Ep 24: Finding the Balance in Complex Care

Sanjula Jain  0:03  

Her Story is a program that explores women’s leadership and healthcare.

 

I’m delighted to introduce you to Arielle Mir, Vice President of Health Care at Arnold Ventures. Arielle’s career has spanned government roles and the private sector to advocacy and philanthropy. Underlying all of her roles has been this relentless focus toward solving health care’s toughest problems, particularly those around complex care and looking at Medicare and Medicaid populations. Arielle, welcome to the show, and thanks for spending some time with us and sharing your story.

 

Arielle Mir  0:40  

Thank you. I’m delighted to be here.

 

Sanjula Jain  0:42  

The first question, as we like to start off all these interviews, do you consider yourself to be an accidental or intentional leader?

 

Arielle Mir  0:49  

That’s a great question. The word that occurs to me is an intuitive leader. I’m a middle child and, when you’re a middle child, you’re never the first for anything. You never get your first pick at anything. You always have to find your way into your space to shine. Throughout my career, I’ve always looked for opportunities to move into spaces where there is leadership needed, where initiatives don’t yet exist, where there’s an opportunity to bring people together in a new way, and not always on the already beaten path. It’s felt more intuitive to me.

 

Sanjula Jain  1:30  

That makes a lot of sense. Your career has tackled this issue of complex care from a lot of different vantage points. For an audience who might not be as familiar, could you give us an executive summary of where you started and some of the roles that led up to Arnold Ventures?

 

Arielle Mir  1:32  

I started my work coming out of college in women’s reproductive health and reproductive rights. This is a perfect example of a fragmented healthcare system, a place where individual needs are not well met. Where lack of good information, lack of good coordination, and poor access to healthcare can have tremendous implications on people’s lives. I started that work in the advocacy space organizing patients, organizing providers, pharmaceutical companies, and motivating policymakers to make the morning-after pill available over the counter. I loved doing that work. I was passionate about it and, in doing it for some time, I realized that there was a piece of the conversation that I just didn’t know very much about the financing and the insurance underpinning of our whole health care system. I realized that bringing a “follow the money” perspective to my work would enable me to have a bigger reach and an even bigger impact on people’s lives. That led me to grad school and then eventually to the Centers for Medicare and Medicaid Services where I assisted the director who oversaw the Medicare Advantage in the Part D program (Prescription Drug Benefit). From there, I went to the Medicare payment Advisory Commission. Medicare and Medicaid are the two largest health insurance programs in our country and the effort it takes to run these programs and to give policymakers the information they need to improve these programs, to make them responsive to the needs of individuals and providers, is complex. Balancing the need to bring data, the need to bring stories, and the need to work collaboratively through hard healthcare problems and in our nation’s fiscal problems takes a lot of energy. I enjoyed that time working at CMS and then Med Pack, but then always along the way, you start to see the spaces on the map that are not yet filled. Having seen the advocacy world, having seen the government world, I also got curious about the role that private sector companies—particularly on the technology side—could play to help improve the health care system. Surprisingly, that led me to Silicon Valley, to a technology company that builds data infrastructure for the National Medicaid program and for insurers and large employers. Again, it was charting this path to figure out how new technologies, energy, and approaches to organizing data could serve our public programs and help make healthcare more affordable. Again, you start to see what one stakeholder, one actor in this space can do and it makes you see the opportunities to do more, so that has brought me back to work in DC at Arnold Ventures where I now work and lead our portfolio around complex care, improving the fragmented care delivery system, in particular for people who have Medicare and Medicaid, and figuring out with our grantees and partners what research needs to be done, what policies need to be developed, what Coalition’s need to be built, and what technical assistance needs to be provided to complete the circle of a vision for a well-functioning healthcare system for every individual in this country.

 

Sanjula Jain  5:28  

Somewhere in between that, you’ve also earned the status— In the time that we’ve known each other, every year I look forward to your health policy Valentine’s on Twitter. That’s one thing that people don’t see on your resume, but it’s worth noting because you have this incredible pulse on the industry and always find a witty way to highlight what some of the major issues are. That’s another fun fact for you. Given the evolution of the industry,—you’re seeing it from the technology side, the data side, the policy side—are we making progress? How do you view how far we’ve come over the course of your career? What are the issues we’re still trying to solve?

