening already overworked healthcare providers.
What Does Partnership with Medical Clinics Look Like?
Partnerships vary depending on local context and resources. White explains, “Some of our healthcare partners do have their own foundation that they’re able to fund the program, but a lot don’t—federally qualified health centers, especially, free clinics, critical access hospitals are already struggling.”
To avoid adding financial stress, the Regional Food Bank aims to offer services at no cost to most partners. This is possible through:
Diverse funding streams: White manages “many, many grants—federal, state, and foundation grants—to take some of the pressure off our organization.”
Direct fundraising: The Food Bank works with local partners like the Integris Foundation and leverages donations to keep programs running.
Flexibility: Some clinics can partially fund the program through their own resources, but most rely on external funding.
Fiscal discipline is essential. As White puts it, “I am juggling many, many grants… and definitely have had to get really good at that and build those skills sometimes through, you know, learning the hard way.”
How Are Programs Adapted to Local Community Needs?
Customization is the rule, not the exception. White’s team relies on a network of Community Connections Managers who work “grassroots” in each county. Their job is to:
Know local partners and community resources intimately
Identify unique barriers (transportation, language, volunteer shortages)
Build trust and design programs that fit the local culture
“Once you go to one food pantry, you’ve been to one food pantry,” White says. “They’re all very different… and have their own culture. We never want to go in and say it’s our way or the highway.”
Programs are built with communities, not for them. This collaborative approach ensures that solutions are sustainable and genuinely effective.
What Are the Key Lessons for Building Clinic-Food Bank Partnerships?
1. Do Your Homework: “Obviously do some landscape research… it’s so much better to not reinvent the wheel if you can avoid that at any cost,” White advises. Know what models exist and what’s already working.
2. Start Small and Learn: Pilot programs are essential. “We did a two-year pilot to start with, to really kind of figure that out… it’s a pilot so it’s a mess, and you have no idea what you’re doing at all.” Embrace imperfection and iterate.
3. Involve the Community: Talk to people who are managing similar programs, understand barriers, and ask local partners what will work best.
4. Expect Mistakes: Flexibility and a learning mindset are critical. “The most important thing to do is to learn. Remind your team that it’s not going to go perfect… bear with me, you know, as much as you can.”
5. Build Trust, Not Dependence: Respect the unique culture of each community and empower local leaders to take ownership.
What Are the Measurable Impacts So Far?
Growth has been rapid. The Regional Food Bank’s Healthcare Partnership Program started as a pilot in 2016-2017 with a single clinic. Now, as White shares, “we went from just a few healthcare partners in 2019 to now we have 57 across central and western Oklahoma. That includes major hospitals, clinics, critical access hospitals, federally qualified health centers, free clinics, even some mobile clinics.”
These programs are associated with:
Improved patient access to healthy food
Increased SNAP enrollment and federal benefits uptake
Better provider confidence in discussing social needs
Higher patient satisfaction with clinical care
While quantifying direct health outcomes requires longer-term studies, the program’s reach and popularity are clear evidence of its value.
Actionable Takeaway: What Can Leaders Do to Advance Food Equity?
Healthcare executives and community leaders should recognize that food insecurity is a health crisis hiding in plain sight—and one that demands proactive, collaborative solutions. Oklahoma’s model demonstrates that with the right partnerships, data-driven screening, and community-driven design, medical clinics can do more than treat illness; they can prevent it at its roots.
Start by:
Prioritizing food insecurity screening in your EMR
Partnering with local food banks and community organizations
Piloting small, adaptable programs
Seeking diverse funding streams and sharing best practices
Remembering that equity and community voice are central—“don’t go in blind… and realize you’re gonna make mistakes.”
Keeley White puts it best: “Always happy to share anything we can do to expand the impact as far as we can. That’s the whole idea.” If you’re looking to move the needle on health, food is a powerful place to start.
