Top 10 Up-and-Coming Industry Leaders in Managed Care 2018

This year’s top 10 emerging healthcare industry leaders hail from a broad spectrum of industry segments. They are pharmacists, doctors, health plan executives, and technology entrepreneurs. Our editorial advisory board members faced the difficult task of culling through more than 30 well-deserving nominees, and selecting their top 10 standouts. To be considered, candidates had to meet the following requirements: Worked in the industry 15 years or fewer; Led key initiatives at their organizations or relevant organizations; Taken actions that led to measurable, positive industry impacts; Accomplished something new or unique in the industry; and Continued to take on more advanced roles and responsibilities in their managed care career path. With many great submissions, the decision was tough. Here are the top 10. Next: The top 10 Euan Ashley, MD, PhD, professor of medicine and genetics at Stanford University and founding director of the Stanford Center for Inherited Cardiovascular Disease, Stanford University Ashley joined Stanford’s faculty in 2006 and led a team that carried out the first clinical interpretation of the human genome. By applying genomics to medicine, Ashley is helping patients and families with genetic risk of heart disease manage their condition and health. He works with colleagues to diagnose and treat entire families who are at risk for life-threatening heart abnormalities using genetic sequencing. This approach helps identify and treat rare and previously undiagnosed diseases. He was also the first co-chair of the steering committee of the National Institutes of Health’s Undiagnosed Diseases Network. MHE: Why did you choose your profession? Ashley: Growing up in the west of Scotland, a region with one of the highest rates of heart disease in the world, I saw my father-a general practitioner-deliver amazing, personalized care to the community. I could think of no higher calling than to try to emulate that. MHE:What has been your biggest learning experience? Ashley: Some of our most important lessons come from outside our industry. In most sectors, you aim to proactively identify problems and address them before they occur. In medicine, we rarely get ahead of disease; instead, we treat it when it occurs. MHE:What change would you like to see in healthcare in the next 10 years? Ashley: We have to become much more proactive. We need to better understand people’s risks and implement programs that help mitigate these risks before disease occurs. At Stanford Health Care, we call that precision health-using technology to predict, prevent, and cure disease precisely. MHE:If you could sit down to dinner with anyone involved in healthcare, who would it be? Ashley: I would love to sit down and chat with Peter Abildgaard. In 1775 Denmark, he figured out that an electric shock can stop and restart the heart. He tried it on a chicken and basically invented the defibrillator. Next: A top pharmacy leader David Calabrese, RPh, MHP, senior vice president and chief pharmacy officer, OptumRx Over the last 12 years of his career, Calabrese has dedicated his work to pharmacy benefit management. His leadership work in areas such as opioid risk management, evidence-based pharmacy and therapeutics committee execution, compound drug management, and pharmacy benefit management transparency have been well-publicized as key benchmarks within the industry. MHE: Why did you choose your profession? Calabrese: I followed in the footsteps of my grandfather, who ran an independent pharmacy in our Connecticut hometown. I was inspired at an early age by his integrity, sense of caring, dedication to the profession, and how well-respected and valued he was among those he served within our community. Throughout my career, I’ve attempted to emulate his professionalism and combine that with the strong sense of accountability and work ethic my parents instilled in me, to help drive further advancements in population-based pharmacy care. MHE:What has been your biggest learning experience? Calabrese: An appreciation for the enormous value of effective data management and analytics in helping to transform our healthcare system from a “volume-based” business to a much more desirable “value-based” model. Within Optum, our ability to harness the power of such capabilities, extending well beyond just pharmacy data, has enabled important advancements in clinical programming. Transforming data into timely, meaningful “next best actions” is helping to empower enhanced provider and patient engagement, drive more rapid adoption of new evidence-based standards, and more positively impact both the overall quality and economics of care. MHE:What change would you like to see in healthcare in the next 10 years? Calabrese: While I’ve witnessed enormous strides in advancing the state of healthcare in the United States over the years, I still remain fairly disheartened by the level of disconnectedness that prevails across our industry. My hope is that the future state will more closely reflect one in which