Tanya Harris, Aspen Institute Health Innovators Fellowship: Fostering Collaboration to Improve Healthcare

Van Ton-Quinlivan: Welcome to WorkforceRx with Futuro Health, where future focused leaders in education, workforce development, and healthcare explore new innovations and approaches. I’m your host, Van Ton-Quinlivan, CEO of Futuro Health.

Today, we’re going to zoom out and take a look at efforts to foster greater coordination and interaction between disciplines in the U.S. healthcare system. My guest is Tanya Harris, executive director of the Aspen Institute Health Innovators Fellowship, where she nurtures a growing community of leaders committed to finding viable solutions to our healthcare problems.

Tanya has over twenty-five years of experience expanding access to healthcare and influencing federal and state program development. Before joining the Aspen Institute, she served as the National Director of Healthcare Operations at Planned Parenthood, amongst many other roles.

Thanks so much for joining us today, Tanya.

Tanya Harris: Well, thank you so much for having me, Van. It’s great to be here.

Van: Absolutely. Well, I would love to start by having our audience learn more about your background and what led to your interest in healthcare in the first place.

Tanya: Yeah, absolutely. You know, I often describe myself as an AIDS activist baby because my career really started when I was in college and I volunteered at Gay Men’s Health Crisis. I was in New York City.  When I volunteered, they put me in the sort of financial benefits program for volunteer purposes, and so they trained me up on everything that was happening in terms of benefits available to people with HIV and AIDS, really, at the time.

I’m so glad that I decided to volunteer there and engage with them because it actually meant that I had a skill set when I graduated from college that I could use to market myself to gain employment after school. So, I took a job as a case manager for people with HIV — although then it was really primarily AIDS because this was before AZT, before we had any medications — and it was a complete wake-up call for me.

I had grown up really middle-class and just had never had the experience of how horrible and dehumanizing healthcare could be, and suddenly there I was, this like, very young, very naive white woman visiting black and brown people who were estranged from their families because the disease was so stigmatized then. They were living in subsidized housing programs where they were required to allow me to come visit with them once a week while they were dying because pretty much everyone on my caseloads back then died.

I had just been so ignorant about how bad healthcare could be until I regularly accompanied people on Medicaid to their doctor’s appointments. Everything from unethical doctors, poor safety oversight in hospitals, really poorly functioning facilities, horribly long waits and opaque processes to recertify for Medicaid…the whole experience really changed me and inspired me to go into healthcare and see if I could fix it. And that’s what took me into the profession.

Van: Well, I’m glad that that volunteer experience inspired a career and your impact subsequent to that. Now, I’m sure this whole experience of viewing healthcare on the front line up close and personal has influenced your current role and why you’ve chosen your current role. So, give us an overview of the Aspen Institute and the Health Innovators Fellowship.

Tanya: Sure, absolutely. I have really, just by way of transition, spent my entire career since then in nonprofits or in government, whether state, federal, or local. The Aspen Institute really offered an amazing opportunity for me because it’s such a unique institution existing to ignite human potential to create possibilities for a better world. Aspen was founded in 1949 out of the experience of the Second World War and started with this fundamental idea to drive change through dialogue, leadership, and action to help solve the most important challenges facing the United States and really the world. For almost 75 years, Aspen has been investing in individuals, whether it’s through seminars and reading classic literature and engaging in these discussions about it in the context of their lives — which is what happens in the fellowship — but also, Aspen’s just great at convening and bringing people together across political spectrums, across different schools of thought to really dive in and think deeply about how we make progress and move forward.

My role in particular is with the Health Innovators Fellowship. This is really a fellowship that is domestically focused and our core mission is to bring humanity back into healthcare by breaking down the silos and barriers that exist. We do that by creating a network of leaders poised to make a direct impact in people’s lives. The fellowship is available to folks thirty-five to fifty years old who are at what we call an inflection point in their lives. And that’s really folks that are sort of thinking a little bit bigger and thinking about the opportunity to help them identify what their contribution is going to be to society. We use that age criteria to sort of loosely get at folks mid-career while there’s still significant time for them to make that impact and increase the impact they have in the world.

The fellowship itself is a two-year program. During those two years, there’s four weeks where folks come together. We have about twenty folks in a class and they come together for these week-long seminars. They’re away from family, they’re away from work and they’re in this big free space and really so they can think differently and engage in big ideas. They can engage with nature and they can engage with their colleagues in the program. But finding space for new ideas also means sometimes old notions have to be dislodged, right? And so we sort of create space for that.