Introduction: The Urgency of Transforming Healthcare Navigation
In today’s healthcare landscape, both patients and clinicians face unprecedented challenges. From administrative complexity to staffing shortages and mounting clinician burnout, the system’s burdens often seem insurmountable. Yet, at the intersection of leadership, wellness, and community engagement, innovators are finding ways to break through the inertia. Few stories better illustrate this than that of Dr. David Wilcox, Chief Clinical Officer at MAKE Solutions Inc., a clinician, leader, and relentless advocate for patient and staff empowerment.
This feature explores Dr. Wilcox’s remarkable journey, the strategies he’s championed, and what healthcare organizations can learn about putting people—both patients and clinicians—at the center of transformation. Through real-world examples, leadership insights, and a focus on actionable change, we’ll examine how intentional collaboration and listening can improve outcomes, reduce disparities, and make the healthcare system more humane for everyone it touches.
Dr. David Wilcox: A Life Shaped by Systems—and Their Failures
Dr. Wilcox’s path to healthcare leadership was anything but traditional. Raised in upstate New York, his entry into the medical world was shaped not by academic curiosity, but by necessity—and personal experience with the system’s shortcomings. “I have a special needs daughter, and I had her early when I was young, about 17. I would be dragging her around to doctor’s appointments… I saw a lot of really good clinicians, but I saw a system that was really broken.”
Laid off from a manufacturing job, Wilcox used a year of unemployment benefits to train as a nurse, starting as an LPN (Licensed Practical Nurse). The immediate sense of impact—“I loved doing something where I really affected people instead of making parts”—set him on a new course, leading to further education and new roles in North Carolina’s healthcare system.
A chance assignment as a float nurse in a short-staffed emergency department revealed both his adaptability and a crucial skill: “I was able to de-escalate situations,” Wilcox recalls. This talent quickly propelled him into leadership roles, first as a night supervisor and then as Patient Placement Director, where he was tasked with fixing the very operational bottlenecks that frustrate patients and staff alike. “They were just giving me everything that was broken operationally and asking me to fix it. I thrived on it.”
Wilcox’s drive for solutions and relentless pursuit of improvement led him through a gauntlet of educational achievements (from BSN to a doctorate), stints in healthcare IT (notably at Cerner, now Oracle), and ultimately authorship—his book, How to Avoid Being a Victim of the American Healthcare System, is aimed at giving “the 17-year-old me what they should know before they ever access the healthcare system.”
Leadership That Listens—From Staff Burnout to Systemic Change
Listening as a Leadership Imperative
If there’s a single throughline in Dr. Wilcox’s approach to healthcare leadership, it is the priority placed on listening—both to staff and to patients. This isn’t lip service; it’s the engine behind real-world change. As Wilcox puts it, “You have to listen to your patients… [and] you have to listen to your staff, right? That’s the big thing.”
This principle was never more evident than during his time managing nurse staffing amid chronic shortages. Traditional solutions—throwing money at the problem through overtime and incentives—were producing little more than staff burnout and ‘gaming’ of the system. Nurses, incentivized by extra pay, were stretching themselves dangerously thin.
The Worked Hours Reward Program—A Case Study
Wilcox’s breakthrough came after researching how another hospital had tackled similar challenges. “I found this article on this hospital up in Albany, New York that had done something different. So I took that information and tailored this program called [the] worked hours reward program.” The basic structure was simple: nurses who fulfilled their scheduled hours received a bonus, scaling based on employment status (full-time, part-time, etc.).
The effects were immediate. “Staff were getting burned out and we didn’t have… the safest care at that point. So what happened was all these PRN staff… bumped their hours up, removed things on their own personal schedules to come to work. And 9s were like, ‘Hey, I want to pick up an extra shift so I can get the extra money.’ So it just kind of evolved into better quality outcomes for patients and much more satisfied staff because they weren’t working short anymore.”
Beyond the immediate morale and safety improvements, the program produced concrete financial results: “We saved the hospital system like two million dollars doing it this way as opposed to just throwing… cash on top of a burning fire of staff shortage.”
Reducing Health Disparities—Meeting People Where They Are
Community Collaboration as a Core Strategy
Wilcox is unambiguous about what works when it comes to reducing health disparities: “You have to go to the people.” He points to the evolution of population health tools that allow leaders to pinpoint communities most in need. But the true test comes in the follow-through—whether organizations are willing to build trust and bring care to where people actually live.
