Healthcare Unlocked: Jeff Grant on Policy, Payments, and People

Speaker A: Welcome to Govcom Unfiltered, where your journey through the labyrinth of federal contracting begins. I'm Alexa Choi, your guide and host on this epic adventure here, we dive deep, uh, into the heart of government contracting, shedding light on the heroic tales of those who navigate its complex terrain. Our mission, to bring you closer to the action, revealing the critical steps, triumphant victories, and occasional pitfalls that our intrepid adventures face. Your journey into the world of government contracting starts now, and we could not be happier to have you with us. Let's embark on this adventure together.

Speaker B: Thank you for tuning in to govcom Unfiltered. Today. Our guest is Jeff Grant. If you haven't heard of him, and if you don't know him, you're in for a real treat. I'm really excited. Looking forward to this, Jeff. Go ahead and introduce yourself.

Speaker C: Thank you, Alexa. I'm Jeff Grant. I have had 42 years of government service between the Navy and the, uh, Centers for Medicare and Medicaid Services. I recently retired from CMS February 28th and started my own company, Schedule F Health Care Strategies. So I'm really looking forward to this conversation.

Speaker B: Perfect. Well, I do love the name of your company. Before we jump into our five questions, can you just tell us why you picked that name?

Speaker C: Well, during the previous version of the Trump administration where we got a lot of major things done toward the end of the administration, they created a special schedule of the civil service called schedule F, where they could shift high powered people over to schedule F, make uh, them at will employees and then terminate them without notice or cause. And then toward the very end of the administration, on the last day, they published a final rule that term limited my job. They did not get that to the Federal Register. They just missed by a day making that an actual term limit on my job. And so I felt with the new administration coming in, there were a lot of signs that they intended to get rid of certain people in certain positions. Not personal, just positionally. They wanted to take over those positions in the administration. So I built a company out named for the way I thought I would be forced to exit the government. And it was also be a place for people to land. If there were high powered healthcare people that were great policy analysts that wanted to build out a consulting practice, I would provide them that place to do so.

Speaker B: So it's kind of like a Deepwater point, I think, which actually got purchased by Wolff Den. And I'm not sure if they've landed on the new name for it, but you know, the place where retired Government folks could come and help build out a consulting practice, correct?

Speaker C: It hasn't worked out that way because they've done things a little bit differently now by getting rid of lower ranking employees rather than the ones that were originally targeted under schedule F. So I've kind of taken a different course, but that course still remains open should schedule F get implemented at some point in time.

Speaker B: I see. Well, thank you so much for that. Let's hop into question number one. So we would love to know from your perspective, a pivotal moment from your early career that reshaped who you are today and maybe something that's not in your official bio.

Speaker C: So, uh, what people won't know is kind of how you become who you become. And my formative experience as a young adult was in the United States Navy and I took on a job as an aviation electronics technician and then in that capacity volunteered to become an air crewman on long range anti submarine patrol aircraft where we would do these long missions. And my job was in flight technician. And I always define that job as troubleshooting and repairing electronics so that we could keep the mission going on these eight hour tactical missions. And I was kind of comfortable with that definition until somebody that I was trading sea stories with about big fixes we had done on flights said, I bet you can't tell me the job of an in flight technician. At the time he was a, uh, trainee in my program, only technically because he was coming back into the Navy. And I'm like, I'm the evaluator for this program. You say I don't know the job. And he says yes. And not only that, you will admit you're wrong when I tell you wrong. So I gave the definition, uh, I just provided that I troubleshoot and fix electronics. And he says wrong. And I said, well, what is the answer? He said, prevent mission abort for avionics. I'm like, okay. You said the same thing. Shorter. He goes, no. You said you fix things. But we've been talking about missions where you troubleshot it and it was something you were unable to fix in flight, so you had to figure out how to complete the mission without fixing anything. And it was like, ah. And that has kind of become what I've done throughout my career is it becomes a feature, things go wrong and some you cannot control, but you cannot allow a thing that goes wrong to derail the accomplishment of the overall mission. So prevent mission abort is like something that got burned into my brain as, uh, that's what you really do. You don't get everything to work the way you think it's supposed to work, because nothing ever works that way.

Speaker B: Facts. So did you tell him that you were wrong and he was right?

