Katie Fullam Harris Interview Transcript

The following is a transcript of my interview with Katie Fullam Harris. To find links to the audio files and more information about the interview, please click here.

These transcripts are made possible by a gift from the NNEAHE.

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Mark Bonica:	Welcome to Forge, Katie.
Katie Harris:	Thanks so much for having me. I really appreciate the opportunity to speak with you.
Mark Bonica:	You went to Columbia University as an undergrad. What did you major in?
Katie Harris:	I majored in English, English Literature.
Mark Bonica:	Did you know at that time that you wanted to work in policy?
Katie Harris:	I knew at that time that I did not want to work on Wall Street which was where a large portion of my class I went. I knew at that time that I did not want to be in the science realm which is where another large portion of my class went. I ended up thinking that writing skills would be good for me to use in any job that I moved forward with. Definitely, I almost minored in PoliSci so policy was always of great interest to me.
Mark Bonica:	One of your early jobs was working in government relations for Planned Parenthood of Northern New England as the Director of Public Affairs. Now, Planned parenthood is a political lightning rod. It gets a lot of attention.
Katie Harris:	It does.
Mark Bonica:	What does planned parenthood and, in particular, Planned Parenthood of Northern New England actually do?
Katie Harris:	Planned Parenthood of Northern New England actually provides preventive care, cancer screening, annual exams, birth control to women, particularly women who have few means in a comprehensive way. They provide accessible both from an individual perspective, as well as a geographic perspective care across the continuum of women’s health.
Mark Bonica:	What was this early job that you had? What was it like? How did it shape your future interest?
Katie Harris:	That’s a great question. The job was amazing opportunity to really learn about women’s health, to learn about health policy, and to learn about a lot of the challenges that planned parenthood and some lightning rod organizations face as it relates to policy.
	I happened to work there at a time when there was a great deal of strife occurring in the choice community there. One of the things that occurred while I was there was the Brookline shooting. I was responsible, at that point, for doing some of the communications, the external communications, working with the media. I had an amazing view into the lives of people who were impacted directly by the protesters, by the violence that was brought forth by a very few people but that impacted a lot of people. It gave me a great empathy particularly for women in rural areas who do not have access to a continuum of health care services otherwise.
	I think, actually, things have improved in terms of access to health care since those days. It t was the early ‘90s, but it was very eye opening to feel the pain that they felt as they were trying to access services and having the attention that was placed on those services they were trying to access.
Mark Bonica:	You were working both in public affairs, as well as government relations. What does that mean? What is government relations and what did you do in that role?
Katie Harris:	I served as a lobbyist. I actually promoted our policies at the Statehouse. We actually passed a bill that ensured that women had protection and access to abortion services as needed that the Choice Act, I think it was called at that point. I also worked very extensively to prevent unnecessary barriers from being passed that would have made it even more difficult for women to access health care services.
	Many of the same laws or bills that we continue to see today were promoted at that point in time, such as requiring minors to have a parent sign off before they were able to get birth control requiring which we actually have now in Maine. We got a law passed to prevent that from happening, 24-hour waiting periods before a woman could access abortion services, those kinds of things that really haven’t unfortunately disappeared; although with the Supreme Court’s recent decision, they may.
Mark Bonica:	What skills did you learn in this job?
Katie Harris:	I learned a host of skills from a technical perspective, a lot of media training, lobbying skills, how to listen. Something that’s really important to my work and my career has been having an understanding of what individuals who have differing opinions from those that I’m promoting are. I learned that in that job.
	I also learned that there is always a small segment of individuals on both sides of an issue who won’t listen and for whom you’re never going to reach consensus, but from a skills perspective, it really was having the ability to process the information and try to understand where people are coming from and why they’re coming from that place.
Mark Bonica:	You were at planned parenthood for about three years. Then, you moved to the Maine Department of Mental Health, Mental Retardation, and Substance Abuse Services as the assistant to the commissioner. In this role, you moved from a nonprofit planned parenthood to a government agency. How was that experience different for you?
Katie Harris:	It was night and day in many respects although there were definitely similarities. The role that I played at the department was similar. I had responsibility for working with oppressed at a very volatile time, and particularly, the mental health world in Maine. I also had responsibility for serving as the liaison to the legislator. I don’t think we technically call that lobbying when you work for a government agency but liaisons of the legislator and I was the liaison to the governor’s office.
	In that capacity, the department is obviously much more diverse in the issues that it has to contend within planned parenthood. I was responsible for working with our internal team or on budget issues in the legislator. Our budget had to go through both the vetting process of the governor’s office, and then get passed ultimately by the legislator.
	The skills I learned at planned parenthood were exceedingly helpful in the role at the department but the department role was definitely far more comprehensive and a whole new set of issues. Mental health, substance abuse, and developmental disabilities as what then is called mental retardation was an evolving world at that point. It still is to some degree. We wrap it all into something called behavioral health services now.
	We were downsizing our former Augustus State Mental Health Institute. We were operating under a consent decree. We closed a long standing, I’ll call it, Residence Institution where we housed people with mental retardation while I was there. The development of the community-based service system, we were under constant pressure to develop it and to try to save money at the same time. It was a wild ride and it was incredibly interesting. It also provided me with a great look at how you work under a great deal of pressure and how you build service delivery systems. A lot of the services that we created in that time continues to exist today.
Mark Bonica:	What would you say were the critical lessons you learned from that experience?
Katie Harris:	I would say that the lesson I learned from planned parenthood about listening to people got magnified by about tenfold when I went to the department and the importance of bringing teams of people together with differing perspectives to provide input into decisions that are being made and to own some of those decisions that are being made.
	When you’re dealing with a governmental agency, it might have the power to do to communities but you will not ever be successful if you don’t ensure that the communities own that which you are creating at some level or, at least, most of the community. There will certainly be times when you have NIMBY kicking in and it may be important.
Mark Bonica:	NIMBY - Not in my back yard.