 

Arielle Mir  6:04  

One of the biggest things that has changed over the arc of my work in this space is real growth in a sense of accountability and awareness of what happens to people outside of the four walls of a doctor’s office or a hospital and orientation around population health and continuity of care and coordination of care. Prior to the enactment of the Affordable Care Act, we had very few quality measures that providers or plans were held to. We had very few strong incentives for coordination across providers. We had very few conversations at the national level about how to weave together the service delivery and community conditions to help optimize people’s health and well-being. That has been a humongous shift and something to be proud of. The growth in the number of companies, standing up ACEOs helping to square the circle of referral loops to social services to do data and analytics to support plans and providers as they move into risk contracts, shows that we’ve made a lot of progress. There’s still more work to be done. In particular in the space of long-term services and support. The care that people need to remain safely in their homes—to overcome functional limitations, to dress, to bathe, transportation, to get around—are the kinds of things that not everybody thinks of as medical care, but dramatically impacts people’s health outcomes. Those are things that dramatically affect people’s health and can have huge implications for their health outcomes. Yet, the providers who offer those services, the homecare attendance, those community-based services, we don’t think of them as medical providers. We don’t pay them like medical providers, we don’t train them like medical providers. Yet, Medicaid is a huge payer of those services, so this is a place I think, where we can look even further beyond the walls of doctors and hospitals to think about improving people’s health.

 

Sanjula Jain  8:23  

Well, kudos to you. That’s not easy. As you and I have talked about, payment is policy and, in some ways, our industry is starting to latch on to the fact that Medicare and Medicaid are the largest payers of healthcare. That’s where a lot of this change stems from. You and I have chatted in the past about how leadership means different things to different people. Although you’re making decisions every day, a lot of the body of your work is how to influence the decisions of those entities or policies on more of a frontline level. You kind of have to hand it off to others to then make a call. How do you think about influence in that context?

 

Arielle Mir  9:02  

I think that’s what I was saying earlier about intuitive leadership. There are leaders everywhere, even the ones who aren’t elected, who don’t sit in the C suite. Among those leaders, of which I consider myself apart, you have a tremendous amount of power and responsibility to determine whose voices are heard, what stories are told, what kinds of momentum is created behind different decisions, what kind of creativity and systems support those policy decisions. When I think about my role at Arnold Ventures,—which is not policymaking; I sit at private philanthropy—the grantees we choose to work with, the reports we support putting out, the coalitions we build, the conversations we broker. Let’s create the conditions for the best possible decisions by policymakers. We know that the policymakers need data, they need information, they need to understand the trade-offs. They also need to hear human stories. They also need mental frameworks for thinking about governing complicated programs. You need a lot of people like me and my colleagues and our partners out in the field to make sure those policymakers, members of Congress, and folks in the administration can do their jobs well.

 

Sanjula Jain  10:27  

As you know, that’s music to my ears as a health services researcher. Data is essential to making decisions, so I’m glad you’re thinking about it from a systemic view. Shifting gears a little bit to how you got to where you are, you have a terrific portfolio of these large organizations with tremendous impact on the industry. Earlier you got your degrees in political science and Public Affairs at the University of Chicago and Princeton, both tough programs, the prestigious ones for your field of study. Did you plan on healthcare when you were seeking out those degrees? Or what led to the interest in health care?

 

Arielle Mir  11:06  

I think it’s in my genes. I’m the daughter of an infectious disease physician and a nurse turned epidemiologist, so I was born with a health care mission. Growing up, I always had the sense that there were other tools I could use to help improve health care for people. Not just one at a time in a clinic, but levers using public policy that could be really, really impactful in improving health care in this country. I thought it was a hard conversation with my dad when I told him I didn’t want to go to medical school but I wanted to use those disciplines and political science and Public Affairs to chart a path into this work in the public policy space. Just like there’s a wide variety of drugs that can be used to treat different conditions, different procedures, different medical approaches, to heal the system, there’s a wide variety of approaches that are needed as well.

 

Sanjula Jain  12:06  

Absolutely. You touched on this earlier, but with that framing of considering yourself to be an intuitive leader, at what point did it hit you that you are a leader in healthcare? As long as I’ve known you, you’re so passionate about the industry it shows in all the work you do and you’re so focused on getting it done, which is awesome. At what point did it hit you, “Man, I’m actually responsible and in charge and I have this incredible influence.”

 

Arielle Mir  12:34  

A funny story: My first job in DC was at a behind-the-scenes advocacy organization called The Reproductive Health Technologies Project. At the time I got the job, I was the second employee. I was right out of college, not qualified to do anything, and my friends joked that I was the vice president at the time. What I learned in that work is that—when there is a space to fill, when there is a need to elevate an issue that people aren’t talking about—every person can be a leader. Like I said, one of the things we worked on was expanding access to the morning-after pill. I took on the role of coordinating and managing the nationwide coalition of patient and provider groups and pharmaceutical companies. I stepped in and I took on the work that was needed to be done. The work I was passionate about and where others weren’t taking the lead, I stepped up. It was a strange first job experience in DC because DC is often like an old boys club.