Speaker C: So he told me he would bet me a beer. And then I told him, I'm not buying you a beer. Honestly, I did. And he just looks at me in shock. He goes, but you admit you're wrong? I said, yes, I'm not buying you a beer. I'm buying you two. One because I lost the bet, and the second one because you just taught me something I am never going to forget.

Speaker B: Wonderful. Wow. That actually is a really great learning lesson.

Speaker C: Yes.

Speaker B: And then you've applied that same logic to your entire career, which is pretty impactful. So can you. I just want to take this thought and apply it to cms, apply it to Medicare and Medicaid, because as you know, this is a hot topic right now. So let's take that lens and apply it to this agency and talk about, from your point of view, what your job was there and how did you. How are you successful?

Speaker C: Well, from 1999 until I left, I was doing some version of a new implementation on a basically continuing basis, even in the private sector. When I was in the private sector briefly, I was doing new work. And new work always has this great game plan. You're really smart. You're like, this is how we're going to do it and it's going to work wonderfully. And then things start going wrong or the plan is too big and you're like, oh, uh, we can't get all that done. So you start having to reshape the plan either because things break and don't work the way you want them to, but you still have to get done by a certain date. So you have to deliver. And you keep refiguring out how to deliver with the constant focus on what your overall mission is, not how you thought you were going to accomplish that mission. And at times you come back to the original plan and you ultimately implement the full original plan. That's pretty much the exception in my experience. A lot of times your original plan wasn't as smart as you thought it was, because we're never smart enough to figure out everything we need to know until we start doing it. And so you end up with some different version of that plan. If you're smart enough to watch what's going on and figure out how to adapt so that you're focused on the mission, not the plan, to accomplish the mission.

Speaker B: Right. I feel like, you know, especially nowadays it's so easy to get lost in the Susan. Right. It's like, you know, really focused on the things that you're doing to accomplish the things, not the reason why you're doing it, like what you're actually trying to accomplish over here. Right. So this is really interesting. All right.

Speaker C: And uh, there's always a reason that you can find that you can't get something done.

Speaker B: Right.

Speaker C: My whole career was based on finding the way to get it done and never having a reason that we couldn't get it done.

Speaker B: Right. Well, I have to say I've worked with a lot of amazing CMS um, folks. So I believe that, you know, you and the rest of the crew probably were tightly knit group that, you know, had to figure some things out along the way. Perfect. All right, well, so let's move on to question number two. I'm super curious because this kind of goes into question number one. What were some of these unconventional strategies that you use to really advance in government service that others might be hesitant to try, but they should consider?

Speaker A: M.

Speaker C: Well, so way back in the early 2000s, I was working out in the CMS gym with a guy, uh, that I'd known for years in cms. We had come in around the same time and he made some comment to me about how government employees were risk averse and that's why they were government employees. And I think risk is this very broad spectrum. So I will admit that when I was in my 30s and 40s, I didn't leave government, start some startup, put my life savings into it, put my kids college education at risk. So I wasn't way out there on the entrepreneurial startup risk matrix. But I also was not in the what I think, what people think of the category of risk averse government employee. I frequently went after projects that could be impactful, but many people were afraid to take on because you're assuming great personal risk. And also people were afraid to accept the personal risk to put themselves personally on the line, to put their own personal credibility on the line. What I find is that at least if you feel you have a decent understanding of what's been asked of you and that it is able to be accomplished, that then you completely put your personal credibility on the line. You take full accountability for the risk because that just deepens your commitment. If we go back to the first question, you want that full commitment to accomplish a mission until somebody says we're not doing that mission anymore and so you want to be all in on it and taking that personal risk, establishing that accountability just deepens your commitment, but it also shows the team around you that you have fully bought in. And if you want a team to fully buy in, you can't be dodging accountability and responsibility. You have to make it clear that you accept full personal accountability, full responsibility, and that you're there to get it done regardless of what it takes. And so I have found that people will follow you if you choose to lead, but you have to have the courage to lead.

Speaker B: Right. There's a lot to unpack in there. Have you seen Ted Lasso? Because I feel like I have.

Speaker C: I love Ted Lasso.

