Interview with Allison Rizer, Principal with ATI Advisory. Established in 2014, ATI Advisory(ATI) is a DC- based advisory services firm that helps business and government leaders transform care delivery for frail older adults and their families.
1. You have been a leader with ATI Advisory for just over a year. Tell me what it was like joining this organization at the start of the pandemic.
I often refer to my first day with ATI as “the day DC shut down.” It was March 16, 2021.Washington, DC (where our office was located) had been rolling out various public health emergency orders. The area had just experienced our first local COVID death, and cases were starting to tick up. It was an unusual time to start a new job – I met a co-worker in the parking lot of a diner to get my new laptop. We were both masked up and kept our distance. My oldest daughter was in the backseat of my car because schools had just temporarily closed, and they hadn’t figured out a virtual plan yet. I recall disinfecting the laptop box when I got home – there was still so much uncertainty about the surfaces the virus could linger on.
Despite this rather unconventional first day, I felt like I was part of the team immediately, and there was a sense of resolve among all of us to do something meaningful in the context of the pandemic. Our firm focuses on Medicare, Medicaid and long-term care across a spectrum of clients including providers, health plans, foundations, investors, think tanks – nearly every inch of our business was directly impacted by the pandemic. But because ATI is a smaller organization, we were able to pivot quickly, in a way that helped our clients make some sense of COVID. We dug deep into COVID waivers, we pushed out a significant amount of information on policy changes, we evaluated the role of telehealth, we shared data on the disparate impacts of the virus on low-income individuals, we worked with providers and caregivers. It was fast moving and dynamic, and everyone felt the urgency to do something.
2. What attracted you to an organization like ATI Advisory?
So much – most importantly, the team culture. It was palpable when I was interviewing here. There’s a strong spirit of collaboration at ATI and an emphasis of ensuring everyone shines. I often heard the phrase “culture eats strategy for breakfast ”when I was working on my MBA, and it’s so true.
Similarly, there was a lot of mission alignment. The entire team is passionate about the work we do, but in particular, the CEO (Anne Tumlinson) is genuinely committed to improving the healthcare experiences of frail older adults. And she’s pragmatic. ATI feels really close to the “issue” – like we’re having a direct impact.
Something else attractive to me was the size and growth trajectory of the firm. ATI is a newer company, and there were only six staff when I joined. I loved the idea that I could have my fingerprint on growing and shaping an organization – to feel like I was directly a part of building something. There are definitely advantages to working for a large organization, but it’s harder to influence internally, and this was something I was craving.
And finally, our work spans the spectrum of health plans, providers, policymakers, foundations, researchers. I really appreciated the diversity in stakeholders that ATI works with. Having the perspectives of the broader ecosystem is important if you want to effect meaningful, sustainable change. All around it felt like a great fit.
3. What kind of impact has COVID-19 had on the populations you support?
Significant. ATI generally focuses on the frail, elderly population – individuals with long term care needs for example – and this population was at the center of the COVID pandemic. We also do a fair bit of work focused on dual eligibles –individuals who have both Medicare and Medicaid. Dual eligibles are medically, functionally and socially complex. They’re low-income. They’re more likely to be Black or Hispanic than the general Medicare population. And they were by far the most adversely affected by COVID. They had the highest hospitalization rates. And now we’re seeing that they’re potentially resistant to COVID vaccination.
4. How has the changes by CMS around stopping direct contracting apps for some providers impacted patients and/your firm?
We were disappointed when the announcement came out, but we also appreciate CMMI wants to be more intentional about its models. ATI works with providers across a number of different Medicare ACO and risk-bearing models, and we were enthusiastic about the potential of direct contract.
I was particularly excited about the Medicaid MCO direct contract model and was hopeful it would give states the ability to promote Medicare-Medicaid integration for their dual eligibles. Nationwide, about 60% of dual eligibles are in Medicare fee-for-service, which means plans and states really have no ability to coordinate their complex needs, and this model was aimed at addressing this serious gap. These are vulnerable individuals and our system needs better options to serve them.
