Top 10 Up-And-Coming Industry Leaders in Healthcare 2019

May 7, 2019
Karen Appold
Karen Appold

Volume 29, Issue 5

Managed Healthcare Executive has identified 10 emerging industry leaders, working in the areas of pharmacy, health plans, health systems, and technology.

Every year, Managed Healthcare Executive picks 10 up-and-coming leaders from across the healthcare industry. From health systems to tech companies, these rising stars have made made big waves in the industry-and we’re excited to see where they go from there.

Our editorial advisory board members faced the difficult task of culling through more than 30 well-deserving nominees and selecting their top 10 standouts.

Click here to see last year's winners

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 so many great submissions, the decision was tough! But here are our choices for the Top 10:

Katherine Di Palo, PharmD, clinical program manager, Hospital Readmissions Reduction Program, Montefiore Health System, Bronx, New York

In a role she created, Di Palo, 32, has translated her experience as a pharmacist who worked at the bedside to the boardroom at Montefiore Health System, the University Hospital for Albert Einstein College of Medicine. She co-chairs the executive Hospital Readmissions Steering Committee, connecting historic silos to ensure vulnerable patients safely transition from hospital to home. Di Palo directly leads working groups that tackle key initiatives including care infrastructure, information technology changes, clinical data analysis, multidisciplinary education, and care continuum partner engagement to improve outcomes established by the Institute for Healthcare Improvement’s Triple Aim.

MHE: Why did you choose your profession?

Di Palo: Administration is in my DNA. My father started as an orderly and through education and perseverance rose through the ranks to hospital CEO. Similarly, I began my career as a teenager at a local independent pharmacy and quickly found that clinical pharmacists are integral in evidence-based medicine delivery and patient advocacy. As a result of infinite curiosity, strong mentors, and a desire to challenge the status quo, I shifted from optimizing care at an individual patient level to a systems level within a visionary organization.

MHE: What has been your biggest learning experience in the industry? What did it teach you?

Di Palo: To successfully transform an initiative from a pilot program to the standard of practice, bidirectional communication is key. Listening to clinicians, leaders, care providers, and most importantly-patients-allows for the development of innovative and common-sense solutions that fit the culture.

MHE: What change would you like to see in healthcare in the next five to 10 years?

Di Palo: Patient access, especially to primary care in underserved areas, is integral to quality and cost reduction in chronic disease management. Currently, pharmacists are not considered healthcare providers under Medicare Part B despite robust evidence demonstrating their positive impact on outcomes. Many primary care models integrate pharmacists for longitudinal medication management consistent with state scope practice laws and regulations, however lack of reimbursement prevents patients from clinical pharmacy services. Recognition of pharmacists as healthcare providers at the federal level could facilitate team-based, patient-centered care.

MHE: If you could sit down to dinner with anyone involved in healthcare who would it be? 

Di Palo: Given the opportunity I would like to meet Hippocrates-the Father of Medicine. I admire his revolutionary thinking, discipline, compassion, and ethics. Finally, the modern translation of the Hippocratic Oath-that there is an art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug-is something I firmly believe.

Patrick Fenningham, chief product officer and executive vice president, EIR Healthcare, Philadelphia

Fenningham, 31, started his career at Johnson & Johnson as a biomedical engineer, before earning an MBA and relocating his talents to Siemens Healthcare, where he focused on market analytics and product management. He went on to become the head of commercial operations at Thomson Reuters Intellectual Property and Science (now Clarivate Analytics). Today, his work includes developing an enterprise-wide product strategy, defining research and development roadmaps, and driving innovation to help strengthen EIR’s position as a leader in modular technology in the healthcare industry.

MHE: Why did you choose your profession?

Fenningham: Ever since my grandfather died of cardiac complications when I was 12 years old, I wanted to understand why it happened. This drove me to enter the medical field. I began my college education by taking the pre-med cardiology track. While there, my interests transformed from cardiology to biomedical engineering. My goal grew to helping patients with all kinds of ailments. I am now focused on improving the overall healthcare experience for patients and caregivers.

MHE: What has been your biggest learning experience in the industry? What did it teach you?

Fenningham: If you truly want to make a difference in your space, sit with the people who actually do the work. Early on in my career, I found that those who really knew what was going on with the products and services within a company are the boots on the ground, not the executives or board of directors. As I climbed the ladder into management roles, I always felt my greatest asset was my ability to connect with the people on the front lines. They can tell you everything you need to know if given the chance.

MHE: What change would you like to see in healthcare in the next five to 10 years?