Speaker B: Me too. I feel like you're preaching from his playbook right now. And you know, his, the way that, you know, he was hired to come in and lead a team of a sport of which he'd never even seen played. It's like soccer. I don't even know how, uh, this works. Right?

Speaker C: Oh, yeah. And the, the beautiful thing, as someone that had like, I came the opposite way. Right. I developed expertise and then came into leadership. So I'm kind of the opposite of Ted Lasso in that respect. What I had to learn was what Ted Lasso knew right away is you don't have to know all this stuff. You've got people for that. And he used delegation brilliantly. He had no idea how to do because he never, he didn't have that experience, but he knew how to lead and he understood his job was to set the tone and then, uh, to put people in places to succeed. It's harder when you actually come in with the expertise. Probably the best thing that happened to me was having to lead healthcare.gov which is a website. And that was my last job, my entire job.

Speaker B: Never heard a small website.

Speaker C: Yeah. But every job I've had prior to that was doing payment, which is back end batch run data faces. You are not forward facing. You don't have a website, you don't have consumers, you're not operating 24 7, 365. I still am kind of like the Ted Lasso of websites. I can get a website to succeed, but I got people that really know how to make it work way better than I know how to make it work. I know enough to get in trouble.

Speaker B: Right? Right. One of the things that I think that you're saying right now that I really loved about Ted Lasso is it's really about the people, right? Correct. It's about leading the people, having the courage to lead the people. And he really came in and was like, I don't know anything about this country? I don't know anything about the sport, but I know people. And it was an incredible story. Story about how the storming norming before you can be performing path works before you even see what success looks like. And some of those peaks and valleys that he had to, uh, really work through in order to kind of get through it. So it kind of sounds like very similar to what you're saying. And we're comparing, you know, healthcare.gov, cMS, Medicare, Medicaid to Ted Lasso. This is a new show. Just wait for season one in a couple years. I keep thinking that Silicon Valley or, I mean, Hollywood's gonna get a hold of some govcon story and make like a series of episodes. That would be pretty funny for us anyways. They have to live it every single day. You just can't make some of the stuff up.

Speaker C: The other thing I love about Ted Lasso is leading with kindness like he proves like in a TV series. But this is something that I think we learned with Hins Desaio, and it was something that I had to be taught because I used to say, I don't care how nice somebody is, if they can get the job done, we're going to get this job done. And I learned I created a false dichotomy between being kind and being good and effective at your job. And actually you're most effective when you can be kind, be a, uh, great coworker, and also be super effective. And I just didn't have a lot of role models of that early in my career when a lot of the effective people were kind of a little bit rough around the edges. And I really got, uh, taught by the people that worked for me. That's not a choice you have to make. You can be both.

Speaker B: You can be both. And honestly, when you're a leader, your only job is to motivate your people. And they're best motivated when you're being kind and understanding where they're coming from and understanding what their challenges are and meeting them where they are. So. And it's funny that you said in your early career, some imagining the military doesn't foster kindness as a leadership tactic. I find that very shocking, sir.

Speaker C: Yeah.

Speaker B: Uh, all right, next question. This is my favorite question, and I'm so glad that you picked this question out of the 10 that I sent. So looking back at your journey, who was the one person that opened an unexpected door for you? And how has that experience really influenced how you help others today?

