Ep 12: Fitting the Pieces Together

Carolyn Magill  0:02   

I learned early on that by using my voice and having an opinion, I was more likely to create an outcome that I wanted. There are discoveries that you make along the way about the context in which, maybe, you can become a leader. And those are serendipitous, more than anything else.

 

Lan Nguyen  0:20  

That was Carolyn Magill, CEO of Aetion, a technology platform that turns real-world data into the regulatory-grade evidence for healthcare decision making. 

 

Carolyn Magill  0:31  

I went from payer to provider to data and technology. It was all curiosity and recognizing, “Okay, so now I understand this piece, but I don’t understand that piece. I’d better go try to figure out that piece.

 

Lan Nguyen  0:41  

In this conversation, hosted by Lynne Chou O’Keefe, Founder and Managing Partner of Define Ventures, we learn how Carolyn’s accidental foray into healthcare, but intentional path to leadership, has shaped her wide-lens view of the industry. So let’s jump into Her Story, a program where we explore the intersection of women, leadership, and healthcare.

 

Lynne Chou O’Keefe  1:07  

Well, thank you for joining us at Her Story. I’m Lynne Chou O’Keefe, founder and managing partner of Defined Ventures. I’m incredibly honored to have Carolyn Magill join us. Carolyn has a long career in healthcare and leadership positions, spanning the United Health Group, to Evolent, to Remedy Partners, to Aetion as their CEO. Carolyn, thank you so much for joining us on Her Story today. We always like to start from the beginning, which is, as you grew up, and as you started, in your leadership roles, did you have certain influences or experiences that really guided you, or support systems, in that journey in the early years, of your, even if it’s childhood or early in your career?

 

Carolyn Magill  1:56  

Well, thank you, Lynne, I’m really happy to be having this conversation with you today. Yeah, absolutely. I have influences from my very early days, and I think that they do continue to have an impact on me to this day as I become more aware of my career evolves, more things start to click together. So my dad is an entrepreneur. He grew up on a dairy farm in my hometown, and then founded a heavy metal fabrication job shop. So this means that they fabricate steel, and make bases for large machinery, and casings for incinerators, that kind of thing, all kinds of different things made out of steel. And I would say from my very early days, you know, just wandering around the shop floor, wondering what the machinery was, and even just understanding the different roles and responsibilities of people on his team, it incited a curiosity in me to understand how businesses work. And it also helped me appreciate what it means to have tangible progress. So, to do something and to be able to point to it afterward, “I built that wood stove,” or, “I operated this machine and punched some holes in the piece of steel, as an example, and it fits into this incinerator, fits into this other broader machine.” And so, just understanding how things kind of fit together got me very curious. And I think that has helped me in my career.

 

Lynne Chou O’Keefe  3:27  

I’m imagining you as this little girl around this machinery with like a hard hat, and maybe that’s apropos of like healthcare, right. All the redefinition and the hard work and to your point, being able to see tangible progress, I think that’s absolutely been a part of your career. So how did you go from that upbringing with your father and seeing that kind of more industrial environment? How did you find healthcare?

 

Carolyn Magill  3:53  

So it’s an interesting path. And you just said this thing about me wandering through the shop floor, you’re reminding me of an experience I had. I think I was in maybe the fifth or sixth grade, and I was wearing a white shirt and these cute little culottes – remember culottes? 

 

Lynne Chou O’Keefe 4:09

Oh, yeah, of course. 

 

Carolyn Magill 4:11

And for whatever reason, I stopped at, down to the shop, and my dad was standing there talking to someone. And of course, this is a shop floor. So you’re covered in steel shavings, or whatever it might have been, and my dad introduces me to this guy, and this guy extends his hand. And as I go to shake his hand, I just started thinking about my white shirt. And I just looked at my hand for half a second, I swear, and then I shake the guy’s hand. And that’s it. It was like a two-minute interaction. And that’s it, I kind of run on my way. And then later, my dad was like, “Carolyn, if you’re going to shake the man’s hand, you shake it.” There are all kinds of examples like that with hanging out and just observing things and being called on behaviors as an example, that has helped me appreciate what it means to connect with people and the impact that you have in the way you carry yourself, and I’m sure, sure I was, I just looked at my hand for half a second, but he knew what I was thinking. And that, that hesitation and what did that mean to the guy whose hand I was shaking and maybe undermine the handshake. So without belaboring that too much, it’s the kind of thing that I think does stick with you over time. And as you have different contexts throughout your life, you revisit moments like that and think about what they actually mean. And for me, the path into healthcare is related to those early beginnings, because I have this appreciation for being able to point to things that you create, and recognize how to measure progress as an example. 

