HMP Connections - A New Way to Connect!

A Conversation with Tony Keck

Last month, I had the opportunity to interview Anthony ‘Tony’ Keck, the Executive Vice President of System Innovation and Chief Population Health Officer at Ballad Health, when he was in town for the Michigan HMP Alumni Board meeting. Tony earned his MPH from HMP in 1993.  

Tony’s career has spanned multiple sectors of the healthcare industry. From a not-for-profit community clinic in Louisiana, to consulting with Johnson & Johnson, and public policy work as the Director of Human & Health Secretary for South Carolina’s State Department before taking his current role as a senior executive with the 21-hospital health system, Ballad Health. Tony’s story is one about hard work dedicated to impacting lives for the better and recognizing the big role that relationships and a little bit of chance has to play along the way.

Amanda Fakih MHSA '19
(April 2019)

---

When and why did you decide to apply to HMP’s executive program?
I was working with a local healthcare consulting firm here in Ann Arbor after finishing up my bachelor’s degree in Industrial & Operations Engineering. I had been working with them for three years when at some point, I made the decision that I was going to try to get into the On Job On Campus, HMP’s executive program.  I didn’t hear for several months, it was around June, so I thought well I didn’t get in and I had decided that I was going to get out of health care and go back to school to get my teaching certificate, join the Navy, work on a nuclear sub and then I was going to come back and teach physics. I was getting ready to do all of that, had it all planned out, and then I got my acceptance – I must have been the last person to get in. Most of the people in the program were 35 or 40… I was 23, so I just snuck in under the wire.

When I was deciding to come to HMP, I remember talking to one of my mentors at the time, and I said look, I know that I will have small impact on a few people for sure if I go and be a teacher. But, maybe if I go to health management and policy, there’s a small chance that I’ll have a big impact on a lot of people and one day be a health secretary or something similar.

Well you did end up becoming a Health Secretary! I’ll ask you about that experience in just a bit. What did you do after HMP?
Well, I got a random letter in the mail from a head hunting firm, looking for somebody to be senior management engineer down at Ochsner Clinic in Louisiana.  And it just so happened that I was working on a project in New Orleans at Tulane University Hospital – so I said I’ll be down there in a week, so again coincidence worked – and I got the job. I ended up working there for about 3 years.

One of the people I did some work for was the Chairman of Medicine. One day I was standing in line at the dry cleaner by the clinic, and he walks in. He was this older, formal New Orleans guy, he was a big deal – and he says, “Hey – is that your truck with the ‘Eracism’ sticker on it?” And I said yes, not knowing where this conversation was going and he says, “Well I’m the chair of the board of a community clinic down in the St. Thomas-Irish Channel housing development – would you mind coming to look at some of the systems down there because we’re having some problems,” and I said yes. What started out as a three day project on the side turned into my next job.

What was your time like at St. Thomas Health Services?
They were in the middle of it – it was a very poor neighborhood, the Catholic Church had leased them this big old mansion for like $1 a year and that’s where they started the clinic. When I started, he had described it as ‘we’ve been here a long time, we have a lot of grants and great relationships with the State and donors, and I just want you to take it to the next level.’ But within three months of my arrival, our funding got cut by 30 to 40%. For the next two years, I spent my time just trying to keep the lights on. We had a lot of strengths — we were affiliated with Ochsner so their residents and physicians would come down to provide care, and there were people at Ochsner who believed in the clinic and provide other support. Most importantly, the community was super politically active, and had organized itself to help create anti-racist organizations and governance. This was a particularly difficult process when you’re running a clinic in a 99% African American low-income community with almost all doctors and board members (and me) coming in from outside the community – it was a conscious effort to try and turn that around. It was first and foremost about providing care to folks but it was also very much about creating this anti-racist organization and community. Now that clinic is flourishing – it’s grown substantially and has often be recognized as a national model.

What was one of the lessons you learned while at St Thomas?
I remember when I first came into that clinic as a young manager – maybe 25. The Medical Director was this terrific woman who was an Internist. I remember I spent four or five months sort of berating her. Nothing ran like I thought it should, so I just pounded away about how could everything be so screwed up? Then I spent the next two years realizing – wow, this is hard, we have no money, we have a constant turn-over of staff and docs, and there are always more people who needed services than we can provide.

Karma came back around when I decided to leave, and they hired a young woman to replace me who was also a young manager. She came in to shadow me for three months while I was there. She spent those three months pounding on me, complaining, ‘why isn’t this done’ and ‘why are things done like this?’ It was a big lesson for me. It’s one of my key management tenants now – everything wasn’t screwed up before Tony Keck showed up. Management is about fixing problems – if there weren’t constant problems to solve, you wouldn’t need managers.

You began your doctorate degree but ended up deciding to pursue a career in public policy after Hurricane Katrina hit – tell me about that time in your life.
After St. Thomas, I spent about four or so years in Chile consulting with Johnson & Johnson. A few years after that, I decided to go to Tulane to work on my doctorate. I was teaching a lot, working on my research, and doing some consulting on the side. Then the hurricane hit. Everything got turned upside down. And again, as with my previous career transitions, some forethought but a lot of chance led me to my next job. A friend of mine became Bobby Jindal’s healthcare transition team leader. In a fairly quick series of events, I left Tulane and became the chief of staff for the Department of Health and Hospitals for about a year and a half, and then worked as the Governor’s health policy advisor for about six months before becoming the Deputy Secretary of the department. It was an umbrella agency – Medicaid and all of the other health agencies, public health, mental health, etc.  When I became Deputy Secretary I was overseeing everything except Medicaid.

We did a lot of great work while we were there and it was during the time that the ACA was passed. We converted the state Medicaid program to managed care and started a birth outcomes initiative that became a model of improving infant mortality around the country. We had to manage a portion of the BP Deep Water Horizon oil spill response, two back to back hurricanes where we evacuated the coast, and a H1N1 Flu epidemic – it was just everything. At the same time, we were trying to make fundamental changes to how the department worked. In Louisiana, we had a lot of people who were institutionalized with mental illness and developmental disabilities. With many of them, we could be having a conversation like you and I are now, and yet, 30 years ago when they were young, they were put away in an institution and the state had never worked to try to get them out and living independently. We spent a lot of time building up community-based services and were met with a lot of blowback by the institutions that felt threatened by a loss of jobs.  I viewed it as civil rights issues, which is essentially now how the federal government also views it.

Did you feel like your previous experiences had prepared you for your roles in public policy or was there a lot of learning on the job
There was definitely a lot of learning on the job. All of a sudden I was chief of staff in a department of 13,000 employees with a $9 billion budget. My boss was a guy with a lot of experience in this space. I remember my third day on the job, we were in a helicopter together, jetting off somewhere, and I had no idea what to do. I was writing down everything he said as fast as I could. And he finally looked at me and said, “what are you doing? Would you just relax a little bit?” He’s actually my boss now in the private sector.

I was on a high learning curve about the department, but a lot of what was necessary was just good management. I didn’t know a lot, for example, about developmental disability, but I knew good management. I knew the importance of relationship building, I had done coalition building – all of those things built on each other.

What were some of the initiatives you worked on during your time as the Director of South Carolina’s Health & Human Services?
Well, South Carolina had decided against expanding Medicaid but Governor Nikki Haley was committed to getting more people access to care. During my interview for the role, she asked how I planned to do that and I told her there are a lot of people who are eligible for Medicaid but not enrolled. There were other populations not getting served – for example the waiting list for disability waivers was tens of thousands of people long, and these are some of our most vulnerable citizens.  I said there is a lot that can be done without taking the ACA Medicaid expansion if you let me do that. She did.

That’s what I spent my first few months working on. Even though the legislature didn’t want to expand, we had around four hundred thousand people who were eligible but not enrolled. During one of my confirmation hearings, a Democratic Senator asked me, “What are you going to do about people who are eligible but not enrolled?” I said, “The legislature set the eligibility limits, my job is to get people enrolled.”  In many states there are games played with how difficult the state makes it to enroll and stay enrolled.  With the help of some community activist probably opposed to everything else we were doing, we ended that.  In the next fiscal year, we made a few changes to our processes, such as looking at the receipt of SNAP benefits as an indicator for presumptive Medicaid eligibility. In one day, when we flipped the switch, we enrolled about 80,000 people.

People commonly refer to our healthcare system as broken – were you ever demotivated by the flaws in our system?
I was energized by them more than anything and so were the people that I worked with. The amount of authority and impact you can have, especially in state government, is significant. You are right there in the thick of it, things move more quickly than the private sector sometimes, and you can get a lot done.

It is hard though. You don’t make much money and you’re getting beat up all of the time, but what matters is that you’re changing people’s lives and that feeling is great.

What is like being back on the provider side with Ballad Health?
This is my first time being in a large hospital system, so talk about learning curves. I had learned a lot over time, but I had certainly never been a senior executive in a 21-hospital system. I did bring with me 30 years of management and leadership skills I had developed, and a strong understanding on how the health care system worked at all levels. My initial areas of responsibility were marketing, communications, government affairs, our foundation, strategy, our ACO and our insurance company. All of those were things I had led before. After the merger my responsibilities were expanded to include population health and IT.

Because of our merger and the way that we did it under state law in Tennessee and Virginia, we have a lot of requirements related to community health improvement. One thing we’ve done is build a Department of Community Health and they are in the process of organizing a multidisciplinary, multi-sector effort to help us do this. There are over 200 organizations participating in this Accountable Care Community across 21 counties and two states, with the goal of aligning all the participants, big and small, around strong starts for kids and families and the opioid epidemic. We are the catalyst for the group but we don’t want it to be just a Ballad Health initiative, it has to be a whole community effort.

What are some of the initiatives to address social determinants of health in your communities?
We have a CMS grant in southwest Virginia where we screen at least 75,000 Medicaid and Medicare patients annually for social risk such as food insecurity, violence, housing insecurity and transportation barriers. If you’re identified as having high social risk and high emergency department utilization, you are placed in a control or intervention group. The control group gets a list of geographically accessible services tied into your social need – such as the closest food bank to where you live.  The intervention group gets assigned a navigator who works to make sure services are actually received.  We are getting amazing data from this. We are now able to heat map, down to the individual and location, where the social risk is, and when we lay that over top of maps of where the resources are, we see big gaps in coverage.

CMS is funding this work to determine if those with navigators end up spending less on their health care and if CMS should start paying for services related to social determinants. We don’t have that data yet. But in the meantime, we are having everyone collect stories – stories can be very powerful. One example was a woman screened with high ED utilization and high social risk who was then assigned a navigator. The patient expressed that she never had enough money to feed her family. She also shared she was spending $400 a month on her prescriptions for a chronic illness. The navigator connected her with existing prescription drug assistance programs, wiping out that $400 a month out-of-pocket spending and now she has $400 extra for food. Story after story is like that. All of these services existed – we just historically in this country do a terrible job of coordinating them.

What is the role of the provider versus the payer in managing population health?
I believe population health is most effectively managed on the ground locally. The old model is that insurers have care managers in some office somewhere who call patients to try to help them manage their diabetes. Yes, they have the claims data, and some clinical data, but they don’t know this person, they don’t know the local culture, and they don’t have a relationship. Our push is to try to separate out who does what best.  For example, insurers now have the ability to manage big data and use it for predictive modeling – that’s extremely useful. If that information can be properly packaged in a timely manner and given to our local care teams – that’s where the power is. The idea that you can accomplish long lasting behavioral change from a call center somewhere – I just don’t believe that works.  

Why did you decide to join the alumni board at school? What is your advice for those of us who are interested in serving on boards in the future?
One thing that I probably didn’t do very well during my life was participate in organizations like ACHE. I didn’t stay that involved with the alumni association after leaving school. I got so focused on working that I left a lot of that behind. Over time I’ve realized that professional connections are important and I have something to say and offer – and something to always learn.

I serve on a number of boards. I find it’s good to be quiet and mainly listen for a while – again, everything wasn’t screwed up until Tony Keck showed up.  The people I find that are most effective on boards are usually the people who speak less and speak last. Then when you do speak, people listen and you get a chance to better understand where people are in their thinking. Whether that is in a single meeting or over time, there is a usually a time to talk but more time to listen.

Your advice for young careerists?
There’s a line between keeping your powder dry and being a wallflower – it just takes practice. The biggest way I’ve found to make a positive impression is just preparing. It’s amazing to me how many people come unprepared for meetings. If you come in and you’re prepared, you have two to three points of importance, and spend most of the time listening with some intuition about body language, and have previously developed relationships with people in the room, you’ll do well. I also had a conversation recently with new graduate who told me that they aren’t comfortable being a salesperson and I said, hold on – no matter what you’re doing, you’re selling – products, services, policies, ideas.  How comfortable you are with that is dependent on whether you care about what it is you’re selling. 

Amanda Fakih is a 2019 MHSA graduate from the University of Michigan School of Public Health. In her spare time, Amanda enjoys spending quality time with her friends and family, traveling, and eating "mmm" inducing food.

---

A Conversation with Mark Herzog

In April, had the chance to speak with Mark Herzog, retired President & CEO of Holy Family Memorial, Adjunct Professor and Executive in Residence, and University of Michigan HMP Alumni Board Member. Mark earned his MHSA from HMP in 1982.

Mark shared valuable advice about maximizing experiences in HMP, navigating a career in the industry, and the importance of seeing the big picture.

I hope you enjoy and learn from this interview as much as I did!

Philip Cooper, MHSA '20
(April 2019)

---

What was the most beneficial experience you had during your time as an HMP student?

Learning directly from several of the true national thought leaders (Southwick, Donabedian, Griffith, Feldstein, Lichtenstein) and finding the program truly encompassed the deep knowledge base and skills needed to be a leader in healthcare.  I worked hard while at HMP to “blur the lines” between the hospital focused program and the medical care organization and policy programs through socialization, intramural teams, and other activities. The tone was set to seek excellence in performing wherever my career path might lead.

How do you think HMP shaped your career? Are there experiences that every student should maximize during their time in the program?

I was attracted to the program’s focus on “the breadth and depth” of the healthcare field.  For me a big picture approach encompassing management, policy, public health and more was incredibly important.  Healthcare leadership is so challenging and complicated that familiarity outside a narrow specialty can make all the difference. My advice while you’re at HMP would be to take advantage of the fantastic palate of people and events to learn as much as you can about the breadth of the healthcare industry.  Explore insurance or policy if you came in focusing on the provider side, for example.  Challenge your assumptions.  Importantly, every two years the Griffith Leadership Center Symposium provides a great opportunity to recharge your insights back in Ann Arbor.  You never know what connections may happen, when or how you can use them to make a difference.

Can you describe your last role as President and CEO of Holy Family Memorial? When you were a student in HMP, did you expect to be the CEO of a hospital?

I was President at HFM for nearly 17 years.  It was one of the few remaining true CEO jobs in this environment of big systems and operating company models.  Having full responsibility for developing and managing an operating board, strategy, culture, operations and everything in between called on every skill I have and my capacity for emotional intelligence and continuous learning.  Most importantly, I had the honor of directly serving a community and balancing its needs with the corporation’s needs and seeing direct cause and effect as we implemented change.  Today, such an opportunity is rare.

Coming into HMP I lacked healthcare experience, so I wasn't sure I wanted to be a hospital CEO, but always thought I could do it.  While at HMP my initial focus wasn’t solely on hospitals, so I was open to other pathways.  However, that’s the course things took, and I have absolutely no regrets.  I wanted to test myself and found the experience to be enormously challenging, professionally humbling and deeply rewarding.

Looking back over your career, are there any highlights or significant accomplishments you are particularly proud of? Were there any notable challenges you faced that shaped your perspective, leadership style, etc.?