Katie Harris:	Right, sorry. It may be important to push the envelope a little bit to ensure equity and equality, but it is also equally important to work collectively with the communities to ensure that you’re hearing what they have to say about whatever services that you’re developing. Listening to people who have behavioral health issues whether they’d be mental illness, or developmental disabilities, or substance use disorder, and ensuring that you’re ensuring a system that works for them is paramount to ultimate success.
Mark Bonica:	I knew, around this time, New Hampshire was going through a lot of the same kind of volatility. I think we saw some significant court cases where the state was told, “Hey, you’re not doing what you’re supposed to be doing in terms of providing the services in the community as deinstitutionalized.” Was Maine seeing that same pressure?
Katie Harris:	The consent decrees that I mentioned were exactly that.
Mark Bonica:	Okay, that’s what you’re talking about.
Katie Harris:	The court issued a consent decree, and actually ended up appointing a court master in both consent decree around mental health services and a consent decree around developmental disabilities, services for people with developmental disabilities.
	One of those Consent Decrees exists today. It’s just the state is still operating under what was known as the AMHI Consent Decree which was the consent decree for adults with mental illness. It started with adults with mental illness who were deinstitutionalized but it expanded to really be a consent decree that operates to ensure that there is enough funding and access to community supports for people with behavioral health issues, mental illness in particular.
Mark Bonica:	Fascinating. You left the department in 2000 and went to be the Director of Development for Sweetser. You stayed in the mental health field at this point.
Katie Harris:	I did, yes.
Mark Bonica:	Sweetser is Maine’s largest mental health services agency. What did you do as the Director of Development? What is that role?
Katie Harris:	Sweetser actually started as a children’s home for orphans and children who didn’t have another place to go. They operated at a pretty significant fundraising arm to ensure that the services that they provided as they transitioned over time and started serving adults. As best practice changed over time, Sweetser’s service delivery moved from strictly serving children in a residential setting to providing community-based services and providing a comprehensive array of services for children and adults who had mental illness, in particular.
	Fundraising was a pretty key component of ensuring that the children, in particular, had access to care whether it’d be treatment but also, food, and shelter, and clothes. Their fundraising supported a whole host of things for children, some for adults as well, but it was primarily for kids and making sure that kids who had challenges were able to have those challenges met, their needs met.
Mark Bonica:	Development refers to fundraising?
Katie Harris:	Correct, yes.
Mark Bonica:	That’s not something you had been doing prior to.
Katie Harris:	That is clearly not something I had done prior to that, no.
Mark Bonica:	What was that experience like shifting into that?
Katie Harris:	That was really interesting because fundraising is very methodical and formulaic a little bit. You certainly need to be innovative in the way you go about it but there are things that you do. There are processes in place which are really important to follow if you’re to be a successful fundraiser, entirely different than the chaotic world of working in the government where you never had enough resources to do anything that you wanted to accomplish.
Mark Bonica:	Right, I am familiar with that, yeah.
Katie Harris:	I have found that it helped me really learn how to do process and I also managed the team. I learned management skills there.
Mark Bonica:	Is this the first time you’ve been a supervisor?
Katie Harris:	It was the first time I was a direct supervisor. I love doing that. I love building a team and accomplishing things. I was there for a year. I wasn’t there for a long period of time but working as a manager and that teamwork was something I really enjoyed.
Mark Bonica:	As you said, you left Sweetser in 2001, and you joined the Maine Development Foundation where you were a program director.
Katie Harris:	Yes.
Mark Bonica:	What is the Maine Development Foundation? What do they do?
Katie Harris:	The Maine Development Foundation is a really interest nonprofit that was formed to provide help to the government in areas of research primarily and some training both for government officials but also for the business sector. It’s in services and intermediary that does research and allows government to intersect with the business sector primarily.
	The Maine Development Foundation had a long standing, really neat program, I’ll call it, where they developed quality indicators for the business and economic indicators for the business community and business climate to really measure how we were doing as a state in the business world, that and how our entire economy was working or not working.
	The got a Robert Wood Johnson grant working in collaboration with the governor’s office to develop a similar set of indicators for health care specifically. I was hired to run that grant. It was a fascinating opportunity because I worked in the key administration at the department and his philosophy is very team-oriented and bringing all the players to the table. He still, as senator, does this today, listening to all the perspectives and working out the solutions through that process.
	We used very similar process at the Maine Development Foundation and brought together a diverse group of leaders from across the sectors. It was not health care-heavy at all. We had a school superintendent. We had people who are chair of the board of a Brunswick Economic Development Committee. A whole host of different people. One of the co-chairs was a high-up official at Bath Iron Works but we pulled together a set of performance indicators for the health care system that were based on quality, cost, and instead of using access, we talked about having people engage in the health care system. I think engagement was the third area that we identified.
	Those indicators, we didn’t have a lot of data in those days to actually support the indicators. The project didn’t last, didn’t survive beyond the development of the initial set but a lot of the indicators that we identified are still used and some in our contracts today.
Mark Bonica:	Interesting.
Katie Harris:	Yeah, it was a very interesting project.
Mark Bonica:	Up until this point, you’d worked in three nonprofits and a government agency. In 2003, you left the Maine Development Foundation and joined Anthem Blue Cross and Blue Shield as the Director of Government Relations. This is a name?
Katie Harris:	This is a name.
Mark Bonica:	Okay, because we also have an Anthem in New Hampshire.
Katie Harris:	Yes, same Anthem.
Mark Bonica:	Yeah, but it’s the local state.
Katie Harris:	It’s the local version, yes.
Mark Bonica:	State portion of the organization. Anthem is a for-profit organization.
Katie Harris:	That, it is.
Mark Bonica:	I hear in your voice, it’s quite different than working either for a nonprofit or a government agency, I’m thinking. Can you talk about the differences?
Katie Harris:	Different in many, many aspects. I would say that the biggest difference is that you have to pay attention to Wall Street. Anything that you say that gets reported in the press can be turned into a stock price change. That is a dramatically different perspective than one has when one works at a local agency.
