Ep 03: Payment is Policy                                    

with Nancy-Ann DeParle

April 1, 2021

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Nancy-Ann DeParle
Managing Partner & Co-founder, Consonance Capital Partners; former Deputy Chief of Staff to President Barack Obama; proud ACA architect; former CMS Administrator

Nancy-Ann DeParle is a managing partner and co-founder of Consonance Capital Partners, a private equity firm that focuses on investing in the U.S. health care industry. She is a director of CVS Health and HCA, in addition to Consonance portfolio companies Enclara Pharmacia, Turn-Key Health, and Psychiatric Medicare Care. From 2011-January 2013, she was Assistant to the President and Deputy Chief of Staff for Policy in the Obama White House. A health policy expert, DeParle served as Counselor to the President and Director of the White House Office of Health Reform from 2009-2011. In that role, she spearheaded President Obama’s successful effort to enact the Affordable Care Act and managed the initial implementation of the law.

 

After leaving the White House in 2013, DeParle was a Lecturer in Law at Harvard Law School and a Visiting Scholar in Economic Studies at the Brookings Institution. From 2006-2009, DeParle was a Managing Director of CCMP Capital Advisors, a private equity firm formed by the former buyout professionals of JPMorgan Partners, LLC. She was also a Senior Fellow of Health Systems at the Wharton School of the University of Pennsylvania and a trustee or director of several corporate and non-profit boards, including Boston Scientific, Cerner, Health Affairs, Medco Health, and the Robert Wood Johnson Foundation. From 2002-2008, she was a commissioner of the Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare policy matters.

 

From 1997-2000, DeParle served as Administrator of the Health Care Financing Administration (HCFA), now the Centers for Medicare and Medicaid Services (CMS). As Administrator, she directed Medicare, Medicaid, and the State Children’s Health Insurance (SCHIP), which provide health insurance for more than 105 million Americans at an annual cost of $870 billion. Before joining HHS, DeParle served as Associate Director for Health and Personnel at the White House Office of Management and Budget (OMB).

 

Often the companies we invest in are family-owned businesses that someone had an idea and was stubborn and kept working on it and building it and finally it got traction and it's helping people. Then we come along and we help them grow it further.

Transcript

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Gary Bisbee  0:06  

Healthcare leadership is hard work, but what if you could learn from the most brilliant and influential minds in healthcare and beyond? What would you ask them? Would you ask about politics, policy, or maybe leadership? On The Gary Bisbee Show, I’ll do just that. You’ll hear from healthcare’s most successful leaders and those experts who they listen to, as together we’ll explore how the healthcare economy is transforming. 

 

Nancy-Ann DeParle has been a remarkably successful leader in both the public and private sectors. As Deputy Chief of Staff for President Barack Obama, she managed the legislative sausage-making process that delivered the Affordable Care Act, a major follow-on to the Medicare and Medicaid legislation of 1965 for increasing the nation’s access to health care. Nancy-Ann has led the Department of Human Services in the state of Tennessee, as well as the federal Medicare and Medicaid programs. We will discuss the lessons she learned by leading programs at both the federal and state levels. I can attest to the fact that she is a superb board member, having served on the Cerner board with her for multiple years. She currently sits on the CVS and HCA boards, and she has served on a number of boards through the years. What is the primary role of a board member? What lessons has Nancy-Ann learned? We will explore with her in this conversation. Nancy-Ann has an undergraduate degree from the University of Tennessee, a JD from Harvard Law School, and a BA and MA from Oxford University, where she was a Rhodes Scholar.

 

Good afternoon, Nancy Ann, and welcome.

 

Nancy-Ann DeParle  1:57  

Thank you. Good to be here.

 

Gary Bisbee  1:59  

Let’s learn a little bit about you, particularly to help us think through the progression of your career and how you’ve thought about decision-making and leadership. What was your life like growing up?

