As a part of my series about “Big Ideas That Might Change The World In The Next Few Years” I had the pleasure of interviewing Terry Hush. Terry is the CEO of Roji Health Intelligence LLC. Terry is a health care executive with experience across the spectrum of health care in public, non-profit and private sectors. Terry is an expert strategist in leading change, and a thought leader in healthcare. She co-founded Roji Health Intelligence technology and services in response to the critical need for providers to deliver better value health care. As director of the Illinois Medicaid program, she instituted major programs to provide better access to medical care for women and children. She also served in executive leadership for both private payers and physician organizations. An expert at creating consensus for desired change through education and collaboration, Terry helps organizations take actions that will direct their future through meaningful technology and programs.
Thank you so much for joining us! Can you tell us a story about what brought you to this specific career path?
It’s very funny. I pursued a Master’s in Public Affairs because that’s where I thought I could make a difference — in the public sector. You know, it’s like the government is here to help, right? I was idealistic enough to think that being in business was about selling things, and that being in government was about the public good.
My first job out of graduate school was as a budget analyst for the Governor’s office in Illinois. It was great training. There was a whirlwind of politics and policy, but the biggest lesson I learned was how to boil down all policy and budget implications to a one-page decision document. Making an impact requires you to get your persuasive arguments into sound bites and dollars, and basically, it’s for selling your position.
Two years later, I took a job creating regulatory policy for the Insurance Department. I was in charge of Blue Cross Blue Shield regulation and health care cost containment at a time when the crisis of health care costs was emerging. I had to learn very, very quickly about health care and its financial insurance mechanisms because I only knew to follow the money.
I guess I did well enough, because I later took on the management of the state’s own health care system for its employees, which is very large. Everything I draw on today came from those experiences — how important it is to challenge the system of finance, how to use payments and funding to transform health care. When I went to direct the Medicaid program in Illinois, I understood how payment mechanisms could work to engineer reform, and I went about redistributing dollars to get better care for beneficiaries.
At that point I leaped to the private sector, first with a major insurer and then with a big academic health care system. Both of those paths were about implementing change, getting doctors and other providers on board with it. Then I saw the need that all providers would have, and together with my partners started Roji Health Intelligence.
So, in the beginning I wanted to make an impact and I thought I could do it from government. But I learned along the way that if you want change to be sustainable, it has to be rooted in the private sector.
Can you share the most interesting story that happened to you since you began your career?
The biggest obstacle to change is fear, and it is caused by a feeling of loss of control by stakeholders or participants in a given system. Entangled with loss of control is always a concern that money will be affected. When I was Medicaid Director, my goal was to expand resources significantly for providers who were treating more Medicaid women and children. This was a positive thing since by any standard, physicians were underpaid by Medicaid relative to other insurance sources. But it was taking place at a time of a tight fiscal year.
Because this involved annual budget decisions and also avoiding big budget cuts to the Medicaid program, discussions within the state were very sensitive, and no final information could be released prior to the budget proposals. Then after the Governor’s budget was announced with my program in it, we got rumors of busses going to Springfield to protest the program. It was too big a change and much money was involved. Stakeholders were not immediately supportive — and that included everyone, from medical and hospital associations to community organizations. The lack of support from major medical organizations promised to kill it.
I took the advice of a major community organizer and went grass roots. I started task forces involving community organizations to educate and transition the program, and I met with specialty medical societies to support the initiative. I needed to build the trust necessary to clarify the intent and involve them in the change. It worked. Instead of protesting, the busses of community people supported the budget. The medical leadership supported it as well. It taught me about how to build trust and consensus. Change can be fast but only when people who are affected are in collaboration. It’s a lesson that I repeated in every job after that.
Can you tell us about your “Big Idea That Might Change The World”?
I want to make tools available for women so that they can have a real voice in their health, and they can access health care that will better serve them. These tools come from a better method of measuring effective health care for women, part of which comes from reports by women themselves, and the access to that data through websites and mobile devices.