Cardiovascular disease for many years has been the top health issue.  Starting in 1990, I led a force of leading Ohio community hospitals against the academic medical centers to introduce cardiac catheterization and eventually angioplasty in community hospitals, which the tertiary medical centers had banned through regulation.  This was a classic case of outdated beliefs and entrenched leadership protecting business interests over what’s best for patients and communities.  We successfully lobbied to change the rules in 1991 and introduced community-based heart care in Ohio later that year.  I continued this crusade at HFM where we achieved 35 minute average door-to-balloon times and were named a regional Heart Attack Receiving Hospital.  Thousands have benefited because of this focus on the patient. 

To be a more effective leader I learned about emotional intelligence and culture shaping as ways to strategically create a culture of adaptability, innovation, and resiliency at HFM.  Unfortunately for this culture to emerge the number one thing that needed to change was me!  I partnered with Janet Dombrowski, a fellow HMP alumni, as consultant in this journey.  Being aware of and intentional about applying emotionally intelligent and behaviorally informed change was a bit of a revelation.  Success meant my casting a very different leadership shadow for the organization, and in turn coaching the rest of leadership. 

I had the unique opportunity to share this story in front of 19 different nations in a Keynote address to a non-healthcare international audience at the 2013 CoDev Open Innovation Forum.  The really cool part was that a VP for Green Mountain Coffee was the speaker after me. In my house the Keurig machine is disruptive innovation at its best!

What would your advice be to students interested in pursuing a career in hospital administration, especially considering how industry trends might impact the field's future landscape?

Take every opportunity for self-discovery and growth in emotional intelligence; understanding and managing yourself precedes for most of us the ability to fulfill our commitments to serve others meaningfully.  Going in, know that typical hospital organizations are profoundly complex, inefficient and they confound systemic standard work.  Be courageous and resilient in challenging this model; we can and must do better. 

But the people are amazing!  Anyone engaged in hands-on care is or will soon be experiencing extraordinary pressures from business processes making it harder to deliver care empathetically and personally, such as the current insurance model, electronic records, digital fragmentation, etc.  Whatever industry segment you choose, try always to be an advocate within your environment for the people and communities that are being impacted by and hopefully benefiting from your service.  While it’s great to be personally successful it’s ultimately more meaningful to be significant in serving communities and others

Do you have any other advice for Wolverines?

Being “Leaders and Best” is something to be enormously proud of.  However, it’s not something to be satisfied with.  The University of Michigan Health Management and Policy Program has set the highest standard in healthcare leadership for many years.  Our nation’s healthcare system is at a critical juncture of change promising to be both seismic and traumatic, and the current political environment is unlikely to result in anything resembling purposeful improvement process.  Bold and thoughtful leadership has never been more in need.  Our Program traditionally has produced leaders well positioned to step up to the plate and help the dialogue turn the corner towards betterment, and lead organizations to serve effectively in the new day.  Remember why you went into this field and have the courage to make a significant difference, whatever that might mean in your role.  That’s something we can all strive for!

Philip Cooper is a first-year Master of Health Services Administration Candidate at the University of Michigan. When not studying for class, conducting research at Michigan Medicine, or working on the PHSAD executive board, Philip enjoys reading, spending time with friends and family, volleyball, and cooking.

---

A Conversation with Alexis Ahlstrom

I am so grateful for the opportunity to chat with Alexis Ahlstrom, who has had an impressive and multifaceted career in healthcare and is currently the Vice President, Head of Policy for UnitedHealth Group. Alexis Ahlstrom earned a Master of Public Health in Health Management and Policy in 2000.

During our conversation, I was inspired by Alexis' passion for disruption in healthcare, and her willingness to take advantage of opportunities and challenges that come her way. As a recent graduate, I learned a lot from Alexis and I know readers will too.

Andrea Nguyen, MHSA '19
(April 2019)

---

Can you start from the beginning, and talk a little bit about why you wanted to pursue an MPH?

Of course – to understand my motivation behind pursuing a degree in public health, I think it is important to understand the context of healthcare in the U.S. at the time. I graduated undergrad in 1997, and during this time there were social injustices in accessing care which I wanted to be a part of changing. All around the world people living with HIV and AIDS were facing a lot of stigma with significant barriers to accessing care and I felt like the health care system needed to work for everyone. My desire to advance care and access led me to pursue a Master of Public Health, where I focused in health policy.

You have had an impressive career in multiple sectors of the healthcare industry, including working for the government, private insurance companies, and a pharmaceutical manufacturer. Can you discuss your career path and what you learned in these roles?

I’ll preface this first by saying I think there are two types of people (both are good) in terms of career development – those that know where they want to end up and take a direct path there, and those that stumble into opportunities without an idea of where they will lead. I would say I am the latter type of person. I have made several job changes because I wanted the opportunity to be a part of something that excited me.

In my first job at the Congressional Budget Office, I gained invaluable skills in analyzing how a policy would impact our complex health care system – both direct and indirect impacts, and near-term and long-term impacts. This ability to delve deeply into a policy solution is something that I have carried with me throughout my career and helped me extensively in other jobs.

After three years at the CBO and after the Medicare Part D legislation passed, I decided to move into consulting, learning how the legislative changes that I had been analyzing were being implemented and carried out “in the real world.” I spent seven years there advising in Medicare and Medicaid, before making a move back into government to be a part of something I was passionate about: helping implement the ACA insurance reforms at the Department of Health and Human Services. After almost three years there, I went back to the private sector, this time for the Blue Cross Blue Shield Association to continue to implement the ACA. After a short stint at GSK I am now leading UnitedHealth Group’s policy development.

Given your extensive career, have you been able to reflect on how the Michigan network influenced your career?

Definitely – there were many times that career moves were due to the breadth of the Michigan network. Many of the opportunities, I felt, came to me rather than me seeking them out. I actually got my ACA job through a friend of a classmate from SPH. I am so appreciative of the network U of M has provided then, and even today.

Can you describe your role at UnitedHealth Group and what you do on high-level?

Certainly, so UnitedHealth Group has two business segments: UnitedHealthcare, which is our benefits business, and Optum, which is our health services and technologies segment. As Vice President, Head of Policy I oversee and help develop the enterprise-wide policy positioning and advance this position at the state-level, federal-level, or both.

From your extensive career, it is clear you have the ability to bring people together, even when there are competing priorities. Many students and recent graduates will need to do this in their own roles. What advice do you have for them?

This is true, and over the course of my career, I have found that meeting people where they are and seeking their point of view has been an effective strategy. It is important to understand your audience and explain a position to them in the language and points that matter to them, as well as hear them out.

How do you stay up to date with health care topics? Favorite newsletters or podcasts?

I definitely spend a lot of time reading, and for my role it is extremely important to know and understand healthcare policy topics and industry trends. A lot of what I learn is on the job through my work networks. I also frequently attend conferences, and connect with people who are experts in their respective areas, which helps further my understanding at a deeper level.

We recently had an interesting exercise in class where we went around the room calling out what inning of a baseball game we were in if the end of the game means achieving the ideal future state of healthcare in the U.S. What inning of the game would you say the U.S. is currently in?

What a fun exercise! Given what I know about baseball, I would say we are in the sixth inning – not yet at the seventh inning stretch for sure. During my career I have seen progress in terms of knowing what the future state might look like and the changes we need to make to get there, as well as an awareness of a need to change the direction of U.S. healthcare system and incorporate social determinants of health. There has also been tremendous innovation in medicine, but also in care delivery and the use of technology. We know what we need to do, and now we need to take steps toward implementation and building a foundation and infrastructure for success.

What are the most prominent challenges we need to provide solutions for first before getting to the ideal future state?

One thing that comes to mind, and something we are working on at UnitedHealth Group is leveraging technology and data to increase access and make the right decisions for patients and providers. To fully utilize the power of technology, we will need to create an environment that allows for interoperability between systems and where data sharing is done safely.

Any last words of advice for HMP graduating students?

Similar to how our interview started, I would recommend taking advantage of opportunities when they present themselves to you or when you are passionate about something. I would tell new grads looking for a new job that they shouldn’t be disappointed by not getting a job they coveted or comparing their first job out of school to others. Every role is a learning opportunity and a step in advancing your career. You will have the opportunity to do something different or new, and don’t be scared of that. When you have the opportunity to reflect on your career, each job serves a purpose and you’ll be appreciative of it.

Andrea Nguyen received a Master of Health Services Administration degree in 2019. During her two-years at U of M, Andrea served on the executive board of Institute for Healthcare Improvement-Open School as Member Engagement Chair and Quality Education Chair. Andrea is originally from Seattle, WA where she loves to be outdoors, eat amazing food, and spend time with her friends and family.

---

A Conversation with Thomas Klein

I recently had the opportunity to connect with Thomas Klein, who is currently the Director of Physician Relations and Business Development at St. Joseph Mercy Oakland, part of Trinity Health. Thomas is also a member of the University of Michigan HMP Alumni Board and a 2013 MHSA graduate.

Thomas shared valuable insight into making the most of the Michigan HMP experience, navigating the fellowship/job search, and the future of healthcare.

I hope you enjoy this interview as much as I did!

Esha Kamath, MHSA Candidate '19
(April 2018)

---

Q: What is your best memory that you have from your Michigan HMP experience?
It has to be the friendships and the relationships I built and developed – not only my colleagues and classmates who are some of my best friends, but also the faculty. Just being able to continue to stay connected with the program speaks volumes. There are several of my classmates who I keep in very close touch with, not only in the professional level, but also the personal level. We bounce ideas off each other. Everybody is around the country doing really great things at completely different organizations; it's a really great network to be a part of.

Q: How do stay connected with your cohort, faculty, and alumni?
There are various forms of communication – whether it's LinkedIn, phone calls, texting – depending on your relationship with each of those individuals, you'll have a different style of communicating with them. This past fall, I visited a few colleagues in DC and we went to the Michigan vs. Maryland football game. It just depends, but if folks are in town – get together to meet up – whether that's dinner, drinks, sporting events. Conferences like ACHE are also opportunities to keep connected, get to know someone outside of your current environment and your current work. It's good to reach out to some of those folks who may be in a different organization and have a different perspective on how to solve a problem.

Q: What is your biggest regret from your HMP experience?
That's a hard question to answer. As an undergrad at Michigan, I took courses at the Ross School of Business as well as HMP prior to joining HMP as a graduate student. I probably could have taken a course or two as a graduate student in Ross or Ford school to get a different perspective. SPH is great, HMP is great, but just another one or two classes outside of the School of Public Health, to not only diversify my portfolio a little bit, but also to think critically on topics. Healthcare is always changing, you now see JPMorgan Chase, you see Berkshire Hathaway, and Amazon getting into the business and you see CVS buying Aetna. With that in mind, a couple of courses from other schools would have helped gain a greater breadth of perspective, so that is probably one thing I would have done differently.

Q: You mentioned the changing landscape of healthcare and I wanted to hear your perspective on that. Where do you see the future of healthcare going?
I don't want to give the textbook answer on this question, but it's going to sound like that. You see other entities, other businesses trying to get into healthcare, and why is that? It's because 20 cents of every dollar is spent on healthcare, and it's going to continue increasing. We are talking about a quarter of every dollar in the economy being spent on healthcare. That's a big deal. With that being said, where is it going? We have to reduce costs. There are only so many dollars to go around, both for the federal government and for local governments. It's not competitive in the global economy and also locally, so I think what you are going to see is – where's the heavy cost? The heavy cost is in the hospital. The continued push that we have seen, even in our organization, is toward more outpatient, more ambulatory care. Total join replacements are going from inpatient to outpatient as we speak, and we're working on that. Other cardiac procedures are being done more outpatient, and also making sure you have enough ambulatory centers in the communities where people live and work to support population growth and population health. Also making sure people go to the urgent care for a $200 visit versus a $5,000 visit in the emergency department. That push from the bricks and mortar of a hospital to more ambulatory care is actually some of my work in my current role, and a key part of our strategic plan.

Q: Reflecting on your current role, how did you decide to enter the provider setting after HMP?
I wasn't totally sure what I wanted to do, but I knew I wanted to do an administrative internship to see if a fellowship was right for me. The quote from Wayne Gretzky is, "skate where the puck is going, not where it's at." I actually did my capstone project on accountable care organizations. A couple of my colleagues and I went and interviewed different leaders who ran ACOs in the state of Michigan, built a report, and developed our project on that. What really intrigued me was being on the physician side of things – medical group management, physician alignment and growth. I actually chose an administrative fellowship with Trinity Health that was specific to physician network organization development. I'm coming up on my fifth year here since I graduated. I've continued the same work, with progressive responsibility over those five years. It's exciting work, it's an exciting time. I believe that personally, I chose this field because my goal is to make communities healthier and make the system more equitable and more efficient. I think I can do that through an administrative role in making sure we're providing the right physicians, providing the right care and in the right places. That's a lot of what my work is. We want physicians who are high-quality, committed to population health initiatives, and doing the right thing for our patients. That's really where my passion lies, and I think it's a very exciting time to be doing this work.

Q: Could you talk a little bit more about your fellowship experience and how that led to the role that you have today at Trinity?
I'd be happy to do so. I applied to various fellowships around the Midwest, and ultimately chose the one with physician-side work because that is where my passions lie. I really wanted to get a few things out of a fellowship. One, an opportunity to work with physicians and medical staff, two, work with senior leaders on significant projects, and finally be a part of a large health system.

The differentiated part about the Trinity Health fellowship is that you get two preceptors. If you're based at the corporate office which is in Livonia, Michigan, you get a system office preceptor, and then you get a hospital-based preceptor to get the dual experience. And then vice-versa, if you're based at a hospital for your fellowship, you get a secondary preceptor at the system office, which allows you to link in with the system and also your local level. My primary preceptor was at the system office, and my secondary preceptor was the physician network leader in Oakland County. I think three or four months into my fellowship, my secondary preceptor's leader over at the primary care clinics was going out on maternity leave. At that time I was asked, "Tom, I need somebody to serve as Interim Director at the primary care clinics. Are you interested?" Of course I was excited and ended up doing that for six and a half weeks. During that time, more opportunities became available at St. Joe's Oakland working on special projects for the president in terms of business development. That kind of rolled into my first job, Manager of Business Development, which I was in for a year and a half or so. Then, I got promoted to the Director of Physician Relations and Business Development, which is my current role. There are usually a few ways in which someone gets a role post fellowship – one, there's either a new role that was created because they're offering a new service at the time and need someone to support that. Two, a job opens up due to someone retiring or leaving. Or three, there is something you do in your fellowship or job that you are leading or working on that becomes a full-time role.

Q: As students, we often get told when searching for jobs to find an organization that's the right "fit." How do you characterize "fit" and how did you find that in your current organization?
That's a great question. I think a lot of people talk about "fit" and I remember when I was sitting in your shoes going, "what does that really mean?" But, here's what I can tell you. It's actually really important and it's hard to put into words, but you understand it when you start going to interviews and you meet with the leaders and you connect. You'll understand – is this an organization with values that you support? Do they live, work, and breathe their values and their mission statement? Is this a leader that not only you can learn from, but they can also learn from you when you partner together?

When you're interviewing for a fellowship, make sure you are interviewing with the preceptor because that's how you get to see that "fit." Most fellowships do, but some don't. Look to an organization that has a history of fellows and understands the program; talk to current and former fellows when you have the dinners and lunches beforehand. You'll really get an idea for how they embrace the fellowship and go from there.