 

Nancy-Ann DeParle  2:12  

I grew up in a very small town in the eastern part of Tennessee called Rockwood. It’s a town of around 4,000 people. I had a single mom who raised my two brothers and me on her own. My mom was from Rockwood and grew up there before going away to Knoxville—which is not that far away—to get a nursing certificate. She became one of the first Army nurses in World War II and then came back to that area. Afterward, she met my father who was from Shanghai in Knoxville. She was working as a nurse to an ophthalmologist there. They were together for a few years, had the three of us children, and then split up. My mom came back to Rockwood to raise her three children. She was a remarkable person. My childhood was great in some ways, but not without hardship, and my mom worked very hard.

 

Gary Bisbee  3:10  

It sure seems like it. Do you find that the hardship you went through has been useful to you and your career?

 

Nancy-Ann DeParle  3:18  

It has been, Gary. You know it has been. There used to be a lot of coal mining in that area of Tennessee. When I was growing up and running the Tennessee Department of Human Services, I got to go down in a coal mine. When I came out of there, my reaction was, “Wow. I say I work for a living, but what I do isn’t work.” I felt the same way about my mom. She had to worry so much about just putting food on the table and taking care of three kids on our own. It definitely gave me a perspective that I feel fortunate to have.

 

Gary Bisbee  3:52  

Off to the University of Tennessee, you were the student body president when you were a senior, I believe. The first woman to be the student body president. What kind of special memories do you have about that?

 

Nancy-Ann DeParle  4:04  

Among others, I remember first of all— this is a story that I often tell, especially to groups of young women. I want to be clear that, even though I was qualified and I had been the student body vice president, I would not have run had it not been for two guys, Scott Lucas and David Long. One of them was president of the interfraternity council and the other one was a very active guy on campus. They came to me and they said, “You should run.” My reaction was, “Oh, no, no. One of you should be it.” They said, “No, you should run and we’re going to run your campaign,” which they did. I remember we persuaded two of the Tennessee basketball players who were very popular at the time,—Ernie Grunfeld and Bernard King—the running down players to campaign for me. It was a lot of fun.

 

Gary Bisbee  4:55  

Was that the origin of your interest in politics?

 

Nancy-Ann DeParle  5:01  

I don’t remember a time when I wasn’t interested in politics.

 

Gary Bisbee  5:04  

Where did the interest in health care come in?

 

Nancy-Ann DeParle  5:08  

From my mother and my grandmother. My grandmother also raised three children on her own. She walked a couple of miles to work every day in Rockwood and worked as a nurse, not with a certificate and not with anything but on-the-job training for the local doctor. My mother was also a nurse. There was a long time when I thought I might be a nurse. I have a vivid recollection of sitting at my grandmother’s kitchen table with her. She had a little shoebox where she had her bills and she was holding one of her bills from Blue Cross. She said, “You know, President Johnson just signed this bill called Medicare and I wonder if it’s going to help me.” It’s funny the things you remember, but I do remember having that conversation with her, so it’s always been something that interested me. Then for a sad reason, too, because when I was a junior in high school my mother—who was the center of everything to me—was diagnosed with lung cancer, so the rest of my time in high school was spent worrying about her, taking her to treatments. She went to radiation treatments in Knoxville. I was trying to help her get through that. She ended up dying during the Christmas break of my freshman year in college. I came home from the University of Tennessee and she was in the hospital and she died two days after Christmas, so that also is a reason why I was very interested in health care. She was sick with pneumonia and obviously cancer, but the precipitating cause of her death was not cancer. It would have killed her, but the precipitating cause was that she had gone back to work when she shouldn’t have and got pneumonia. She was so weak in the immune system. She was worried about losing her job, losing insurance, and that we wouldn’t have insurance. That was wrong. That’s a big part of why I got interested in health care.

 

Gary Bisbee  7:14  

Well, we’re better off now than during those days. On a happier note, you’re off to Harvard Law School. Were you thinking about being a practicing attorney? Or what was your rationale there?