Fenningham: I would like to see an open-source collaboration across the industry using data analytics to create predictive indicators that will be used to directly impact patient outcomes.

MHE: If you could sit down to dinner with anyone involved in healthcare who would it be? 

Fenningham: Babak Parviz, PhD, who heads the Amazon Grand Challenge, a division of Amazon primarily focused on cancer research and electronic health record technology. I find it incredibly fascinating when very successful and well-educated groups outside of the healthcare world bring a new perspective to the industry. Understanding his high-level approach on how he plans to tackle healthcare would be exciting.

Vivek Garipalli, co-founder and CEO, Clover Health, San Francisco, California

In his current role, Garipalli, 40, is addressing a demographic that is commonly ignored: seniors living with complex health issues that the healthcare system is unable to manage effectively. Under his leadership, he has grown Clover, which uses proprietary artificial intelligence and machine learning models to improve health outcomes, to nearly 40,000 Medicare Advantage plan members and more than 500 employees.

Prior to Clover, Garipalli founded CarePoint Health, a fully integrated healthcare system serving Hudson County, New Jersey; Ensemble Health Partners, a national revenue cycle company headquartered in Huntersville, North Carolina; and a network of outpatient facilities.

MHE: Why did you choose your profession?

Garipalli: When I first entered healthcare, I saw it solely as an economic opportunity. But I stayed in healthcare because I knew it would offer me the chance to add value to the world. At Clover, our company’s success is directly related to our members’ health; that alignment of mission and business model is something incredibly special and unique. We believe that by leveraging technology in a logical way, we can have a dramatically positive impact on our current and future members’ health.

MHE: What has been your biggest learning experience in the industry? What did it teach you?

Garipalli: Four years ago at Clover, we had an idea to offer the same cost-sharing in and out of network and remove that friction for customers. Therefore, we created marketing materials and launched a plan. But CMS had a very different interpretation regarding physician obligations to see customers out of network, and we had to immediately cease the marketing approach. That experience taught me that the learning curve on compliance in Medicare Advantage was much steeper than I had realized. That’s when we hired a chief compliance officer. That experience taught me the importance of hiring subject matter experts, even if it’s a space you’re familiar with.

MHE: What change would you like to see in healthcare in the next 5 to 10 years?

Garipalli: I’d like to see more healthcare companies focus on underserved populations and helping the most vulnerable members of society. High-quality healthcare should not be restricted to the wealthy. At Clover, we’re committed to making healthcare more equitable, by serving a population that’s far more diverse than the industry average.

MHE: If you could sit down to dinner with anyone involved in healthcare who would it be? 

Garipalli: Someone who’s been on my mind lately is Jonas Salk, the inventor of the polio vaccine. In the midst of the public debate of pharma pricing and research costs, he was an incredibly important figure who had zero interest in personal profit, sought no patent for the vaccine, viewed public health as a moral commitment, and in turn was responsible for saving hundreds of thousands, and potentially millions, of lives.

Peter Kelly, MBA, executive director and business development leader at CareMount Medical, Mount Kisco, New York

Kelly, 36, feels fortunate to have spent six years in his early career as an Avalere Health consultant. The firm grew from 45 staff to more than 200 during his tenure. There, he gained specialized knowledge in U.S. healthcare reimbursement and finance, especially for governmental programs. After business school, he joined Universal American as director of strategy and then served as executive director of the New York Medicare Advantage and accountable care organization market. In this capacity, he helped launch the Mount Kisco Medical Group ACO. In 2016, he joined MKMG, which became CareMount in his current capacity. In 2018, the company launched the CareMount Next Generation ACO. The ACO currently manages 35,000 Medicare patients in full alignment with CareMount physicians. He serves as executive director and oversees key areas including strategy, finance, recruiting, risk contracting, data analytics, delivery system performance, and preferred network.

MHE: Why did you choose your profession?

Kelly: I was interested in helping to solve the high cost of healthcare as an undergraduate. Learning more about governmental programs and fee-for-service reimbursement led me to focus on managed care. Then, at Universal American, I spent time with the market leadership of a successful and innovative Medicare Advantage plan in the Houston market, named TexanPlus. This opened my eyes to the possibility and inherent leverage of physician-led delivery systems in managing the medical premium.

MHE: What has been your biggest learning experience in the industry? What did it teach you?

Kelly: The importance of building a team. Integrating the healthcare provider and managed care operations spans so many critical functions- finance, clinical operations, contracting, data analytics, quality, med management, and pharmacy. To do it well, you need leaders or rising managers across these areas. Experience has taught me the importance of organizing people and aligning them with a core mission and narrative. For my team at CareMount, the goal is to achieve total quality outcomes for our patients.

