Financing a human-focused healthcare system

Karen Dale, CEO of AmeriHealth Caritas DC.

Interviewed by Eric Letsinger.

Karen Dale, CEO of AmeriHealth Caritas DC, emanates deliberate joy in her work which she approaches with unbounded creativity, intense focus on results, and a collaborative, team-centric spirit. As the leader of DC's largest Medicaid managed care organization, Karen is intentional…about everything…seriously…EVERYTHING. As I walk into her office for this interview, she’s already thought through a few options as to where we each might sit to foster the most candid conversation. For Karen, it all matters…and not only is she right, she’s delivering the results to DC that prove it. We choose the chairs by the window “so we can see the people” and we get at it. 

Eric: Your education was in psychiatric nursing. How did you find your way to the health policy and financing side of the table? And how did that early training shape your perspective and prepare you for this role? 

Karen: It’s an interesting story about how everything leads to the right place, eventually. My psychiatric training was so critical because humans are social beings and how we feel influences how we act, respond and engage. Somehow over the years we’ve structured a healthcare system that is not oriented around human beings. It’s quite patriarchal in that it’s largely driven by getting a patient/member to be compliant. I’m incredibly excited to see that it’s all coming full circle, back to some of my early psych training. We’re starting to understand that life, and therefore health, is about defining what you want. We must start there. Therapy doesn’t work unless you get at trust and engagement. Health is not about compliance or the doctor’s office, it’s about knowing and getting what you want. I was ahead of the game on this because of where I started. Everyone is coming around to this thinking now.

My last rotation in grad school was at a psych hospital and it turned out to be the early predictor of where I’d end up. At the time, managed care had not yet come to behavioral health. My senior project, involved creating a different paradigm for adolescent behavioral health inpatient stays to ensure the confinement was medically necessary, and brief. Clinically, this made sense as it aligned with adolescent development stages. I became obsessed with bringing managed care to behavioral health in the same way it existed on the medical side. I was in my early 20’s and proposing radical change which caused quite a stir at the hospital. My mind just works differently. I see unbridled possibilities that are unsaddled with current constraints because of “where we are today.” I like to ask others to lean in with me and imagine…just imagine. I spend time every day intentionally imagining the possible.

On my last day at the psych hospital, the CEO showed up and asked ‘Who and where is Karen Dale?” Everyone pointed at me. I assumed I was in trouble. She asked, “Are you the little lady turning my hospital my upside down? Well, I want to hire you…now.” I said yes and I was off to races.


Eric: You have a reputation for “urgently pursuing for way better.” How do you operationalize that?

Karen: People say I’m lucky, and I am. The universe brings me gifts; things I don’t know how to ask for. What I know to be true is I’m good at recognizing capacity in every individual on our team. I amplify these strengths and connect opportunities with these capabilities. I love finding myself in this dense forest of endless, and often untapped, capacity. Yes, we each bring some baggage, but if you celebrate each person’s good side, you get presented with a dizzying array of new idea generation. One of our team’s most successful project ideas was to give grants to nursing schools to build the field. This idea originated from a most unlikely source of creativity…our compliance officer! Yup…that happened! I have fun being a part of a team of leaders. They energize me and we stick with each other, even when it’s tough, we hang in there.  We’re a team worth being on.


Eric: You’ve adopted an aggressive innovation agenda that includes the Pay For Success work underway with Quantified Ventures. Where did you get your fearlessness?

Karen: Funny…I was recently wondering the same thing. A colleague recently gave me a book by Darrin Donnelly, “Grit: The Power of Passion and Perseverance.” The first thing is we have to stick with the things that we are passionate about. Our passion makes us want to continue doing the “thing” even when you fail, which is inevitable. When we fail at the thing we love doing, then it’s just part of the process of doing what fuels our engines. I got lucky early in my career when I found the thing I’m passionate about (bringing human instincts around motivation to health care). Not everything we try works, but we’re learning at a faster rate than most, and improving at a similarly steep rate.

The second thing about grit is “showing up,” which speaks to the conundrum of health “noncompliance.” We simply don’t understand why people don’t show up for their own health. Then when they don’t, we absolve ourselves. We continue to fail to understand what we don’t know. It’s unlike human beings to not show up; we’re a gritty crew. We have to figure that out. I spend a lot of time thinking about this. We need to listen harder, translate people’s stories into understanding and then operationalize it using human design via multi-channel approaches that meet people where they want to be met (why are we forcing people to use call centers when they text everyone else in their lives?).

My team is getting the “grit” bug. Not only are they showing up, but the passion meter is pushed to the right. I don’t have a lot of patience for things that move slowly when I don’t think they need to. I’ve also got a real sense of urgency about our work, which tends to focus our efforts. My team is so great because they keep bringing me great business opportunities. I don’t know where they find them, but they do. They know what questions I’ll ask them and they know we’re reaching for “way better,” so they don’t bring me small ideas or incremental opportunities with bloated timelines.


Eric: What drew you to the Pay For Success work that we’re engaged in together?

Karen: It’s transformative from Day 1 in the structuring process. You’re enabling us to connect dots, find value, and create payment sources to drive meaningful change. We have wicked, thorny problems. We’re missing lots of pieces of the puzzle we’re working on together, but the Pay For Success structuring process helps us find them, create them; at a minimum, we will identify which pieces are missing. We’re stepping off the curb and getting into the traffic where the action is through this process. We’re finding our way. I sit on a lot of boards, which gives me a view into other organizations. People don’t like change, in general. My team—we thrive on it!


Eric: Why health?

Karen: That’s all my Mom’s influence. She worked at the World Health Organization and placed a high premium on education. During my weekends and summers, she used to make me read health reports from around the world. I’d then have to write about it, or discuss them with her.  She invested in me like that, which is critical for parents to do. Health is both core and complex…I came to understand that early, thanks to my Mom.


Eric: You have a big mission. How do you stay motivated? Is it your daily impact or the future vision that motivates you?

Karen: Working toward the big vision and impact is what gives me juice. Aetna is moving away from “healthcare,” and toward being a health business; they’re committing themselves to be all about wellness. When I read something like that, I’m inspired and eager to tackle the day-to-day work that will change the status quo and move us in that direction. Each day is either learning or advancing toward the possible.


Eric: What comes to mind when people ask you about your biggest achievement thus far at the helm of AmeriHealth Caritas DC? 

Karen: That’s easy…our community investment. It took some time to develop the strategy, create alignment, and get buy-in. However, once that was all in place things really took off. I love working for a company that gives back locally. We continue to look for opportunities to contribute to creating an equitable and resilient DC.


Eric: What would you say to those who are earlier in their careers? Advice? Things to look out for?

Karen: Surround yourself with people who challenge you, then listen hard to them. I’m an optimist, so I need people around me to be my barometer if I’m being too much of a zealot. Collaborate and partner…don’t think you need to, or can, do it alone. Surround your organization with strong partners and don’t expect them to be perfect. Try with them, expect to both fail and succeed with them, learn with them and allow the partnership to evolve as both trust and understanding mature. Some things just don’t work out. Be ok with that for yourself, and be ok with that for others in your life. Just keeping building into the gaps.

Eric Letsinger