“Setting up a farmer’s market in a place where they don’t have access to fresh food and vegetables and subsidizing it… I’ve seen that work really well,” Wilcox explains. Mobile vaccination clinics, pop-up health screenings, and other hyperlocal initiatives reflect a philosophy that prioritizes outreach over passive expectation.
Data with a Human Face
For Wilcox, technology is an enabler, but it is not the solution in itself. “We now have tools that we never had years ago, such as population health tools… But if you don’t reach people where they’re at and you’re expecting them to come to you, you’re going to have a much sicker population.”
Clinician Well-being in an Age of Administrative Burden
The Impact of Digitization—Unintended Consequences
The digitization of health records, while a historic advance in patient safety and data availability, has paradoxically become one of the greatest sources of clinician frustration. “When we digitized the health record, we created a huge burden. All of a sudden docs were having to type in orders… They want to take care of patients, right?”
The situation is especially acute for nurses, whose workload is split between direct care and documentation. The result? “If you’ve got a lot of patients, you want to get in the room and get out of the room,” Wilcox observes. This robs patients of meaningful interactions and clinicians of the time to teach, build relationships, and even learn from their practice.
Technology as a Force Multiplier—Virtual Nursing and AI
Yet, innovation can also offer relief. Dr. Wilcox is enthusiastic about new models such as virtual nursing, where a remote nurse manages tasks like admission assessments and patient education via HIPAA-compliant video platforms. “The beauty of it is that nurse also has time to teach the patient about their new prescriptions or their new diagnosis while the other nurse is tending to the tasks that need to be done.”
Perhaps the most promising development is the emergence of artificial intelligence (AI) as a documentation and workflow tool. “Don’t be afraid of artificial intelligence. Just make sure it’s trained correctly, and get comfortable with it.”
With tailored training for each clinical specialty, AI can prompt nurses to conduct thorough assessments, automatically generate accurate notes, and keep both clinicians and patients informed. As Wilcox explains, “The AI might say to you, ‘Was that your first attempt?’ And then you might say, ‘No, it was my second.’ So it documents everything correctly, but it’s got to be intuitive to your workflow.”
The impact isn’t just about efficiency; it’s about restoring the core value of care. “This gives the opportunity for the patient or family member to ask questions… We’ll actually see increases in HCAHPS scores because of things like this.”
Clinicians as Agents of Change—Empowerment Through Involvement
Inclusion as a Prerequisite for Success
If systems change is to take root, clinicians must be at the center of the process—not mere recipients of new rules, but active architects. “Over my career I have seen organizations try to make clinical improvements without involving clinicians. That never works well and clinicians feel like, oh, this is coming from the top down. We have to do it.”
Wilcox is adamant: “If you’re going to make a change—maybe you’re implementing a new electronic medical record, or maybe you’re looking at a workflow and trying to make it more efficient—if you don’t involve clinicians, it’s never going to fly. I can’t think of one instance where I’ve seen an organization not involve clinicians and it worked.”
This message extends beyond technology adoption. From workflow redesign to new care models, clinician involvement is the difference between fleeting compliance and genuine improvement.
The Power of Rounding and Realistic Expectations
For leaders looking for practical steps, Wilcox recommends a time-honored but often neglected practice: “Round. I remember when I was a patient placement director, people felt a connection to me.” Whether it’s updating staff about bottlenecks or simply being present, visible leadership builds trust and clarifies expectations. “You have to set realistic expectations as a clinical leader.”
Patient Empowerment—Bridging the Knowledge Gap
Why Patient Education Matters
At the heart of Wilcox’s work is the belief that healthcare is a partnership. Yet, most patients are ill-equipped to navigate the system’s risks and opportunities. “It’s not a matter of if you’re going to need healthcare, it’s a matter of when. You need to get knowledgeable because you can’t walk into a healthcare system thinking that everybody’s going to do the right thing.”