MHE: What change would you like to see in healthcare in the next five to 10 years?

Kelly: I think a responsible expansion of Medicare Advantage is good public policy. Along with it, we need a regulatory framework that creates a transparent and credible glide path for providers to take delegated premium risk under the plans.

MHE: If you could sit down to dinner with anyone involved in healthcare who would it be? 

Kelly: I would ask Jeff Bezos how he views patients as customers and how to streamline the customer experience in healthcare. We probably could go to a good restaurant, too.

Dan LaVallee, director of Government & Business Relations for Government Programs, University of Pittsburgh Medical Center Health Plan (UPMCHP), Pittsburgh

After earning a master’s degree in health policy, LaVallee, 31, joined America’s Health Insurance Plans in 2010. He then became one of the youngest Democratic nominees for Congress in Pennsylvania’s 3rd congressional district in 2014 at age 26. When he didn’t win his bid, he joined UPMCHP in 2015. His work focuses on underserved populations such as the Medicaid population, the LGBTQ community, the homeless, people with unstable housing, and individuals with intellectual or developmental disabilities, among others.

MHE: Why did you choose your profession?

LaVallee: Ever since I was a child, making an impact for those in need was important to me. I chose this profession to be able to have the greatest impact on the largest number of people-especially the underserved, disadvantaged, and those left behind.

MHE: What has been your biggest learning experience in the industry? What did it teach you?

LaVallee: I learned that it is possible to create innovative models to serve underserved and at-risk populations that can then be driven to scale and leveraged. This became clear to me through leading the development of UPMCHP’s permanent supportive housing program into a scalable model for how health plans can partner with housing support providers to reduce homelessness and improve health outcomes for an underserved population.

MHE: What change would you like to see in healthcare in the next five to 10 years?

LaVallee: In order to provide the best and most effective health outcomes, we need to continue to make progress in realizing that each patient- especially those who are often left out of the healthcare system-is a person of worth and dignity. We cannot assume that they will appropriately access the healthcare system if they don’t feel listened to and understood. Hearing directly from the individual-such as the woman who is homeless or the transgender man looking for non-judgmental and competent care-is the only way to effectuate the meaningful change we seek.

MHE: If you could sit down to dinner with anyone involved in healthcare who would it be? 

LaVallee: I would love to have dinner with Lee Bass, MD, my childhood pediatrician. He was the type of doctor who treated his patients not just as patients, but as people that he valued. After my brother died when I was six years old, Bass, came to my house with a gift of a toy truck and played on the floor with me-not as a child who needed treatment, but as a child who was grieving my brother. I would love to thank and tell him that I am trying to follow in his footsteps.

Sinead Madigan, chief operating officer, Health Alliance Medical Plans, Champaign, Illinois

Madigan, 46, started at Health Alliance in 2008 as a pharmacy Medicare specialist. After less than two years, she moved into the corporate relations manager role, advancing the next year to become the director of government relations. After serving as executive director of Medicaid and government relations, she became a vice president in 2016 and assumed the senior vice president of government relations and business operations position in July 2018, then was recently promoted to chief operating officer. She is responsible for building its business and helping forge new relationships, as well as providing better customer service, and maintaining and expanding key provider partnership operations and compliance.

MHE: Why did you choose your profession?

Madigan: I started my career in state government. I believe in servant leadership, and have a keen desire to help others achieve their healthcare goals and understand how to be advocates for their own well-being through health literacy, strong provider-patient relationships, and optimal use of health plan benefits, including those beyond the plan itself.

MHE: What has been your biggest learning experience in the industry? What did it teach you?

Madigan: Our industry has been slow to focus on the customer experience. I’ve realized that our teams need to really think like a consumer in everything we do. We continue to break down internal and external silos to achieve continuous improvement for our patients and members.

MHE: What change would you like to see in healthcare in the next 5 to 10 years?

Madigan: I believe innovation is vital to improving healthcare. While government regulations serve as important guideposts, I would like to continue helping policy makers focus on ways to give the healthcare industry greater flexibility to innovate so we can best serve patients and members to achieve the positive health outcomes we all desire.

MHE: If you could sit down to dinner with anyone involved in healthcare who would it be? 