Q: Do you have any parting advice for current students and recent graduates?
A couple things. Use your network at Michigan to build those relationships that are important and stay connected. The program is what it is because of its people, its history, its commitment to excellence, and its research. Give back. Make sure you're spending time mentoring students and do the same thing that you have benefited from. You may have been an H-Net mentee or you may have had a preceptor who's an alumnus, but when you get into roles and are in those situations, do the same and be helpful and give back to the program.

Esha Kamath is a second-year MHSA candidate at the University of Michigan, Ann Arbor. Outside of classes and her role on the MHESA executive board, she enjoys spending time with friends and family, running, and trying new restaurants

---

A Conversation with Jonathan Waller

Last month, I had the pleasure of interviewing Jonathan Waller, a Healthcare Consultant with Blue Cottage Consulting and University of Michigan HMP Alumni Board Member. Jonathan earned his MHSA from HMP in 2016.

As a recent alum, Jonathan offered a unique perspective as a young professional who completed a fellowship after graduating, and then moved into the consulting space. With the healthcare landscape rapidly changing, it was great to get Jonathan’s thoughts on how HMP students and alum can take advantage of Michigan’s resources and position themselves for success as healthcare leaders.

Hilary Bragg, MHSA Candidate '19
(April 2018)

---

Q: You graduated from Michigan and took a fellowship with Palmetto Health in South Carolina. What was that experience like?

My fellowship was a fantastic experience. Palmetto Health is a massive organization that provided me with lots of personal attention as the fellow. They’ve gone through a merger since I left so they’re even bigger than they were when I was there. For me, in our fellowship, we reported directly to the CEO, Mr. Charles Beaman, who is a fantastic guy. He really did a great job of putting us in positions to understand what it means, and feels like, to be an executive in a health system. Our offices were among the C-Suite, so we had access to everything that the executives did. Most of our schedules involved spending time with the Chiefs in various ways to really understand what their lifestyle was like, what their roles entailed, and really seeing what the day-to-day of an executive is. From my perspective, coming out of Michigan, that really is the goal for our students -- to become leaders in healthcare -- and that usually involves an executive position. So, to leave HMP and to be put into that position to really see up close and in person what my long-term goal at the time looked like, that was amazing. The project work was great. For Palmetto to be such a power player in the state and to have such a large footprint of hospitals throughout the midlands region of South Carolina, it was really a great experience for me as a young professional to understand what it's like to run an operation at a grand scale like that. I loved every minute there. I really enjoyed all the executives, all the directors, managers, front-line staff; all great people. I have no regrets about my fellowship experience. For anybody who reads this, although Palmetto Health may not be a household name nationally, I think it's a fantastic fellowship experience as far as being put into an executive position, understanding what they do, and having access to pretty much anything you would want across an integrated health system.

Q: You mentioned the fellowship’s ability to put you in the role of a healthcare executive, beyond that, are there are specific skills that you gained that you may not have gained elsewhere in that first job out of HMP?

I think my fellowship experience was less hard skill intensive. I would encourage anybody in the Michigan program or any student to always at the bare minimum become very proficient in the Microsoft Office Suite, specifically Excel. I think that's the most powerful tool in the Microsoft Office Suite. But I think the soft skills were where Palmetto Health shined for me. We had a very close relationship with the Board of Directors, so understanding how to navigate the Board relationships, understanding what it looks like to discuss initiatives in the boardroom and what it looks like to relay that information down to the staff and even out into the community; it’s a true science. So, understanding what it looks like and how to craft your words and your message, or even working with the marketing team to craft outreach or publicize initiatives; it really is a little more complex than I thought it would be, at least coming out of the program. You really learn how the politics work and how to rub shoulders and understand what it means to be an executive because health systems play such a big role in the economy of communities. If you're the leader of that system, you're almost a politician; you’re always on the public record. People are going to know a lot of what is going on at your job, more so than other jobs. It's really a science. And that’s where Palmetto Health impacted me the most.

Q: What would your advice be to students considering a fellowship upon graduation?

I do think that there are certain students in the program who may not need the fellowship experience, per se, as far as an introduction into healthcare administration. There are people who do have work experience that is probably at a higher caliber than what they’d ask from you in the fellowship experience. My one caveat for these people would be to strongly consider the opportunity to be placed into a C-Suite right out of school; it is going to take a while to break into that environment, so it may serve you well to take a year or two coming out of graduate school to get that exposure. Some fellowships do differ as far as exposure to the organization -- for mine, I was truly in the C-Suite. I was treated like an executive by the executives as far as my expectations for being presentable, being prepared to be put on the spot, and asked questions in any meeting. There were times that I was cold called, and you need to be ready for that. The ability to pop into an executive’s office and ask them about their career path, or why they said what they said in a particular meeting, or what they think is going to happen with the organization off the record really fast-tracks your professional growth in my opinion. You don’t really get that opportunity again in your career to be that young and have that exposure. I'm a proponent of fellowships personally, and that may be because of my own career path thus far, but just the ability to mature quickly in that fashion is irreplaceable.

Q: After your fellowship you switched gears and joined Blue Cottage Consulting. What spurred your move to the consulting arena?

I truly loved my experience at Palmetto Health, both from the work experience standpoint and the people I was able to meet and be among for my time in Columbia. However, I think it's important to know yourself, your work style, the environment that's conducive to you producing your best work or augmenting your skill set. I think I was looking to get into something a little more fast-paced. I really enjoy being dynamic and being among different types of environments and people, so for me, I like consulting for a couple of reasons. First, I could really see the results of my work fairly quickly. The health system is bureaucratic, there’s no other way to put it. There are a lot of levers that must be pulled, or stamps or approval that you need before initiatives can really be put into play and you can see the results; it takes a long time quite frankly. In consulting, it's much quicker, it’s client-oriented, it’s customer service. You’re expected to produce something within a time frame, there’s a level of expectation of your work. For me, that appealed more. At Blue Cottage in particular, I love the fact that we help organizations to build the healthcare facilities of the future; with the direction our industry is moving, organizations need to establish as much standardization and as many operational efficiencies as possible, and we are an industry leader in the operational and transition planning work that we do.  It is also neat to have the opportunity to work in different types of care settings such as safety net hospitals, pediatric hospitals, or academic medical centers. To be able to do such rewarding work in many places in such a short period of time has been a lot of fun for me thus far, and it all started with establishing a level of comfort in hospital operations during my fellowship. 

Q: What is the most challenging part of your job, or something you wish was different?

Consulting isn’t for everyone. It does sound appealing when you talk about it. You get to travel to really cool places; however, I think the most important thing to emphasize about consulting is that it truly changes your overall lifestyle. You’re now working in a client-based industry, which means you’re working on other people’s time. You have to be places at difficult times of the day or times of the week; you have to do things sometimes at odd hours of the day because you’re being paid to bring a service to someone that you don't technically work for. That changes your lifestyle. For me, it really has forced me to improve my time management. It has forced me to be more proactive in spending time with friends and family. It also forces you to hold people accountable with their own time management. For me, it's much harder to spend time with people if they’re running late. It’s hard because that can influence your lifestyle. You’re two hours late, you have to fly out at five in the morning, that really affects your day or even your work week! You haven't been home in a week, and you need to do a bunch of chores, that really affects your weekend plans. You really have to get your time management down to a science in consulting. For me, a younger person coming out of graduate school not too long ago, it’s been a challenge, but I think I'm finally starting to know myself and what I like to do and really what I value with my time.

Q: From what you’re seeing in the consulting arena and what you saw in the healthcare system space, where do you see healthcare moving? What does the future of healthcare look like?

The future of healthcare is pretty well known, but at the same time very unknown!  We’re moving to a more outpatient space. You’ll have to be very sick to be an inpatient in a hospital with the direction healthcare is moving. I think that consumerism and transparency in pricing and services are going to continue to come to the forefront, just because technology gets better over time, by the day really, so it’s really moving to the point where you’re really going to have to be able to offer exactly what people want. I don't know exactly what that means, but it's about understanding your market, your strength as an organization and what you can offer patients, and really sticking to that. I don’t think you'll see healthcare organizations offering a wide variety of services as they do now unless they are huge. I think we’ll begin to see organizations really focus on their strengths and just put a lot of their resources into their strengths at the best possible value in their market, and I’m interested to see how this will influence the M&A environment. I think that’s what we’ll continue to see in healthcare, but we’ll see! I think the mergers have been really interesting. There have been a ton in the past year or two. So, it'll be interesting to see who rises to the top and who struggles as their organizations become larger. As you become larger you have more resources and more market share, but you’re less nimble. I think you're going to have to be nimble in healthcare moving forward just because once consumers gain knowledge they can change their buying patterns relatively quickly. The consumer wins in almost any industry. 

Q: Jumping back to HMP and your time here at Michigan, what would you say was your most beneficial experience as a student?

I think this is a two-pronged answer for me. First, I think the true benefit for me was being among such competitive and talented students, because it really pushed me. I think most people who come into the program have a distinguished academic and/or professional background. So, for the first time in a long time for a lot of us, because we come from places that we did well and were among the top performers, you’re among people who are just as equipped to succeed as you are. Iron sharpens iron and I think that’s really exhibited in our program. Secondly, I think the benefit of the alumni is unmatched to any program in the country. Our alumni involvement is so strong, and I really appreciate the time they give to us students in coming back to the program or meeting across the country. I've been to events in DC, San Francisco and Chicago in which hundreds of alumni take time out of their day to come and connect with other alumni and/or current students, and that’s just unbelievable. As far as the actual coursework, I thought the classes led by alum, such as Joe Horton or Steve Nelson, were fantastic. Also, shameless plug in that my CEO at Blue Cottage, Juliet Rogers, taught a fantastic course as well; she really did!  But then I would also say case competitions really prepared me for the working world. Just the amount of work needed to be competitive in the case and the team dynamic you have to establish. In work, especially in consulting, you work in a team for everything. Just understanding situations that can come up within your own team or working with a client, and how to get around those situations, how to bring forward a strong solution or recommendation. I think that was a valuable skill that really helped me be comfortable in the working world; number one, just because you know how to navigate that environment, and number two, if you do it well, it gives you confidence that you can do this work. I think those are the two main buckets: the people -- students and alums -- and secondly, for me, the cases. Just putting your course work to the test in real-world simulation and seeing how you do.

Q: What was your biggest regret from your two years in HMP or what would you have done differently?

I think that I would have liked to challenge myself to be more technical while I was in school. I think there were a lot of really good resources not only in HMP, but at the Ross School of Business or the School of Engineering, just those types of clubs or programming opportunities they had to become more technically skilled. You can never be too technical. I think technical skills are how you can make yourself more indispensable in any organization. I did take some courses, but I wish I had put more emphasis and time into that. I also wish I hadn’t worked while in school, just because I would have focused more time into the program. But, it was a necessity at the time, so I can’t really say that's a regret.

Q: What can students be doing now to best prepare themselves to become leaders in healthcare, or what might we not be getting in the classroom that would be great to have?

I think building an understanding of commonalities across healthcare that you would see in any provider space; an understanding of support services -- pharmacy, lab operations, supply chain operations. The more you can speak to the details like that, the easier it will be to understand holistic healthcare operations once you're in that space and you’re a fellow or employee somewhere and really trying to understand the big picture. These areas are also where many organizations look first for cost-savings initiatives, so if you know how these areas operate, then you bring some value right out of the gate.  Secondly, just continue to network. As I meet more and more leaders in healthcare working in all the places I am able to travel, and even during my fellowship experience and being involved heavily in conferences, I’ve learned that a lot of people get to leadership positions because of their ability to leverage their network. I think most people are capable of having the basic technical skill set that most executives have, but I think the key is for being an executive, can you work with people, are you liked by people, do people look to you as someone they can trust, and are you a known entity? And that all comes down to the networking piece. Spend time; it doesn’t have to be an hour-long phone call. It can just be 15-minute conversations. People are busy. No one wants to be on the phone all day. But it could be as simple as a text or email note. But just a way to let people know, hey I’m thinking about you, or I value your opinion on this decision I have coming up do you have 10 minutes for me to run this by you? The little things are what really is going to create the foundation for career success for all of us. As Coach Harbaugh would say, the basic blocking and tackling of it all is networking. 

Q: What do you think differentiates Michigan students and alumni?

I think Michigan does a good job of giving a holistic view of healthcare and health services offerings in our country, starting with HMP600. It's one of the first classes you take. For me, it was a hard class because it was so much information. But starting with that as a foundation, at the very least, you need to be a bit dangerous in conversation as far as knowing what’s across the healthcare chasm. I think that's a good foundation to start from. Once it comes time for internships and fellowships, I think our students have a decent picture about what they want to do. I think part of being successful is alignment. So, if you know what you want to do, or at least what you don’t want to do, you can cut out potentially wasted time. Just because you have an opportunity doesn’t mean you should take it if you know that's not what you’re going to enjoy. It allows our students to be more efficient in where they want to start their careers. If you have a leg up at the start of your career, there's a better chance of gaining momentum and staying in a good place throughout your career.

Q: Any final thoughts?

I think that it's important for students to be involved in some sort of organization because part of that networking piece is not just Michigan people. Join a minority organization or a women’s organization, or some sort of organization that speaks to what you enjoy -- whether that's something based on Lean Six Sigma or something else -- some sort of professional organization that can get you around people from all over the country, and maybe the world, that like the same things you do. And just being able to be part of that comfort zone, whether you go to the annual conference or whether you are just on the listserv. It's important to not just be Michigan-centric. Get around other people. There are any other great programs out there, meaning there are many other great people who choose not to go to Michigan, but you can still connect with those people and learn a lot from them. Some of my closest friends in healthcare did not go to Michigan and I still talk to them to this day, and I would never have met them without being a part of a professional conference.

Hilary Bragg is a second-year MHSA candidate at the University of Michigan, Ann Arbor. She will serve as the IHI Speaker Chair and HMP Alumni Board Assistant during the coming year. In her free time, she enjoys supporting the international girls empowerment and skills training organization that she founded in 2014.

---

A Conversation with Nicole Cooper

I recently had the opportunity to interview Dr. Nicole Cooper, HMP Alumni and Senior Director of Social Responsibility at UnitedHealthcare. Dr. Cooper holds an MPH from the University of Michigan School of Public Health and DrPH from the Harvard T.H. Chan School of Public Health.

With varied previous experience working in provider and payer organizations and in health policy, Dr. Cooper presents a multifaceted reflection of her time as an HMP student and now as an alumna. 

Neeharika Jaladanki, MHSA Candidate '19
(April 2018)

---

Q: What is your most valued experience as a student and as an alumna?

The thing that comes to mind is my most recent experience as an alum of the program, which is sitting on the alumni board. I think it is a great opportunity for me to actively contribute to the success of the HMP program, a program that I am assured really helped to propel me professionally and helped to advance my career. I value my master’s education in Health Management and Policy very much and want to serve the department. This most recent experience as an alumni board member is particularly meaningful for me.

Q: What is an HMP resource that you wish you would have taken advantage of as a student?

I had an HNET mentor while I was an HMP master’s student. I definitely activated the alumni network that was both local in Michigan and across other alumni groups that I met along the way. I wasn’t perfect, but I certainly worked my very hardest to make sure I met and sustained relationships with alumni that I met, was active as a student leader, and worked to develop relationships with faculty. I suppose there is always room for improvement in those areas, but I worked hard to do all three.

Q: So, would you suggest for current and future HMP students take advantage of the alumni network to grow their connections?