data and electronic health information is more fully unlocked and seamlessly shared across the healthcare continuum to achieve more patient-centered, higher-quality care, greater cost-efficiency, and a healthier society. MHE:If you could sit down to dinner with anyone involved in healthcare, who would it be? Calabrese: It would be Sidney Garfield, MD, the lesser-known cofounder of Kaiser Permanente and one of the pioneers of managed healthcare in the United States. Throughout his career, he held firmly to the belief that healthcare should not simply be focused on care for the sick, but more broadly emphasize a focus upon the entire spectrum of care from prevention, to education, to wellness and health maintenance. His ultimate goal was to make healthcare more accessible, efficient, and affordable for everyone, while still providing the highest quality medical care. Today, his vision remains as a beacon of guidance for advancing the future of healthcare. Next: A top health system leader Tina Freese Decker, MHA, MSIE, FACHE, executive vice president and chief operating officer, Spectrum Health Freese Decker oversaw a $300 million transformation of care models and installation of Epic, an electronic clinical and revenue cycle platform. She also championed the launch of MedNow at Spectrum Health, a proprietary telemedicine service. By employing a virtual medicine strategy, the health system reduced hospital utilization and costs, and increased virtual visits by 355% over the prior year. In addition, the health system saw positive movement in employee and physician satisfaction during this extensive care transformation effort. Feese Decker has a commitment to building engagement, collaboration, and a culture of inclusivity supported a “people first” environment. Freese Decker was also integral to Spectrum Health’s graduate medical education transition to a direct sponsorship model, resulting in a new Spectrum Health-Michigan State University department for 300 residents and fellows. This model improves the learning experience by increasing connectivity and engagement between residents, fellows, and faculty physicians. MHE: Why did you choose your profession? Freese Decker: I saw a need to remove barriers, make access easier for everyone, and positively impact the community’s health for generations to come. A consumer partnership focus is fundamental to my leadership strategy as evidenced by our health system’s new digital tools-MyHealth patient portal and MedNow telemedicine tool, which help more than 500,000 consumers every year. MHE:What has been your biggest learning experience? Freese Decker: The speed at which our industry is changing forced me to realize that we needed to lead rather than follow; to be innovative and create new solutions rather than be reactive. We must push the boundaries and conceive of new ways to provide care and coverage. As a result, we are collaborating with new and different partners such as major retailers and genetic wellness researchers. We have also developed new care models, such as community health workers who visit patients in their homes to assist them with health needs. MHE:What change would you like to see in healthcare in the next 10 years? Freese Decker: I would like to see health systems be aligned with keeping people healthy and reducing the total cost of care. This will require innovative business models, a focus on delighting and engaging with consumers, and new payment models that reward health and wellness through prediction and prevention. MHE:If you could sit down to dinner with anyone involved in healthcare, who would it be? Freese Decker: I would prefer to meet someone outside of the industry for a different perspective: Alan Mulally, former president and CEO of Ford Motor Company, who brought it back from the brink of bankruptcy. He transformed the company to think and work differently. Healthcare is being disrupted by new entrants to the industry. To be successful as an incumbent, we need to understand how others improved and embraced ideas. We must take our legacy systems and culture and reshape them into a 21st century, consumer-first organization. Next: A health system innovator Grant Geiger, founder and CEO, EIR Healthcare Geiger, 30, started his healthcare career by first working for Siemens Healthcare and later for Cerner Corp., developing products and services for the healthcare information technology industry. At Siemens Healthcare, he became the youngest director in the company and led a project management team that oversaw a $23 million a year capital budget and worked on $100 million in projects. Geiger started EIR Healthcare in 2016 to continue his father’s legacy of engineering and design. EIR creates modular healthcare rooms that decrease construction time by 30% to 50% and money spent by 30% compared to traditional construction when building hospitals. These pre-fabricated hospital rooms are delivered to a healthcare facility. Called MedModular, the product is the first of its kind to link industrial engineering, ship building, and hospital construction. Rooms