 

Sanjula Jain  13:51  

I know that well.

 

Arielle Mir  13:53  

You just have to look at the Congress and the administration to see that women aren’t well represented. In this organization, it was pretty much all women, and this amazingly tight-knit group of women were motivated to improve health care for women and families, but also motivated to support each other and to make space and to mentor one another and to cheer each other on. I think that put a confidence in my step that helped me to seek out other spaces where I could take on the work that needed to be done and to do it with confidence no matter who is at the table.

 

Sanjula Jain  14:34  

With that, you basically had an early start and, as you said, you stepped up and you figured it out. As you look back on your career and those various roles, did you feel like there were certain capabilities or skills you had to intentionally seek out or build for yourself and, depending on the role or the organization, how did you approach that?

 

Arielle Mir  14:56  

The number one skill that anyone can have in any workplace, in any family, in any community is empathy. In a connector role and a translator role, in a building role, you have to understand where people are coming from, what they care about, what they’re going through, what lights them up, what motivates them and to use that to build a strategy. Whether I’ve been working with technical experts building the Medicare Advantage, the risk adjustment model, or staff on Capitol Hill trying to figure out what to put in a major legislative package, starting from that place of empathy and of active listening has never ever failed me.

 

Sanjula Jain  15:46  

That’s great. In the time that we’ve known each other, I’ve often sought your counsel on career advice. You definitely get a lot of those sentiments. One of the things you’ve been great at helping me think through is decision-making. At what point do you decide to make the leap to a different role or a different organization? You have this incredible Venn diagram mental model, could share a little bit about how you think about making decisions on when to switch roles or different organizations and what you ultimately chase after?

 

Arielle Mir  16:15  

There is a tension, and it’s a tension I’ve felt throughout my career when you do mission-driven work, when you care about the work, when you care about the people that you work with, you sometimes get tricked into feeling that you are the work, that you are inextricably connected to the organization or the company or the initiative. It’s not true. You’re a participant. Ideally, you’re valued and engaged and feel a sense of belonging, but in each of the roles that we occupy there’s our growth trajectory. When I look for a job, I look for the convergence of three factors. I look for (1) an important healthcare mission, an important public health care mission. That’s the thing that’s driven me. It’s genetic. The second is an incredible team. Smart people who also operate with empathy, integrity, good humor. Then the third circle is a growth mindset. For me, I love to change something. I love to build something from scratch. I love to do something new, but not every organization is a startup. There’s a certain breed of us who are attracted to startups. An organization with a real growth mindset, a willingness to interrogate strategy, to learn from its mistakes, to grow, to lean into new spaces, to listen and respond to what is needed, that’s the sweet spot for me. In that growth mindset, you can get to the end of your growth curve and an organization, and then it’s time to move on to the next thing and that requires some bravery and it comes with some grief and sadness of leaving an organization, leaving colleagues that you care about. If I’m honest with myself, when I think about those transitions, I know it’s intuitively time to seek a new space to occupy. The beautiful thing about healthcare is that, while it’s such a huge part of our economy, it’s a very small world and the opportunity, as you and I have circled around one another in multiple phases of our careers, no one ever goes far. Having those relationships, having those shared understandings has tremendously impacted my ability to be successful at each next job.

 

Sanjula Jain  18:48  

Absolutely, and underlying all that is people. I know you have an impressive group of mentors, both male and female. What role have they played in your path and journey?  Not only from a decision-making point of view but how you approach healthcare in the world.

 

Arielle Mir  19:04  

For one, having mentors who have made a seat for me at the table has been foundationally important. When you walk into a boardroom or the conference room of the administrator or director of something and the person you’re with pulls out a seat and says, “You sit here,” that matters a lot. I’m a person who always has a good attitude about things. I have an improv and comedy mindset. It’s always “yes, and…” I have appreciated having mentors who are extremely skeptical sometimes. Sometimes starting from a place of “no” and helping me see the different sides of an issue has helped me set good boundaries for myself, set high standards for what I can and should work with, and where I can grow and where I can push myself out of my comfort zone.

 

Sanjula Jain  20:10  

Is there a particularly difficult piece of feedback that you’ve ever received from a mentor that didn’t necessarily set you back but caught you off guard? How did you overcome that?