Mark Bonica:	Why do you care about that?
Katie Harris:	You have to care about that because you are working for an organization that is publicly traded. It is pretty important to all who … As a publicly-traded company, it relies upon Wall Street and its performance on Wall Street to provide the capital to invest in the initiatives that its seeking to use to grow. I love working at Anthem. I will say that it provided. It was very dedicated to its employees and to teamwork. We had tremendous access to resources that you don’t have in a lot of the other sectors.
	With those resources comes accountability which is really important, but it was an organization, as a Blue Cross plan, an organization that was dedicated to better serving its customers. That’s something that goes across any sector that you’re in. I think that was very important. They really made a tremendous effort to ensure that their customers were happy. We used to call it the LL Bean of customer service.
Mark Bonica:	Nice.
Katie Harris:	The Beans is so well known for its customer service. Anthem really did do a lot to ensure that its customers were provided for. When I was there, it was a period of great growth for Anthem. They merged with WellPoint which was significantly a larger company actually. It was based in California. We had a lot of change while I was there. They invested a lot in change management and trying to ensure that it didn’t impact the local states to a degree that it could have certainly.
	It’s important to understand how important jobs are to those. It’s ultimately people running those businesses and those people care about the people who work for them. Anthem was very dedicated to ensuring that its workforce was taken care of in Maine. They did everything they could to support a strong workforce here.
Mark Bonica:	Your role again was Director of Government Relations. Why does an insurance company have a Director of Government Relations?
Katie Harris:	Because in the broad scheme of things, most people view insurance companies as being the answer to fixing their woes around health care. The number of pieces of legislation that gets submitted would have a direct impact on people’s lives often times negatively without their necessarily even understanding it creates a volatile environment for insurance companies at the legislator. They rely upon government relations in a significant way to ensure that they can have a steady business climate in which to do their jobs, and to do their business, and to provide the coverage for their insurers that their insurers need.
Mark Bonica:	Can you give an example of maybe a legislation or a policy that you worked on while you were there that was important?
Katie Harris:	Yes, I certainly can. I would say probably the most important piece of policy that I worked on when I was there that was a multiyear effort was the Dirigo Health Plan which was predecessor to the Affordable Care Act. Maine has its own mini version of the Affordable Care Act, along with Massachusetts actually, and it was quite similar to Massachusetts.
	In my capacity at Anthem, I worked both at the legislature to try to shape that legislation to be such that insurers would be interested in providing it, and then worked internally at Anthem to convince them to actually attempt to provide it. They did. They actually went after the RFP and gained the RFP for the first year. We were the only insurer that was interested in partnering with the state to provide insurance to a group of individuals who needed subsidies in order to afford health insurance.
	It was a very interesting experience. I learned a lot of business philosophy through that work. I also learned quite a bit about the challenges of partnering with the state on something that the state feels quite passionately about when it’s only one of a number of initiatives that you are engaged in, and not necessarily that which is going to be most important on a priority list.
Mark Bonica:	For the company?
Katie Harris:	For the company, but it was a great learning opportunity. I think, actually, Dirigo provided the state with a lot of the infrastructure that made partnering or the Affordable Care Act as successful. The exchange is successful as it was when it got offered in the state.
Mark Bonica:	In 2008, you joined Maine Health as the Senior Director for Government and Employer Relations. Before we talk about your roles since 2008, can we talk a little bit about Maine Health for listeners who are not familiar with the organization?
Katie Harris:	Absolutely.
Mark Bonica:	What is Maine Health?
Katie Harris:	Maine Health is Maine’s largest integrated health care system. It’s eight hospitals in Maine and one New Hampshire. Memorial Hospital in New Hampshire is part of our system. We have about 950 physicians that are employed by Maine Health. We also have an Accountable Care organization that includes independent physicians. The total number of physicians is about 1400. We have three affiliate hospital systems. I call them local health care systems that are part of our organization as well.
	We have a home health agency and we have an integrated behavioral health organization. That component is actually, I’m not sure it’s unique to the country, but it’s rare in the country to have the integrated behavioral health component of a health care system that provides community-based services, crisis services, and we have an inpatient psychiatric hospital.
	Maine Health services Maine’s eleven southernmost counties, as well as one county, Carroll County in New Hampshire. We are very committed to our mission which is working together so our communities are the healthiest in America.
Mark Bonica:	How did Maine Health come about?
Katie Harris:	Maine Health was the brainchild of a couple of people here who saw the importance of collaboration amongst health care providers. We live in a world in which resources are scarce, and we have a wide geography to serve in Maine, and collaboration is really paramount to ensuring that our patients have access to the highest quality care possible.
	From that initial thought process which I think involved only one or two hospitals, small hospitals initially with Maine Health, our health system has obviously grown pretty dramatically. We’re seeing the integration of health care delivery across the country now in a pretty significant way.
Mark Bonica:	You mentioned geography.
Katie Harris:	Yes.
Mark Bonica:	Talk a little bit about geography and how geography impacts your mission?
Katie Harris:	Geography and Maine’s demographics impact our mission pretty substantially. As an organization that’s committed to the health of our communities, we serve a lot of rural areas. We have a 650-bed teaching hospital at Maine Medical Center. It’s tertiary care level one trauma center with really high quality specialists and subspecialists that people will go to from states all around. We also have critical access hospitals that are 25-bed facilities that are really integrated into their communities provide not just the health care delivery in their communities but also importantly, jobs with benefits in many of the rural communities.
	Maine is the oldest state in the nation. We also have a high level of uninsurance. We chose not to participate in the Medicaid expansion yet. We also have a high level of individuals who are on government programs whether they be Medicare or Medicaid, particularly for the elderly because we’re poor. We have challenges related to the fact that we’re a large geography. We’re old. Therefore, have a high occurrence …
Mark Bonica:	When you say old, you mean the population.
Katie Harris:	Population is old. Yes, sorry. Not Maine Health.