5. Have there been any positive changes or “silver linings” resulting from COVID-19that you have identified?
Several, yes. There’s the professional element where everyone is Zoom-ed out, but this has also allowed us to recognize how far we can push technology to feel like we’re physically together. It has pushed team dynamics a lot too, creating connectivity regardless of geographic location. For ATI, it’s opened up our recruiting nationwide, which I think has been a positive. It’s also given us a glimpse into everyone’s life in a more personal manner, which helps to humanize the people you work with and can forge stronger work relationships.
In terms of the healthcare system, I hope the silver lining is a more public awareness that our LTSS (long-term services and supports) infrastructure in this nation is severely underfunded and policies don’t appropriately match the needs of our country. COVID has shone a spotlight on this, both in terms of facility infrastructure as well as softer infrastructure like caregiver and direct care workforce capacity. COVID also accentuated the racial and social disparities that exist in our healthcare system, which I think has and will continue to increase efforts to better understand and address these disparities.
6. What types of trends do you see in the future of LTSS?
An increased shift to the home, an emphasis on technology and an effort to provide coverage in a more holistic manner. First the home – the policy environment was already trying to head in that direction both with long-term care and primary care, but COVID accelerated it by years. Facility settings will rebound, but I hope in amore modern, innovative manner.
Technology and telehealth also grew by lightyears during the pandemic and we will continue to see it grow, whether it be advanced or enhanced remote patient monitoring in the home or other technology solutions to complement the caregiver workforce.
And generally, policymakers, providers, health plans, researchers, others – they’re all thinking more holistically about how an individual’s needs evolve. The pandemic raised awareness of social isolation, other social needs, unmet LTSS needs. We started to see incremental opportunities with Medicare Advantage benefits several years ago, but I expect we’ll see more solutions and proposals emerging to provide expanded services to individuals who are at risk for needing LTSS in the near future, or who have vulnerable social needs.
7. Have you needed to hire any key roles this during the pandemic? If so, how hasCOVID-19 impacted obtaining top talent?
We have! When I joined, we had six staff and now we are at ten, including several senior hires. The virtual experience of COVID has opened up opportunities for staff to work in geographies beyond the immediate Washington, DC area. This has expanded our recruitment efforts in a way that I think is positive for ATI – it’s allowed us to bring in expertise and perspectives we otherwise might not have been able to bring in. And I think it’s changed our longer-term approach to “team” for the better. We’ve become incredibly intentional about touch bases and virtual facetime to ensure we all feel connected, regardless of ZIP code.
Something else I hope COVID has done is increase the focus on healthcare and long-term care as a career path. It’s likely too soon to tell, although we’ve definitely seen a fantastic amount of diversity in the backgrounds of our own candidate pool, but I truly hope this pandemic inspires many brilliant minds to seeks the solutions we need in our healthcare system.
8. What is one piece of advice for more junior talent getting to roles supporting the aging population?
Find a role where you can be exposed to as much of the system as possible. It is so easy to get stuck in the view of a single stakeholder, a single sub-population or a single payer. Throughout your entire career journey, it’s important to understand the impact of your work on the whole system. But in particular as you are beginning your journey, try to become exposed to as much of the system and the various stakeholders as possible. Providers, states, health plans, patients, families, federal policymakers – I heard someone once referred to the healthcare system as “whack a mole” where you focus on one issue and another pops up. This is so true, and if you don’t anticipate the next issue, your current solution falls apart. I’ve seen a lot of policies and programs that looked great on paper fail in reality, because they were built without the full appreciation and perspectives of all the affected stakeholders.
And seek out a company that will support your growth! I mentioned earlier, culture is a large reason why I chose ATI. Exposure to different leadership and management styles is important. You can learn so much from those around you, and you need different styles depending on where you are in your growth. And most of all, stay curious. There is always more to learn.
Interviewed by Alex Drury, Principal, Morgan Consulting Resources, Inc. (6/8/21)