Madigan: At the risk of jumping on the thought-leader bandwagon, I would spend time with Bill and Melinda Gates. I would soak up details about their health-focused global initiatives, as well as their big ideas to address healthcare and poverty for more specific needs-ideas our enterprise and industry can springboard off closer to home. Innovation isn’t just a buzzword with the Gates Foundation. It’s a way of life to help people reach their potential.

Brigitte Nettesheim, president, North Central Region and Joint Ventures, Aetna, Chicago

Nettesheim, 46, began leading strategy for Aetna’s joint venture markets in 2016 and its North Central territory as well in 2018. In these roles, she is responsible for deepening Aetna’s relationships with consumers, employers, and providers, with a focus on transforming the way healthcare is delivered locally. Previously, she led Aetna’s Accountable Care Solutions and was a principal at The Chartis Group. She also held roles at Aetna in strategy, sales, service, and network management. Nettesheim served in the U.S. Army, rising to the rank of Captain.

MHE: Why did you choose your profession?

Nettesheim: As I transitioned out of the Army, I wanted to continue to serve the common good. I saw healthcare as a way to help improve people’s lives. I also saw opportunities to lead and drive change in healthcare. The military teaches you to have focus, agility, and the confidence to be decisive-all great leadership qualities.

MHE: What has been your biggest learning experience in the industry? What did it teach you?

Nettesheim: I learned that achieving better health goes far beyond the physician’s office and is heavily influenced by social determinants of health, such as conditions where we live, work, and play. I also learned the importance of having patience. In a large, complex industry like healthcare, sometimes things don’t move as quickly as you would like.

MHE: What change would you like to see in healthcare in the next five to 10 years?

Nettesheim: Our industry has an opportunity to sharpen its focus on consumers and their need for better and more affordable care. Accomplishing that takes teamwork and collaboration, which can be challenging at times due to the industry’s complexity, misaligned incentives, and the wide variety of stakeholders. That’s one reason why I’m so encouraged by some of the more progressive value-based care arrangements like joint ventures that create the aligned incentives among payers and providers needed to deliver greater value to consumers.

MHE: If you could sit down to dinner with anyone involved in healthcare who would it be? 

Nettesheim: I’d love to sit down with Lyndon Johnson after he signed Medicare and Medicaid into law. Such programs drew debate during his and previous administrations. It would be fascinating to learn more about what drove his commitment to those programs and what he thought about their sustainability at that time. 

Darren J. Sommer, DO, FACOI, founder and CEO of Innovator Health, and assistant professor of medicine and technology, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, both in Jonesboro, Arkansas

Sommer 47, created Innovator Health with the intent to provide lifelike telemedicine experiences for patients so they can continue to build strong relationships with their physicians. The technology allows a physician to be at the patient's bedside in their life-size form, with direct eye contact and in 3D. He also personally uses his technology to ensure that more than 3,000 rural and underserved patients have access to telemedicine services annually.

In addition, Sommer created and teaches the first ever integrated telemedicine curriculum for first- and second-year medical students. Hundreds of student physicians are now more comfortable providing telemedicine services after having participated in his training program.

Furthermore, Sommer has more than 23 years of active and reserve military service and is currently a lieutenant colonel in the Army Reserves.

MHE: Why did you choose your profession?

Sommer: As a college drop-out, I never imagined I’d become a physician. However, after spending a few years in the military and being trained as an emergency medical technician, I fell in love with healthcare and helping people. Following the military, I was blessed to meet an osteopathic physician who mentored me and supported my pursuit of medicine.

MHE: What has been your biggest learning experience in the industry? What did it teach you?

Sommer: My most significant learning experience in healthcare was during my first clinical rotation when a frustrated, bitter physician trained me. This physician spoke in detail about the issues plaguing the healthcare industry, yet never once discussed how he planned to make it better.

Listening to this physician made me realize that I didn’t want to find myself in the same place 20 years down the road. As a result, I’ve focused my career on finding ways to make the healthcare industry a better place for future physicians and their patients.

MHE: What change would you like to see in healthcare in the next five to 10 years?

Sommer: I would like to see the complete integration of all electronic health records. Having a ubiquitous exchange of patient information will allow for a better quality of care and dramatically reduce the costs of healthcare services.

MHE: If you could sit down to dinner with anyone involved in healthcare who would it be? 

My healthcare hero is Joseph Murray, MD. As the physician who successfully completed the first human organ transplant, I’d like to know how his peers received such a radical concept back in 1954 and how he persisted through what must have been a challenging experience both clinically and politically.