Mark Bonica:	Just want to be clear.
Katie Harris:	Yes, we’re an old state and we are a poor state. What that adds up to is significant challenges. We know from social determinants of health that income levels and education levels really impact people’s ability to take care of themselves, to eat well, to exercise, to live healthy lives.
	We have a strong commitment at Maine Health to providing to what some people might view as public health kinds of services but they are population-based services around things like tobacco treatment and cessation, and vaccinations, diabetes care, things we are very committed to working within our communities to provide the necessary services and supports to ensure that people can live healthier lives. Not easy in our old, poor, and rural state.
Mark Bonica:	Yeah, and those are things that are generally not well-compensated.
Katie Harris:	That is absolutely correct. When I say we are committed, we are a rare health system. That is, we actually measure ourselves. We do a whole health index report every year with a series of measures and measure ourselves and our success based on how well we achieve those kinds of very difficult measures, many of which have little, some but not a lot of impact by the medical system.
	These are not things that you go to a doctor to fix. They really involve people participating in their own health and engagement. We have, as I mentioned, things like vaccinations, campaigns around improving vaccinations, childhood vaccinations, working with the provider community and providing education and tools to them.
	We also have a unique, really neat program that provides primary care and case management support for adults who fall below, I think, it’s 250% of the poverty level who are uninsured. They have direct access to their own primary care physician and to the supports through case management to help them navigate the system. We found that that has significantly contributed to a reduction in emergency department utilization and inpatient utilization for that group of individuals. We’re committed to doing the right thing for our patients regardless of their health status, their income level, or their insurance status.
Mark Bonica:	We’ll talk some more about policies as we go along but let’s now talk a little bit about your jobs here. You came in 2008 as the Senior Director of Government and Employer Relations. Was this Government Relations similar or different to the one you had at Anthem and maybe Planned Parenthood?
Katie Harris:	Yes, it’s different. No question about it. My government relations role here, I am representing a series of members as opposed to an entity. Quite different in that regard.
Mark Bonica:	When you say members, you mean individuals or organizations?
Katie Harris:	Organizations. Maine Health as an integrated health care system is made up of these local health care systems. They are independent. They are part of us but they all have their own balance sheets, and all they represent their communities, and have their own sets of needs. We developed processes to vet and to ensure that the positions that we’re taking on pieces of legislation reflect all of our communities.
	Also around clinical issues, it was the first time I’d really jumped into the broad array of clinical issues that the legislature has to deal with, Lyme Disease, opioids being a big one this past year, vaccinations, vast array of topics that they contend with, and working with developing processes internally to make sure that we are reflecting best practice in whatever positions that we’re taking.
	I often don’t testify directly anymore. I rely upon the experts in the system to testify and work with them. That’s, again, a variation on what I used to do at Anthem or Planned Parenthood.
Mark Bonica:	Coordinating the effort now rather than doing it all yourself.
Katie Harris:	Coordinating and overseeing as opposed to necessarily doing specifically myself.
Mark Bonica:	You also have the role of employer relations. What does that mean?
Katie Harris:	It’s evolving. Employer Relations is evolving. We had been members for a long period of time with an organization called the Maine Health Management Coalition that is a collaborative effort between employers and plan sponsors purchasers of health care, the providers, and then the insurers.
	We recently decided to leave that organization. My role around employer relations was working primarily with the employers within that organization in developing opportunities around transparency, opportunities to better inform their patients and their decision making as purchasers to make sure that we were providing them with the data, and that the policies that they were promoting made sense to our providers as well so that there was a good collaborative conversation going on.
	The coalition has a pretty robust website that provides series of health care measures, and indicators, and cost quality, and access, and with an emphasis on quality. We would help to shape which indicators got put on and how they got placed on that website.
	The role as it evolves now is really working collaboratively or directly with the employers and making sure as we are looking at changing the way we get paid for health care, providing them with opportunities to work collaboratively to shape new models of payment and transparency around health care. It’s evolving, as I mentioned, but we do have some employers that were seeking to develop new types of partnerships with.
	What that ends up looking like over time, I can’t tell you today but we’re hopeful that we are going to work together to ensure that the financial incentives that we have as a provider system and that our physicians have as direct providers are aligned with the goals of improving the value of health care for individuals, and not just getting paid for producing widgets which is what we have …
Mark Bonica:	Fee for service.
Katie Harris:	A fee for service which underlies all of the system still today.
Mark Bonica:	You were promoted to Vice President of Government and Employee Relations in 2012. How did those responsibilities change when you title changed from Senior Director to Vice President?
Katie Harris:	There were a few additions to my requirements. I’m trying to remember from the various evolution.
Mark Bonica:	Let me just throw in that. Then, you were promoted in 2013 the Senior Vice President.
Katie Harris:	That’s where the big evolution took place. When I was promoted to SVP, I took on, for a period of time, a role of staffing our Accountable Care organization. I also worked in the contracting realm as we were developing what I’ll call value-based contracts with our ACO. I worked collaboratively with our Accountable Care organization. We were working with either the TPAs, third party administrators and/or insurers of which there’s a complete overlap in Maine.
	It’s the same organizations providing the TPA services and the insurance services to develop contracts that started down that path of incentivizing us to do the right thing. Sometimes those contracts would include reimbursement for care management for patients who have high levels of need. In turn, they would hold us accountable for meeting cost targets and quality targets along the way.
	I embarked upon that for a period of time and helped serve on a steering committee in which we identified a real challenge that we had in having too many organizations that were doing similar things that weren’t totally aligned. We had a PHO, a Physician Hospital Organization. We had an ACO of which there was a great deal of overlap, but they had separate governance structures. Then, we had a physician, Community Physicians of Maine which is the physician arm of the PHO which, again, had its own governance structure, and very cumbersome to try to actually process any of the work that we did.