Yes, definitely. I would suggest being strategic about which alumni you reach out to, finding alumni who have roles that you think you want in your career, and being steadfast in fostering relationships with them while recognizing how busy many of the alums are who are leaders in the field. I had an awesome experience being personally mentored by alums of the program when I was a student. I think it makes all the difference in the world to make it one of your focuses while you are in the HMP program. The faculty relationships are immeasurable as well, as there are key faculty that I met while I was applying for the program who, eight years post-graduation, I still connect with about how I am doing and where I am going professionally. They still advise me to this day.

Q: That’s wonderful that you’ve maintained all of those connections! You have background working in the provider, payer, and policy space. How was the career transition from one area to another?

At times, I think provider organizations, payers, and policy makers approach central U.S. healthcare issues in different ways. From the policy and regulation standpoint, the focus most recently has been on national reforms and establishing the proper reforms for the U.S. healthcare system according to how the Affordable Care Act was intended to be implemented 

When I think about my choice to enter the payer space, in particular where I sit now at UnitedHealthcare in social responsibility, I’ve been tracking my career to the role that I currently play because I believe payers have an awesome opportunity to improve population health. Payers can and are doing a whole lot more when it comes to improving the health of populations.

There is so much opportunity before us to truly set up care models that encompass critical clinical care and access to supports and social services across the healthcare system. There is opportunity to innovate like we have never done before. As I see it, my professional transition has been one where I have focused on doing public health work in healthcare spaces. For me, that currently looks like leading social investment strategies at UnitedHealthcare at the national level. The transition has been a good one for me and I have been intentional about the various types of national organizations I have worked in. 

Q: What are some challenges you faced early in your career and how did you overcome them?

Early in my career, I was unsure of what track to choose. When I was in the Health Management and Policy master’s program, I was initially thinking that I would become a hospital administrator. That is not my chosen profession today. However, I learned during my two years studying at Michigan that I didn’t really have to choose a track per se in that I was able to put myself on both the management and the policy track because my interests were so broad, yet I was still pretty clear on what I wanted to do. The need to choose one track so early in my career was challenging for me. Now I know that I didn’t have to choose at that exact moment, and I eventually ended up figuring it out by the time I was approaching graduation and entering the field post-HMP.

Q: What is something you enjoy about being in the payer space, especially in your role in corporate social responsibility?

I enjoy the impact that we are making. I was very focused on working with a national payer and I spent some time at Humana at the national headquarters in Louisville, KY working on what they call the Bold Goal initiative that aims to improve the health of communities that the company serves by 20% by 2020. That was my first taste of working at a large payer organization, and learning how payers are approaching population health and addressing the social determinants of health at the national level. That led me to the role that I currently play at UnitedHealthcare and I am really enjoying this path. It requires me to be innovative and to work with governmental affairs and policy leaders at UnitedHealthcare. I also work very closely with colleagues within the business who run the health plan operations. For me, the external and community engagement pieces of my role are truly meaningful. The fact that I get to create some of these programs and strategies from scratch is a huge growth opportunity, and I learn a lot each day. I get to use several of the areas that I’ve been honing my skills in for quite some time now. I work at the crux of health policy at the local level and also in spaces that allow me to think most strategically about social investment at the national and local level that could make an impact and improve health and access to health.

Q: What do you think the future of healthcare holds? What kind of role do you see yourself playing in the future?

I think the future is one where there are innovative, never-been-crafted-before partnerships across the healthcare spectrum. It goes back to your initial question around transitioning from payer to provider to federal policy roles. We all will be working together more meaningfully —and I know I’m being very hopeful here— in ways that really get us to where we need to be.

I know that the term that people often use for this type of work is “public-private partnerships”—I think we will be engaging in this type of work at a larger scale while trying to advance these issues alongside one another. I’d say the future lies in things like jointly funding various pilots or ideas at the local level in ways that we haven’t before on how to meaningfully integrate health and social services. That’s one area that I want us to get right soon; where we reimagine how to serve underserved communities in the U.S. that we know need more support and integration at the local and national levels. Payers should work in joint collaboration with local government bodies to carry out these unique models of serving the most vulnerable patients in the U.S. healthcare system. That’s what I want us to get right soon.

Q: What led you to pursue a DrPH? What would you tell current students who are interested in pursuing another public health degree after graduation from HMP?

I would say the other big development happening within public health and healthcare is in thinking about leadership training and the necessary competencies to lead in healthcare like we have never done before. I made the choice to attend the Harvard DrPH in the very first cohort because I felt that I needed even more skills. I did feel well trained from the Michigan HMP MPH program, but I had some additional funding to return to graduate school to obtain a doctorate. What I was really enthused and enticed by for the Harvard DrPH program was how they wanted to reimagine (and I don’t use that word lightly) what a DrPH should look like in our field and what it would look like if it were squarely focused on leadership and management competencies. So I thought that was very compelling—it was right up my alley and I am pretty pleased by the training I received in that program and the fact that I was required to work while studying and writing my dissertation at Harvard. Students in the program are required to complete field immersions and to have meaningful professional experiences in that particular doctoral program. To get to your initial question, I would definitely encourage anyone interested in pursuing a doctorate focused on healthcare leadership and management to do so because the field is recognizing that we need leaders that are trained to the highest level to lead us. 

Q: Do you have any advice for current students? Alumni?

I recommend using the opportunity as an HMP student to seek out where innovative, never-been-done-before things are happening in healthcare. I know that is a broad recommendation, but it is very important to work at the intersection of innovation at this point, whether it is innovation in payment reform, delivery of care, or in supporting various sub-populations within the U.S. patient population, managing healthcare costs, etc. If alums and current students focus on working where innovation is happening, where solutions are being brought that perhaps haven’t been conceived before, we can achieve breakthroughs that we have never achieved in U.S. healthcare. 

Neeharika Jaladanki is a second-year MHSA candidate at the University of Michigan, School of Public Health. She is the current Public Health Student Assembly Treasurer and HMP Class Representative. When she isn’t busy studying for class, she enjoys spending time with her cohort, volunteering with the UM Student-Run Free Clinic, and catching up on a very long reading list. 

---

A Conversation with Mike Romney

I recently had the pleasure to interview Mike Romney, VP of Business Development at nThrive and University of Michigan HMP Alumni Board Member. Mike received his MHSA from HMP in 2012.

As someone who switched industries nearly ten years into his career, it was great to get Mike’s insight on the value he derived from the HMP program. 

I hope you enjoy this interview as much as I did!

Ryan Zayance, MHSA Candidate '19
(April 2018)

---

Q: Take me through your career path post-MHSA. What kind of work are you doing with your current company?

My career has been more non-traditional and unorthodox compared with most of my colleagues that I work with, but also for my cohort that I graduated with, in that most people had some kind of a healthcare focus (before entering the program), or maybe public policy. I started my career 19 years ago with Deloitte, as part of their assurance and advisory team. Then I got the entrepreneurial bug while I was still young and started my own book of business within commercial real estate brokerage in Phoenix, when the market was extremely hot. I did that for about 6 years, but then I wanted to work with folks who were a little bit more focused on something other than just money and making deals every day. I started talking with the then-CEO of one of the Banner Health hospitals out in Arizona, and I thought I could bring my skillset that I had developed up to that point in my career into the healthcare setting, and not only add value, but get more out of everyday work. So, I uprooted my family of three boys and moved to Michigan for graduate school. I graduated from the program in 2012 and joined Accenture’s health strategy practice in Detroit. A year and a half into that opportunity with Accenture, I was approached by a startup healthcare technology company. I thought, “Now this is exciting.” It was a little group called Equation. I joined Equation to help grow their consulting business, as they were transitioning from a consulting company to an analytics technology company. We were just on the verge of really starting to grow, and then we decided to join on with a private equity company to form an end-to-end revenue cycle management company. That’s where I am today, at nThrive. It’s been an exciting ride, the merging of five different cultures. I’m part of our national sales strategy team where I help us ensure we’re meeting market demand and hitting our revenue targets.

Q: Why did you choose to go into consulting as opposed to the provider route?

My intention was, when I interviewed with John (Griffith), to become CEO of a hospital as quickly as I could; I saw Michigan as enabling that progress. It came down to an administrative fellowship in Houston and Accenture. The reality at the time was, with four children in my mid-30s, my wife said, “You’ve got one offer that’s X, and you’ve got another offer that’s 3-4X. You tell me what’s best for the family.” But in all honesty, we were willing to make that sacrifice, and it was a really hard decision because I really wanted to get into the provider setting, and work with clinicians and all these great people. At the end of the day, I’ve got a personality that’s very ADD, if you will. Consulting allows me to jump around quite a bit, work on a lot of different problems, come up with a lot of different solutions, and, essentially, work at a different “shop” every couple of months. I’ve thoroughly enjoyed the consulting route in my career. You get to work with really bright people – people who are trying to solve problems. You get to connect with the C-suite at all these hospitals and work with executives. I’ve really enjoyed the atmosphere and the challenge – it’s a new challenge every week.

Q: What did you feel were the most valuable resources, or maybe the best part, about the HMP program?

Two things come to mind that have helped me the most in my career. Actually, I’m going to say three. When I first came out of the program and joined Accenture, my very first project right there in Detroit was with a very large health system. My senior manager handed me a big set of data and said, “Hey, I need you to figure out, across these nine hospitals and hundreds of thousands of patient encounters, what the average length of stay trend across this health system is, and then match that up against industry benchmarks. I need to present that to the CFO soon, like, as quickly as you can do this.” I had recently finished my last semester and had taken David Mendez’s Access database/operations class. I remember at the time thinking, “Why the heck am I doing this? When am I ever going to use Access to look at data?” The short version of the story is, within 48 hours, where the senior manager expected it to take at least a week or longer, I was able to turn that data around. I was able to deliver very quickly because of that skill that Professor Mendez helped me develop in school. Bigger than that, there are a few things I always say that provide me the most value from the HMP program at Michigan. Number one, the breadth of the knowledge base. I’ve always enjoyed the fact that we focus on both policy and management. I strongly believe that even if you’re not in a formal “policy” role at your organization, it’s a part of everything you do regardless of what your role is and where you happen to work, be it provider, payer, pharma, whatever it is. I thoroughly appreciated that. And then secondly, I’ve always said this, and I’ll continue to emphasize it, the network that we have is unrivaled. There are so many HMP alumni that you can call on anywhere, literally. Whether you’re looking at entrepreneurial opportunities within a startup in healthcare tech, a CEO of a large health system, a director within an insurance company, or someone in a PBM like CVS; wherever you want to go, you will find a Michigan alum. If you have a problem that you want somebody else’s opinion on, you have a network of individuals at all different levels, all different ages, all different experiences, that you can call on at any time to bounce ideas off. I really value that.

Q: What is something you didn’t take advantage of during your time here, that, looking back, you think you should have?

Honestly, this is the one time in my life that I can say there is nothing that I didn’t take advantage of. I completely maximized my time at Michigan. I had the luxury and the perspective of having been out of school for a decade. So, when I went back to school the second time around, I told my wife, “I’m not going to be around a whole lot.” I went in saying, “I’m going to take complete advantage of everything I can.” I would go meet with professors constantly after class, I was president of MHESA, I was involved in IHI, I was involved in HPSA, I was involved in every student association you could be involved in. All the different healthcare conferences, too. I went over and took classes at Ross, I took classes at the engineering school, I took classes at the nursing school - I maximized that investment to the best of my abilities. At the time I was the old man in my cohort, and I was always reminding my fellow students, saying, “You have to take advantage of the networking opportunities.” Anytime you can meet and talk with somebody, you have to do it.

Q: Do you think the recent vertical integration trends in the industry (CVS-Aetna, Cigna-Express Scripts) will be as transformative as they are made out to be?

I absolutely think they will be. It’s an interesting balance in healthcare because it is so slow to accept change and move in the direction it needs to; healthcare has a lot of these transformative changes that are happening, like vertical integration or just value-based care in general. The challenge in healthcare is we know where we need to be, we know what we need to do, we know the changes that need to occur, but you have so many moving pieces and parts that’s unlike any other industry, and everybody has to be on the same page. Providers and health systems can want to implement value-based care all day, but if the payers aren’t aligned and reimbursement is still reimbursing you to just do services, then there’s misalignment. That’s a constant battle. When we see this vertical integration, when you’re pulling all those complex parts under one roof, now you’re going to get alignment. You can finally get everyone at the table, together and on the same page. I’ve only been in the industry for eight years now, but when I look at the rate of change in any other industry, and you look at how slow the rate of change is in healthcare, transformative change is just waiting to happen. You see vertical integration (like CVS-Aetna) and as long as markets and regulations allow it, it’s going to continue because the margins are there. If it’s profitable, that’s all the business cares about at the end of the day. Consumers are starting to accept that. Studies show that Millennials, Gen X, and everybody else that’s younger, are okay with paying more out-of-pocket for their health insurance. These worries are no longer obstacles in the market to impede this type of progress.

Q: There is the notion that the hospital, in due time, will no longer be the center of the healthcare system, as a result of a population-based approach. Do you see the center of care moving outside the four walls of the hospital? 

The services are moving to the outpatient setting. You look at the recent trends, and I’ll pick on CVS with the Minute Clinics. Look at one of our own alumni, Amir Rubin (who just left Stanford recently to work with One Medical Group) in that Minute Clinic concept. Younger generations want healthcare either on their phone, in an app, or around the corner. They don’t want to call to schedule an appointment six weeks out. In what other industry, when you have a need, do you wait six weeks? Amazon wouldn’t be in business. None of these other companies would be in business. It’s an old, broken model, but we’re moving away from that. The hospital will always be the center for tertiary care. All these basic, everyday medical needs that we all have will be met by concierge medicine. Telemedicine is taking off. All the indicators in my mind are pointing to the fact that there will still be large tertiary centers, but other than that, more and more of our everyday primary care needs will be met by, hopefully, mid-level nurse practitioners, physician assistants, and others that are in easily accessible settings, or even just out on the web.

Q: What do you feel has made you successful in your career? What advice do you have for future healthcare leaders?

How I’ve gotten to where I am today is absolutely through mentors and good leaders who were willing to take a risk on me. I’ve tried to reciprocate that, and mentor as many folks as I can. I follow a lot of Adam Grant’s work, and I’m a big believer in what he describes as “givers” and “takers” in the world. I think folks that give, at the end of the day, are actually the ones who end up growing, and helping others grow. I’ve relied on great colleagues throughout my career, especially since I’ve transitioned to healthcare. That starts with my first informal mentor at Banner, who I mentioned I spoke with before I even made the jump into healthcare. Ever since then, it’s professors within the department that I’m still close to, and reach out to and bounce questions off of all the time. It’s colleagues, clients, and everybody that I’ve worked with over the last six years now. I’ve tried to surround myself with a great network of folks who believe in me, want to take risks on me, and are willing to help me grow. Number two is that I really have tried to reciprocate that mentorship and give back as much as I can to those around me. I’d say those two things have helped me get to where I am in my career today, pay the bills, and keep my wife and boys happy. Everybody’s got something to give.

Ryan Zayance is a second-year MHSA candidate at the University of Michigan, Ann Arbor. Ryan is excited to serve as IHI Project Co-Chair and MHESA Corporate Relations Co-Chair in the coming academic year. In his spare time, Ryan is either watching romantic comedies or taking recreational flag football way too seriously.

---

A Conversation with Serena Wang

Last year, I had the pleasure to interview Serena Wang, the Manager of Mergers, Acquisitions & Partnership Development at Trinity Health and University of Michigan HMP Alumni Board Member. Serena received her MHSA from HMP in 2010.

With her experience in the provider space, it was great to get Serena's perspective on the value of an HMP education towards her career.

I hope you enjoy her words of wisdom as much as I did!