 

Nancy-Ann DeParle  7:26  

Growing up in this small town, I looked around for role models. My role model was my uncle, my mom’s younger brother, who was a lawyer. I used to go over to the courthouse and our county seat, Kingston, and watch him try cases. You’re going to think I’m making this up, but let’s put it this way: If you ever had anything go wrong in that area of the country, you should run—not walk—to get him as your lawyer. He would get in front of the jury and virtually everyone on there, the judge would be questioning the jury to make sure they could be impartial. “Does anyone on here know Mr. Cooley?” Everyone put their hand up. “How do you know him?” “He helped my brother with whatever.” He was paid, sometimes in livestock. This was a different time, but what I loved about watching him in the courtroom was how smart he was. I viewed law as a way to help people because that’s what he did. He solved problems and helped people. I worked in his office when I was in junior high. He hired me—I’m sure I wasn’t that much help—to answer phones for him after school, probably just to give me that exposure. I would see all the people coming in and sitting in his waiting room and calling him. It seemed to me, more often than not, he brought people together who were arguing over something and helped them resolve their conflict. I wanted to be a lawyer, someone who made a good living, worked hard, was smart, helped other people. That seemed like the ticket to me.

 

Gary Bisbee  9:06  

You’ve done all of that for sure. Where did the Rhodes Scholarship idea come in?

 

Nancy-Ann DeParle  9:11  

When I was a senior at the University of Tennessee in the fall of ‘77, I was a history major and I was in the area where the history faculty had their offices. This professor named Milton Klein, who was a very well-known professor,—his main interest was New York history, so he was kind of an expert on that—stopped me in the hallway and said, “Hey, look at this article. They’re now letting women get Rhodes scholarships. You really ought to consider applying for that.” So he gave me this magazine. It was People Magazine, and it was an article about the first class of women Rhodes Scholars. The problem was that the article was written after they got to Oxford. It was November. That year and you had to apply for it in September or October, so I missed the deadline. I was a senior, I had a serious boyfriend, I was determined to go to law school, so I dismissed the idea, to be honest. The following fall of ‘78, I was at Harvard Law School, my dream. I started thinking—and this shows how naive I was—“Gee, I’m not even 22-years-old. I’m going to be doing this for the next three years in law school then I’ll be out and I’ll be practicing law for the rest of my life, so shouldn’t I try to do something different?” I know you’re laughing because I haven’t done it.

 

Gary Bisbee  10:42  

It’s just, we’re all at 22 nits. We’re all that way.

 

Nancy-Ann DeParle  10:47  

A young person’s myopia or whatever. So I thought, “Maybe I should do what Professor Klein said. Maybe I should look into that.” Then I also applied to the Kennedy School because they had a program where you could get a joint degree. Again, my interest in politics. I thought, “That could be interesting. That might be something to look into,” so I applied, not having any idea how competitive it was. Then I won. I’m embarrassed to say this, but I actually considered not going. My grandmother, my mother’s mother who helped my mother raise us three children, said to me, “Oh, don’t do that.” I said, “Why grandmother?” “Well, it’s cold over there. I don’t think you’re gonna like it.” “Okay, we can deal with that. Why not?” She said, “Because you will never get a husband if you do that.” At the time, I didn’t really care. There might have been some truth to what she said, it might have narrowed my scope in some way. Not for that reason, but for other reasons I did consider not doing it because I had a scholarship at law school, I would be stepping out after my first year. It seemed more complex than it did when I’d sent off the application. It changed my life. I’m so grateful I had that opportunity.

 

Gary Bisbee  11:58  

Very good. What was your project for the Rhodes Scholarship? Didn’t each Rhodes scholar have a specific study or project?