 

And then my personal interests were more in foreign policy. And I’d written my thesis on terrorism as an example, in college, and I won this research fellowship. I moved to DC, and I’m thinking I’m going to get my Ph.D. in international relations, and I spent every day doing research, sitting behind a desktop. And I was doing research on nuclear weapons accidents, and nobody really cared. Except during my fellowship, India and Pakistan happened to test weapons, so for two weeks, we were super relevant running around town, etc. And in that experience, I realized I need to do something that matters to people and that feels tangible. And I think that research in the late 90s, people weren’t experiencing nuclear weapons every day in their lives as an example. And so I just thought, “No, this isn’t quite right. I don’t know what it is.” I got into management consulting and got on some healthcare projects by accident. But when I did, I realized the impact that you have is tangible, because every single person you know has a personal experience with healthcare. And then the results matter. And there’s an urgency around the kind of ways that you can make somebody’s life better depending on how you support them, how they access care, or how you measure outcomes.

 

Lynne Chou O’Keefe  6:55  

It’s interesting, because you almost say like, in the beginning, in some ways your foray into healthcare and healthcare leadership was accidental. But it sounds, actually, also very intentional in terms of the impact, and, if you will, in the sector. So how do you see your leadership? Is it more as an accidental or intentional leader?

 

Carolyn Magill  7:17  

I think leadership manifests in all kinds of different ways, and I would say that I’m likely more of an intentional than an accidental leader. Jesus also probably has roots in my early beginnings. So I’m one of four kids born in five years, and I’m the oldest girl. So to pave my way in this family, I likely learned early on that by using my voice and having an opinion, I was more likely to create an outcome that I wanted. So I’m sure that that helps become more deliberate in pursuing leadership. And then I think there are discoveries that you make along the way about the context in which, maybe you can become a leader. And those are serendipitous more than anything else. 

 

And so there are moments like when I was in the second grade, it was the end of the school year, I had this teacher, Mrs. [inaudible], who actually went to high school with my dad in my hometown, and just really loved her. And so we’re nearing the end of the year. And she says, “Oh, we’re switching classrooms, moving my classroom to next year. So I need students to help me move bookcases and desks and such from this room to the room that I’m going to for next year.” So she called a few of my classmates to help her. And they were all boys. And I was like, “I’m stronger than them – faster than them, too. Why isn’t she asking for more help from the girls in the room?” So I stayed in from recess. And I wrote her a note, and I said, “Girls are just as strong as boys. Why can’t we help you?” And I remember being nervous. I remember leaving it on her desk. She wasn’t in there. I left it on her desk, and then we came back from after recess. And Mrs. [inaudible] stands at the front of the class, and she says, “Class, I have an apology to make.” And she apologizes for not choosing girls to help her move the furniture. And she’s like, “Carolyn, won’t you choose a couple of girls to help you and you can take that bookcase.” And it’s moments like that – she could have ignored my letter, she could have laughed at it. She could have said, well, all the work is done. So sorry, I’ll keep that in mind for next time. She certainly didn’t have to apologize. She certainly didn’t have to call it out in front of the whole class. But the fact that she did, and then she changed her course of action, that’s an empowering leadership moment. And I wasn’t aspiring to be a leader. I was mad. And I have this terrible FOMO that has also stayed with me for my whole life. And you know, like, “Hey, I’m missing out on that experience, what the heck.” But I think that those are the kinds of things that help you – you experience something like that. And you think, “Oh if I speak up, I’m rewarded.” Yes, it becomes less accidental over time because you start realizing, well, I want to affect this change, or I want this outcome, and if I don’t talk about it, or I don’t try to do something differently, then it may never happen.