Ashley Reid, MHSA Candidate '18
(August 2017)

---

Q: You currently serve as a Manager of Mergers, Acquisitions & Partnership Development at Trinity. How have the skills you learned inside and outside the classroom translated to your current role?

I would say the most relevant skills I learned came from the HMP Strategy and Marketing class, along with the Strategy role I worked in for three and a half years prior to my current job. Each one really helped contribute to how we evaluate opportunities, if they are going to help strategically, and how it fits into the big picture. My first exposure to strategy was through the department and I think that was definitely my favorite class. I loved hearing about the actual cases that were done, going through real-life examples, and thinking about what I would do if I was in that situation. I was lucky enough to move into this area at Trinity Health!

Q: What was the most valuable thing you took away from the program?

That's a good question. I'm a relationship-oriented person. Personally, I took away a lot of great memories and lifelong friendships. Professionally, it laid down a foundation of thinking and understanding of public health, understanding how the US healthcare system runs, and ways we can improve it. There's just so much you learn on the job too, so it was a good starter I would say.

Q: What is your favorite memory from your time at Michigan?

I took a leadership class and that involved a lot of introspection and sharing. It was our last semester in the program, so one day our class decided to have an international and multicultural foods day. Everyone brought something that was close to their heritage or something they identified with. That was a really fun day! I think that was a great way to have everything culminate together with the learning process of HMP, while coming together as classmates and friends.

Q: Looking back, what would you have done differently?

I think I wish I had taken more finance classes other than what was initially required for the MHSA track. In M&A there's a lot of evaluation involving financials. There's work that I do on the side to try to strengthen those skills since I didn't have an undergrad degree in finance. So, I think being able to bolster that area to strengthen my financial acumen is something I would have tried harder to do during my time in HMP. But, it was really nice that there was such a wide range of healthcare courses and topics to choose from within the program!

Q: How have you utilized the alumni network both as a student and an alumnus?

As a student and as an alum, I knew the importance of the HMP alumni network. It was one of the big reasons why I decided to go to Michigan. To me, it felt like you could get a position anywhere geographically and not necessarily feel the need to stay local after HMP. Although I've personally stayed in Michigan this entire time, I think that's definitely proven to be the point with many of my classmates, in part due to the large alumni network.

As a student, I went to the coffee talks, attended various networking events through public health organizations, and ran the H-Net mentorship program which really helped to create those chances to connect with people on a more personal level. The mentorship programs, such as H-Net, are beneficial for both students and alumni. As an alum, I'm always sure to have an H-Net mentee each year. Being a mentor, and previously being a mentee in the program, I found how valuable it is to really connect and talk to someone personally. I like to hear what experiences students have had, how that's shaped their decisions, and what kind of lives they want to lead as an alumnus too. Through relationships with my own alumni mentors, I've been able to get advice on decision making, and when it is the right time to make a job move.

I also tried to take advantage of the many great alumni networking events HMP sponsors. I actually networked with the HMP Alumni Board previously between being a student and serving on the board and I think it really helped me see the value of continuing to give back. So, I was very excited to be able to officially join the board just this last year!

Another chance I got, just because I am local, was the opportunity to help guest teach a class for Operations Research with David Mendez. We had hired him as a consultant to work on some forecasting and Monte Carlo simulations, so it was pretty cool to actually take something from a very typical standpoint and refine it.

I've been pretty lucky to have all of these continual touchpoints. I think it's certainly easier being local, but I would encourage others, even if they're not, to create those opportunities and stay connected to the department.

Q: What do you think students can be doing now to prepare themselves best to enter the healthcare industry?

One thing I did as a student and more as a fellow was reaching out and networking with a lot of local alumni. I did this more as a fellow, but I think it was really helpful as a student too. As a student, there's so much you can really spend your time on. I reached out to all of the previous Trinity Health fellows and talked to them about how their career progressed, what their ambitions were, and what changed throughout that whole process. This gave me a lot of perspective on things I may not have otherwise thought about and created a networking opportunity to personally connect with someone. It's something I happened to try doing and I now see the fruits of it years down the road with a great set of mentors I can tap into if I ever want or need to.

Q: Any advice for current students and fellow wolverines?

I would say if there's anything you're passionate about or interested in, definitely explore it! Or even just kind of spread your wings and take the initiative to see what's out there. The University has so many amazing opportunities that you can tap into. I mean, I haven't done any global health work since right after I graduated, but we did a service trip to Jamaica which was a really cool experience. Since UofM is such a great institution where a lot of the programs are highly ranked, I would recommend students take classes in anything they're interested in through other schools, as well. Just to kind of broaden your knowledge and see what else is out there and you never know what will happen from that. You can always volunteer or consider other ways to get involved in school, but I think the university and Ann Arbor have a lot to offer. Realizing early on that everything is kind of a tradeoff, you should prioritize what's most important to you because you'll always be saying no to something. It's hard to maximize everything! School is also a really good way to test out work-life balance. It's good to be cognizant of the decisions your making, but also don't be too hard on yourself!

Ashley Reid is a 2018 MHSA graduate at the University of Michigan, Ann Arbor. When she’s not with her HMP cohort, you can find her running with her labradoodle named Reggie, working at MVMNT cycling studio, or searching for quality Mexican food.

---

A Conversation with Bo Snyder

I recently had the pleasure to interview Bo Snyder, the president of Bo Snyder Consulting and University of Michigan HMP Alumni Board Member. Bo received his MHSA from HMP in 1988.

With a foothold in both the provider and consulting world, it was great to get Bo's perspective on the value of an HMP education towards his career.

I hope you enjoy this interview as much as I did!

Anthony Parel, MHSA Candidate '18
(May 2017)

---

Q: You began your career at a provider organization where you spent 18 years before starting your own consulting practice. Was switching careers scary for you?

I was 42 years old, and that was 11 years ago. I had a really great 18 year run with a wonderful organization...that had just won a Baldrige award, by the way. At that point in your life [40-something] you kind of assess things. After mulling it over, I decided that I would give starting my own company a shot. That was 11 years ago, so I would like to say that it worked. But yeah, as for your question "was it scary?" yeah, it was horrifying. I needed the complete support of my wife, and I had that so that was definitely helpful. But I was the sole breadwinner for our family. My wife didn't work and we had two kids in elementary school at the time so I kind of just jumped and hoped for the best. I figured it out as I went along which was both scary and exciting.

Q: What spurred your move?

I was at a good organization that became a great organization during the 18 years I was there. I felt that it was a blessing and a curse to being in a great place: the blessing is that it's a great place; the curse is you're there for so long that you get stale. Just because you're ready to do more, doesn't mean that the organization is ready to do more. This is my advice to young people: if you're on the provider side, go to a place that's big enough for you to move around and make sure that there are lots of opportunities within that organization. There will come a point in time where there are just fewer opportunities for you to move and you have to be patient. You have to either be patient, or you have to move...I felt like I needed to move but I didn't want to leave town; I had two kids in school. Since consultants can travel, I could set up shop in the town I lived in. So that's what I did.

Q: Do you have this same advice for people who start out in consulting, policy, or payer?

Well, that's the thing, I don't know because I didn't grow up in those worlds. But I will say this, take the time to think your career out, don't be rash, and make sure that you have trusted advisors. Also, consider how long you might want to stay at one job. Is the job you're looking for a means to an end or is it the end? I know people who make mistakes on both sides: people who stay at a job too long and people who jump too often. If you aren't sure what you want then find an organization that is big enough for you to move around in. But that's just my two cents and what I wanted to get out of my job. So I guess my key point here is that you should focus on what you're passionate about; just make sure to be flexible too. But definitely, try and find your niche and think about where you can succeed.

Q: You mentioned the importance of having mentors/advisors. How did you go about reaching out to alumni to be your mentors and did you feel as though they helped you grow as a student and professional?

To be honest, I didn't really take advantage of our alumni base early in my career. I've been on the alumni board for a long time now and I think that we've come to this point where there are better opportunities for students to connect with us. I don't know if the alumni network wasn't as active then as it is now or if I was too stubborn and myopic. But I never took advantage of that, in retrospect I wish I had. I kind of made up for that by building my own network and I try to be that mentor to any student that needs one. But that is honestly the best part of this program. Anyone and everyone will sit down with you and give you their time. High-level executives will gladly get coffee with you or any other student and that is invaluable.

Q: What do you think the future of healthcare looks like?

I have to be honest, I don't know. But as a healthcare leader, I'm prepared to deal with whatever happens and I look at the future with both interest and curiosity. There is work to be done whether or not the ACA is repealed. I'm a bit agnostic on the whole issue because I don't want the issue to detract from all of the other important work going on in the field. That being said, it is an important issue; I certainly hope more people have access to affordable healthcare but there are a lot areas in which we need to improve. We can't let this drama detract from the work that all of us healthcare leaders produce. Think about how much time you spend on productive things. If you spend too much time thinking about Washington drama, unless that's your day job, then you are not using your time well.

Q: What was your most beneficial experience as a student of our program?

There was learning at every turn. There was classroom learning, learning when meeting with Professors, and there was study group learning. We were a close class and I think that we learned a lot from each other. This wasn't solely a classroom construct, this also happened when we went out to bars and to get dinner. There was this real passion and desire to make a difference in healthcare and I think everyone grew from that engagement.

Q: What was your biggest regret from your two years in HMP?

I wish I had reached out to alumni more and taken more advantage of the network. I always felt inferior and awkward while talking to alumni. That was a part of coming into the program straight out of undergrad. When it comes to my career, I always wonder "Did I stay in provider for too long? Am I staying in consulting for too long?" I mean, I'm 53 years old; I'm at the last third of my career. What am I going to do for the rest of it? And I've been having this discussion with my wife: "Am I okay with what I'm doing now or do I need to change gears?" Luckily my kids are in college now so I no longer have roots that tether me to one place so I have the option to pivot.

Q: What is the best way to implement change within an organization?

Wow that's a big question. One answer is to get people to envision how things could or should be. Let me digress into my Baldrige world. Baldrige in three parts is: 1.) Is your organization performing as it should be? 2.) How do you know? 3.) What can you change or improve? Get people to articulate what better looks and feels like. Getting people to talk about it is the first step. Once people start talking about it, the gears start turning. People need to be able to identify with and buy into what point B is. Once people can identify point B, the job is easy because you have the wind at your back. A huge component of a leader's job is to think about articulating what point B is and then figuring out how you'll know you're there. Then finally deciding a cadence of accountability, "We are going to meet once a week for one hour to work on getting to point B." Keep chipping away and make sure that you meet every week. Be disciplined. Don't let your efforts become the flavor of the month.

Q: Last question! How do you become a change agent?

Looks for opportunities within organizations and just volunteer and take that opportunity over because no one else is doing it. Find a vacuum and jump in and take ownership and begin to move things. But make sure you do it respectfully because people may push back and challenge you. All in all, make sure that you have allies and people that both share your opinions and challenge them because that's how you really grow. A narrow view is limiting and you need to make sure that you listen to every side and angle as you make change.

Anthony Parel is a second-year MHSA candidate at the University of Michigan, Ann Arbor. When not studying for class, staying busy with class-rep affairs, or interviewing HMP Alumni, he enjoys discussing existentialism, debating the ideological divide between Sartre and Camus, all things outer-space related, and Brooklyn quality pizza.

---

A Conversation with Erin Shigekawa

Last month, I had the pleasure to interview Erin Shigekawa, a policy analyst at the California Health Benefits Review Program and University of Michigan HMP Alumni Board Member. Erin earned her MPH from HMP in 2013.

With so much attention on health policy in today's news, it was great to get Erin's perspective on the value of an HMP education, particularly the policy angles of that education, and how students can make the most of the opportunities here at the University of Michigan.

I hope you enjoy this interview as much as I did!

Ashley Hill, MPH, MBA '17
(May 2017)

---

Q: What was the most beneficial experience you had during your time as an HMP student?

I'll give a few examples, because I can't pick just one thing.

First: the collegial environment of the department and the people there. I had great classmates and fantastic professors. I really liked that the coursework we had was interesting and demanding - we were challenged on our assumptions and to defend our logic, particularly in classes like Public Health Law or Health Law with Peter Jacobson. I learned a lot from the Data Management course with David Mendez, and appreciated opportunities to make connections between the classroom and the "real world"; the policy capstone and the managing people course that emphasized emotional intelligence and self-awareness are two examples. When I was at CHRT, I remember being nerdily excited to apply things I learned in health economics to a project on behavioral economics in health care.

I appreciated that SPH overall, the department and the Griffith Leadership Center made connections between what we were learning in the classroom and what was happening in practice through speakers and other events.

Second: I really tried to make my experience interdisciplinary. My summer internship was with Blue Cross Blue Shield of Michigan in the Policy Development & Reimbursement Strategies Department. I learned a lot about the process of setting medical policy as a major insurer, and had a substantive project to work through pretty autonomously. During the school year, I worked with Barbara Israel's team at the Detroit Community-Academic Urban Research Center within the Health Behavior & Health Education department. It was really valuable to get out into the community and learn more about this partnership approach to research. I helped out with community trainings for teens who were advocating to policymakers about the impacts of violence on their communities. We did trainings on community blight and discussed how different environmental factors impact health. It was a wonderful experience. I wanted to get a feel for industry, academic research, the community perspective and other areas; with experiences like these, I was able to do that.

Third: I enjoyed being a part of the Health Policy Student Association and other student activities. It was great to have applied experiences in the Michigan Capitol. I remember my first year speaking with legislators and staffers about the helmet law debate; getting perspectives from outside of academia was important. As a second-year student, fellow-HPSA members and I planned a case competition at SPH that required interdisciplinary teams to solve a community health issue through policy. The interdisciplinary aspect made my experience all the more enriching and created a lot of growth.

Lastly, this wasn't during my time as an HMP student, but when I was in college, I participated in Rich Lichtenstein's Summer Enrichment Program (SEP) which Ebbin Dotson now leads. Participating in SEP and completing my summer internship at Mercy Primary Care Center in Detroit were very beneficial experiences, where i learned a lot about domestic health care, health policy and health equity issues. During SEP, I first learned about the Detroit Urban Research Center (where Rich was a PI with Barbara) and began to consider Michigan as an option for grad school. Rich, Ebbin, and SEP's program staff should be commended for the program, which has served as a model for other similar programs across the country.

Q: Looking back, what would you have done differently?

There's really not a lot I would have done differently. Perhaps I would have tried to make my experience even more interdisciplinary. I could have pursued more classes at the Ford School, maybe a Social Work class - just trying to get a handle on perspectives related to health but outside of public health is beneficial. I love so many things about public health, but I think it's good to get other perspectives.

Related to my current work, it would have been good for me to take a regulatory policy class, because the work that I do at the California Health Benefits Review Program touches on many stakeholders: the legislators that are making the policy, health plans that are providing insurance coverage, providers, and regulators. Outside of the scope of a single state, focusing on how state regulation differs from federal regulation and having a class on that would have been really great.

Q: Since graduating, you've been a fellow at CHRT and now a policy analyst for the University of California system. What drove your decision to pursue roles in health policy?

When we talk about health policy, there's the traditional health care policy: access, quality and cost issues, health insurance coverage and health care delivery. That's already incredibly complex; it's a really important part of people's lives, and can have positive and negative consequences.

Then there's health policy in that health can be affected by every policy decision: a "health in all policies" framework. This, I think, is fascinating. So much outside the traditional scope of health care impacts health: the built environment, behavioral factors, existing systems and power structures. We only spend so much time in the doctor's office - if we even have access to a doctor. Understanding how these other factors impact health is crucial. It also causes a conundrum - if health impacts everything, where do you start?