The end goal is a fundamental change in three arenas:
For health systems and their providers, improvements in:
- Time to diagnoses for specific conditions of high incidence in women;
- Protocols that ensure consideration of the unique symptoms and diseases of women;
- Adoption of data-driven medical decision-making processes for women’s treatment, and the support and education of providers to effectively engage in these processes;
- Support women physicians and researchers.
For research institutions providing both basic science and clinical research:
- Creation of better recruitment strategies to enable women to participate in research;
- Assurance that proposals for research in basic science and clinical trials include female subjects in significant enough quantities for gender-analyzed results;
- Making data and research available to any consumer, without charge;
- Distribution of condensed results and fact sheets to practicing physicians and other medical personnel so that, if appropriate, they can be operationalized into protocols and standards of diagnoses and/or treatment.
For women themselves:
- Greater participation in medical decision-making;
- Greater participation in research to determine effects of treatments on women and understand biological variations; and
- Greater participation of women in medical and research leadership.
How do you think this will change the world?
Women have been dismissed and overlooked by our health care system. Their conditions and health issues are not adequately researched, stemming from years of non-inclusion in clinical trials. Where there are sex differences leading to different disease pathologies or unique problems, there is higher mortality or morbidity for women. They die from treatments researched only on men. Their pain is believed to be hysterical or emotional. Women physicians and researchers are not supported and unequally paid, and don’t advance to leadership where they might have influence in directing change in health care.
Only by measuring and improving women’s health can we create the foundation for improving health. But basically, women must drive this change to the finish line because their lives and quality of life is at stake.
Good health care measurement and other tools depend on the power of data. Yet there are erroneous conclusions that can be drawn from measuring results by data. The data can have inherent biases or be flawed, and it can be inconsistently collected or inconsistently entered. Diagnoses can be coded incorrectly, defining patients with conditions they don’t have. Therefore, any method of quantifying quality or health access data must be carefully designed to avoid inappropriate negative or positive characterization of providers, and allow providers to validate or respond to measurement. Additionally, the purpose of data and information should be to educate women initially on how to pursue fact finding and medical decision-making.
Was there a “tipping point” that led you to this idea? Can you tell us that story?
As a woman executive and a health care leader, I am keenly aware of how health care is affected by culture. My business is involved in improving health care performance and creating better value. We develop strategies that should help to improve care for everyone, but it is clear that the focus of providers is on broad, general strategies. That makes meaningful change difficult.
In exploring strategies that the industry seems to be missing in favor of “easy” solutions to cut costs, I started looking into the research about health care disparity. That led me to women and the conclusions dovetailed with some real-life experiences of my own. So, these issues were on my radar when, in the beginning of January, I wrote a company blog about the trends to watch for in health care. Many organizations were citing technology and trends that have been occurring for several two years. For me, I saw the movement around #MeToo and health care converging, and I began writing women’s health. I was astounded at what I was reading, and that was my tipping point.
What do you need to lead this idea to widespread adoption?
The first task must be to educate women about what science knows, and doesn’t, about their health. This will mobilize them — and advocacy organizations — to take action. Central advocacy is essential to create entities that can create a consistent source of information to women and a resource to collaborate with providers and insurers.
The first reaction I get to what I have been writing about gender disparities in health care is shock, even among physicians. They don’t want to believe that health care suffers from the same issues we see in our common culture. That same shock needs to register with women, and they must then be in action to do something about it.
What are your “5 Things I Wish Someone Told Me Before I Started” and why.
5 Things I Wish Someone Told Me Before I Started Roji Health Intelligence
- Health Care is driven by Culture. Economics is obviously a big factor driving health care decisions, but I really underestimated culture in my early years. Culture is why you find that women, despite completely different systems for heart attacks, are misdiagnosed when they show up in the emergency room. The patient is viewed through a gender-specific lens; care is never completely objective.