 

Arielle Mir  20:19  

A mentor at a recent job gave me a piece of feedback in a review that was something like, “Sometimes you care too much,” and it did set me back. I thought, “Well, gosh, that’s my superpower, right?” I’m passionate and committed, but I think what she was saying was, “I want you to give yourself some space, to let go of ideas sometimes. Let go of conversations to be a little more playful and resilient around challenging issues, decision-making processes, ideas that you might get attached to.” What I took out of it was not “don’t be passionate.” It was not “don’t be passionate.” It was to bring more playfulness, curiosity, and openness to tricky situations so you can continue to be “yes, and…” and you don’t get stuck on an idea that isn’t going anywhere.

 

Sanjula Jain  21:23  

What do you think about your journey? You mentioned you’re often one of the only women in the room. I know in the DC policy sphere that’s quite common. How have you thought about your experiences? Are you hyper-aware of the fact that you’re one of the only women in the room? How do you navigate some of the situations or interesting obstacles that you’ve faced?

 

Arielle Mir  21:46  

The secret to my comfort and ease in a lot of different situations is an understanding of the audiences, the messages, and the tools that resonate in different spaces. Sometimes you have to come with a stack of data and statistics you can read out and say, “Here’s why you need to care about this: you’re spending X, Y and Z. It affects this many people.” Sometimes that’s the thing that gets you in the door, a real command of the data. In other cases, it’s a story. I’ve sat in enough rooms with enough male members of Congress to know that a story about a provider, a doctor, or a hospital in their particular district is going to be so much better received than a stack of charts. Understanding the roles I play, the coalition’s I represent—when you feel steady in who you are, what you have, and what you can bring to a conversation—it’s always given me the confidence to find my way in and be heard. Of course, it changes from room to room.

 

Sanjula Jain  23:01  

Given all your roles, on top of your day job, when you’re not busy corralling national policy, you’re also a mother— and not just any mother. I know you homeschool your children, which is quite impressive. I don’t know how you juggle all of that. How has motherhood influenced your approach to leadership?

 

Arielle Mir  23:19  

It’s certainly a lot. Earlier in my career, I had this idea that to be an effective leader, you had to be present in the office at all times and be the last person to leave and the person to know all of the information and have your hands in all of the pots. Of course, when you become a parent, it becomes much more difficult to play that game. It cost me to see and grow into a leadership posture of cultivating a great network around me, trust in the people around me, clarity in the roles I play and my team play, and interrogating what is enough and what it means to get the job done and get the job done well and to understand what we’re trying to drive to. The quantity and the quality don’t necessarily correlate. I read a book when my older son was about two and starting to assert his opinions. It’s a book called How to Listen So Kids Will Talk and Talk So Kids Will Listen. They gave these techniques for, again, this active listening and reflecting back what you heard. When a kid says, “Cookie!” Instead of saying, “Oh, it’s dinner time, honey. We’re not having a cookie,” say, “I hear that you want a cookie. Cookies are really delicious,” to make them feel heard. Don’t you know, that is a good technique in the workplace. When someone comes to you with a strongly held position in any working relationship, that kind of skill is really, really valuable. I would never say to my colleagues, “I’m treating you like my toddler son,” but those superpowers and motherhood, the kinds of things that you have to practice every day as you’re holding the space for another human being to be learning and growing and establishing their own place in the world, serves you well in leadership.

 

Sanjula Jain  25:32  

That’s a great perspective. Thinking about you in terms of how you juggle all of that, that’s quite a load and, in some ways, such a misnomer. We never perfectly get that work-life balance down-pat, but what do you do for yourself to stay sane and keep perspective and juggle it all?

 

Arielle Mir  25:49  

On the point of balance, on the side—I call it like my “superhero” profession, the thing I do at night in spandex—I am a yoga teacher and a meditation instructor. Sometimes it feels too precious. Like, “Oh, you do all these things, you check all these boxes,” but truly having that physical practice, that body and breath practice, is the space where I work out things in my body that I can’t make sense of in my mind. To this conversation about not caring too much, it takes practice to let go. It takes practice to know what it feels like to release your grip on something that you care about. In yoga, you can feel that in your joints. You can feel it in your muscles when you tense and release. I’m not going to get too woo-woo on you, but there’s a body and mind and spirit connection that, when practiced, supports me in all my goings about life. In yoga, I love the balance poses the most. My favorite is what’s called “half-moon pose,” where you stand on one leg and extend your arms out to a tee and twist yourself to the side. It looks very fancy. It looks very show-offy, but the workhorse of the pose is connecting to the ground, feeling your foot on the ground, and using the steady, unsexy muscles in your legs to help you be in the wobble. When I do those balance poses on the mat, I get more and more comfortable with being in the wobble, whether it’s being in a challenging problem that you’re trying to figure out at work, being in a space of not knowing what you’re going to do next professionally. As you said, there’s no way to get rid of the uncertainty, the complexity but, the more we can get comfortable in the wobble, we can feel more at ease.