Overall, I pursued a career in health policy because I think we can address existing issues to improve people's lives. Whether it's health care policy or the more-nebulous notion of health policy more broadly, there are opportunities to improve people's lives through better policy.

Q: What has been the most beneficial experience you've had since graduating?

I work now as a Principal Analyst at the California Health Benefits Review Program. We were established by the California legislature to give objective, unbiased information about the projected impacts of bills related to benefit mandates and health insurance coverage in the state. We provide evidence-based information that allows decision makers to make informed health policy choices.

What I really love about the work is that it's like piecing together a puzzle. For each bill that we analyze, we look at the background of the issue, the context, what other states are doing, and how it interacts with federal law. We also look at the medical effectiveness of whatever's being considered - whether or not it works according to the literature- and then at the benefit coverage, utilization, and cost effects: how much the bill would cost, would it change usage, how would coverage change? Then we look at public health: how would this impact Californians in a broader sense? Would it impact existing health disparities or health inequities? To answer these questions, we work collaboratively with a group of faculty and staff from across California and actuaries.

I find it really interesting to piece together this puzzle - to give a comprehensive report about the issue and the impacts we think it would have in a very short amount of time. We generally finish each report within 60 days. It's neat to hear the stakeholder perspectives: those of the bill authors or sponsors, the regulators, agencies, advocates, and then to attend hearings and see the whole process be debated or voted on. I also enjoy hearing about other bills that are being considered and debated at the hearings. Last week when I was at a hearing, there were bills related to opioid treatment, labeling of toxic products in commercial beauty salons, school-based health: all sorts of different things that impact health. Being a part of the hearings is a really interesting part of the process.

Q: What might students be surprised to learn about your work? Anything that you have done or do now that would have surprised you as a student?

People think of policy change as slow, and in some cases, it can be very slow. There has to be the political will, the timing has to be right, and the public needs to be interested in the topic. But in my job, it feels like policy can move pretty quickly and that can be really interesting to witness.

From January to April or May, we are analyzing bills that have been introduced to either Health Committee in the California Legislature. Throughout the year, bills are being debated in both the Assembly and the Senate. If a bill makes it through both houses, the governor decides whether or not to sign the bill into law around September. If a bill passes, it may go into effect relatively soon after; January 1 of the following year, for example.

In my first year at CHBRP, I worked with a team to analyze a bill, SB 999, to allow women in California in certain health insurance plans to receive up to a year-long supply of certain types of birth control at once. It was introduced and passed into law in September and as of this past January, women can receive up to a 12-month supply instead of having to receive one month or three months at a time.

Of course, we only see a bill if it's already coalesced into a bill, after it's been raised by a constituent or perhaps a similar bill has passed in another state. Still, in some cases, it's faster than what we think of when we typically think of policy change.

Q: What can students be doing now to best prepare themselves to enter the "real world" of health and health policy? Anything you feel we are not getting in the classroom that you think would have been great?

Try to wrap your head around what's happening in the current health policy environment. Thinking about the state's role is important right now. A lot of states are reacting to what's happening at the federal level; there's a lot of activity there to watch.

Something that stuck with me, that HMP really tried to drive home, is that you're not just on policy track, not just on management track. They're both important and they're both intertwined and nothing can be done in a vacuum. That is so true.

CHRT, the Center for Healthcare Research and Transformation, which HMP alum Marianne Udow-Phillips directs, is a good example of this. When I was at CHRT, half of board was from Blue Cross Blue Shield of Michigan, half was from the University of Michigan Health System [now Michigan Medicine]. Those two perspectives were both important; both sides also had to consider both the policy environment and how that would impact their organization and operations. At my current job, there's agencies, regulators, the insurance industry, providers, advocates and other stakeholders. Nothing is just policy or just management. You have to think about things not only on a broad policy level but also how the policy would be operationalized, how it would impact insurance - that point by the department was spot on.

It's also hard to overemphasize the importance of writing, especially writing about issues that are complex and technical. Being able to make those kinds of issues accessible to any audience is crucial.

Q: Any final advice to students?

I would encourage students to stay open. Be interdisciplinary and always consider perspectives from other fields outside of public health. Your ability to communicate the role and value of public health and health policy to non-public health audiences is important.

Challenge yourself. Make sure that in whatever job you take after graduation you're always trying to grow and learn. Be proactive about broadening your experience and making yourself an asset to your team.

It's an exciting time to be in public health and health policy. With uncertainty and the changing environment, there are certainly challenges, but there's also the opportunity to address problems and to innovate.

Ashley Hill (MPH, MBA 2017) is a recent graduate of HMP and the Ross School of Business at the University of Michigan. In her time at Michigan, she served as VP of advocacy and community partnerships for HPSA, VP of finance for WiHL, and as a research assistant for Professor Peter Jacobson. Ashley is always down for bike rides around town, visits to the library, and ice cream from Blank Slate.

---

A Conversation with Mira Spaulding

This month, I had the opportunity to sit down with Mira Spaulding, MHSA 2013, who is currently the manager of geriatrics and supportive care at Kaiser Permanente in the San Francisco Bay Area.

She shared valuable insight into making the most out of a fellowship, the first years of an administrative career, and the amazing network at the University of Michigan.

I hope you enjoy the interview as much as I did!
John Crist, MHSA Candidate '18
(April 2017)

---

Q: Can you start by talking about your fellowship experience?
Definitely. I was fortunate enough to participate in the Kaiser Permanente Northern California fellowship which was a rotation-based 18-month program. I started off working in Vallejo, a low-income and diverse community, which I was very excited about. I spent six months there with the medical group on a variety of projects: process improvement in the lab, managing teams in outreach call centers which was fascinating for the people management experience, and improving interpretive services for our Spanish-speaking members. The fellowship was a wonderful experience where I was able to see management from the top level. I was fortunate to have really strong mentorship and built a lot of great relationships. After six months, I uprooted and moved to Sacramento where I worked with our hospital & health plan side of the organization. I did some work on establishing a patient advisory council, hospital flow around discharges, partnering with local FQHCs and their promotoras [Hispanic/Latino community health workers] to build more links to our Spanish-speaking patients.

We partnered with the promotoras to learn about the experiences of Spanish-speaking patients navigating the KP system. They also led focus groups on perceptions of care, especially around colorectal cancer screening and diabetes care which we were prioritizing at the time.

Q: How did the connections that you made with leadership help you get where you are now?
During my first rotation, I had a great mentor who ended up offering me a position as an executive consultant when I was done. I wouldn't have had that opportunity without the fellowship. The relationships and the networks I was able to build during my three rotations were huge for opening doors in multiple areas and gave me options for where I ended up going in the end.

Q: What does it mean to you to maintain a relationship? What is the right amount of contact?
Some people are very good at this, sending articles or notes frequently and saying, "I thought of you when I read this." For me, I was lucky to work with my mentor as my boss for a year after my fellowship. For my other preceptors, I tried to stay in touch as it felt natural to me. For example, when I saw something about promotoras I reached out and asked how that project was going. Also, at Kaiser Permanente we often do site visits to our sister facilities, so I would say, "I'll be here on this day, would you be free to have coffee or lunch?", and everyone is very open to re-connecting. Also, if you're struggling with making a change or having an issue with a project, our fellowship alumni network is very tight knit and any of us are more than happy to jump on the phone and talk you through it.

Q: Was executive consulting something you were interested in from the start?
Generally, graduates of the fellowships take one of two paths when they are finished with the program; either transition to a management role, or consulting for an executive or with an internal consulting group. For me, executive consulting was a great opportunity to work on strategy and maintain connections with local leadership, while putting my roots down and exploring areas in which I might want to pursue a management role.

Q: So it sounds like you found your niche in geriatrics.
Yes, it was an exciting transition to my EC role. I helped develop a lot of the strategy and business plans for creating the service line, so it was a natural transition to managing those teams as well. Another reason I was excited about this role was that I had a great relationship with my physician partner, I knew we already worked well together and I was really excited about his vision. I also felt that we were truly thought partners, which can be rare. So much of management is about the people you work with every day, so it was a nice step for growth with friendly faces.

Q: I've heard from several alumni that "fit" is both key and difficult to determine from interviews.
Yes. As I interviewed with different fellowships, people discussed the notion of "fit" which can feel intangible. During the interviews, I started to realize more of what they meant by "fit" as I started to make stronger connections with certain organizations, but the interview process is not always the easiest place to figure out "fit"; being able to spend some time at the organization with your team is key if possible.

Q: What do you like most about your job?
It's a mix of strategy, business development, and managing people. We are still growing our programs, doing a lot of performance improvement work, and starting new initiatives. I like the mix of day-to-day operations with more forward thinking about where we are going with our geriatrics program overall.

Q: What is Kaiser Permanente or your department doing really well with geriatrics care?
I'm really excited about our home-based care programs. In our local service area, we've been piloting and testing new programs to see what might be sustainable and spreadable for the growing elderly population. We have a small group of physicians leading a home-based care program for the elderly – we are currently doing a formal evaluation the program. I'm very excited to see what the results are because we hear such great comments on a daily basis around patient satisfaction and appreciation it will be fascinating to see what the larger analysis shows us.

Q: What is the most challenging aspect of your current position?
We are currently in start-up phase for some of our clinics and programs. We have two new palliative care clinics that have opened this year, we are still hiring, building the teams, designing our space, and mapping the workflows. But mostly, it's exciting to be able to design the model and figure out what will work best for us and our patients.

Q: How does having a start-up culture within a giant organization present challenges?
Sometimes I have to take a step back and ask how I can influence change if it's not something I have complete control over. Where do I need to make alliances or bring someone else into the conversation so they can understand the processes and be an advocate for us? Strategizing about how I can move our programs forward or motivate others when I don't have direct control is a fun challenge to work through.

Q: I wanted to transition to professional development. When you transitioned from classroom to the career setting, what was the biggest roadblock for you?
I went straight from my undergraduate to graduate program, so I hadn't been in a full-time work position. The "newness" of the career was exciting but there were a lot of unknowns. The fellowship was a great way to push and test myself, wondering what my life would look like, and how I could contribute and add value. A lot of it is believing in yourself and your education. Graduates from the HMP program leave well-prepared, so have faith in your previous experience and allow it to carry you through the uncertainty. Having the network behind you is really powerful, too. My classmates are a great support system.

Q: As an early careerist, how do you deal with more senior employees who may be more resistant to change or less convinced of a young person's ideas?
Despite your age, your reputation ultimately comes down to the relationships you are able to make with people. When you are young and starting out, when you show your work and what you're able to accomplish, people begin to trust you and listen to you more. Additionally, having common goals and working towards them as a team, takes the focus off the individual, and has been a helpful approach in my management role.

Q: To your point on figuring out how to structure your career and what you are able to provide, what have you found is helpful for maintaining work-life balance?
A lot of it is setting boundaries. I know that I will be much more effective when I make time to exercise. When I make that a priority instead of working late, I know I do better work because I have taken the time to refresh. I also work at an organization that offers things like mindfulness and yoga sessions, walking meetings, and a general mentality of wellness. There are always times when deadlines require working late, but I try to be conscious of maintaining a balance.

Q: Have you had any pushback on your work-life balance routine?
I haven't seen much resistance, but there are days when I won't be able to stick to a normal routine, so I have to plan for how to recharge over the weekend. The organization is very supportive of taking time to refresh and do what's necessary to balance your workload. If you are overwhelmed with your work or your fellowship, it's important to let your supervisor know. The organization values balance and will help work with you to find it.

Q: You've had a great start to your career. What do you do differently than most early careerists?
I remember during our professional development course, we did an exercise in career planning. We thought about where we wanted to be, what's next, and what skills and experiences we needed to get there. It's not something I think about every day, but I certainly reflect on what areas I have not had as much exposure to, but feel the need to understand better. I will then ask my boss how I can get experience in that department in a way that would be mutually beneficial. The organization is very open to professional development. It's something to keep your eyes open for, but finding a mentor can be extremely valuable and rewarding. A lot of my growth and opportunities have come from the first mentor I had in my fellowship being an advocate for me, helping to push me and open doors.

Q: Do you have a formal way of self-reflecting?
I keep a document that I review from time to time, as well as a running list of projects I've worked on. For now, my subspecialty is geriatrics and palliative care, so I am thinking about how I can get broader experience and how to make links between geriatrics and other departments.

Q: Which courses did you find most valuable during your education?
I always loved 600. The case study of the young boy [Deamonte Driver] who had a dental infection and ended up passing away really stuck with me. Learning about disparities, because they are the reason I went into healthcare, was really valuable to me. I also did an IHI Open School project that was very applicable in terms of moving an organization forward with problem-solving tools from Lean. The professional/leadership development course on focusing on EQ, self-reflection, professional presence, coaching and building relationships has also been extremely valuable in my career.

Q: Last question of the day: What parting advice to you have for fellow alumni and current students?
What I got out of Michigan more than anything was the network of my classmates. I value the connections I made both on a personal and professional level. When I reach out to friends from the program, they offer support and professional perspectives. It's amazing to have this network. Related to your earlier question about maintaining contact - making those connections a priority is so powerful for keeping your network growing and going strong, which is one of the reasons I came to Michigan in the first place.

Q: Anything else you'd like to add?
I love working on the alumni board because it's a great experience to connect with and support current students with needs, general questions, case competitions, or anything else. One thing I am hoping we will do more of is create more pockets of interaction outside of Ann Arbor; for example, there is an event on the west coast at the end of May [editor note: HMP Connect! Bay Area Innovation Summit]. It's great to touch base with other early careerists and people more senior in their career and outside your organization who you can learn from. I highly recommend serving on the board!

John Crist is a second-year MHSA candidate at the University of Michigan, Ann Arbor. John is excited to serve as IHI speakers chair and MHESA philanthropy co-chair in the coming year. In his free time, John is outside as much as possible, climbing, camping, and biking with his friends and girlfriend.

---

A Conversation with Gerry Meklaus

A few weeks ago I had the pleasure of connecting with Gerry Meklaus, Managing Director at Accenture, University of Michigan HMP Board Member, and a 1992 MHSA graduate.

This is part of an ongoing series where students (like me) conduct in-depth interviews with alumni (like Gerry) and post the results. I hope you'll get as much enjoyment out of reading the following excerpts about the successes of our fellow HMP alum as I did hearing them.

Ruchi Aggarwal, MHSA Candidate '17
(March 2017)

---

Q. What is your favorite memory from your time at Michigan?

There are so many. It was such a rich experience, but if I had a favorite it was anytime I had the opportunity to be taught by John Griffith. I have many "Griffith Moments" but having the opportunity to listen to his pearls of wisdom and unique style of delivery was a great experience. It was a lot of fun to learn from him and watch his unique approach to education.

Another one of my favorite memories was the Organizational Theory class taught by Jeff Alexander. Jeff is one of the preeminent organization theory academicians in health services. It was a real pleasure to take a course with him and I got the only A+ I've ever received so I have great memories of that class.

Q. You currently serve as a Managing Director at Accenture. How have the skills you learned inside and outside the classroom translated to your current role?

In my current role, I lead a couple of areas of our practice around value-based care and physician enterprise. The skills I've learned along the way are fully integrated in this role because I touch everything from information technology to strategy and organization change. I am asked to integrate all of these skills when crafting solutions for my clients. Thus, it's not individual skills but it's the ability to integrate them and create a holistic picture of where organizations should be going and assist them in making that transformation that is a key takeaway from my time at Michigan.