Then the other requirement of the fellowship is that each fellow commits to a venture which is an externally facing passion project. We really just encourage them to go for broke and try that one crazy idea they’ve never been able to stop thinking about. We have fellows doing a variety of things. You happen to have met one of our fellows who gave up a twenty-plus year career as a healthcare executive to start a nonprofit serving farm workers in California’s Central Valley for her venture. And so the real intention is that by making this investment that Aspen’s choosing to make in these healthcare leaders and bringing them together with others across all of healthcare — which is just so siloed and organizations are run as fiefdoms — that good things can happen, and we’ve seen that. People take bigger bets in their own professional journey than they might’ve otherwise.

We’ve got a group of fellows coming together tackling adolescent mental health through a pilot project in Mississippi. Others thinking about how they can collectively impact health equity. It’s a really impressive group of folks that have been in and continue to be in this fellowship, and the possibilities are really endless.

Van: Well, I certainly enjoyed meeting some of these fellows at the event that you held out here in the West Coast. I would imagine that for many of these individuals, they’re in the silos of their discipline within a healthcare system but your fellowship actually had individuals participating that were outside of the healthcare providers. So, maybe you could just elaborate a little bit more on that because weren’t they from venture capital and banks and academia? There was quite an array of backgrounds and experiences.

Tanya: Well, I’m so glad that you appreciated that and I’m so glad to talk about it because I think it’s one of the things that makes us really unique in the healthcare fellowship space. We really try very hard to recruit healthcare fellows from all across the industry and healthcare is just so complex and there’s so many sectors within it. To your point, that’s venture capital, academic medicine, clinical research, biotech, community-based organizations.

One of our fellows in the current class is a fire chief because he oversees emergency medical services and they’re doing a lot of ER diversion. So, we really do try and bring folks together from all across the healthcare sector and that is very intentional because healthcare is just so large and so complex and expensive. We’ve got to find better ways to reach across political divides, ideological disagreements and narrow, sector-based perspectives. Aspen’s just perfectly situated as an organization devoted to challenging leaders to refine their values, to really bring folks into this space.

The other thing that’s surprising about this fellowship is that it’s a lot more emotional and in sort of ‘heart space’ than folks may anticipate when they’re coming into the program. That group of twenty people have a really profound emotional connection that is made and therefore the strength of the connection between the fellows is really quite lasting as a result. And then we multiply that out, right? We’re on our sixth class, so we have 121 people who are part of this growing network of individuals who believe we need to do better and we need to be grounded in values while we make those decisions and we need to have people around us that we can test our ideas with and think about things as we create the new world that we want to see.

Van: You talked about when you were young, your volunteer experience exposed you to a balkanized healthcare system that was large and complex and impersonal. And frankly, it sounded like it was very cold, right? And so you’re working with the fellows to engender greater coordination and interaction across disciplines. Are there some examples or stories that you can share with us on their journey through this fellowship program?

Tanya: Yeah, sure. That’s a great question. I think one of the big areas where we’ve seen cross-collaboration, which we’re super excited about, is someone who has a mental health, tech-enabled therapy service, someone who has an IT platform that engages folks during their healthcare experience, a community-based organization led by one of our fellows that provides youth and adolescent healthcare in Mississippi, and this fantastic physician who’s helping them stay organized and work on this project. Three of them started at one of our seminars in 2022 in Vermont, when they got galvanized around this idea. There was a big front section ad in the New York Times about the crisis in adolescent mental health and folks just got energized and started really thinking collaboratively about how they could bring the forces of all of their organizations to bear to try and solve this problem?

The community-based organization in Mississippi said, let’s make a big bet in Mississippi, of all places. And so what they’ve begun to pilot and are continuing to roll out — and are now hoping to expand beyond Mississippi — is using these different platforms to take young people through what’s called a hope scale to identify who is feeling hopeful and who is feeling less hopeful and to triage young people into different categories and then direct them to appropriate services — whether that’s an online Cognitive Behavioral Therapy platform or more immediate services as they need. That’s really our current example of what it might look like to collaborate between disciplines and while a number of these folks were looking at mental health, they were looking at it from different directions, so that’s really one of the ways that we think about that.