	We brought those. We worked over a period of about a year, and developed a new governance structure, brought those together, and collapsed them into one single governance entity now called Maine Health ACO or MHACO. When that occurred, the PHO took over the function of staffing MHACO. I am still engaged in some of the contracting efforts but I’m really starting to focus more on working directly with the employers, and we have someone else who I bring the contracting questions to, and he would execute the actual contracts.
Mark Bonica:	You mentioned value-based contracts. Can you talk a little bit about what that means and what do they look like?
Katie Harris:	That’s a nice question.
Mark Bonica:	What are you trying to accomplish by this?
Katie Harris:	What they look like, we’re paid through this fee-for-service world. We’re paid per visit or per code as it might be. Then, these value-based contracts that lie in top of the fee-for-service contracts hold accountable our system, primarily primary care providers right now are the basis of it, for achieving quality targets. The number of your patients who have diabetes whose hemoglobin levels are X, Y, or Z. They will actually pay us based on our ability to achieve targets for those quality measures or there are disincentives associated with that too.
Mark Bonica:	If you missed these?
Katie Harris:	If you missed these, you will not achieve or you might actually end up … We don’t pay money back but we leave money on the table if you don’t achieve them. The same goes for cost. They will track the total cost of care spent per member per year. Assuming you’re making those quality targets, all of them have quality as the most important element, but if you’re achieving the quality and you achieve cost targets, then we may be able to, for example, share in the savings. If our target was $100 per member per month, and we come in at $90 per member per month, we can share with the plan sponsor, the employer, in that $10 per member per month savings. That’s an example.
	Another example would be we actually take financial risk. If we come in at $110 per member per month, we actually have to pay some of that. The difference between the $100 and $110 back to the plan sponsor. It’s starting to move the system and our providers to think about the total quality of care provided, and the total cost of care that’s provided to our patients, and to look at it at a higher level than the individual patient, but looking at population health.
	What does it take to ensure that all your patients with diabetes have the right test at the right time, have the tools they need to self-manage their care, and have the supports they need when they need them if they have questions or if they need help with something? We know that chronic disease is a significant part of the cost and overall health status of our population, the folks that tend to be chronic disease around the quality and cost targets initially.
Mark Bonica:	You had said earlier that Maine Health has historically made investments in public health claims of areas like diabetes management. Now, this value-based contracts will actually provide you some reward for the work that you’re trying to do.
Katie Harris:	Well said, absolutely. We actually had, at our PHO care management, a whole care management structure long before it became Dirigo and we …
Mark Bonica:	We’re the cool kids before.
Katie Harris:	We were the cool kids, and we were providing our physicians’ offices with access to nurse care managers who would work with patients who had high levels of need. That has become a more ubiquitous across our system now, but that was something that we’ve had in place for a long period of time. As a result of that and a lot of initiatives, when you look at national data, we have very low spending per member per month or per member per year. The cost of delivering care in this region is low compared to other parts of the country.
Mark Bonica:	Maine Health publishes its strategic plan online. I had a chance to skim through that a little bit. One of the things that I saw was a reference to the idea that you are participating in an accountable care movement. What does that phrase mean?
Katie Harris:	I think it really is that value-based purchasing concept that we just talked about, but it’s incorporating the Institute for Health care Improvement’s Triple Aim. They came out with the Triple Aim quite a few years ago.
Mark Bonica:	I was going to ask you, what does that mean? What is that?
Katie Harris:	It’s always shown with the triangle. One side of the triangle is patient experience, how the individual patient experiences the system. Another side of the triangle is population, health, and quality. From a broad perspective, what is the quality of care provided to a population that you’re serving? The third side of the triangle is cost, how are you doing this and maintaining the lowest cost possible.
	In a fee-for-service world, providers are incentivized to provide as much care as they possibly can, as much expensive care as they possibly can because they make more money doing that. What we’re trying to move towards in an accountable care model is changing that paradigm so that we are incentivized to provide the right care at the right place at the right time. Our patients have the access to the best quality, highest value care that is possible. That requires changes in the way we deliver care, and it requires changes in the way that we’re paid for that care, and that’s really what we’re talking about. That’s a shift that’s occurring across the country.
Mark Bonica:	How has the passage of the Accountable Care Act affected Maine Health?
Katie Harris:	I love that you called it the Accountable Care Act. It’s the Affordable Care Act.
Mark Bonica:	Sorry, the Affordable Care Act.
Katie Harris:	No, no. That I called it the Accountable Care Act for ages.
Mark Bonica:	At least don’t call it Obama Care.
Katie Harris:	I don’t even mind that, I think he did a good job at embracing it. How has it changed? We were headed down this path, but they have ratcheted it up, the level of activity that’s occurring. I’d say there’s so many pieces of the Affordable Care Act, it’s hard to identify one, but a broad level, the Affordable Care Act has provided access through the exchanges to individuals who are struggling to afford health care.
	We have not seen the full value of that because Maine chose not to participate, and, at least thus, far has chosen not to participate in Medicaid expansion, and that has left a significant number of patients without access to affordable care. Because we’re low income, there are a lot of people, particularly people with pretty high levels of health care needs, who can’t access health insurance. They fall below 100% of the poverty level, and no one would suggest they could afford it on their own, and they do not have access through Medicaid.
Mark Bonica:	Even though they could potentially qualify for subsidies …
Katie Harris:	They can’t qualify for subsidies.
Mark Bonica:	They can’t?
Katie Harris:	No. The exchange is limited to people between the 100% of the poverty level and 400% of the poverty level.
Mark Bonica:	It’s below the 100%.
Katie Harris:	Interesting.
Mark Bonica:	They’re caught in a window.
Katie Harris:	They’re caught in a window. Maine had actually expanded access through a waiver back in the Dirigo days prior to, I think it was in 2002-2003. Actually, we were the only state that not only did an expanded Medicaid but we actually moved backwards and we reduced eligibility for Medicaid in the state. We actually had people who lost coverage when the exchanges took effect.
Mark Bonica:	Interesting.