are inserted into a building and are already wired for electric, HVAC, and plumbing-creating a plug-and-play solution. MHE: Why did you choose your profession? Geiger: I always felt like my profession chose me. I graduated from Drexel University and participated in its co-op program, which allowed me to gain real-world work experience while in school. Since then, I’ve always worked in healthcare. It’s the best way to have a positive influence on society. MHE:What has been your biggest learning experience? Geiger: My biggest learning experience, which has been reaffirmed time and again, is at the end of the day, the people in our industry do care about human life. We want to improve outcomes for everyone. This has taught me compassion and knowledge of the human experience. So many people struggle daily with health issues. Our industry is continuously searching for ways to improve the patient experience. MHE:What change would you like to see in healthcare in the next 10 years? Geiger: I would like to see the introduction of the next generation of healthcare leadership and thinking. These leaders will push the tipping point within life science, pharma, information technology, and infrastructure. If we are able to introduce significant changes within healthcare, simultaneously we will usher in innovation in the delivery of care that hasn’t been seen in almost 100 years. MHE:If you could sit down to dinner with anyone involved in healthcare, who would it be? Geiger: Florence Nightingale-simply because I would love the opportunity to have a current conversation with someone who had such a grand vision. Her ideas and concepts around care for patients, medical statistics, and training standards ushered in a major revolution in care in the 19th century. Perhaps even now she would have ideas and suggestions on opportunities for reform today. Next: A physician leader Veena Goel Jones, MD, medical director, Digital Patient Experience, Sutter Health and Pediatric Hospitalist at Sutter Health’s Palo Alto Medical Foundation Jones completed inaugural fellowships in pediatric hospital medicine and clinical informatics programs at Stanford University. She joined Sutter Health in 2016 at age 30 as medical director of digital patient experience, while simultaneously practicing clinically as a pediatric hospitalist. She helps set clinical priorities for digital health implementations including the organization’s online patient portal, telemedicine initiatives, off-site call center operations, and strategic partnerships, and offers subsequent stewardship over the operational implementations of these programs. Her passions lie in harnessing technology and digital tools to empower patients and their families to make informed decisions as they navigate all aspects of their healthcare. MHE: Why did you choose your profession? Jones: It is my greatest privilege to help children and their families navigate illnesses and the healing process as a pediatrician. I chose this profession because I have always been humbled and moved by children’s innocence and resilience. During the course of my medical training, I also developed a passion to improve the overall quality and delivery of care within healthcare systems. I am fortunate to have found a career that allows me to leverage digital technology to lead organizational change, while also revolutionizing the experience of patients and providers. MHE:What has been your biggest learning experience? Jones: The most powerful experiences I have had in healthcare have been at the patient bedside, from seeing a family struggle to access care for a loved one, to holding a parent’s hand as they have grieved the loss of their child, to bringing a smile to an ailing patient’s face. These are just a few examples of situations that have taught me that no matter what incentives are created by healthcare laws, hospital policies, and financial models, at the end of the day, the field of healthcare is about helping people. Maintaining this perspective keeps me grounded and keeps the patient at the forefront of my mind when it comes to making decisions and leading change. MHE:What change would you like to see in healthcare in the next 10 years? Jones: I would like to see digital health solutions more thoughtfully integrated into healthcare delivery systems to make it easier for people to access the right care, via the means they desire, when they need it. From artificial intelligence platforms to telemedicine, there is great potential for such technology to become ubiquitous within healthcare if payment and incentive models can evolve to make care more affordable. MHE:If you could sit down to dinner with anyone involved in healthcare, who would it be? Jones: William Osler, MD-the father of modern medicine. He pushed against previously accepted standards in medicine with his vision for patient-centered medical education. I would be fascinated to get his perspectives on innovating and adapting how we can provide patient-centered care in the digital age. Next: A health plan leader Erin Hafer, MPH, director, New Programs