From surgery scheduling (“Most patients don’t know that if you’re the first case of the day, your statistics are better…”) to medication management (“If you’re going for an elective surgery, you can bag up your own medications, take them to the hospital and ask that the pharmacy use those…”), Wilcox’s advocacy is rooted in hard-won lessons.
His book and website, DrDavidHelps.com, function as knowledge hubs: “I have a healthcare resource guide which is a one-click access to things like Mark Cuban’s online pharmacy… There’s all kinds of resources up there, which would be very difficult for most lay people or, you know, patients to find, and even clinical staff.”
The Post-Discharge Abyss
A persistent gap, Wilcox argues, is the lack of support for patients after discharge. “When we release patients and we discharge patients, we send them off into the wild. We don’t know where they’re going, what they’re doing… They can’t, we should, we should have places where they can call back in the hospital and say, ‘Hey, you know, I was, went to get my antibiotic, but it was… more money than I could spend on it. What can you do for me?’”
Without better systems of follow-up and open communication, vulnerable patients are left to fend for themselves, often turning to unreliable sources like “Dr. Google.”
Key Takeaways for Healthcare Leaders and Clinicians
Leadership Starts with Listening: Sustainable improvement begins with listening—both to staff and patients. Open channels for feedback and be present.
Reward Programs Can Reduce Burnout and Improve Quality: Incentive models that reward consistency and reliability—not just extra hours—can improve both morale and patient safety, while also lowering costs.
Meet Communities Where They Are: Use population health data not just to identify needs, but to build outreach programs—farmer’s markets, mobile clinics, and local partnerships—that close real gaps.
Embrace Technology, But Train It for the Job: Virtual nursing, AI-powered documentation, and other innovations can relieve administrative burden—but only if tailored to clinical workflows and specialties.
Clinicians Must Be Agents of Change: Top-down initiatives rarely succeed without clinician involvement. Engage your staff as co-designers of change.
Empower Patients Through Education: Proactive patient education, both in-person and via digital resources, is essential to safer, more satisfying care. Support patients before, during, and especially after care transitions.
Sustain Engagement Beyond Discharge: Build bridges for post-discharge support—follow-up calls, resource guides, and open lines to care teams—so patients aren’t left alone to navigate the system.
Conclusion: Building a More Humane Healthcare System—Together
Dr. David Wilcox’s journey from manufacturing to nursing, IT leadership, and patient advocacy illustrates a core truth: transformation in healthcare doesn’t happen from the top down. It requires a culture of listening, an openness to innovation, and an unwavering focus on people—both patients and clinicians.
As Wilcox reminds us, “Do your education. Make sure you’re safe in the hospital.” But his story is also a call to leaders: to create systems where everyone, from staff to community members, can thrive. By embracing collaboration, championing clinician involvement, and relentlessly focusing on wellness—at every level—we can chart a path toward a healthcare system that truly works for all.
Introduction
How does a 13-hospital health system cut $7.5 million in pharmacy costs—without sacrificing quality or patient experience? For MultiCare Health System, a nonprofit health system based in Washington, the answer lies in a sophisticated reimagining of the pharmacy supply chain.
Tyson Frodin, PharmD, MHA, Assistant Vice President of Clinical Pharmacy, Pharmacy Supply Chain, and Technology at MultiCare, led a sweeping transformation that achieved a 24% reduction in inpatient drug spend and set a new industry benchmark. In this exclusive interview, Dr. Frodin breaks down the strategic moves, cultural shifts, and data-driven partnerships that delivered multi-million-dollar savings—while improving patient access and experience, especially in rural communities. Whether you lead pharmacy operations or simply want a blueprint for supply chain excellence, this is the inside story you need.
Why Did MultiCare Prioritize Supply Chain Innovation?
MultiCare’s journey to pharmacy supply chain excellence began out of necessity and vision. Dr. Tyson Frodin explains: “MultiCare, we’ve definitely been on a journey to become world class, and that’s one of the things that we’ll continue to drive moving forward, is how do we become not only a world class pharmacy enterprise, but a world class health system that drives significant improvements in care for our patients and populations.”
Several converging factors made pharmacy supply chain optimization a high-stakes imperative:
-Rising drug costs: With $375 million in annual drug spend, even small efficiency gains meant big dollars saved.