 

Nancy-Ann DeParle  12:06  

If you were doing a Ph.D., a DPhil, an Oxford parlance, then you would have a dissertation just like you would here. I chose to do a second bachelor’s degree instead which, in Oxford parlance, is also transformed into an MA, so I have a BA/MA in politics, philosophy, and economics. You do eight “papers,” they call them, so I took economics, monetary policy. Against the advice of my tutors, I took modern British Government. One of the offerings is to study US politics and government. You’re pretty much guaranteed an A in that, but I thought, “I know a lot about American politics. I want to learn about British politics,” so I took that. At the time I was doing it, the US Embassy had this program they asked me to join where you would get to go out in the English towns and villages and give talks about the US government and policy, so I did that. I went to Wales and stayed with a family. It was a great educational experience for me.

 

Gary Bisbee  13:23  

Back to Harvard, wrapped up law school, went to practice for several years. How did the appointment at the agency that runs Medicaid come about?

 

Nancy-Ann DeParle  13:34  

Actually, I didn’t run the agency that runs Medicaid. I ran the Department of Human Services, but I’ll tell you how that came about. The governor of Tennessee was a man named Ned McWherter, who had been the Speaker of the House for 20 years before that. When I was the student body president at the University of Tennessee, one of our activities was to pile in someone’s car and drive over to Nashville—two and a half, three hours—to lobby the state legislature because the state legislature controlled our tuition, they appointed the Board of Trustees. Pretty much everything about our lives as students, they set the policy for. I’d gotten to know then-speaker McWherter during that time and when he ran for governor I helped him. I was practicing law, so when he was elected he called me up and asked me to come talk to him about joining his cabinet. I originally lobbied for I thought Insurance Commissioner because I was a litigator. I’d been doing some work representing insurance companies. He said, “No, no. That isn’t what I have in mind for you. I want to work on indigent health care. I want to get people covered in this state. When I was campaigning, I met too many poor people who don’t have coverage and I want you to run my biggest department—” which was the Department of Human Services, “and I want you to go to Washington and throw your weight around.” He was a 6’4 or five former football player and I’m not, so it was sort of a joke between us that I was going to come up here to Washington and throw my weight around. He was very crafty. He said, “So also, I just need to warn you that I’m going to need you to do a RIF.” A Reduction In Force. I said I was way too young to be doing this job. “Let’s start there.” I forgot to say that part. I was 30 by the time it was announced, by the time he was inaugurated. I said, “Okay, what do you mean by our Reduction In Force?” He said, “Well, there’s about a 10% Reduction In Force.” I remember sitting there and thinking, “Okay, there are 6,000 employees at the Department of Human Services, so that’s about 600. That’ll be no problemo.” I had no idea how wrenching doing something like that would be. Also, my department had a very heavy concentration of people in our state government who were members of the State Employees Association, which was basically a union, so they were not exactly in favor of doing a Reduction In Force. Also, members of the legislature didn’t like it because they had gotten people appointed to these jobs. In many parts of Tennessee at that time, if you wanted a white-collar job and you didn’t want to be a teacher, this was the best job because we had an office in all 95 of the counties in Tennessee. It was a very difficult experience. I drove to all 95 counties to sit down with our employees and explain it to them. We went through the process. After I left that job, I decided I could never be scared of anything again because, from the standpoint of managing a large agency, that was a trial by fire, for sure, but what I loved about it was you could be so close to what really matters to people. My agency handled a lot of the problems that people have, whether it’s child abuse, foster care, adoption, elder abuse. It ran the welfare payments, the AFDC. It did the eligibility determination for Medicaid, so it did meet and work with all the people who wanted to try to sign up for Medicaid. In fact, one of the first things I did was go through that process. I showed up at one of our offices and just tried to go through it. We had a simple system compared to most states because we had one agency, so you didn’t have to go to several agencies. We had one agency that did AFDC, food stamps, child support, Medicaid, and it was still a nightmarish process, so one of the things I worked on was simplifying the eligibility process, out-stationing eligibility workers for Medicaid at some of the big public hospitals so that when someone showed up who was really eligible but had never signed up, you could get them signed up for Medicaid. We did a lot of things that I’m proud of, and I did work on the governor’s plan to get more people covered, which became TennCare.