 

Lynne Chou O’Keefe  10:09  

Yeah, it’s akin to, I mean, seeing your activism and then seeing the change from it. I think a lot of us also talk about, like, taking your seat at the table, if you will, and you have absolutely done that through your career. So walk us through from United Healthcare to Evolent, to becoming the CEO of Remedy as well as Aetion, a very hot startup in the space. Talk us through how that activism translated as you progress through your healthcare career. 

 

Carolyn Magill  10:44  

Well, to be fair, there was a lot of listening and learning along the way. Trial and error, as it happens. When I went back to business school, I had been a consultant previously, and I was consulting at Amgen, and so I knew I wanted healthcare, it’s tangible, great, probably I’ll pursue a career in the pharma industry. I go back to business school, my very first class with Professor Lawton Burns, and he gives an overlay of the healthcare system. And it’s just like this light bulb goes off for me that if I want to affect change in healthcare, I have to understand how we pay for care. And so that set me off on this path to investigate health insurance companies, and among them at the time, this was in the early 2000s, United Health Group was the best performing. And I thought, “Well, if I go there, and I decide healthcare is not for me, at least I will have learned from an organization that has had tremendous growth. And that experience will be rewarding no matter what.” And then because of my interest in public policy, I went into Medicare and thinking that that was the way to blend some of those interests. And I would say this question of accidental versus intentional so interesting. I think what happened in my time at United, first of all, it was a culture where they absolutely rewarded people taking initiative. And they also gave you chances. And that was pretty remarkable, so when I look over my eight years there every 18 to 24 months, there was something that I really wanted to experience, and lo and behold, they were like, “Yeah, sure.” So that was integrating acquired entities, we acquired PacifiCare, while I was there, what a tremendous learning experience that was – PacifiCare’s culture and organization, relative to United’s, and then had an opportunity to launch an operationalized special needs plans. It was a continuation of a program that United had already started at Evercare – an institutional demonstration project. And it was this opportunity to grow and build and work with government regulators. And it was so exciting. 

 

And then over time, as I developed more experience, and had great big P&L in that role, I started to realize, “Geez, I’m in Minnesota. And there’s a lot of chefs in my kitchen,” even though I quote-unquote, own the P&L. I’m not necessarily the influencer, the real decision-maker for some of these things. I had a relatively small team, and much of what I had to do was influencing my call center influencing my network leads, who didn’t report to me. And so I had the opportunity to go out into a health plan. And in doing that, so this was for United Health Group, leading the turnaround of a Medicaid health plan, I didn’t know Medicaid at the time and just found an amazing opportunity to learn from people who had been in Medicaid their whole lives. And in this process, I got closer to physicians and to patients. And I started to get perspective of how hard it is to affect change sometimes when you’re part of the health insurance company. And so when I got the call from Evolent, and Trevor Price, from Oxeon, who recruited me in there, started talking about Evolent, wanting to help health systems take on risk, I thought, “Oh my gosh, now I can see the provider point of view.” So it felt like a natural way to fill that gap of seeing perspective from who was sitting across the table. And then the thing about what we were trying to do at Evolent is that it was large-scale, multi-year, multi-faceted change. It is difficult sometimes to feel the same level of tangibility that you have now come to appreciate has defined a lot of my motivations in life when it’s multi-year commitments if you will. 

 

And I had an opportunity to become the CEO, as you talked about with Remedy Partners. And this was bundled payments. So this is looking at the world in 90-day increments of time and I thought, “Hey, that’s tangible.” As I got into remedy, I realized, “Geez, we’re managing bundled payments for Care Improvement Program, Medicare for fee-for-service program, bundles in that context excluded medications. So when I got the call from Trevor again, he said, “Hey, I know you and I know you’re really going to be excited about this new company in my portfolio.” and when he shared with me that Aetion was focused on causal inference and understanding the impact that medications have, as an example, or clinical interventions have on specific patient populations, using a platform to do this analysis so that it was replicable and scalable, and then most importantly, transparent. I thought, “Okay, now I’m filling another piece in the puzzle payer-provider, now, pharma.” And I really have to understand how pharma works, how we pay for drugs, why we pay what we do, how do we measure whether they work, and being at Aetion, especially over the last three and a half years has helped me to gain that insight.