Integration and Network Development, Community Health Plan of Washington (CHPW) Hafer has extensive experience working with managed care and delivery systems in integrating healthcare reform opportunities through strategic planning, product development, payment model innovation, and legislative advocacy. She partners closely with federal and state agencies and community partners on healthcare transformation activities. Hafer has developed models to improve access to care for individuals with complex conditions, such mental health and substance use disorders. One such model includes the innovative Mental Health Integration Program (MHIP), which embeds mental health professionals in the primary care delivery system. MHIP outcomes include decreasing inpatient admissions, lowering arrest rates for patients receiving services, reducing the average time to improve clinical depression symptoms by half; and saving the hospital more than $11.2 million during the initial 14 months of statewide MHIP implementation, a net savings of $66 per member per month. MHE: Why did you choose your profession? Hafer: I am driven by a commitment to social justice and equity. After starting my career in community organizing with migrant farmworkers and political organizing, I worked in healthcare advocacy. Given my desire to affect change at the health systems’ level and improve population health strategies, the next natural step was to pursue my master’s degree in public health. I was drawn to CHPW due to its mission as a not-for-profit health plan, governed by federally qualified community health centers. In my 11 years at CHPW, I’ve been fortunate to work in several different business areas including public policy, product development, strategy and analytics, and network development. These experiences allowed me to focus on both operational implementation and health systems innovations. MHE:What has been your biggest learning experience? Hafer: Working in product development and health system innovation can be challenging, especially in an ever-changing environment. There is often tension between operational performance and innovation. Building a sustainable culture for innovation requires dedicated resources and an intentional focus on innovation as an organizational goal. MHE:What change would you like to see in healthcare in the next 10 years? Hafer: I would like to see better integration of physical and behavioral healthcare regardless of the care setting and a stronger incorporation of social determinants of health such as housing status, income, education, and ethnicity/race. While there is general acknowledgment of the role that behavioral health and social determinants of health play in health outcomes, there are still many limitations in how healthcare dollars can be used to address these issues. Through better incorporation of the social determinants of health, we will be better positioned to improve not only individual and population health, but also health equity. MHE:If you could sit down to dinner with anyone involved in healthcare, who would it be? Hafer: Having experienced the implementation of the ACA, including Medicaid expansion firsthand, I have seen the benefits of improved access to health coverage. I would love to hear Former President Barack Obama’s reflections on the challenges in passing the ACA and what he feels has worked well and what could be improved. Next: A technology leader Ashish Kachru, MBA, founder and CEO, Altruista Health After working in several industries, Kachru joined United Healthcare as the national director of its business risk management division overseeing many safety net health plans. He soon realized that for the healthcare system to create a lasting positive change in a member’s health, the system would have to be organized around value-based care. To enable this change, technology would play an important role. Kachru founded Altruista Health with a mission to drive improvements in cost savings and health outcomes through such technology. He led the development of a suite of applications called GuidingCare, which ties payers, providers, and members together on a single platform to manage the entire continuum of care. GuidingCare is on track to double its 38 million members this year; its use by provider organizations and health plans continues to grow. MHE: Why did you choose your profession? Kachru: I worked in several other industries before healthcare-manufacturing, nanotechnology, consumer product goods, and venture capital. But because several of my family members work in healthcare, the mission to serve others was a strong motivator. I was passionate about leaning into my experience from other industries to drive positive change in healthcare. MHE:What has been your biggest learning experience? Kachru: Healthcare is vastly different from any other industry in which consumers drive the market. Rules that apply in other industries don’t often apply. Change in consumer-driven markets can usually happen more quickly based on buyer needs and wants. Healthcare is a rather challenging industry to drive