Another person that I’m really excited about due to the work he’s doing is a gentleman named Carter Dredge who is in our fellowship. He’s rethinking financing mechanisms for innovation in healthcare: how can large healthcare systems find stability in their supply chain without going through profiteers? He’s making this argument that healthcare is important enough to think about it as a utility. This work involves bringing together large healthcare systems to collaborate at a big scale and to find some more reliability in the healthcare system through investing in new innovation. That kind of work makes me really hopeful and excited about what we can see coming out of this fellowship and hopefully how we can turn the corner on healthcare in this country.

Van: Wow, that’s a great example. Tanya, you’ve had an opportunity with all these fellows to observe not only their journey, their passion project, but also the substance of what they’re working on which probably gave you some insights on skill sets that are needed to deal with the healthcare situation within the country, but also globally. I’m wondering if you have some insights into skills that may be more valued in the future if someone’s going into the field of care. What are those?

Tanya: That’s a great question and I’m so mindful of all the fantastic work you’re doing at Futuro Health. I think we’ve been talking for years about a caretaking crisis in this country. As we have more baby boomers aging, there are so many people that are so important to healthcare that aren’t physicians, aren’t nurses, or PAs. That’s really the caretakers. I just can’t emphasize enough as more and more people age — and folks always would prefer to be at home rather than in an institution — that means we have to have Visiting Nurses, we have to have healthcare assistants and aides, we have to have nurses, period. Of course, we’re having a terrifically horrible nursing crisis in this country with the number of people leaving the profession.

There’s some incentives that are so skewed in our system. Primary care as a whole and geriatrics are just not well invested in. It is not as lucrative as other specialties in medical training.  I am deeply concerned that we don’t match compensation and prestige with our values and what we care most about. We should be treating people appropriately with a living wage and with benefits. These jobs are just too hard and too important to think of the people doing them as independent contractors rather than them being really a part of the community in full.

Van: If you had a cousin or a niece or nephew approach you about entering the healthcare field, what advice would you have for them, Tanya?

Tanya: I have an enduring fondness for so many parts of the medical profession that it’s hard to say. I think nurses are amazing and can do so many different things. I think that degree gives someone true flexibility to look into many sectors of healthcare. There’s just so many different ways that a nursing degree can be helpful. I also have an enduring fondness for pharmacists who I think just do amazing, amazing work and can be much more engaged than just being behind the counter at our local drugstore filling prescriptions. Those are two examples.

I would really advise someone to really think long and hard about the different ways to get to what they want to do. What is the impact that someone wants to have? And I don’t think that it’s reasonable at this point to assume that the only path to impacting people’s lives is to spend the exorbitant amount of money it costs to become a doctor in this country. There’s just so many other ways to impact healthcare and to be engaged. So, I would encourage any young person to really think about what the end result is, really where they want to go and then explore the many, many different ways there are to get there.

Van: Well, you’re an exemplar of someone who’s taken a non-traditional route into healthcare and continue to have impact on healthcare.

Tanya: Yes, that’s true. After a couple of years working as a case manager in New York City, I tried to figure out what to do. I started a social work degree and then it just didn’t feel right. It didn’t feel like my community when I was in that degree. So, I left it after one semester part-time. Then, I actually had a boss who said to me, “I’ve heard about this public health degree. I don’t really know a lot about it. It looks like it might be of interest.” So, I started exploring a public health degree and that’s ultimately what I pursued was a master’s in public health at Columbia University with a focus on health policy and management because I knew that I really wanted to work around the Medicaid program and I wanted to have a deep understanding of how it worked before I took that forward.

But yes, I would have never predicted. That’s my favorite thing about career paths is how they can be so circuitous and they sort of land us where they should, right? But we can’t predict how we got there. I really did just follow my heart at that point around the issues that were really piercing my heart as I was seeing them play out in the people I was working with.

Van: Well, on this topic of public health, let me just do a plug here. Futuro Health is working on a federal grant with UC Berkeley, California State University, Long Beach and many other higher education institutions. It’s for a field called public health informatics, which is the data associated with delivering on public health. That came about during the time of the pandemic when all the systems were realizing that much more needed to be done to activate the data for the use of care. So, again, these fields are just evolving for all different types of folks and their specialties, and their preferences, right? In terms of skills.

Tanya: Thank God for that, and I’m so grateful for your work in this area. We all have the experience of filling out all of these questionnaires and surveys every time we go to a medical facility and what happens with them, right? So, this notion that folks could be going into that, not just as data managers, but as folks who are gonna critically think about how can we use this information — are we asking the right questions, are we getting the right information back, how can we get this into a virtuous cycle so that we can feed information to the providers and have information fed back about someone’s compliance and adherence — I mean, I think that’s fantastic. I’m excited about that work.