 

Gary Bisbee  18:04  

How did that experience inform your stop in the federal government as the administrator of HCFA?

 

Nancy-Ann DeParle  18:10  

Well, again, it may have been a rarefied environment and I didn’t realize it. We worked together on a bipartisan basis in Tennessee. Yes, there was politics but—when me, the governor, and his team were working to pass a bill—no one told me any different, so I didn’t just go to the democrats in the house. He had been speaker the house for years, he knew exactly who I needed to go to. He told me to go to everybody and try to get their support, which is what I did, so I learned to work with both sides. I found there was a lot more that we had in common than we disagreed on. I found that people were willing to listen, same with the providers. The essence of TennCare was taking the Medicaid disproportionate share dollars that, under the federal formula, went to hospitals to compensate them for caring for a high number of uninsured people, which in Tennessee, there was a high number of uninsured people. We took those dollars with a federal waiver approval eventually—not while I was there, that happened afterward—and we used those dollars to cover individuals. Then, instead of going directly to the hospitals, they went to individuals who would come to the hospital with coverage, and that became a Medicaid expansion. That’s what TennCare was. The hospitals could have said, “No way we’re getting this money. Yeah, we want you to get people insured, but don’t take this money away from us. I need to be able to count on these revenues.” Instead, they worked with the governor. They were nervous about it, don’t get me wrong, because they’re basically giving up something they had under a formula to agree to let people come in the door with coverage, but they worked with us, they worked with the government a quarter, and they got it done. They got an expansion of coverage. Again, I was too young to know any better at the time, but in the back of my mind, I thought, “It’s possible to get things done.” It’s possible that people will, not work against their own interests. People don’t do that, but people will listen to reason. People will try to meet you halfway. Yes, people are rational economic actors, but they can be persuaded to put the interest of everyone on at least equal footing, if not ahead of their own interest. They’re willing to look at it because we were able to do that in Tennessee.

 

Gary Bisbee  20:35  

That’s a lead-in to your time as Deputy Chief of Staff for President Obama and all the sausage-making that led to the ACA, which was highly political, obviously. Looking back on that, what lessons did you take away from that whole experience?

 

Nancy-Ann DeParle  20:52  

People asked me, “What would you have done differently?” The only thing I would have done differently— Look, do I wish I were clairvoyant about policy and how each thing would work out? Of course I do, but the only thing I would do differently is I would have had Republican support for our bill. When I joined the White House, and you’ll remember this, Gary, because I talked to you about it right when I did it. I believed that after 10 years of bipartisan, strange bedfellows discussions about how to achieve objectives like lowering the cost of care, reforming the insurance markets so that people with pre-existing conditions didn’t have to be excluded, getting everyone into coverage, an individual mandate (everyone having the responsibility and if they couldn’t afford it, getting some assistance). Again, maybe I was in a bubble, but those seem to me to be bipartisan objectives that people all agreed to. I did think, coming into this in 2009, I wouldn’t have taken the job if I thought “this is going to end up being partisan, and there will not be a single Republican vote for President Obama’s vision shared with others.” I know that isn’t what he thought either because we talked about it. Again, I ruined a bunch of pairs of shoes and didn’t get the memo about not working with Republicans because I spent a lot of time listening to them, working through their issues. In the end, there were some hot button issues for them that were not included in the law and a lot of their ideas were in it, and yet they couldn’t vote for it. What did I learn from that? Politics can be ugly. People have teased me about wasting time, and that’s a bit of how some progressives now look at the legacy of the Affordable Care Act and the time that we spent. They say we wasted that time, we should have just passed a bill that had the public plan in it and a more expansive set of subsidies and the things that progressives really wanted. Within a few months of the President’s election, we shouldn’t have tried to work with Republicans. I think they’ve forgotten that it’s not like we had 60 votes at the beginning, first of all. Secondly, that just isn’t who President Obama is or was. He wanted to work with Republicans, in part because he had studied history and he knows that the legislation that has bipartisan support is stronger. It just is. Do I think we still would have had a lawsuit against the law the minute the President put the pen down from signing it? Probably. There was a set of actors who were kind of determined to do that no matter what, but I do think the last 10 years would have been easier of implementing the Affordable Care Act had it not been for how polarized things got.