Speaker C: So that woman is Sharon Arnold. And she was my boss not once, but twice. But the first time that I met Sharon, I had agreed to become the head of budget for a center within cms right after they established the centers, and they had basically not allowed for budget and personnel operations. They had centrally located those. And the centers had been stripped of that expertise. And all of a sudden they had to do budgets, and nobody was there to do it. And I was a special assistant to the guy in charge of the budget committee for the center that went in and got us our money. And somebody said, well, would you come in and run the center's budget? You seem to know a lot about it. And I had told them three times I would not do it because I was a program person. And so even as a program person, you had this concept of who the budget people were. And there were budget people. They didn't do policy, they didn't run Medicare. And that was not the path I wanted. And I was worried that I'd get pigeonholed into budget and never get out. So I agreed to do it for a year. And then I wanted an opportunity to jump to a new job. And I had a concept of what that was. And there were five group directors at the end of that year in the area that I worked in that were told, hey, we would like to place this guy. Will anybody take him? Four said no. Uh, one said yes, and that was Sharon. And Sharon did not offer me one job. She offered me three. Now, I had come into it with an idea of what I wanted to get into, which was payment policy. And only one of them was really operational payment and operational payment policy. And I could get in on the ground floor of what is very commonly known now, but unknown at the time, which is risk adjustment. It is how all of MA payment are made, how the marketplace pays health plans. It's used in Medicaid, it's used in the private sector. But in 1999, it was a startup, and I got in on the ground floor. It changed my entire career. I became the risk adjustment expert. I get paid to consult quite well now on risk adjustment. But what Sharon had done and what I came to see from her as I did that implementation, and then I came back and was her partner on aca. Implementation was how she evaluated people. And it was never by the job they were doing. It was by the capability that they had and, uh, the potential. Like how you saw how they did something, not how you saw what they were doing. And learning to see how to evaluate people for their potential rather than what they're doing at the time allowed me to really get a lot of talent, people around me, as I did implementations and help promote people and move people into the kind of jobs they should have been in, not based on what they were doing, but based on what they demonstrated they could do. So Sharon was really a great mentor in that way. And I mean, she changed my life. I would not be where I am today if I had not gotten to work on risk adjustment back in 1999.

Speaker B: Well, I hope she can watch this and hear how much, you know, she had it positively impacted your life.

Speaker C: I will let her know.

Speaker B: Also, one thing that I really like that you said was, um, you kind of learn to evaluate people for what they've shown they can do. Not really what it is that they're doing. Right. But what that requires is that somebody's paying attention. And in this day and age, and I'm sure you've had to work with some Gen Z folks and you know, millennials, younger gens that are, you know, their attention span may be shorter and even for everybody. Right. Like, our attention span has gone from here to here to like here. So m. You know, that's another aspect of being a good leader is knowing your team, knowing the tools that you have, and knowing how to keep them sharp, keep them motivated, and how to keep them plugged in the right. In the right roles. Right.

Speaker C: And I've never ascribed to these, like assign, uh, a generation to people. People are people. We were weird to the people. Then when I came in the Navy, we were the generation that was a problem for the senior leaders in the Navy when I was a senior leader. The generation that was coming in as a problem, now they're a strength and the next generation's a problem.

Speaker B: Right? Right.

Speaker C: There are changes that happen, but I find this generation exceptionally capable. They think in ways we never thought. They think way bigger than we thought in my generation. I believe I am in awe of them. And we hired mainly junior people and all those junior people really inspired me to be better at my job. So I am a big fan of these younger generations and what they can do.

Speaker B: I also love the idea of paying attention and being intentional about your movements as a leader, which it sounds like Sharon did for you, which was great.

Speaker C: Yes, I will say intentionally opportunistic. So I never have had this charted out career path. And even upon leaving government the last three months, I. I've been about as opportunistic as you can imagine as things come up because I didn't know where things were Going to lead on some of the things I'm working on. And so I have principles that I'm living by. I have things that I want to get done, but the way to get them done, uh, there's so many different paths you can go on. So you just have to look for that moment and then strike when that moment is there to advance what you'd like to get done for yourself. Right?

Speaker B: Right.

Speaker C: Yeah.

Speaker B: I love it. All right, we'll move on to the next question. When you think about your network, what has been your most effective approach for not just building connections, but turning them into mutually beneficial relationships? This question, I think, is why? A lot of people listen to the podcast. The one question I get over and over is, how do I become a better networker? And I'm always like, you know, teaching people how to make friends is really hard. So I would love to hear your take on this one.