-COVID-19 disruptions: The pandemic exposed weaknesses in procurement, inventory, and rural hospital support.
-Expansion into rural markets: MultiCare’s growth into Idaho, Montana, Alaska, and Oregon required new strategies for small, remote hospitals.
Dr. Frodin’s rural roots shaped his focus: “The thing that brought me to MultiCare was the opportunity to have MultiCare grow into northern Idaho, Western Montana, Alaska, as well as Oregon... my experiences as a chief operating officer and director of pharmacy in critical access hospitals really lend themselves to helping this expansion and growth over other rural facilities across those other states.”
What Role Do Rural and Critical Access Hospitals Play in the Pharmacy Supply Chain?
Rural hospitals are not just small, isolated facilities—they are essential strategic partners for health systems. Dr. Frodin emphasizes that these facilities, often operating under cost-based reimbursement, can be leveraged to optimize patient flow and finances:
“Right now there’s over 700 hospitals, rural facilities that are at risk for closing. That concerns me because those are my friends, my family. If you understand the ins and outs... being cost-based reimbursed, having access to swing bed, they can be a huge blessing to larger healthcare organizations, especially when looking at, well, how do I get rid—I don’t want to say get rid of—how do we transition patients that are in acute care setting, that are eating up our length of stay and our DRG? Well, if you have that relationship with a critical access hospital... you then can swing those patients.”
Key benefits of integrating rural hospitals into the pharmacy supply chain:
-Shorter inpatient stays at large hospitals: Transition patients to swing beds in rural facilities, freeing up acute care beds and reducing length of stay.
-Cost recovery and reimbursement: Administer high-cost medications in critical access settings for cost-based reimbursement.
-Enhanced patient experience: Patients recover closer to home, minimizing family disruptions and travel costs.
“From that standpoint, it really enhances the patient experience by being able to get the emergency treatment that’s needed upfront to get them stabilized and then go back home... where family members can go and visit and help provide that support that’s needed for them to recover faster and better.”
How Did MultiCare Achieve Centralized Purchasing—and Immediate Savings?
The first and perhaps most crucial step was building a centralized, coordinated purchasing structure across all MultiCare hospitals. Before Dr. Frodin’s tenure, purchasing was fragmented, with each hospital operating independently. He changed that:
Appointed two lead purchasers to oversee all purchasing decisions.
Standardized the review process: Lead purchasers reviewed all orders systemwide for compliance with preferred products and pricing.
Aligned product selection: All sites used the same markers and contracts for best pricing.
“Within six months, we achieved close to $650,000 in savings by just selecting the best preferred product across our system. It drove savings, but with MultiCare being a 340B eligible entity, it also helped our 340B team clean up our crosswalk and enhance accumulations across our health system and get better 340B pricing.”
Why don’t all health systems do this? Dr. Frodin is candid: “I think a lot of it is, it might be something that’s easily overlooked. It’s just one of those things that you would assume that it’s already being done. But it also is quite a significant lift... We committed to that. We saw the value in doing that, and it was easy to see the success from that with the savings that we were able to achieve over that initial six months.”
What Technology and Automation Drove Additional Reductions?
After centralized purchasing, the next lever was upgrading pharmacy automation to enable perpetual inventory management and waste reduction. MultiCare invested in:
-Pharmacy carousels at all sites
-Automated dispensing cabinets (BD Pyxis MedStations) and anesthesia carts
-Health Site Inventory Optimizer (HSIO) for advanced data analytics
These technologies allowed MultiCare to:
-Track inventory in real time
-Identify and eliminate unused or expired medications
-Reduce carrying costs and stockouts (to less than 0.8%)
-Engage nursing in more efficient workflows
“By doing that, we were able to reduce stockouts to less than 0.8% across our entire system, really improving nursing workflows. Nursing was super engaged and super excited about that work. As well as reducing our overall inventories and reducing our waste... we’re able to reduce that dramatically.”
How Did Data Analytics Unlock Multi-Million Dollar Savings?
The real breakthrough came from leveraging best-in-class data analytics to identify hidden savings opportunities and optimize supplier relationships.