 

Gary Bisbee  23:48  

It was and, in a way, I think it was the first real sign for the general public about the hyper-partisanship that we’re in now. You just took the brunt of that. Segwaying to the current Biden administration, what advice would you give them regarding the ACA and the moves that they’re making there?

 

Nancy-Ann DeParle  24:13  

Well, I haven’t sat silently for sure. I’ve given them some advice. Among my advice is to look at California, to look at the states where it’s been very successful both in getting a lot of people covered and having competition, holding premium rates down. I believe last year in California the rate increases were less than half a percent. Why is that? It’s because California went all in. It’s because California expanded Medicaid and told the plans, “If you want to be in Medicaid in California, if you want to be part of Medical, great! We would love to have you, but you also need to participate in the marketplaces for the uninsured.” They’ve spent their own money on doing marketing enrollment in California. They have spent money. Even so, the so-called “Young Invincibles” have been hard to bring into the marketplace and it does appear that one thing they’ve learned is that the tax credits to defray the cost of premiums and the subsidies are important. They just went through a round about a year ago of improving VAT in California and it’s made a difference in getting people into the market, so there’s a whole playbook from California of how you go about strengthening this law. By the way, it doesn’t involve a public plan. They haven’t had to do that. They have plenty of competition. I believe we can do that. I believe President Biden has already taken a start towards that and what just passed, the Rescue Act. That’s what I would do: I would build on that foundation.

 

Gary Bisbee  25:51  

It appears he is doing that, and that’s the right thing to do, in my opinion as well. Let me ask a question. It’s a leading question because it’s hard to escape the football over your left shoulder and I know right above that there’s a case with a pretty important pen in it. Can you share that story with us, Nancy-Ann?

 

Nancy-Ann DeParle  26:08  

The box is a fancy box that they gave me with one of the pens that the President used to sign the Affordable Care Act. The football below that has the presidential seal on it. As I was sharing with you earlier, Gary, a lot of people see that in my Zoom background and assume it’s a Peyton Manning signed football from my Tennessee Vols. Actually, the seal on it is the presidential seal. It was signed by the four military aides to the president who were there when I was serving as President Obama’s Deputy Chief of Staff. The night before I left the White House—which would have been January 19, of 2013—there was a knock on my door in the West Wing and I opened the door and the four military aides were standing there holding the football. The football has special significance to them and to me because they travel with the president everywhere and they stand outside his door no matter where he is and carry a big suitcase that weighs 60 pounds. I know this because I’ve picked it up at one point. Inside that suitcase is a machine that has the nuclear codes in it, so that is the so-called “football,” so that’s why they gave me a football. It has a special place in my heart because all of them have a special place in my heart because I got to spend a lot of time with them when I was traveling with the president. To hear the stories of their service to our country, to see what fine young people they are and leaders of our military is really inspiring.

 

Gary Bisbee  27:39  

Speaking of service to the country, many of us are very grateful to you, Nancy-Ann, for the service you’ve given the United States. Well done. On to private equity, where you’ve spent time and clearly are a key outstanding leader in that space, can you share briefly your thoughts about private equity and what you’re doing now?