change in, but it is possible. You need to address the various forces driving the industry which requires a delicate balance. MHE:What change would you like to see in healthcare in the next 10 years? Kachru: I would like to see all stakeholders in the industry aligned-patients, payers, providers, policymakers, and vendors. We all need to be driving the bus in the same direction to achieve the kind of transformation we need to fix healthcare in our country. Until this happens, we will not see the changes needed to truly deliver value-based care. MHE:If you could sit down to dinner with anyone involved in healthcare, who would it be? Kachru: Ted Kennedy-who was extremely passionate about healthcare reform throughout his political career. To have this much passion and drive for a single cause, and to dedicate your entire career to it, is very impressive. I’d like to understand what fueled his passion and how it kept him going, even during times when he did not achieve his goals. Next: A pharmacy leader Patrick Mitsch, PharmD, pharmacy director, UCare After receiving a doctor of pharmacy degree from the University of Minnesota in 2012, Mitsch worked as a retail pharmacy manager for CVS. He then joined CVS’ health insurance arm, Caremark, in 2013 as a clinical pharmacist in its Medicare business unit. He came to UCare, a not-for-profit health plan, in 2015, and he quickly ascended to director of pharmacy in 2017. At UCare, Mitsch, now 31, uses his community experience to lead innovative quality programs that advance medication adherence and focus on preventive opioid management, cost containment, and member and provider education. MHE: Why did you choose your profession? Mitsch: Growing up, I saw a pharmacist’s impact firsthand as my grandfather cared for my grandmother who had Alzheimer’s disease. This pharmacist always ensured that my grandfather had the necessary knowledge to manage my grandmother’s complex medication regimen. This experience led me to want to become a community pharmacist. After achieving this goal and being able to impact patient care on an individual level, I soon realized the benefits of influencing patient care on a population health level. As director of pharmacy at UCare, I can positively impact patient care for those communities and populations that need it most, including communities where I grew up and worked. MHE:What has been your biggest learning experience? Mitsch: Working for a health plan that serves many underserved populations has taught me that we need to have a holistic view when approaching patient care. For example, if we want to drive medication adherence for these members, we need to meet them where they are and understand the cultural, economic, and social issues that may be barriers. MHE:What change would you like to see in healthcare in the next 10 years? Mitsch: I would like to see the opioid epidemic become a thing of the past. This nationwide crisis requires engagement from all stakeholders to drive the kind of change needed to end this epidemic. Health plans play a significant role in this process and we must collaborate with, educate, and empower patients, providers, and the communities we serve at large. MHE:If you could sit down to dinner with anyone involved in healthcare, who would it be? Mitsch: Scott Gottlieb, the acting commissioner of the FDA. Gottlieb came into his role at an unenviable time with the opioid crisis and high drug prices constantly making headlines. He has taken a sensible approach to addressing these issues-increasing generic drug approvals, pushing a high-risk opioid off the market, and advocating for more widespread availability of medication-assisted treatment for opioid addicts. He has taken positive first steps to address these tough issues. Next: A health plan innovator Michael Polen, executive vice president, Medicare and Operations, WellCare Health Plans, Inc. Since joining WellCare in 2005 as director of business planning and analytics, Polen, 38, has taken on roles of increasing responsibility. Today he serves as WellCare’s executive vice president of Medicare and operations. Under his leadership, the company has transformed its Medicare program through membership growth and market expansion. He has also led enterprise-wide improvements in quality, operations, provider networks, and customer experience. MHE: Why did you choose your profession? Polen: When I began my career, I wanted to do something that was interesting, challenging, and allowed me to do some good in the world. This led me to healthcare-a dynamic industry where things are always changing. Rising costs and an aging baby boomer population are putting unprecedented demands on our current system. I wanted to help provide solutions so that today’s seniors would have quality, cost-effective healthcare as they age. MHE:What has been your biggest learning experience? Polen: Managed care is a highly regulated industry. We work closely with government partners to meet strict care delivery metrics and guidelines to ensure we’re providing access to the highest quality, most cost-effective