Catherine Turbett, executive director of national performance operations, Steward Health Care Network, Dallas

Turbett, 33, began her career in practice operations, responsible for the patient experience and efficiency. She went on to work for Steward Health Care Network’s ACO, tasked with improving quality performance at point of care. She became responsible for organizational strategies and, in 2018, became executive director of national performance operations. She oversees a team of 300, who are focused on improving performance in Steward’s health plans and ACOs.  

MHE: Why did you choose your profession?

Turbett: My mom spent years in and out of the healthcare system as a patient, so I became an expert in navigating its complexities and knowing good components of care when I saw them. When she waited weeks for necessary appointments, I realized that our healthcare system has challenges for everyday consumers. When I worked as the operations manager at a physical therapy practice, the owners became my mentors, leading me to the idea that there was more than one way to impact the continuum of care. They suggested I explore a master’s in healthcare administration.

MHE: What has been your biggest learning experience in the industry? What did it teach you?

Turbett: When I joined Steward Health Care, it had just begun working to improve how patients experienced care. I developed and implemented a strategy to improve our Consumer Assessment of Healthcare Providers and Systems (CAHPS) performance. At the time, our ACO consisted of Medicare and commercial patients; our efforts improved performance from -0.7 to 2.0 in patient experience in three years, a 230% improvement in commercial patient experience scores. In 2017, we implemented a Medicaid ACO. When we received our baseline CAHPS performance, it became clear that this segment experiences care differently than others as it rated us 5% to 10% lower than Medicare and Commercial populations-even though we achieved national benchmarks in CAHPS for Medicaid populations. Therefore, our teams had to implement efforts in different ways than before.

MHE: What change would you like to see in healthcare in the next 5 to 10 years?

Turbett: I would like to see greater transparency on CAHPS and quality performance. Patients should have access to information in an easily consumable way to make decisions about where and from whom they receive care. This includes access to ratings regarding experience of care and quality. At Steward, we’re taking steps in this direction, asking for feedback and reporting quality across our organization.

MHE: If you could sit down to dinner with anyone involved in healthcare who would it be? 

Turbett: Margaret Chan, former director-general of the World Health Organization, would be a fantastic date. I’d like to discuss her statements around universal coverage being a powerful equalizer and a concept that rules public health debates in the modern world.

Rose Jose, PharmD, chief operating officer, Outpatient and Specialty Pharmacy Services, LifeBridge Health, Baltimore, Maryland

Jose, 38, earned her doctorate in pharmacy in 2004 and became a licensed pharmacist at 23 years old. In 2008, she assumed a role in pharmacy administration at the University of Maryland Medical System in Baltimore. In 2012, she joined LifeBridge Health as the director of outpatient pharmacy services, where she is now the chief operating officer of outpatient and specialty pharmacy services.

MHE: Why did you choose your profession?

Jose: I decided to pursue pharmacy after my father and I were in a serious car accident when I was a young teenager. I was hospitalized and wheelchair bound for months. My mother, a cardiothoracic nurse, took amazing care of us once we came home from the hospital. When my mom had to go back to work, I took on additional responsibilities around the house, including giving my dad each of his many medications at the right time. I felt that I made a real difference in my dad’s recovery and wanted to continue making a positive impact in the lives of people who need it most.

MHE: What has been your biggest learning experience in the industry? What did it teach you?

Jose: Entering the pharmaceutical industry at 23 years old was a challenge. When you’re young in the profession, you’re sometimes perceived as “green” and need to establish credibility to gain your peers’ respect. I had to work extra hard to earn trust from my colleagues over time, and that that gave me confidence in my abilities as I took on more advanced positions and leadership roles.

MHE: What change would you like to see in healthcare in the next 5 to 10 years?

Jose: I’m fascinated by the rapid advancements in genetic testing. Pharmacogenomics presents an incredible opportunity for personal medication management, and I’d like to see how we can leverage the widespread availability of testing to improve patient outcomes. A patient’s prescription could be tailored to their individual DNA test results, meaning we eliminate waste, decrease side effects, and create optimal therapeutic outcomes.

MHE: If you could sit down to dinner with anyone involved in healthcare who would it be? 

Jose: CEO of GlaxoSmithKline Emma Walmsley. She’s fascinating for many reasons. She was named Fortune Magazine’s most powerful international woman in business and is the first woman to run a major pharmaceutical company. I’d like to learn about her perspective of the drug industry and other hot topics such as drug pricing transparency or lowering drug prices. One of her main focuses is on drug development. I’d like to hear about her outlook on vaccines in development for conditions such as cancer, HIV, and other illnesses that affect so many people, and how these advances can shape healthcare’s future.

Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.

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