Dr. Frodin partnered with QuicksortRx, a specialized pharmacy spend analytics platform. Here’s how it worked:
“They did the analysis, identified about a $1.25 million opportunity for MultiCare and we hit the ground running... because we’d already created that centralized coordinated purchase structure, and had done the legwork to update our pharmacy automation... we were able to triple that savings value that first year. Instead of saving $1.25M, we saved $3.5M that first year, and it’s been an amazing opportunity and it continues to drive about a 12 to one ROI for MultiCare.”
The cumulative result: $7.5 million in acute care pharmacy savings over 2.5 years, and a 24% reduction in inpatient pharmacy spend—compared to the industry’s 7% benchmark for similar organizations.
How Did Strategic Partnerships Expand Savings—Including Mark Cuban’s Cost Plus Drugs?
With superior data, MultiCare could now select the best vendors for every line of business. Notably, they added Mark Cuban’s Cost Plus Drugs Marketplace (For Business) as a secondary wholesaler for retail pharmacy, yielding another $1.8 million in savings.
Dr. Frodin breaks down the rationale: “With the data analytics that we used, we could see where [our GPO and wholesaler] were increasing pricing and where they were making their money. When it comes to the retail space, looking at oral generic solids... that’s where they’re making a lot of their markup. So by utilizing data analytics... it made it easy for us to be able to identify savings opportunities with other strategic partners.”
Key partnerships included:
-Mark Cuban Cost Plus Drug Company: Used for retail, oral generics; significant cost reductions versus legacy wholesalers.
-Meg (online platform): Used for inpatient generic IV injectables, buying excess manufacturer stock at a discount.
-Direct-to-manufacturer deals: Data analytics enabled MultiCare to quickly compare utilization and pricing, making direct contracts viable and efficient.
What’s the Future of Pharmacy Supply Chain? Centralized Hubs and Direct Sourcing
The next evolution: building an Integrated Services Center (ISC), a central warehouse sourcing directly from manufacturers.
Dr. Frodin explains the logic and potential: “We can purchase directly into that hub direct from a manufacturer. And when manufacturers are shipping direct to you, they’re bypassing all the admin fees from your traditional wholesalers and GPOs, and they can pass that enhanced savings onto us as an organization. And so we’re seeing anywhere from 15 to 20% increased savings, even based off of any of the GPO pricing or 340B pricing that we’re seeing out there.”
The Integrated Services Center Model:
-Bulk buys and forward buys (one year of product at once)
-Buffer stock to mitigate shortages
-One truck delivers multiple service lines (lab, pharmacy, sterile processing) to each facility, optimizing logistics and saving further on distribution costs
“If you’re having all that brought in centrally and sending it out on one truck versus having one truck per each service line, just on the logistics piece, you can save a ton of money for your organization.”
When does a central warehouse make sense? Dr. Frodin advises that a 500-bed system is the tipping point for strong ROI, but organizations with robust ambulatory or specialty pharmacy programs can benefit at smaller sizes—especially if they centralize additional services.
Actionable Takeaway
MultiCare’s pharmacy supply chain transformation is a playbook for any U.S. health system feeling the pressure of rising drug costs and tight margins. The essential steps:
-Centralize purchasing and standardize processes.
-Invest in perpetual inventory and automation.
-Deploy advanced data analytics to benchmark and identify opportunities.
-Leverage data to pursue new vendor relationships and direct sourcing.
-Consider integrated distribution hubs as your system grows.
As Dr. Tyson Frodin says: “We’re all in this together. Any opportunities we have to collaborate and work together, it’s time well spent... Looking to emulate what MultiCare has achieved? Please feel free to reach out.”
For more stories and strategies from the frontlines of healthcare supply chain, follow the American Journal of Healthcare Strategy and connect with Tyson Frodin on LinkedIn.
This article is informed by a podcast interview with Tyson Frodin, PharmD, MHA, Assistant Vice President, Clinical Pharmacy, Pharmacy Supply Chain and Technology, MultiCare Health System. For complete resources and links, see the episode notes.