 

Sanjula Jain  26:58  

The amateur Yogi in me is needing to take a class with you when I’m back in DC. That’s a good perspective. Rounding us out a little bit, you’re a learner and you’re constantly very thoughtful and reflecting on each and every one of these experiences and trying to take your approach to the next level. Is there something you believed early on in your career that you now think about and you’re like, “Huh, that was totally wrong,” or “I’ve changed my perspective on that”?

 

Arielle Mir  28:27  

Absolutely. Every day. Every day, I’m changing my perspective. If you had asked me growing up who were the leaders we needed to emulate or follow, I would have named the leaders who are elected, the leaders who are out front, and the names and the faces that people follow. With every passing day, I have a growing appreciation for the leaders who do the work behind the scenes, the leaders who see spaces that are not occupied or who see conversations that feel intractable and who show up, who listen, who connect to chart a path forward, who support the box top decision-makers, who support the policymakers, who support the C suites. They do it with humility and often with grace. That’s the leader that I have aspired to become and continue to grow into.

 

Sanjula Jain  29:35  

Absolutely. Building on that, is there a piece of advice you’d give your younger self?

 

Arielle Mir  29:40  

The piece of advice I would give my younger self is to be patient with yourself. We have big problems in this country, big challenges to solve, and we should not be patient with those. You may not have all of the answers today about how you’re going to solve them, about exactly what role you will play but, with intuition with patience, with real listening and empathy, you will figure it out. If my younger self had heard and believed that advice, she would have gone on more vacations. She wouldn’t have as many wrinkles as she does today worrying about how it was all going to come together, so I would say, be patient with yourself and impatient with the challenges.

 

Sanjula Jain  30:28  

I’m curious now that you say that. With your team now, do you do regular group meditation, or group yoga sessions together? Is that something you’re encouraging them all to do?

 

Arielle Mir  30:40  

It is. I actually lead a meditation circle once a week at work. I don’t require my team to attend. I find that there is something—again, I don’t want to get too woo-woo with you—but there is something powerful about stopping together, about breathing together, about reflecting on our own and next to each other. When there are challenging things that happen in the world, when there are challenging things happening in our organization, coming together and holding that space where we can breathe together and reflect on our own can be a sweet way to smooth over the edges of doing the hard work of solving our nation’s hardest challenges.

 

Sanjula Jain  31:33  

Final question for you: As you think about the legacy you want to leave behind, what Arielle is going to be remembered for in healthcare, and as a healthcare leader, what would be the title of your autobiography?

 

Arielle Mir  31:44  

That’s a great question and a hard question. I have two sisters. One of my sisters proposed to me that if I ever ran for Congress that my slogan would be, “I got you, sister,” and I love it because I think it reflects a real authenticity of my passion for improving people’s lives by improving healthcare, and my willingness to show up right at every level. For my colleagues who are paving their own way, who need advice about how to frame their argument for a promotion, or how to practice explaining something complicated, I got the time. “I got you, sister. We’ll work on this problem that’s right in front of us.” When it comes to a client or a customer or a grantee, the perspective of “I gotcha. We’re doing this together. We’re committed to something.” Then “I got you, sister” in the broadest sense of the word, to know that I am someone who shows up every day to work on policy because it affects a lot of people and there are Medicare and Medicaid beneficiaries and women and men and families all across the country who stand to benefit because of the work that I did behind the scenes. That motivates me.

 

Sanjula Jain  32:59  

That’s so well said. Your career is so inspiring. Your energy and passion are really infectious. Thank you for caring so much, as much as you do. You’re a great public servant and have so much that you’ve already brought to the industry and will continue to bring. We hope to see you run for office one day, the way that your path is headed. Thanks so much for spending time with us today and for sharing your story.

 

Arielle Mir  33:23  

My pleasure. Thanks for having me.

 

Sanjula Jain  33:27  

Her Story is a podcast produced by Think Medium. For more leadership stories from inspiring women across healthcare, tune in every Wednesday. Please subscribe to Her Story on Apple Podcasts, YouTube, or wherever you’re listening right now. You can also view Her Story episodes and videos and access exclusive content on our website atthinkmedium.com. Be sure to rate and review Her Story so we can continue bringing you insights from influential women across the country. If you enjoyed this episode, we appreciate you spreading the word to your friends, family colleagues, and mentors who might be interested. For questions and suggestions. Please contact us at herstory@thinkmedium.com Thanks for listening.