Speaker C: Well, I think when I think about networking, I believe people sometimes approach it the wrong way. So there's a great book called Give and Take by Adam Grant. It talks about givers and takers and how people approach relationships. So there are some that just want to get something from every relationship. There are. There are some people that are willing to give to a relationship without an expectation of getting something back. And then there's a big middle where people are very transactional. So you put me on this podcast now, like Alexa, I'm going to have to figure out, like, what I do to compensate you. Or maybe you feel like me appearing on your con podcast is some kind of value to use. So now you owe me something, or I feel that way that the ledger is constantly being tracked. Takers never care about the ledger because they don't owe anybody anything. Givers never care about the ledger because they are never owed anything. And I think networking tends to be thought of too transactionally. So people are doing it like, I'm doing this to accomplish something. No, you're doing it to establish a network, and you never know where it will lead. It may be because I have met you and established this relationship, that at some point you may need a favor. And because we know each other, yes, I can do that favor for you. It may be that I need a favor, and, um, because I know you, yes, you can do that favor for me, but you're not doing it with the intent of advancing an agenda. You're doing it to establish a community. And so I have, for a long time, not really done networking. As I look at it, I have built this community of people that I know. And you never know where that community is going to lead you. There are times now where I'm asking things of that community. I am still giving back to that community. There are communities that I'm giving a ton to without asking anything back ever. And yet sometime, I expect somewhere in the future, that giving act will come back to me. But you're not doing it with that intent. So I think being pure of intent, getting to know people for the sake of getting to know them, being curious about people so that you're really learning about people and using your network to enhance your understanding of the world you live in. And then at some point in time in the future, one connection, one understanding, this broader thing you've established will give back to you. You don't know when that's going to be. It's not like you're just building up these blocks. And then I can take this network and convert it into a promotion or a job or something like that.

Speaker B: Right. This is very good advice. I love it.

Speaker C: And I highly recommend that people read Give and Take.

Speaker B: Give and Take by. What was his name? Somebody. Grant.

Speaker C: Adam Grant. He's an organizational psychologist at the Wharton School. He's off the charts. Brilliant. I highly recommend following him. He's got a podcast. He's just a brilliant person about how to thrive in the world.

Speaker B: I will definitely check that out. I love books along these lines like Eaters Eat Last and, you know, Never Eat Alone. And there's another one called the Go Giver. Like, there's a whole a lot of philosophy around not approaching things in business transactionally because ultimately that doesn't work out great.

Speaker C: And I will say you're going to be humbled by this book because even if you consider yourself to be a giver, I considered after myself reading the book that I was on the giving side of the ledger. I can't hold a candle to most of the people in that book book because he's got the paragons of giving in this book. And some of the things they do just make you say, oh, wow, I could do a lot better than I am. It's a very humbling experience to read about some of these people.

Speaker B: That's great advice. Thank you for the book recommendation. We'll have it in the show notes for sure. Great. All right, so next question. This is our last question. What was a risk that you took that seemed crazy at the time. I think you're gonna. I think I know where you're gonna head with this answer. But at the Time fundamentally changed your trajectory and how did you build the conf take that leap?

Speaker C: So I'm going to talk about three career transitions I took. The first one being I was in the Navy. I was active duty. I was highly successful. I was on the list of people like to get the next promotion as soon as possible. Uh, and I was at the end of my first enlistment. My wife was just finishing up at the University of Michigan. She had just graduated and we were in family housing there still. We hadn't moved out yet. And I was not done with the Navy. I was in Michigan and I didn't get the orders that I was supposed to get. And the detailer was kind of a jerk. And he said, well, your master Chief said, I don't really have to give you those orders because you're a lifer and you'll take whatever set of orders I give you. Now, by rule, he was supposed to give me the ones that I asked for if they were available. And he gave it to four other people, not one. And that was when I realized that I didn't want 20 years of somebody having that much control over my life. And the further you got in toward retirement, you wouldn't be able to get yourself out. And so I made a decision that I was jumping out and going to school. We had a six month old child at the time and my wife was still looking for a job and I was going into the Navy Reserve, which was not going to pay all our bills and I didn't have any scholarships or anything, so. And people told me, you're crazy. You know, you'll make master Chief if you stay in the Navy. You have your whole career in front of you. You're throwing it away. I didn't throw my career away. I made senior Chief in the Reserves and I had a very highly successful civilian career. But I had to just believe that I could get it done. And again, it was belief like, I don't know how this is going to work, but we will make it work. It's the commitment to making it work that my wife and I shared that allowed us to get it done. And then you fast forward many years and I'm 15 years into CMS career and 20 years toward retirement in the government. I only need 10 more years and I can retire and I jump out of government at the end of implementing part D to start a new career in the private sector. And I jumped to a startup that had eight people the year that I joined them. Wow. But they were very good at what they did. And that was, again, I believed in their mission. I believed in the people, and I believed in my ability to be able to contribute, which I was able to. I helped grow the organization. They later sold for around $65 million a few years later. Um, a similar company had sold two years before them for 18 million. So we had. And we were behind them, I would say, in the standings at the time I joined them. So we leapfrogged them and then some. But at the time they sold, I had already come back to the government. So I did not. I had given up my ownership interest, sadly, and came back to the government to work on the Affordable Care act, which was another leap of faith. And, you know, there was a chance that we never got across the finish line. Two years into my stint at, uh, cms, the second time around, we went in front of the Supreme Court for the first time with everybody expecting that the Affordable Care act would be found to be unconstitutional. And I'd be sitting there two months after my company sold with me getting nothing from it, then having nothing on the other side, too. But I believed again in the mission. I believed that we could get it done if we could survive the court challenges. We survived multiple court challenges, and we survived a really rough start, and we got it done. And the reason this was important to me is I'd come into CMS in 93 to work on Clinton's healthcare reform, which never happened. And so 2010 was like this opportunity to do it again. And no matter how crazy and risky it seemed to be to jump into this venture, I really believed with all my heart that it was the right thing to be working on. And if we got the right people working on it, we could get it done. And we have hit it out of the park. I'm very proud of what we got done. Um, almost 25 million people now covered by the marketplaces that would not have coverage otherwise. So I'm very proud of having made that contribution. But, you know, each one of these things was kind of a leap of faith at the time that I did it, that this would all work out.