Katie Harris:	Yeah. It’s very unfortunate. They are most vulnerable. We have seen another group of patients who are accessing health insurance through the subsidized exchange who otherwise would not have access. That’s terrific. It’s great to see that group. They fall between the 100% and 400% of the poverty level.
	Very importantly, a piece of the Affordable Care Act that people don’t know a lot about unless you are in this health care world is the centers for Medicare and Medicaid services created something called the Center for Medicare and Medicaid Innovation which was part of the Affordable Care Act. That organization has done a lot around developing models of care pilots, if you will, that they have spread throughout the country, and different organizations have applied for and been part of some of these pilots to test different models of whether it would be payment reform or delivery system reform. A lot of it, primarily payment reform.
	We are a part of the Medicare Shared Savings Program which is a test pilot that is for a Medicare population that is starting to hold us accountable and tracking the cost and quality. It’s a shared savings program which I described earlier. If we are able to meet a benchmark or exceed a benchmark in terms of the cost of care and the quality of services delivered to our Medicare population, then we can share in the savings.
	The first performance here, we were incredibly successful. I think we were the fourth or fifth most successful in the country. The second year, we came within the benchmark. We didn’t actually meet or exceed the benchmark to share on savings but there’s a window, and we were within that window, and we currently haven’t received the results from our third performance here yet.
	That process, that’s the most conservative actually of the different pilots that they have out there, and there are a number of others that are really pushing the envelope to encourage health systems to just start to take what we call a downside risk, financial risk for the care of populations they’re serving.
Mark Bonica:	These is like the example you gave before with the $100 …
Katie Harris:	You pay back.
Mark Bonica:	… per member per month and you …
Katie Harris:	Yeah, exactly. There are far fewer health systems participating in those models, but it’s great to see how it’s working. Actually, Eastern Maine Health care Systems in Maine is one of those organizations that is participating.
	At the same time, the Affordable Care Act is absolutely requiring that all, first, hospitals, and now physicians start to pay attention to quality and to the value of care delivered. They have developed mandatory programs for hospitals that require hospitals to report on quality and cost measures. They get paid based on how they do on those measures, things like hospital-acquired conditions. It’s a big piece. Infections, they track the number of infections, and you actually don’t get paid. Your reimbursement rate is changed based on how you do one of those measures.
	They are just in the process of implementing similar programs for physicians. All physicians, mandatory program, will participate in a program in which they are reimbursed at some level based on the quality of care that they deliver.
Mark Bonica:	Is this part of MACRA?
Katie Harris:	MACRA, exactly.
Mark Bonica:	This is the Medicare Access and Chip Reauthorization Act.
Katie Harris:	Right. It’s a big deal.
Mark Bonica:	What is a day in the life of Katie Fullam Harris like?
Katie Harris:	Never a dull moment. I rarely do the same thing twice in a course of a week which is what I love about it. During the legislative session, I might be in Augusta one day. I might have meetings with employers another day. I might be developing a presentation third day. Third and fourth often takes me a while. I might spend the fifth day working on our opioid strategy to develop a standardized approach to addressing the opioid use crisis across our system.
	In a half an inch deep and a mile wide and a lot of the work that I do, but I get very engaged. I was always a learn-for-the-test kind of person. Whatever the issues at the moment are, I dive right in. If you ask me five years down the road what the specifics were, I’ll probably never be able to tell you about that.
Mark Bonica:	How much do you work with the affiliate organizations when you ‘re doing something like an opioid crisis plan, for example?
Katie Harris:	That’s a great question. From a strategic perspective, we bring our affiliates in around all of the community health improvement activities that we are engaged in. They’re not brought in. they’re not part of our contracting or financial discussions, but community health improvement includes our affiliates or they’re, at least, invited. This opioid work that we’re doing, work group across our entire system, clinicians from our affiliates, as well as each of our local health care systems have come together to develop a plan to address education, prescribing, and treatment for opioid use disorder in a standardized way across our system.
	If we have a dearth of providers right now. We have a crisis. We had 272 deaths in 2015 in the State of Maine. That’s unacceptable. It’s public health crisis. It’s the first public health crisis that the health care system very inadvertently has played a role in creating through prescribing practices. This is an opportunity to rectify that and to better serve our patients.
Mark Bonica:	When do you interact with, let’s say somebody like Patsy Aprile who’s the Chief Operating Officer of one of your larger facilities? Tell me, when does she call you up on the phone and say, “I need to talk to you about X.”
Katie Harris:	Whenever they’re having a struggle dealing with the regulatory world. Whether it’d be in Augusta or Washington, I often get brought into those conversations or if a legislator calls them and has questions about something, I’ll get brought in. I work very closely with the communities around the employer community, and how we’re best meeting their needs. Occasionally, on something like this when I’m working on a project that’s a one-off project, we will interact very closely with the local communities.
Mark Bonica:	Do they retain? I know at Southern Maine has it’s on board still. Is there a Katie Fullam Harris down at Southern Maine?
Katie Harris:	They don’t. No. We …
Mark Bonica:	They rely on you for that service. They rely on Maine Health for that service.
Katie Harris:	I have a colleague who helps support me in Augusta. They do rely on Maine Health as one of the shared services. It’s one of the benefits they get being members of our organization. They all have local people who work within their community. They might have, and I strongly encourage them to have, relationships with their local legislative delegations, but from a strategic perspective the strategy comes in collaboration with them but through the process that we have with all of our organization. Then, we provide the service.
	Another benefit would be where we’ve developed integrated human resources and we’re developing integrate billing office. The most important integrated function that we have created that is key to being a system is what we’re calling the Share Program which is an electronic health record system that will be adopted by all of our members by, I think now it’s 2019, that will allow a patient to access service from any point in our system. That electronic health record would be available to other providers within the system who are caring for that patient to ensure that they have continuity of care and the full picture of what’s going on. That system will also be able to provide us the policy level with data to understand how our system is working.