 

Lynne Chou O’Keefe  15:43  

Such an amazing career and how you, like, to your point, intentionally have wanted to progress, if you will, your exposure and your leadership in so many parts of healthcare. If you were to kind of reflect back to are there certain aspects or edge or differentiation, that you drove to kind of be in these leadership positions, with each progressive stage, ultimately being, if you will, the CEO, what advice would you give like your younger self and a sense of how you created this edge differentiation to these leadership positions?

 

Carolyn Magill  16:22  

I would say I was always very curious. Someone once said to me, one of my mentors, he said, “Carolyn, you’ve never met a problem you didn’t love.” Like, oh, that might be true. So always very curious. And I think that’s how even what I’ve just described to you, how I went from payer to provider to data and technology, it was all curiosity and recognizing, “Okay, so now I understand this piece, but I don’t understand that piece. Yeah, I better go try to figure out that piece.” And that’s really what has propelled my career, and then I would also say that understanding how my role contributed to the broader organization, or the broader challenge, so “Okay, I’m solving this piece, but that’s not the be-all and end-all of what we’re trying to achieve. It’s just a part of what we’re trying to accomplish. So what’s happening over there, or how do these pieces fit together?” And I think that too, has helped because it means that over time, I’m still doing the very same thing today, as I did 20 years ago, or even in the second grade with Mrs. [inaudible]. It’s just that the scope of the problems and their complexity has grown over time. And the other piece, of course, is that your actions become more visible, more people are weighing in on whether you’re taking the right actions. And that adds a dynamic that I didn’t have to experience earlier in my career.

 

Lynne Chou O’Keefe  17:42  

Let’s talk about, I mean, you’ve even gone from a large company, United Healthcare, now to CEO of your own startup, which also is fast growing. How has your leadership role, even at Aetion changed after each successive funding and milestone you’ve hit?

 

Carolyn Magill  18:02  

It’s a really interesting thing to reflect on, Lynne, because it is also relevant to where we are today, and where the company will progress over the next 18 to 24 months, three years, five years, and beyond. And it’s humbling to consider how what’s been asked of me as a leader has evolved over the past three years, and then how it will continue to evolve, and anticipating how it will continue to evolve, and in trying to stay ahead of that curve. It’s another new challenge and something that’s very exciting. 

 

When I first joined Aetion, the first order of business was to listen and to learn. So I mentioned I had done some pharma work as a consultant at Amgen in the late 90s, but it was as a consultant, and it was quite limited. I didn’t really understand the pharma industry. And I didn’t understand how we decided how much to pay for drugs, as an example. And there were a lot of things I needed to learn about pharmacoepidemiology, and how our platform worked, and why it was differentiated – what is causal inference? And those are the kinds of things that I didn’t come in with an understanding of but I certainly understood why they were important relative to the context of the broader healthcare system. And then there were other things that I needed to learn about the organization itself, “What’s happening in science? What’s happening in technology? What’s happening with our customers? Do they like what we do? How can we improve it?” So the early part of my leadership style needed to be listening and learning and paying attention, understanding the business and the immediate opportunities. And then as we took on our Series B funding as an example, which NEA led, then that gave us an opportunity to say, “Okay, we’re on to something here. Now, I really need to be thoughtful about our vision – what’s our North Star? What’s our mission? And how do we change that? Or how do we transform that into goals and measures and OKRs for our organization to appreciate how what they do is contributing to that broader mission. Recruiting, mobilizing the team – those are different skills, and really kind of digging in on the operations is a different leadership style than the listening and learning that I had done when I first got there. And from there, so then we brought more strategies into the fold, as an example, from a funding stream. Tremendous partners, as it were, Scott Gottlieb joined our board, the FDA chose to partner with us. Brigham and Women’s Hospital chose to partner with us. So [inaudible], we started to get some recognition in the industry, and that fueled our momentum. Well, in that circumstance, now, it’s not so much inward-focused about how to get the operation to run more smoothly, especially since we’ve now recruited in a leadership team that is professional, and accomplished, and amazing, and wonderful people besides. So now it’s more about what’s being asked of me as a leader is growth and scale. And thinking about “What does it mean to position Aetion as a leader in the industry?” That means connecting with leadership at the FDA as an example, or EMA over in Europe. It means collaborating with thought leaders who are approaching questions around how much we should pay for drugs and care from different perspectives. So not just within the pharma industry, but in the health insurance industry, with leadership of integrated delivery networks and at-risk providers, and what does it mean in those contexts. So now, I have to understand certainly what Aetion does, and what we do really well, but then also understand what’s happening more broadly in the industry, and how to manage in that context. So it’s a whole nother dynamic.