Speaker B: So I would be remiss if I didn't ask you, since you have such a great long career at the government, but you also have worked on the contractor side as well as. So what would be some best practices contractors could do to show up better for our government counterparts?

Speaker C: So I'll be clear, I haven't. When I was out, I was consulting to Medicare Advantage plans, so I haven't spent a lot of time on the contractor side. I've been a consumer of, uh, contractor services. I've had great results with contractors. I think think I didn't have the term. Andy Slavitt actually used the term, but it was a concept that I had in my head and I'm thankful for the term, which was bagelist team. And he's not the only one to have used that concept. But the whole idea, a lot of times we're putting things together and a contractor is a piece of a bigger whole. And so it's getting back to really the first thing I talked about is what is the mission? What are we trying to get done here? So you've got a contract, you've got terms that you have to meet under the contract. But I've had this conversation with many contractors. If we were having a discussion of the terms of your statement of work. We are not having a successful contract. We are now arguing over whether or not you are successful based on very nitty gritty contract language as opposed to, you know, I was hoping we would get this big thing done together. And now we're talking about whether you're meeting a specific term and condition of the contract, which is not the kind of discussion I want to be having. That's like an assumption that all those will be met. But then how do we exceed expectations and make a super successful program? How do we not say I'm succeeding but Alexa's failing and get into the finger pointing game? If Alexa's failing, we're all failing because the project failed. So don't tell me that one contractor is bad and you're good. Tell me what you're doing to lift Alexa up. How are you lifting the program up? How should I not even be able to see that there's a problem between you and Alexa? Because we're going to work through this because the two of us have committed to the success of the project and that overrides everything else. You can't go outside the scope of work, obviously, but within the scope of work, there's a lot of room to either be a success or a failure. And it's really focusing on what the government defines as success. Now I think that's when you're well managed by the government. I think the other piece of advice is if you're being very poorly managed, manage up and be very firm. Not aggressive, but firm in managing up and be very clear and direct and as direct as you need to be. And don't let any ambiguity by a core or to derail you so that like one day you think they want this, the next day, maybe it's this. Establish clarity. Get it in writing. If there's seems to be confusion about what your top priority is, lay out everything you've heard and say. Can you rank these one to five for me? Because I think you want these five things. We're willing to work on all of them. But tell me what order you want them delivered in, those kind of things. Because I think people don't want to push on the government. They want to maintain the relationship. But then a poor manager will derail the entire contract. And not everybody is great at managing things. You have to help them manage when they're not managing. You have to manage them, but you have to recognize they're your manager too. So you have to do it in an appropriate way. You have to be respectful, but at the same time, get what you need from the cor, from the contracting officer, contracting specialist, so that you can be successful. And they in turn can be successful.

Speaker B: Right. Well, thank you so much, Jeff, for this super enlightening conversation. Catch us next time on UM Gov. Come unfiltered. But for today, have a good one.

Speaker C: Take care. Thank you.