	Thus far, it’s been pretty siloed and very difficult to get data related to quality or cost at the individual provider level or practice level. This will allow us to just start to look at where the outliers are, and to start to better manage care, and better manage the utilization. We’re finding a lot of people just they don’t even know what their practice necessarily is. It’s a great opportunity to work collaboratively with our physicians and move the system to a new place.
Mark Bonica:	What are common mistakes you see the senior leaders make in the realm of government relations when you get called in to clean up something or work on it?
Katie Harris:	Yeah.
Mark Bonica:	Frequent areas or is everything different?
Katie Harris:	I wouldn’t say frequent but I would say forgetting to bring government relations to the table early enough to help develop whatever strategy you are working on or particularly when you’re reacting to something, government relations can provide an important perspective that can prevent worse things from happening down the road such as legislation being submitted, so much legislations based on anecdote. It’s really important to bring leaders to understand what bad things have happened or, at least, perceived bad things have happened so that you start to work on those before they get to the legislative level.
	I see in government relations, people don’t listen enough and don’t necessarily know when it’s time to just say, “I understand. I respect that,” and will agree to differ here, and walk away because burning bridges when you’re in government relations is the worst thing you can do. You may be mortal enemies with someone on a piece of legislation today, and need their vote on something that they support you on tomorrow. It’s important not to burn those bridges and not to take things personally.
Mark Bonica:	Do you have a team now that you manage?
Katie Harris:	I have eight persons.
Mark Bonica:	Eight person, okay.
Katie Harris:	That’s my team. Yeah, he’s great. He’s great, but yes.
Mark Bonica:	As the Senior Vice President for Government Relations and Accountable Care Strategy, what keeps you up at night? What are you lying in bed staring get to see what you’re thinking about?
Katie Harris:	How we are going to continue to meet our mission of providing access to a full array of services regardless of ability to pay in a world of shrinking resources. I really worry about that we are ratcheting back the resources available. This is primarily the federal levels through CMS at a rate that’s going to make it very difficult for us as hospital-based health care systems to continue to provide access to primary care and substance abuse treatment and the whole array of services that we’ve been subsidizing for a very long time for the uninsured and underinsured and that’s what keeps me up at night.
Mark Bonica:	Let’s transition a little bit and talk about leadership. I realize you have a large team that you’re overseeing but really, what I’m hearing you saying really is that your leadership is more about influence and relationships.
Katie Harris:	Absolutely, yeah.
Mark Bonica:	What would you say is your leadership philosophy?
Katie Harris:	My philosophy is to bring together diverse sets of opinions on whatever topic you’re working on to identify where people are coming from and why, and to develop a position and a strategy based on their opinions. I am really relying upon hearing the perspectives of others and a broad array of perspectives to develop my own opinions about things and to understand what the implications for any given policy change may be on our organization and on our patients.
Mark Bonica:	What would you say are the characteristics and behaviors of a good leader and how do you aspire to those yourself?
Katie Harris:	I think a good leader really can have the vision and recognize that different people may share in that vision, but be able to hear how people’s perspectives can feed into that vision even if they don’t immediately appear to do so, and how you can ensure that you’re bringing all those perspectives to bare in implementing the vision.
	I think developing culture is incredibly important. Ensuring that people feel safe but that there are appropriate boundaries as well. Culture, something that Anthem actually did a terrific job at creating a strong culture in which employees, I think, felt pretty supported. They may not always have the end result they were necessarily looking for but ensuring that people feel heard and indeed hearing them is pretty critical.
Mark Bonica:	I was going to ask you about culture. Do you think the important aspects of organizational culture are being heard, feeling safe?
Katie Harris:	Being heard, feeling safe, and having the ability to operate at the top of your skill set.
Mark Bonica:	You said Anthem was particularly good at that.
Katie Harris:	They were particularly at the first two. Yeah. No, I’d say all three. Anthem has a great promotion. It’s a huge organization. They have the ability to promote people which is really tough in an organization the size of Maine Health, for example. We’re small. We’re under 200 employees. We have a very high functioning group of people. It’s often hard to provide them with the opportunities that they are seeking to move with any organization.
Mark Bonica:	Did you have a mentor or mentors early in your career?
Katie Harris:	My career, I’ve had mentors all along the way. I would say one of my earliest and most influential mentors was a woman I trained with. I was an equestrian. She actually ended up getting a bronze in the Olympics, phenomenal woman in Vermont, Kara LaVelle. She taught me so much about strength, about women being strong, about the importance of education. She was an MIT grad among other things. Also humility, very important.
	At every step of my career, I’ve had different people who have mentored me. It’s hard to call others out but I have been incredibly fortunate, and feel certainly for my learning style that that has been very influential in my career. Governor King’s office was full of mentors, people I still rely on today. That was an incredible group of mentors.
Mark Bonica:	What does a good mentor do?
Katie Harris:	A good mentor encourages you at the right times, holds the reins, or discourages you at the right times, and provides you with the self-confidence to pursue avenues that you might not otherwise pursue. Also teaches skill sets as well, but from a broader perspective. I think those are helping to shape the way that you think, the way that you process information or intake information. Recognize, certainly in my case, has provided me with a real understanding of different types of learning styles, and the importance of trying to ensure that whatever learning styles someone may have you’re able to connect with, and that the information you’re providing connects to that.
Mark Bonica:	How do you find this? It sounds like you’ve had a lot of people who’ve taught you and …
Katie Harris:	I have been very fortunate.
Mark Bonica:	That’s fabulous. How did you find them?
Katie Harris:	I think they often found me. I think it was just I didn’t go seek people with the exception of Carol. I wanted to ride with one of the top writers in the country and I went and found her. The other cases, I’ve just been fortunate to work with people at different points of time.
	Erin Hoeflinger at Anthem Blue Cross and Blue Shield, she was the President of the plan. She was a terrific mentor, a year or two older than I am, but she had already done so much in her career, and she had the self-confidence to feel comfortable building up everyone else. She saw that it’s her mission to ensure that people moved and were able to attain the skills to work the highest capacity they could work.