 

Lynne Chou O’Keefe  21:40  

We have such a diverse audience for Her Story. Imagine people who are in large healthcare organizations today and some in startups, etc. But your, again, choice here from being in large companies, publicly traded companies United Healthcare, Evolent, and now, into, then, being the CEO of Remedy and Aetion. How do you compare and contrast, if you will, large corporate, established players versus where you are in that journey, you just said, of leadership? Love to hear a little bit about that as well.

 

Carolyn Magill  22:19  

So for my journey, it was important for me to see how things work in both contexts. And in the two different phases of my career, if I could think of them like that – after college, and after business school. In both instances, I went from large organizations into startup environments. And going from United as an example, first of all, starting at United after business school was absolutely the right call for me. Because it was the first time that I got to see a very well-performing large organization build on its momentum, and figure out what processes work, what things may be stymied are opportunities, and just observing that experience. And then also seeing – United Health Group has obviously had a tremendous track record – and so just looking at, well, “Geez, how did they pivot? How did they know to move into that new segment? How did they handle it when CMS came in and slapped a sanction on something or, you know, how did they rise when they had a setback?” And those are all the kinds of examples that being in an organization with those kinds of resources and that kind of brainpower at the top, you just can absorb things like a sponge, and going from that environment into a high-growth organization, as I did with Evolent, it’s very different. And to be fair, I spent the first 30 days just thinking, “Oh my gosh, if I had just an inkling of the resources that were available to me when I was at United, we would kill it tomorrow. We have to build everything here from scratch.” So that was a nice wake-up call. 

 

But you find that the adaptability of a smaller organization, the ability to be built for purpose, and truly focused on a specific need that you’re trying to address – so you don’t have to be distracted by all the other things that are happening in an organization – there’s a lot of value in operating in that kind of a world. And so I think that there are lessons that I took, and I try to emulate, from my time at an organization as large and complex and accomplished United Health Group. And then there are things that I fall back on from my time at Evolent, which experienced very high growth while I was there, and I learned so much from Frank Williams, Tom Peterson, Seth Blackley, the founders of that organization, that I tried to then take to my subsequent leadership positions at different startups. 

 

I have also, Lynne, found my niche, I think. I love growing and scaling and I love this navigating through ambiguity and the messiness: “Who are you going to recruit and what skills they need to bring And how are you going to evolve over time?” That is just really, really fun for me. So I think part of it, too, is just trying to figure out, “What is your personality? And what are the environments in which you thrive? Who are the people that you really feed off of – they give you energy? And then how can you put yourself in a position where you get those elements every day?”

 

Lynne Chou O’Keefe 25:20  

The passion that exudes from you, when you talk about it, it’s just so palpable, and just why you’re such an amazing leader. I often say that a work-life balance, the word balance, that nomenclature doesn’t really work, I think. But what are some other things you’ve done kind of more on the life and support structure for you to become the leader that you are, that you built along the way?