- For Introducing or Demonstrating Technology, Always Have Plan B and C. There must be some kind of physics law dictating that technology fails only when you urgently need it. Fortunately, we have never had a major disaster at Roji Health Intelligence, but enough scares that we have backups and redundancies all over the place! And if I am demonstrating our technology, I never depend on external networks, cables, or projectors. In our early days we would show up at an important meeting yet could get nothing to connect. I remember a particularly stressful demo in our early days. I came out of the building and made a direct bee-line for the chocolate shop after the meeting for consolation!
- People Are Not Convinced by Facts or Fear, but They Can Be Inspired by Ideas. There is a lot of fear-based marketing in health care. For example, adopt this strategy so that you don’t lose money. I find that executives in health care would rather talk about who or what they want to be, and then it is easier to help them get there. I spent my early years talking too much, and since I learned this lesson, I do a lot more listening.
- Change is a Long Arc, with Few Shortcuts. I feel bad for the employees of my first management jobs, and for all those participating in this one-time belief: change is hard, so it is best to make it fast. Not only is it impossible to collaborate in a short time frame, but participants in change need some time to adjust. My timeline is still much shorter than most, but I realize that I’m pushing the envelope and try to be kinder.
- People Need to Hear the Truth. I learned over a very long time that the best business is done with friends and people you trust. Trust is the beginning of every relationship, and it is essential with clients. Part of that trust is owning up when things don’t go right. We’ve had a few situations where data wasn’t processed correctly or completely, and the conclusions were therefore not correct. The best thing to do is apologize and work together to figure out the best solution. The client may be angry, but hopefully that is temporary.
The future of work is a common theme. What can one do to “future proof” their career?
My best advice is to keep an open ear on trends. One should be reading, listening to podcasts, and paying attention to the culture. There is no future-proofing strategy without being aware of what is coming next. I see what’s coming in health care as a revolution among consumers. With information at hand, they will be able to make choices about what to do. All we have to do is make it easy for them by working on analytics and condensing information, and then create the best delivery method for that information.
Based on the future trends in your industry, if you had a million dollars, what would you invest in?
Applications that enable consumers to make better health care choices, using research, or provide their own data on health care symptoms, diagnoses, experiences, and treatments, and to combine it with genomic data to find answers through research. I see the future of health care research from large pools of data contributed by patients, medical records, and clinical research.
Which principles or philosophies have guided your life? Your career?
Integrity is my number one principle and it covers everything. Integrity means keeping promises, meeting timelines, and putting needs of the clients foremost. The second is trying to be open-minded and empathetic. I am frustrated by lack of action, but if I can stand in the shoes of the client or colleague who is having trouble moving forward, it helps. So, I try to understand.
Can you share with our readers what you think are the most important “success habits” or “success mindsets”?
I start every day fresh. I always take time for news, and to follow what is happening in health care research and in advocacy groups. This is what percolates up to business ideas and solutions. I take time to exercise because it keeps my energy up, and I take time for joy with my dogs. I keep my environment filled with people who are positive, and I turn down invitations from people who tend to be too negative. I waste very little time and have a mental schedule for my work week as well as a calendar.
Some very well known VCs read this column. If you had 60 seconds to make a pitch to a VC, what would you say?
Roji Health Intelligence has strategic and thought leadership in health care, and we know that solutions can’t come from technology alone. Women will not get better health care because of population health or other technology. They will get care because they are informed enough to demand it. But at the center of that demand is data, research, and measurement of health outcomes that isn’t occurring now. Our solution is to involve women in the changes that will help them take better care of themselves, understand their risks, and talk to their providers.
How can our readers follow you on social media?
@Terry Hush on Twitter, or Theresa Hush on LinkedIn. Roji Health Intelligence also has a page on Facebook, where we post blogs that have importance to consumers.
Thank you so much for joining us. This was very inspirational.