The traditional health administration program may have focused on certain skills that you would pick up in a business program. Yet, when you look at population health it encompasses epidemiology, health policy, and more. The strength of Michigan's program is that you're not just studying business skills. You're also learning in the context of public health, health policy, epidemiology, and health behavior and health education. The transformation of the healthcare industry is centered on taking a more holistic view of populations and consumer behavior, and creating a very different 360º view of healthcare. A view not only focused on the business of healthcare, but also very much focused on population health. I think that the program integrates that in a way that you can't get from a traditional business program.

Our industry has to move away from the traditional concept of treating people when they are sick to much more of a movement towards keeping people well and that's a very different skillset. I think that people who don't have the skillset that Michigan provides, in a holistic manner, will struggle with that concept. The program positions you well for the next generation of healthcare challenges which are much more based on population wellness and not as much on acute episodes. We will still have acute episodes but that's one piece of the continuum. Everywhere you go, even if you go to a health system, you will find that they are focused on making the transformation to a population health company, if you will. That has a lot of other elements that need to be brought together such as community interventions.

For instance, I had a conversation with executives of a leading insurer just yesterday and they were talking about their Medicaid program and how they are reaching out into the communities. They are identifying interventions for people who are homeless and working closely with local organizations that provide transitional housing. They recognize that we cannot be treating just an acute episode. The acute episode is a manifestation of the overall failure of the system. If we don't deal with those root causes, people will get sicker and will result in a higher cost episode. So we, as an industry, have come to realize that we must deal with those root causes—many of which are outside the traditional healthcare paradigm.

Q. What was the most valuable thing you took away from the program?

It's not the hard skills, but the transformation the program makes in who you are. Once you go through the program you have a maturity and confidence level that allows you to articulate positions to key executives in ways that you never had previously. It's intangible but I guess it's the exposure to the faculty combined with your externship experience, which for me was very formative. My externship was a great experience and I had the opportunity to work very closely with the CEO of a major health system. I got to see how decisions were made, how I could contribute, and think about the key elements of success.

Q. How have you utilized the alumni network both as a student and an alumnus?

The alumni network has been extremely valuable to me and I hope I've helped to pay it back. As a student, I went through an externship between the first and second year and I got offered a job out of school. I didn't do a fellowship, but I went back to work for the organization where I did my externship. Even before I graduated, I reached back out to Jerry Fitzgerald, CEO of Oakwood Healthcare which is now part of Beaumont Health in the Detroit Area. I said that I was going to be graduating and Jerry said "I've got the job for you...this is what I would like you to do. Are you interested?" He carved out a role and I walked right into it. So right out of the gate alumni have been part of my life.

After several years of working in the industry, an alum, who was a fellow classmate and had gone into consulting, asked if I was interested in consulting. She said that they had roles open at Ernst & Young, opened the door, and directed me to the right people. Twenty years later I'm still in consulting. With the exception of two additional jobs I've held, the majority of my career has been with organizations where alums have opened the doors. It's a very active alumni network.

Q. As students, we are frequently engaged in discussions about how healthcare will change under the new administration. What are your thoughts? What changes do you anticipate that we will see over the next few years?

At Accenture we are tracking this very carefully. We run healthcare.gov as well as Covered California, which is the largest state exchange. We do a lot of work with the federal government and multiple agencies including the U.S. Department of Veterans Affairs and Department of Defense.

So where do we think it's going? The administration is still settling into their roles and there has been some turmoil. Assuming that plans move forward, they will be consistent with what we have heard from Republicans as their platform. From a philosophical perspective, if you read Paul Ryan's plan called A Better Way you'll get a good perspective on these trends. With respect to the successor to the ACA, we are expecting more emphasis on consumer engagement and consumer decision making. This will likely take the form of health savings accounts (HSAs). They are currently in place with a few employers, but we expect to see more emphasis on HSAs. The emphasis on the consumer will grow and as a result, we will see the industry respond with lower cost options. We are already seeing this happen. If you look at the urgent care business, you will see the growth in that segment of the industry, due to convenience and cost. For example, United Healthcare, through their Optum business, has bought one of the largest chains of urgent care, MedExpress. Thus, we expect more and more consumer based and lower cost options.

There is also a focus on transparency of quality and cost. Up until now the traditional healthcare consumer couldn't figure out what healthcare may cost. We expect that transparency in the industry and the provision of data and information available to the consumer to increase. Consumers will have more access to digital tools that will enable them to make individual decisions about how they access care. Your generation has grown up with the cell phone and a lot of what you do is based on your phone. For example, you use Yelp when you need to make a restaurant reservation. It's all digital and integrated. Healthcare needs to move in this direction and will move in this direction. We aren't there yet, but we are in pockets. It's the old adage: the future is here, it's just unevenly distributed. This is very true in healthcare. If you look across the healthcare landscape there are organizations that have moved forward and new companies are coming up all the time. There is a huge focus on innovation and we will see more innovation coming forward.

However, everything I have described, the consumerism, the innovation, and movement towards digital is independent from what happens in Washington. What's very important to note is that there are certain secular trends that are going to happen regardless of what happens in Washington. We know virtually every major healthcare system has innovatriums (that's a cool new word!) where they are testing new solutions and investing in those solutions. That was not true even two-to-three years ago. So innovation is spreading, consumerism is spreading, and these are secular trends.

With respect to the new administration, we think that the nature of the Medicaid program will likely change significantly from an open-ended entitlement to a per-capita program that funded from the federal government.

Q. Any advice for current students and fellow wolverines?

Stay close to the program, it's a great asset. You will continue to learn by your exposure to the program and the time you put into being on the alumni board, or participating in another activity will be rewarded. You will also be paying it forward to the next generation of students. Our students value the alumni network and when I look back on my experience, the network was central to my life and career.

Ruchi Aggarwal is a second-year MHSA candidate at the University of Michigan, Ann Arbor. When not studying for class or organizing events for the MHESA Philanthropy Committee, she enjoys watching new movies, bonding with her classmates over coffee, and trying new restaurants in Ann Arbor.

---

A Conversation with Gonzalo Solís, FACHE

This week, I had the pleasure of connecting with Gonzalo Solís, Healthcare Executive at Yale-New Haven Hospital, Board Member of the University of Michigan HMP Alumni Association, and a 2009 MHSA graduate.

This is part of an ongoing series where students (like me) conduct in-depth interviews with alumni (like Gonzalo) and post the results. I hope you'll get as much enjoyment out of reading the following excerpts about the successes of our fellow HMP alum as I did hearing them.

Danny Gessel, MHSA Candidate '18
(March 2017)

---

Q: What was the most beneficial experience you had during your time as an HMP student?

I completed my undergraduate degree at the University of Michigan and I was first inclined towards admission offers for master programs at other competitive universities. But Michigan has such a strong program that I couldn't leave Ann Arbor.

My most beneficial experience as a student was to be surrounded by the best and brightest. The quality of the student body and the faculty is one of a kind. It was great to have a very diverse class in every single aspect. My class had students who worked in hospitals and health systems, insurance companies, consulting firms, startups, and government agencies. Some of my classmates were entrepreneurs, physicians, engineers, and soldiers that brought diverse perspectives.

It was unique to find a faculty that were experts in various disciplines with a focus in healthcare -from corporate finance to technology, from health law to economics.- Michigan's faculty are authors of many books and articles used every day by executives in the field. Many programs don't have the resources that Michigan does, which reflects why it has been consistently ranked number 1.

Q: What from your Michigan education has served you best throughout your career?

In addition to learning about business principles and the healthcare industry as a whole, at Michigan, we truly learned how to problem-solve as leaders. We were given all the tools necessary to succeed in the workforce and to continuously improve as we gain more experience through our careers. The fact that you are learning how to critically think about different problems will help in the long-run as a leader.

Q: Looking back, what would you have done differently?

Great question. I wondered if pursuing a full-time before starting my master would have enhanced my academic experience. Luckily, I was very active during my undergraduate studies and surrounded by an outstanding faculty and experienced classmates that enriched class discussions.

Q: What do you think students can be doing now to prepare themselves best to enter the healthcare industry?

First, students should take advantage of all the resources at Michigan. Working on consulting projects during school is a great idea. There are many courses at Michigan that offer consulting services to companies seeking to meet their corporate objective.

Another idea is to get involved in professional societies like the America College of Healthcare Executives. It is a great way to develop professionally and to get in touch with the leaders in the industry. The more contact you have with these leaders the more you can bridge theory with practice.

Q: What has been the most beneficial experience you've had since graduating?

My most beneficial experience was starting from the bottom in an organization. After spending all summer of 2008 gaining experience in an internship at Yale-New Haven, I had plans to return for an administrative fellowship. I graduated in 2009 at the peak of the global financial crisis. Many fellowships and jobs throughout the country were canceled. When most students from the previous classes already had jobs before graduation, only about a third of my class had jobs that year. Consequently, I was challenged with figuring out my next career move.

Yale New Haven had to cancel their fellowship and instead offered me a job as a manager in support services amidst a lot of changes. Senior leadership wanted to improve patient flow and Press Ganey/HCAHPS satisfaction scores in the support services, which had been typically ignored. I saw the opportunity to supervise hospital operations in the frontline and a team of employees early in my career. Since then, I have been fortunate of increasing responsibilities and progressing in leadership roles all within the same world-renowned organization. This is a perfect example of how a challenging situation can be turned into one that positively impacts, not only my organization, but my career.

Q: Tell me a little more about your current role overseeing inpatient and outpatient operations

Hospitals around our nation offer services 24/7, but administration operates during regular business hours. Yale-New Haven Health is one of the largest and most innovative healthcare organizations in the country. Therefore, senior leadership identified the need for developing executives that could provide leadership during off hours. We used to rely on the common model of nursing supervisors that did a great work focusing on the clinical side of the operations, like bed management and staffing. Instead of relying on a senior leader on call for administrative issues, my role was created to have an executive on site during these hours

Currently, I oversee all of the inpatient and outpatient operations of our 1,541-bed academic medical center and its 1,400+ clinical and nonclinical personnel during nights, weeks and holidays. Our AMC includes the 168-bed Smilow Cancer Hospital, the 200+-bed Yale-New Haven Children's Hospital and the 76-bed Yale-New Haven Psychiatric Hospital and serves as the primary teaching hospital of Yale School of Medicine. I was trained by executives of every department operating in the hospital –from legal/risk management to supply chain to financial services- in order to supervise their areas. During regular business hours, I work with these teams on evaluating and coordinating project plans that support operational effectiveness, financial performance, patient experience, and safety and quality. Our major accomplishment was turning Yale-New Haven into a true destination hospital with 24/7 operations.

Q: What have you found is the best way to implement change in your organization?

To translate corporate objectives into culture you need to incorporate all parties involved at every level, including employees. This will lead to everyone sharing their interests and their own ideas to the table. When you listen to everyone with an open mind they will become champions of change.

Q: I see you have quite a bit of experience using Lean & Six Sigma Management how do you think learning lean has helped your career?

Lean and Six Sigma are very useful tools for every leader. As a Green Belt, these have helped remove waste and improve performance in my organization. Its principles are to define problems and goals, measure key variables, analyze the data, improve systems and processes, and control results.

Most importantly, these tools taught me to rely on data and to consider every decision's sustainability. You will hear professors say that culture trumps strategy, meaning that if everyone is not on board your strategy will not work. Since healthcare is constantly changing, then performance improvement tools like Lean and Six Sigma can help us adapt quickly.

Q: It's a very interesting time to be entering health care (or continue to serve in a healthcare role). What are your thoughts? Where do you see the future of healthcare?

There are many factors constantly changing the healthcare environment that makes it very interesting. In addition to our country's economic situation, healthcare is experiencing revenue/cost pressures, increased regulation, changes in clinical care models, modernization in technologies, and more focus on the patient experience. Organizations are trying to adapt to all of these; some are doing it better than others. It is exciting to be in healthcare because what we think of healthcare today will be different tomorrow.

I see a future where healthcare will move away from inpatient care and rely on technology more than ever. Of course, we will always have brick and mortar hospitals, but technology will serve as a resource to improve access and meet our patients' needs in the community.

Q: How do you stay connected with your cohort and other connections?

ACHE and as a member of Michigan's Alumni Board have been the best ways we've stayed connected. And of course, through social media like LinkedIn.
(editor note: you can now follow HMP on twitter and Instagram at the handle @MichiganHMP)

Q: Any last advice for students? Alums?

Always remember why we chose this career. We are fortunate to be in the healthcare sector.
The fact that we provide a service that impacts people in their best and worst times of their lives is very rewarding. Not only it helps me stay focused, but most importantly, helps me stay inspired.

Q: What has helped you have a good work-life balance?

First of all, work for an organization that values work-life balance.

What helps me is spending time with my family and being active in the community via volunteering work and boards. I also exercise and play sports, preferably soccer since I played competitively, to stay healthy.

It's very important to make time for yourself, for your family, and for your community.

Danny Gessel is a first-year MHSA candidate at the University of Michigan, Ann Arbor. When not studying for class or staying busy on MHESA and MCACHE committees, he enjoys spending time with his family, the HMP cohort and running.

---

---

A Conversation with Janet Pinkerton Dombrowski

This week, I had the pleasure of connecting with Janet Pinkerton Dombrowski, President of JCD Advisors, LLC, Board Member of the University of Michigan HMP Alumni Association, and a 1990 MHSA graduate.

This is part of an ongoing series where students (like me) conduct in-depth interviews with alumni (like Janet) and post the results. I hope you'll get as much enjoyment out of reading the following excerpts about the successes of our fellow HMP alum as I did hearing them.

Kim Pham, Global MHSA Candidate '17
(January 2017)

---

Q. What do you cherish most from your experience as an HMP student? And now as an HMP alum?

As an HMP student, one of the things I cherish most has been all of the connections I have made, as well as the people that have comprised this program. It was great to observe so many different perspectives and walks of life, but all with the same interest in impacting health care in a different manner than my direct health care experience. Another thing was the exposure to all of these new ideas. It really broadened my perspective and helped me to understand what health care was outside of clinical care. I loved learning about urban health care, community health, and policy - really getting to understand the underlying themes in healthcare administration.

As an alum, I would say the same still rings true today: it's the connections and exposure that I still cherish. I've enjoyed staying in touch with my cohort, and other alums, and being connected with students as well. That's really special – the students always give me so much energy. I also love seeing how the HMP program has evolved – seeing new focus on subjects we didn't get to discuss as much, like mental health, international health, and population health.

Q. You currently serve as President of JCD Advisors here in Ann Arbor, which combines strategy and organizational development with executive coaching. Traditionally, HMP students are more exposed to hospital administration, consulting, or policy positions. What made you decide to pursue this venture?

[Chuckles] If you had asked me 20 years ago if this is where I would end up, I would've never guessed this. I only applied to fellowships after graduation and was set on hospital administration. I was fortunate to get a lot of experience in strategy development, and business development in both health systems and consulting. Understanding business operations - the value proposition, pitch, and delivery - I had the opportunity to get involved with mergers and acquisitions. At Trinity Health I led negotiations for the acquisition of St. Mary in Livonia, and was part of the leadership team to help integrate St. Mary's into Trinity Health. It was that endeavor where I realized that strategy and business development skills alone were not going to be enough for this organization's success; leadership, culture, and organizational structures were even more important. This was my aha! moment and my opportunity for growth and development.

Through the system's HR department, I was able to train in executive coaching, culture transformation, and other organizational development skills. With these skills, the strong professional relationships I'd built over my career, and a desire for flexibility for my family, I decided to start my own business upon leaving Trinity Health.

Q: How would you advise students interested in pursuing a track like this?