healthcare for our members. This can be a challenge, but it has taught me to be open to change, to be nimble during adversity, to find new ways to solve problems, and to offer innovative solutions. MHE:What change would you like to see in healthcare in the next 10 years? Polen: I’d like to find a way to offer consumers greater transparency. When people have access to information about the cost and quality of their healthcare, they can make more informed decisions. When buying electronics, for example, there are dozens of ways to research and comparison shop for the best new models. But when we visit doctors or fill prescriptions-perhaps the most important purchases we make for ourselves and our families-we often don’t have the information we need to make the most informed decision. I predict the demand for more transparency will only grow, and providers, hospitals, payers, and other healthcare stakeholders will need to work together to provide that information for patients. MHE:If you could sit down to dinner with anyone involved in healthcare, who would it be? Polen: I’d like to sit down with Amazon CEO Jeff Bezos to hear more about his vision for healthcare. Amazon is known for disrupting major industries, and now with JP Morgan and Berkshire Hathaway, the company announced it will form its own independent company to offer health insurance to its employees. The healthcare industry needs to be more innovative; there are plenty of ideas but not enough actual game changers. I’d like to see more industry leaders engage industry outsiders to further develop disruptive ideas aimed at addressing the age-old issues of healthcare costs, access, and outcome transparency. Next: Technology innovators Anish Sebastian, CEO, Babyscripts and Juan Pablo Segura, CPA, cofounder and president, Babyscripts When founding Babyscripts in 2014, Sebastian, 30, and Segura, 30, had a vision of using Internet-enabled medical devices and big data to transform the delivery of pregnancy care. The duo partnered with health systems and raised $8.6 million in venture and angel financing for their business. They also orchestrated large partnerships with General Electric, March of Dimes, StartUp Health, and the White House. The result is the first toolkit for tech-enabled prenatal and postpartum care. The pair are also the architects of the first "Prenatal Care Moonshot,” focused on eliminating preterm birth by 2027. MHE: Why did you choose your profession? Sebastian: I chose it for two reasons. First was my obsession with data and self-tracking. Through my involvement in the quantified self-movement, I have seen the promise and pitfalls of big data firsthand. The second reason was more personal; I saw my family’s experience and struggle with the current status of healthcare. Segura: It was partially opportunity and partially responsibility. While healthcare information technology is an up and coming industry, Sebastian and I chose to pursue a career in transforming prenatal care because of the debt we both had to our mothers and mothers everywhere. There were no companies solely focused on moms in that space. We strove to change that. MHE:What has been your biggest learning experience? Sebastian: Healthcare is a slow-moving beast that is extremely resistant to change-you won’t see rocket-like growth like that seen in consumer segments. This has forced me to be cautious with setting expectations with both our investors and employees. Segura: That entrepreneurship is harder than what you see on TV … but, what I’ve come to appreciate is that the best things in life are not free. Everything worth fighting for will be difficult, and the biggest reward is surviving. MHE:What change would you like to see in healthcare in the next 10 years? Sebastian: Complete interoperability and the ability to combine data across several different patient journeys together to form one holistic view. One can dream, right? Segura: More transparency in every part of how we deliver healthcare-from the pricing of services to the reasons for why certain events and outcomes occur. More transparency means more accountability, which is how our healthcare system will ultimately change. MHE:If you could sit down to dinner with anyone involved in healthcare, who would it be? Sebastian: Atul Gawande, MD, and Johnathan Bush together! Gawande authored one of the first books I read in healthcare, "Complications: A Surgeon's Notes on an Imperfect Science," and I've been a fan of his ever since. It was a firsthand view of how the healthcare system is both protocol-oriented, yet, at the same time, human. Once I started Babyscripts, I witnessed Bush, CEO of athenahealth, a healthcare technology company, in action. His leadership ability is on-point. Underneath his antics and eccentric behavior is one of the sharpest and most knowledgeable minds in healthcare. Segura: Ignaz Semmelweis-the man who championed the simple notion of washing your hands. He was driven mad by naysayers. I would sit down with him and simply thank him for never giving up. Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.