 

Nancy-Ann DeParle  28:05  

What I have done is work with really the same set of people on and off for almost 20 years. What I love about it is finding innovative healthcare companies that are doing something to improve health care, whether it’s making it more efficient or more effective, higher quality. I love that about health care. You and I’ve talked about this. As long as I’ve been around it, a day doesn’t go by where I don’t meet another company or see something new that’s happening. It’s really, really exciting. I think private equity can fill a very important place in our ecosystem around getting businesses to where they can grow and help people. Our former friend and colleague Neil Patterson thought so, too. He and I talked about it a lot. Often the companies that we invest in, Gary, are family-owned businesses—still founder-owned like the company you and I worked with—that someone just had an idea and was stubborn, and kept working on it and building it and finally it got traction and it’s helping people. Then we come along and we help them grow it further. We help professionalize them in areas where maybe they haven’t been professionalized. We help them make connections to other entities they can sell to if they’re a company that sells a product. It can be a lot of fun just to build these businesses. One of the businesses I was fortunate enough to work on was a company called CareMore. We backed a man named Alan Hoops and a woman named Leva Lesson who’d been part of PacifiCare, which was a Medicare plan focused on seniors—I think the first one that just focused on seniors—which they had sold to United and then they decided they wanted to get back into the business so we backed them to buy a physician group in California that was practicing medicine differently than others. It had a very low medical loss ratio cost, but it wasn’t because they were spending on care. It was because if you signed up with them, they spent time with you. They went to your house. They took the throw rugs out of your house, which is often how seniors end up in the hospital from falling and breaking their hip. That’s not a good story, the way that usually ends. It was very high tech, high touch a very different model for Medicare managed care that was really successful. I remember when we made that investment, going out and meeting with some of our members, our beneficiaries and thinking, “Well, this could end my career. I don’t know if this is a good investment or not. But I know this, they’re taking good care of people,” and it turned out to be a good investment, too. What a wonderful gift that is to be able to do that kind of thing.

 

Gary Bisbee  30:49  

Absolutely. Let’s talk for a moment about your directorships. I sat on a board with you for a number of years. You’re an absolutely terrific director. You’re on a CBS board now. You’re on the HCA board. How do you view your role on a board and particularly the kind of leadership you can provide a company through sitting on a board of directors?

 

Nancy-Ann DeParle  31:12  

It’s a great experience. You missed this, Gary: I said you trained me, which is true. You’ll recall that at my first board meeting with you I was nursing an infant. Not in the board room, but he was there with me. He came to Kansas City with me. What I’d like to do in my career and personally is work with people I respect and I learn from on a mission I think is important. At its best, that’s what serving as a director can be. You are representing shareholders. You are trying to get the best long-term value and growth for their investment. I think about it as though I’m representing the public pension plan. I’m sitting there thinking about my mom who was a state employee. How do we make sure they get a good return? It’s by asking questions, it’s by learning the business, getting to know the management team, making sure we have a good succession plan, a deep bench. All the things you and I did together, it’s the same whether it’s a private company or a public company like CVS or HCA. It’s all those same factors that play into what makes them successful. Watching companies like CVS and HCA this past year has been especially uplifting because, with this pandemic we’ve been through, the healthcare industry has shone brightly. The number of lives that have been saved through testing and vaccinations that CVS is now helping to distribute or the direct patient care that HCA has provided our nurses, our doctors. It’s been an awesome sight. It’s rewarding for me as a director just to be part of that enterprise and to try to help support what they’re doing.

 

Gary Bisbee  33:06  

Let’s turn to women and women leaders in particular. You’ve been active in that regard. We appreciate your time at Her Story earlier. That interview was terrific. I remember a story you shared about advice President Obama gave you. I think it was maybe in the Roosevelt Room? Do you remember that story? Can you share that with us?