 

Carolyn Magill  25:45  

Well, I’ll tell you, this, too, has been a process of trial and error and understanding what we need. I remember I was at United, it probably was 2008, and I had an executive coach. And she said to me, “Carolyn, you need to bring your whole self to work.” I was like, “What? No way. What are you talking about? Bring my whole self to work. I need to be serious. I need to be focused, I need to be disciplined. That’s what I need to bring to work.” And she was like, “Yeah, no, it’s okay to smile.” I’m just recognizing this is actually another mentor of mine, Rick Jelinek, when I was at United. One time, he said to me, I always came into his office with a list. And there was never enough time to get through my list. So I was very disciplined about getting through my list. And I remember one of those times, I go into his office, and I’m like, “Okay, item number one. That’s item number two.” He’s like, “Carolyn, what if you just came in here and said, how’s it going? And maybe I would tell you about something that happened this morning, that’s more urgent than anything that is on your list. Hmm. Or expose you to something that you actually needed to know, relative to something else that you’re trying to accomplish?” And I was, like, “What?” So your question resonates. And I think it has been a journey over time to realize slowing down and thinking about how we nurture ourselves and be our whole selves and bring that curiosity to everything we do, without necessarily working towards this very disciplined list all the time is super important. 

 

For me, it is time with my husband. That’s been wonderful during COVID because both of us traveled a ton prior to this period, and just getting to spend more time together at home and doing our little postage stamp of a backyard in Brooklyn, putting art on the walls, going for walks in the city and starting to explore things that are within driving distance of our home instead of always feeling like we had to jet off somewhere, abroad. And then we have nieces and nephews, we actually taught a zoom class to seven nieces and nephews. It was supposed to have been six weeks last spring, and because school just never went back, it ended up being 12. So we are responsible for when our nieces and nephews try to negotiate for things like a dog, as an example. So yeah, finding ways to connect with our family has been really important. And then I also have some passions – I love to ski as an example. I’m always looking for opportunities to do that. And reading and just trying to find outlets that really bring us joy, and then prioritizing them.

 

Lynne Chou O’Keefe  28:21  

Yeah, no, it’s, it’s made me really happy to imagine you and Ellie, to your point, gardening and having time together in this way, and in this time, and to find the beauty of slowing down and kind of, that perspective in your life, which is really exciting. Well, if we were to kind of sum it up, Carolyn, and we like to talk about Her Story, if you wrote your story, I’ll give you two options – if you wrote your own story, how would you title it? Or what would be the theme song of your life today? 

 

Carolyn Magill  28:59  

Okay, I’ll do the theme song and it’s “Ain’t No Mountain High Enough”.

 

Lynne Chou O’Keefe  29:04  

So that’s kind of a good Motown tune. That is awesome.

 

Carolyn Magill  29:08  

Killing two birds with one stone there because like I said, I love to ski and one thing that has happened for me over time is that I have been a little bit of an extreme skier in my day, I like to heli-ski, and I like really steep trails and powder and kind of challenged myself in that way. And then looking for higher, steeper mountains has been really fun. And in recent years, I started to discover the solitude and quietness of skiing in the backcountry. And so it’s just it’s been a really fun journey, and “Ain’t No Mountain High Enough” sort of reminds me of that pursuit.

 

Lynne Chou O’Keefe  29:43  

Well, and in so many ways, I really believe you’re at the apex of your career, and really self-actualization of everything, every experience, coming to this point is really exciting. I’m so excited to continue to work with you, collaborate with you, as you go forward. Thank you so much for your time today. It just, again, says such an inspirational leader that you are in this space. And again, just happy to be your collaborator and your friend through this journey.

 

Lan Nguyen  30:18  

Her Story is a podcast produced by Think Medium. For more stories tune in every Wednesday. Please subscribe to her story on Apple Podcasts or wherever you’re listening right now. You can also access Her Story episodes and video on YouTube and other mediums on our website, thinkmedium.com/herstory. Be sure to rate and review Her Story so we can continue bringing you stories from inspiring women leaders across the country, expanding our vision of what is possible in healthcare. In addition to subscribing and rating, we found that podcasts are known through word of mouth, and we appreciate your spreading the word to friends, family, colleagues, and mentors who might be interested. For questions and suggestions about Her Story. Contact us at herstory@thinkmedium.com. Thanks for listening.