I believe that to do this type of work, you need to have lived the experience of a senior leader or have "sat in that seat". The necessary intuition and gravitas, or the ability to sit with power (to speak candidly with a physician or CEO), comes with experience. A big challenge is finding people who can have the credibility and authority to be able to do this effectively. That being said, anyone can always be a student of organizational behavior. When you and other students start out in your next job, observe how leaders lead, how work gets done, and how teams can be effective. Ask yourself questions, like what would you do differently? What do you think is really important? There are some tools out there that can help give structure to what you are seeing. A great book is The Five Dysfunctions of a Team, it provides a great framework.

Q. Additionally, your firm has emphasized key leadership competencies more widely discussed in positive organizational scholarship, like compassion and gratitude. Could you please speak on the importance of honing those, and potentially other aspects of emotional intelligence, as we all continue developing ourselves as leaders?

You can always build more technical competencies, but it's the behavioral competencies (or lack thereof) that tend to create problems for people. I work with professionals who are already "successful", so it's this idea of having them build self-awareness, getting them off autopilot, and intentionally choosing how to behave as a leader.

I am also learning a lot about the significance of neuro-leadership, the biology and physiology of leadership. For example, when you encounter a social threat (like an organizational or role change), functional MRIs show that your brain's response is similar to when it responds to a physical threat, like entering fight-or-flight mode. While you might not recognize this psychologically, understanding this innate response is important because it means you may have to fight against your self-protective mechanisms in times of change.

Q. As we enter an era of change for health care policy, how would you advise students and professionals in navigating change?

What leaders really need right now is to get the best out of themselves and the best out of other people. Build resilience. Keep people healthy and at their best - this is essential in tapping into their best thinking for innovation and creative problem solving. I like to use this analogy: when we are threatened during change, it's like an aperture in a camera that narrows and closes in (to protect ourselves). What we really need in the face of change or difficult times, is to open our apertures. We need to open up our minds and broaden our perspectives, engaging others' viewpoints.

Q. Any last words of wisdom to share with other fellow Wolverines?

Stay connected to the program and stay connected to each other. This helps to keep your aperture open. There are a lot of ways to stay connected and there's a lot of value in that. Also remember your network - it is there to give you a broader view of the world. Foster relationships, rather than "a network". For example, with LinkedIn invitations, include a personal note. Remember the reciprocity in relationships. Seek to provide value as you grow and maintain your relationships – that is when the value of your "network" will come back to you.

Many thanks to Janet Pinkerton Dombrowski for this lively discussion around leadership, networking, and change. Be sure to tune in next month for another alumni interview.

Kim Pham is a second-year Global MHSA candidate at the University of Michigan, Ann Arbor. When not studying for class or organizing events as an HMP Class Representative, she enjoys playing in the U-M Life Sciences Orchestra, bonding with her classmates, and discovering new restaurants in Ann Arbor.

---

---

This week, I had the pleasure of connecting with Daniel Dimenstein, associate at Witt/Kieffer, Board Member of the University of Michigan HMP Alumni Association, and a 2013 MHSA graduate.

This is part of an ongoing series where students (like me) conduct in-depth interviews with alumni (like Dan) and post the results. I hope you'll get as much enjoyment out of reading the following excerpts about the successes of our fellow HMP alum as I did hearing them.

Marianthi N. Hatzigeorgiou, Global MHSA Candidate, '18
(December 2016)

---

Q: What is your favorite Michigan memory from your time here as an HMP student?

This is probably the most difficult question to start with! Outside of the program, one of my favorite memories was beating Ohio State my first year here. Having done my undergrad at a small Division III school, I had never really watched or participated in big time college football, so it was exciting to see us beat Ohio State. Plus, it was at the Big House, which made it even more amazing.

My favorite academic memory will sound a bit like a cop-out but it's all the really great people I met: both classmates and professors. Again, I went to a small college of 2,200 students in Upstate New York where I had great relationships with students and professors. When I first came here, I thought that, because of size, and being a vast research organization, I would not be able to make those connections. However, I was still able to build these long-lasting relationships not only with my cohort but more impressively with my professors. During the silent auction, I won dinner with PDJ-- I highly recommend you and your classmates take advantage of the auction. That opportunity, and many others like it during my time, was a great moment to get to better know my professors and have discussions outside of the classroom.

Q: What from your Michigan education has served you the most in your career? Looking back, what would you have done differently?

Again, I would say it's really difficult to choose one thing. Overall, being able to understand healthcare trends and articulate them given the country's current status is invaluable: this is something that applies both from my past experience on the provider side and in my current role. Now as a professional, I attend many conferences and still hear a lot of "volume-to-value" and other trends being discussed. At first, I was almost shocked to hear these topics and would think, 'Wow, this is still a hot topic? I learned this within my first semester at Michigan.' At the time, I may have taken it for granted but it's true: we really did get the best education and that has positioned us as graduates to be leaders and the best in the field.

Also, I was pretty young when I entered the workforce (having gone right from undergrad to grad school), but I found that being able to speak articulately with those much older than me about high-impact issues has remained impressive to many I've worked with.

Q: So I wanted to shift the focus a bit: it's a very interesting time to be entering health care (or continue to serve in a healthcare role). What are your thoughts? Where do you see the future of healthcare?

Well, let's start with where I see it going: if I knew the answer to that I'd be wealthy and retired! It's really funny for me to reflect on this because while I was interning at NYU Medical Center in 2012, we were anxiously waiting to hear whether or not the Supreme Court would uphold the legality of the ACA. My classmates and I were in this text thread freaking out and wondering 'Well now what? This is such an important piece of legislation and so many people are going to suffer!' It feels like that again: there's a lot of uncertainty. While I'm not sure where it'll go, I know that, no matter what you feel about Donald Trump, he hasn't been the most forthcoming and there is no real idea of what his plan is to replace the ACA. To me, I cannot see a situation in which he would repeal the law without finding a way to ensure some of these people continue to maintain their insurance coverage. Once you give someone health insurance it'll be hard to take it away: that's why you haven't seen other countries do what we do.

Q: Any advice for us here as students? Is there something we could be doing to help prepare or educate? May something you feel we are not getting in classroom that you think would have been great?

Well, I'm not sure anything will prepare you for whatever Trump has in store! But, I am a bit biased in thinking that one of things the program lacked while I was there and perhaps still may, was the HR piece of the education. I took a class called Managing People (HMP 643) and HMP 603 that I felt were really beneficial to my education, but I would say you should make additional room in your curriculum for classes that address 'what it's like to work in the workplace'. When I worked in the provider setting, these types of classes became very helpful as they addressed what is unique about people and workflows, what doctors do, what nurses deal with, unionization, etc. Really even a survey course would be helpful. Again, I'm biased but I feel it's a really important and have made it a point to address these at Alumni Board meetings.

We're the best here in Michigan, we know that. We look and focus on the technical skill piece and we're so great at teaching and learning that. We get the hard skills, but the softer skills would be something I encourage students to continue to focus on because that's what is going to be the separator for you as you enter the workforce. Joe Horton's class is great too so you should be looking forward to that. It will get you thinking about how to apply what you learn in your other classes to specific cases that can and will happen to you during your career.

Q: You recently transitioned to Witt/Kieffer after having spent some time working in the provider side. Do you think that your roles with providers prepared you for the transition? What was motivating factor?

I initially had administrative fellowship with Hartford HealthCare and had a lot of exposure while there. By the end of my time there, I was working in the medical group, mostly with doctors. I found that I really enjoyed working with them: they are interesting stakeholders within healthcare when you stop to consider their priorities. As much as we administrators like to think of ourselves as the driving force behind the success of the health system, that engine is, and will always be the physicians. This only became more obvious after my fellowship when I took a job at Yale-New Haven Health System's employed physician enterprise, Northeast Medical Group – I started to watch this collaboration between administrators and physicians and felt that [providers] were the future; either when considering care, or the focus of health care, or even the leadership type. That being said, [administrators] need to learn how to work with physicians...so again, I'm tying in the softer skills. We don't have medical degrees but we still work together, and should effectively do so to produce results.

My time at Northeast Medical Group was spent working on projects that focused on development and acquisition for the [medical] group. The dynamic between the university's faculty practice and our health system's employed community physicians was particularly interesting: this relationship had a lot of overlap but also posed some interesting challenges to the work that I was doing. During this time, I was beginning to think about executive search but didn't know anyone who did this. I started chatting with some contacts of mine. I thought it could give me a chance to do the types of things that I loved about my role with Northeast Medical Group, but on a national level. So, after a few conversations and an offer, I made the transition. I was happy where I was but even more excited for this opportunity--and I think that's an important place to be at.

Q: So tell me a little more about your current role?

I currently work with an executive search firm. Our firm only works with healthcare, higher education and nonprofit organizations, and again, I work with physicians only. My job is primarily to identify physician leadership candidates and assess their potential fit with our client organizations. Much like with these physicians, I strongly believe finding your 'fit' is the key to happiness and success: I did with grad school, I'm guessing you did too, and I think professionally it should be the same: finding your fit. I think that's why I like this job so much – because of the importance of 'fit.'

Q: Any final advice to students and fellow wolverines?

So my final piece of advice to current students is this: don't let your classmates stress you out. I've said this a lot but you are at the number one program and are all extremely intelligent. You may study differently but you perform effectively on tests. If a classmate is worried about an exam or assignment, that does not mean you need to have the same mentality... that being said, it goes both ways: don't be that person who puts unnecessary and unwanted pressure on your classmates. Enjoy your time in school: learn the material but enjoy your classmates.

During my time in HMP, I noticed that the difference between us and other schools here is our collaboration and the cohesion among classmates. I've heard other schools where students were very competitive to the point of not helping. Be teammates, and help each other get through this. Keep telling yourself that these will be your future colleagues and the people you go to with questions. Support one another and make the most of it! The Michigan Difference and the Michigan Mafia is really a thing--use that to help you during the program, help you with internships, and help you grow. Being an HMP alum means a lot in the workforce and both your professors and the alumni want you to do well.

Thanks to Dan Dimenstein for taking time out of his day to discuss a wide array of topics. We will be back in 2017!

Marianthi N Hatzigeorgiou is a first-year global HMP MHSA candidate at University of Michigan, Ann Arbor. When not studying class materials or working at the Center for Value-Based Insurance Design, she enjoys spending time with her cohort and friends, drinking coffee, and planning future travels.

---

This week, I had the pleasure of sitting down with Steve Merz, President and CEO of Maine Behavioral Healthcare, President of the University of Michigan HMP Alumni Association, and a 1995 MHSA graduate.

This is the start of an ongoing series where students (like me) conduct in-depth interviews with alumni (like Steve) and post the results. I hope you'll get as much enjoyment out of reading the following excerpts about the successes of our fellow HMP alum as I did hearing them.

There were a few things I expected from the conversation. I was not surprised that Steve is a hard-working, passionate advocate for behavioral health care. Neither was I surprised that he is no less an advocate for the Michigan difference. But there were more than a few things that did surprise me: the cyclical nature of the health system, the challenge of creating an integrated mental health network, and his advice for work/life balance that goes well beyond the credo of "be present" wherever you are.

J. David Fife, MHSA Candidate, '18
(October 2016)

---

Q: What was the HMP program like when you were a student? What was your Michigan experience?

"I came to Michigan because I was convinced that a program grounded in a school of public health and focused on the general health of the community was the future. I came in at a moment in healthcare that was really interesting. President Clinton had recently been elected, and healthcare reform was a major initiative. In fact, it was controversial to have a first lady take on the type of leadership role that Hillary did.

Many HMOs were winding down, physicians were starting to take on more risk, capitation was increasingly accepted as a payment for total cost of care. Systems were purchasing physician practices and Medicare Advantage and Medicaid managed care options were changing public insurance programs.

So, really similar to today. And Professor Hirth, my faculty mentor [and current department chair], also taught his first course to my cohort."

Q: How did you begin to gravitate towards the mental health space?

"By chance, really. I began working at Yale New Haven Health as an administrative fellow after graduation. I worked for the COO of Yale at the time, Marna Borgstrom [currently the system's CEO], and she has mentored me throughout my career. I worked on a variety of projects as a fellow, and it often came down to tackling the challenge of the day and "making lemonade out of lemons".

One of those projects involved the psychiatric hospital. It had been losing money for years, and we were considering shutting it down. However, this would have left the community without a significant kind of care it needed. I wrote a plan, consolidated services with other hospitals, and ended up running a major consolidation effort as a 20-something administrator.

That began a career at Yale-New Haven that gave me a wide variety of experiences and eventually the opportunity to lead the Psychiatric Services service line."

Q: Why the move to Maine Behavioral Healthcare?

"It was an opportunity I couldn't turn down. In 2014, Spring Harbor Hospital, previously a freestanding hospital, had merged with 4 CMHCs [Community Mental Health Centers] with the aim to create an integrated mental health system, and I was recruited to lead that effort.

There are many challenges to merging 5 organizations, and that all happens while still dealing with the particular challenges that mental health care faces across the board. For example, a major challenge right now is that the evidence for what works in terms of clinical outcomes and lower costs is clear, but the reimbursement system lags behind that evidence. We have to determine how to build programs that support needs in our community when reimbursement models are still tied to fee-for-service and there aren't many incentives for improving mental health.

A comparison helps show the difference. If you have broken leg, the health system will pay for your treatment, therapy, crutches, and anything else to get you back on your feet. If you have cardiovascular disease, we'll pay for your pills, a variety of treatments, and even expensive rehab services just to keep you out of the hospital.

In behavioral health, it's the opposite. A family history of drinking or depression generally won't qualify you for insurance-covered preventive services, or you will have a limit on what you can receive until you actually hurt yourself or are in the hospital. You have to demonstrate that you have an active illness rather than having the system pay for services that can prevent you from falling into that risk in the first place.

Despite those obstacles and parity laws to stop this discrimination, we're proud to work on innovative ideas, like the Glickman Center for autism and working for early identification of psychosis with the PIER program.

There are huge and compelling needs in mental health, like the recent opioid epidemic. At the end of the day, organizations like ours are the ones who have to determine how to tackle these problems with a community mindset and new ideas that respect the bottom line and wrestle with these reimbursement and resource constraints.

That's the Michigan difference. With my training, I'm prepared to lead an organization that wants to do better than the people who came before. People are expecting us as leaders to, even if we don't have the answer, still come up with the right questions. Right now is a key time in healthcare. A huge opportunity. The economy is depending on us; the country is depending on us to figure this out."

Q: With that kind of professional pressure, how to manage to balance professional goals with personal ones?

"One thing they don't teach you is that healthcare is an industry that requires a large time commitment in order to lead. We truly are 24/7, 365 days a year industry. Some of that is also driven by the way healthcare works. If you want to meet with physicians, you either have to meet early in the morning before their rounds or late in evening after they close their offices. That can make for a long work day, and work-life balance can suffer as a result.

I didn't have great work-life balance early in my career. Later, I tried to separate work from non-work effectively. When I was at work, I worked liked a maniac. When I was home, I played like a maniac. I was putting in as much energy playing as I did working. And that's made a difference in my life and the lives of my family."

Q: Any last advice for fellow alumni? Students?

"For alumni: Mental health touches every cohort, every disease state, every community, and every organizational level. If you haven't looked for wins in your organization by managing mental health more effectively, look into it!

For students: Find a mentor wherever you can. Mine was very meaningful to my development. Tackle any hill that comes your way. Jump into any project. You never know which path will lead you where you want to go."

A huge thanks to Steve Merz for taking the time to share his thoughts. Check back next month for another fellow alumni interview.

Dave Fife is a first-year MHSA candidate at University of Michigan, Ann Arbor. When not using new knowledge from his first-year curriculum to prove all of his presuppositions about health care delivery wrong, he enjoys spending time with his family, his cohort, and his beloved Dallas Mavericks.

---