	I think that’s something I see as often missing from leaders. They don’t necessarily have the time or the self-confidence to build people or the patients to hear what other may be saying, and help them say it in a way that resonates with others. Erin had it. She was everybody who worked with her. Her team still stays in very close contact with one another.
Mark Bonica:	Wow. That’s good to hear.
Katie Harris:	It saying something.
Mark Bonica:	That’s been a number of years since you’ve work.
Katie Harris:	It’s been a number of years and people in different parts of the universe.
Mark Bonica:	Do you mentor people now do you think?
Katie Harris:	I try. I try.
Mark Bonica:	Formally? Informally?
Katie Harris:	Yeah, I try. We actually have a great formal mentoring program that I participate in here that started last year which is been really fun. I was so excited because my first mentee went to nursing school this year. She’s a Bowdoin grad. She and I work throughout the year to figure out what clear path she really wanted to head down. She is now in nursing school and loving it.
Mark Bonica:	Great.
Katie Harris:	It’s really fun.
Mark Bonica:	Good.
Katie Harris:	I do. I try to serve in formal and often in an informal way and help people think through. I think for young women in particular, it’s really important for them to bond with people who can help them navigate and understand some of the challenges that still exist in the workplace for women.
Mark Bonica:	Institutional sexism stuff or are you talking about what?
Katie Harris:	It can be. I wouldn’t necessarily say institutional but I would say comments that can be made. The way that women process information is often different than the way that men do. Making sure they understand how to be effective in an environment that’s often still ran by men and those kinds of things.
Mark Bonica:	How is it you find somebody and say, “I would have help that person out,” or do they come to you and say, “Would you be my mentor?”
Katie Harris:	Sometimes, they do. Sometimes, we just build up relationships. I don’t necessarily go seek people out but if they seek me out, I’m always willing and happy to do what I can.
Mark Bonica:	What do you see early careers go wrong most in your career? Where do they make mistakes? Is there a trend? Is there something with the …
Katie Harris:	It’s interesting you ask that because there are definitely are trends. When you say, “Go wrong,” I’m not sure that we, the older generation, should be assuming that we’re right. There is definitely a trend around the generation they’re calling the millennial generation. They often want to have a strong work-life balance. They’re not necessarily interested in working 70 hours a week and weekends on beautiful July days. I’m not sure that’s wrong. I do see their being over-confident sometimes among young people that doesn’t serve them well.
Mark Bonica:	It hasn’t been earned yet?
Katie Harris:	It hasn’t been earned yet, but I think it’s important for the rest of us too to be a little more flexible in what it means to earn. I think about the hellish hours that residents used to have to go through in med school, and how dangerous that was, and I think that was earning their stripes. Really important for us to learn from new generations. They’re innovating in ways that older generations can’t fathom but they are the future. I think we just need to be cautious and making sure that we’re paying attention to what they’re telling us. The single thing that is cross-generational where people go wrong is not writing thank you notes after they’ve been interviewed.
Mark Bonica:	All right. Let me write that down.
Katie Harris:	Teaching your business school students, I have not hired people because I didn’t get a thank you note from them. When you’re particularly in a world around relationships, and the development of relationships, that is critical element of developing relationships. That’s very old school.
Mark Bonica:	That’s old school.
Katie Harris:	Yes.
Mark Bonica:	Written versus email or what is it? Does it matter?
Katie Harris:	I’m still written versus email, but email would be just fine if somebody wanted to take the time to do that. Yes. No Snapchats.
Mark Bonica:	No Snapchats. No twits.
Katie Harris:	No twits.
Mark Bonica:	What counsel do you give early careers most? Someone comes in, and you see them, and you think, “This person is pretty good,” and I say, “I want you to mentor me,” what’s the first thing you’re going to tell me?
Katie Harris:	What is it that you really want in life? What keeps you up at night with excitement? Let’s develop a career path around that because life is too long and you really do should follow that which really gets your motor running.
Mark Bonica:	You try to work with them a little bit to figure that out like your now nursing student example.
Katie Harris:	Yeah, absolutely. If that’s what they’re looking for. If somebody is really early, often times they’ll be looking, “Do I go to law school? Do I go to business school?” Let’s not think about that. That’s deciding what major you want. Here in Liberal Arts, I don’t think it makes a whole lot of difference unless you already know what career path you want. Just take the time to figure out what excites you. Then, figure out a career that’s going to support that.
Mark Bonica:	What book has most influenced your professional thinking whether that’s about health care delivery, policy, or anything else.
Katie Harris:	Gawande. I would say a book but all of Gawande’s work.
Mark Bonica:	Okay. Atul Gawande.
Katie Harris:	Atul Gawande, whatever it may be that he’s written. He is extraordinary.
Mark Bonica:	Yeah. Not just for mixed. What is he? He’s a surgeon and he writes the Mediocre.
Katie Harris:	He’s 35. Yeah exactly. We brought him to me. He spoke to our cooperators four years ago maybe. Absolutely extraordinary. Extraordinary man. Communicator. He’s is the great communicator.
Mark Bonica:	Yeah, yeah. I’ve been recommending his work to my students as well. In conclusion, where do you see the opportunity is? If you’re not going to go into delivering but you want to work in administration.
Katie Harris:	I think policy. In health care administration, terrific opportunities there. Particularly, there’s a shifting demographic right now certainly within our system. A lot of our senior leaders are approaching retirement age. Running a hospital¸ running a practice, you actually can incorporate the policy side with the actual direct patient care side which is really exciting. There’s a great opportunity to develop innovative models. We’ve seen that throughout our system a little bit and definitely at a national level.
	I think there are great opportunities. Health care has excitement around the innovation and cures for cancer. There’s so much that is going into improving people’s lives and improving health. There’s so much more consciousness around that these days that those would be the areas that might be a terrific focus for someone who’s interested in the world of health care and health policy.
Mark Bonica:	Excellent. Thank you so much for your time today. I appreciate it.
Katie Harris:	Thank you, Mark. It was really nice talking to you.