Van: Oh, fantastic. So you began your career working with communities of color living with HIV at the height of the AIDS pandemic, as you mentioned, and I know another area of focus for the fellowship is health equity. I was wondering if you can elaborate a little bit on what’s going on that makes a difference in this field of health equity related to the fellowship.

Tanya: It’s an important question and one that I feel like, you know… it has been a very popular topic, but whether we’re really getting to impact, I think is what we’re grappling with right now in the healthcare field. I’m thrilled that it is engendering so much conversation. I’m just eager for action.

One of the places that I think we have started to see action — just because the outcomes have been so staggeringly horrible — has been around black maternal mortality. Whether it’s California, which has taken such initiative in this area or whether it’s healthcare systems, folks have started to really be much more thoughtful about things like standardizing practices to quantify how much blood loss there is after a birth and to ensure that a woman isn’t hemorrhaging.

To my earlier point about there being so many ways to impact healthcare without being a nurse or a doctor, we’re hearing more about doulas. Birth doulas are making a huge difference in black women’s outcomes when they are delivering. Doula is another great example of a profession that we could use so many more of — particularly people of color — in the profession to help provide that support for a black woman to ensure that she has a good birth outcome.

Van: Do you sense, as you observe the fellows, that there is more momentum in the field of value-based care or preventive care?

Tanya: I do. I think that we’re talking a lot more about value-based care. After probably the last decade of these sort of slow starts into the space, I think we are seeing more providers and more institutions being willing to take more risk. The hope is that value-based care gets to the prevention that you just mentioned. The hope is that once a provider or a health center or a hospital system has that confirmation of the amount of payment that’s going to be coming in, they can step back a little bit with each individual person and say, “What’s the best way I can impact this individual?” Because it may not be a healthcare investment that’s needed. It may be abatement of lead paint, it may be an air conditioner for asthma, it may be food stability and access to healthy foods that are culturally appropriate. It can be many different things that ultimately lead to someone’s health. And so I am optimistic, although I don’t know that we’ve seen as much progress as we would have liked to have seen so far in value-based care.

Prevention is this magical word. It’s like an accordion, right? It can expand and mean many different things. You can expand healthcare out. The aperture is so wide it really encompasses all that happens in someone’s life. So, we’ve got to sort of figure out that balance and what issues we can impact and what are reasonable issues for healthcare providers to sort of stretch into in terms of impacting patients and ultimately, hopefully, much better outcomes.

Van: Let’s wrap up by having you remind us, how does someone apply for the fellowship?

Tanya: Folks can go to the aspeninstitute.org, and there’s a search function within that. You can look up the Health Innovators Fellowship and find your way to our webpages on the site. There is a place to express interest and therefore be on our mailing list to hear updates. We try to open up for nominations every year. We are right now hoping to identify additional funders so that we can open up in 2024 for our seventh class. For now, we’re recruiting partners and allies and investors who really want to be part of this kind of work going forward.

Certainly, folks can reach out through the website or reach out to me. I’m happy to be engaged and to talk to folks about the program.

Van: Well, we’ve learned a great deal about the fellowship program and we’ve learned a lot about your values. Is there anything else you’d like our audience to hear or learn?

Tanya: Thank you for asking. I really am interested in identifying, through the fellowship, opportunities to test and think about where we might find new areas of innovation. Because I worry sometimes in healthcare, we’re not asking all of the right questions. The questions I really care about are individual ones. Are you having enough impact? Are you looking at issues holistically? How do we break orthodoxy and create more innovation in healthcare? For me, one of my questions is, why does everyone I know have a healthcare horror story? Many of us also have a success story, but too many people I know have been harmed either physically or emotionally by the healthcare system. We spend a fifth of our economy on it, so our incentives are misaligned.

We really need to think about how we can align our incentives to get to the kind of outcomes we really care about in a healthier society. I’m really excited about the fellowship’s potential to do just that.

Van: Well, you’ve given us great provocations as a way to end this podcast. Thank you very much, Tanya, for being with us today.

Tanya: Oh, thank you so much. It’s been so fun. I really appreciate you having me.

Van: Absolutely. I’m Van Ton Quinlivan with Futuro Health. Thanks for checking out this episode of WorkforceRx. I hope you will join us again as we continue to explore how to create a future-focused workforce in America.