 

Nancy-Ann DeParle  33:33  

I remember having dinner with him one night with other women in the White House, that he asked us to have dinner with him. It was during my beginning days there. I was doing something on The Hill and I was told, “Oh, come back. The President asked you to have dinner,” so I ran over. There were maybe 15 women there. It turns out that Valerie Jarrett, one of his senior advisors, had asked him to do it because some of the other women were complaining about the male-dominated culture at the White House. He said to us words to the effect of, “Okay, I get it. I’m going to be paying attention to this, but I need you all also to know that I chose you because you’re strong and because you are able to show up. This is life in the West Wing. You need to show up for yourself.” He was true to his word. There was a time when I experienced a little bullying, but I would have never said anything about it. There’s a copying machine outside the chief of staff’s office, across the hall from where my office ended up being but at the time I had an office over in the old Executive Office Building. I was standing there making copies of something for a meeting. You don’t know this feeling, Gary, because you’re tall, but when you’re not that tall there’s a feeling of when someone’s standing over you, like passing a shadow on the Xerox machine. I felt that. I looked around. It’s President Obama. He put his hands on my shoulders and said, “Hey, I heard that some people were giving you a hard time and I just want you to know I’ve got your back.” I didn’t hesitate. Whether it was walking into the Oval Office in the middle of a meeting when I thought he needed to hear my perspective or giving him my counsel at any other time, which is pretty heady experience for somebody from Rockwood, Tennessee, but he wanted that. He wanted to know. He wanted you to be completely and utterly authentic with him, so I was. The story I thought you were going to ask me about, which I forgot but another young woman tells about me. She wrote an article about when she had been asked to come to a large meeting in the Roosevelt Room. Her name is Raquel Russell and she had worked for Senator Tom Carper. I’d spotted her on The Hill and thought she was really smart, so I recruited her to come to the White House. She was in the Office of Public Engagement doing urban policy, so she was invited to this meeting. I get to the meeting and I look around, I see Raquel. In the Roosevelt Room, there’s one big table that seats maybe 20 people and then there are some chairs on the outside of the perimeter of the room. I see Raquel sitting in one of those outside chairs and the room’s not completely full. I looked at her and I pointed down at my Blackberry—this is back in the day when that’s what we had—and she looked at her Blackberry and I had written to her, “Sit at the table.” She tells the story of how she felt embarrassed that I had noticed and that she was feeling like an imposter being there. I talked to her later and said, “Look, if you’re in the meeting, it’s because I want to hear your perspective. I want you showing up for yourself.” By the way, no guy I’ve ever known—including my son, who was 10-years-old at that point—would hesitate to go sit at the table, so you need to sit at the table. She says she learned a lesson from that, so we try to pass that on but it’s not that easy to do. I’ve learned to sit at the table with my experience, but Raquel had to learn that now. She’s passed it on.

 

Gary Bisbee  37:25  

This has been an absolutely terrific interview, as expected, by the way. I’d like to ask one final question because your career is typified by working in the private sector and the public sector. You’ve been an outstanding leader in each sector. What advice would you give a young person that might be in the public sector thinking about going to the private sector or vice versa?

 

Nancy-Ann DeParle  37:52  

I can’t imagine a better path. The one I’ve taken might seem a little circuitous, but it’s been so challenging, interesting, never a dull moment, so I would say try to go with your gut to some extent. I didn’t exactly do that the last time I went into government. I really agonized because I thought I’d done my government service. I’d run the Centers for Medicare and Medicaid Services, which is the thing I wanted to do. I love that experience and I was getting established as a business person working with you on the board that we served on. That was a joy, so it was a lot to walk away from all that and go back in and try to get something big done, but I wouldn’t have missed that for the world. President Obama used to say, “Dream big dreams,” so I’d say dream big dreams and—whether you’re in the private sector or in government—try to get something big done. You can. It’s within the realm of possibility. If you can dream it, you can do it.

 

Gary Bisbee  38:53  

That’s great advice. As Neil used to say, this is a good place to land. Thank you for your time. It’s very much appreciated.

 

Nancy-Ann DeParle  39:02  

Thank you. I enjoyed it.

 

Gary Bisbee  39:04  

New episodes will debut every Thursday. Join me in conversations to gain advice and wisdom from CEOs, presidents, and healthcare experts. Healthcare leadership is hard work, but it becomes more manageable as we learn from the remarkable lives and careers of our guests. I’ll see you there.

 

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