State Medicaid leaders have the task of providing health coverage to millions of individuals, many of whom have complex health and social needs, while simultaneously facing leadership challenges related to cost-control, adequate access, improved quality, and program integrity. Although Medicaid plays a key role in the U.S. health care system, many states struggle to recruit and build senior leaders with the range of skills and knowledge they need to succeed in their roles.
Medicaid directors have special insight into developing the leadership capacity of their organizations and a vested interest in building a robust pipeline of future Medicaid leaders. The Center for Health Care Strategies (CHCS) recently spoke with Jami Snyder, Arizona Medicaid Director and President of the National Association of Medicaid Directors, about key ingredients to successful Medicaid leadership and why it is important to invest in future Medicaid leaders. Her insights on leadership and pathways to advancing within the Medicaid agency environment offer valuable lessons for tomorrow’s Medicaid leaders.
Q: Can you tell us about your pathway to becoming a Medicaid leader? What was most instrumental to your success in Medicaid, and what leadership skills prepared you for your role as Medicaid Director?
A: I have spent the bulk of the last 23 years in public service, starting out as a performance auditor with the Arizona Auditor General’s office and fairly quickly moving into the health and human services arena, serving as the director of the Arizona Governor’s Council on Developmental Disabilities and then in an operations and compliance role with the state agency that, at the time, administered the behavioral health benefit for Medicaid beneficiaries. From there, I accepted an operations and compliance administrator role with the Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid program, and eventually moved to Texas to serve as the state’s Medicaid director before returning to Arizona to serve as the deputy director and then the director at AHCCCS.
One of the key factors contributing to my success has been the presence of great mentors. I have had the privilege of working with adept, engaged leaders throughout my career, including current and former Medicaid directors like Judy Mohr Peterson, Kate McEvoy, MaryAnne Lindeblad, and Tom Betlach. Their guidance has been invaluable in terms of my understanding of how to juggle the various demands of the job, as well as how to appropriately attend to the sensitivity surrounding certain decisions.
There are a couple of skills that have been particularly important in my role as a Medicaid Director: (1) a willingness to empower those who work for me to think creatively, make independent decisions, and take calculated risks when those risks are aimed at improving member health outcomes and/or the overall health and welfare of the program; and, (2) an ability to remain calm in the midst of challenging situations and provide a sense of stability so the team can make thoughtful, informed decisions.
Q: Why do you think it is important to invest in emerging Medicaid leaders?
It’s imperative that we provide emerging leaders with the tools and development opportunities needed to successfully navigate the increasingly turbulent and unpredictable waters of the nation’s health care delivery system.
A: Very simply, investing in emerging leaders is perhaps the best investment we can make. Up-and-coming leaders are already shaping the future of a program that now serves over 77 million Americans. It’s imperative that we provide emerging leaders with the tools and development opportunities needed to successfully navigate the increasingly turbulent and unpredictable waters of the nation’s health care delivery system.
Q: What are some of the biggest challenges in developing a robust pipeline of future Medicaid leaders?
Medicaid is a fast-paced environment and there is a real propensity for burnout. That’s something we’re consistently trying to address with various tactical moves within our organization.
A: Medicaid is a fast-paced environment and there is a real propensity for burnout. That’s something we’re consistently trying to address with various tactical moves within our organization. For example, we recently started meeting-free Friday afternoons, and we do 25-minute and 50-minute meetings instead of half an hour and hour meetings. We’ve also paired these strategies with a process that allows leaders at various levels of the organization to route requests for a decision electronically, using what we call an executive management decision form, rather than having to hold a meeting in order to arrive at a decision.
The other piece of the equation is the ever-changing nature of the industry. This is something we have started to think about, particularly when it comes to recruitment and the interview process for prospective candidates. We are now considering interview questions that inquire about an individual’s ability to adapt to change and/or revisit longstanding protocols/approaches when faced with new and demanding challenges. It’s increasingly evident that we must recruit individuals and cultivate leaders who really embrace change and see it as an opportunity to advance the Medicaid program.
Q: How do you measure success and know an impact is being made in the future of Medicaid leadership in Arizona?
A: Like most organizations, we conduct an annual engagement survey. That survey is a good indicator of whether we are on target in terms of providing emerging leaders with the tools and resources needed to achieve their professional development goals and whether they feel that their work truly advances the mission and vision of the agency. It’s also important to set an expectation around the need to have deliberative discussions related to individuals’ career aspirations. Those discussions can inform the creation of advancement opportunities for up-and-coming leaders and ultimately assist in retaining top talent. One of the other indicators of success is a higher level of interest and comfort in engaging on topics of concern to Medicaid programs across the country. Several members of AHCCCS’ leadership team have participated in affinity groups, discussions with policymakers, etc. over the last year, aimed at ensuring that various regulatory changes and legislative initiatives support the ongoing stability of state Medicaid programs. Engagement at that level demonstrates to me that we are not only fostering the growth of leaders within our programs but also positioning team members as national thought leaders in the Medicaid space.
Q: What do you see as an opportunity to diversify the pipeline of future leaders and demonstrate your commitment to equity?
Most importantly, we’re aiming to create a culture of equity, where we as leaders are actively working to provide each person with the tools that they need to be successful.
A: We’ve continued to have honest conversations about how we can cultivate more diversity within our workforce. One of the important steps is offering training and development opportunities that speak to identifying bias in our day-to-day work and having the courage to have conversations about biases and inequities that exist within the organization.
Most importantly, we’re aiming to create a culture of equity, where we as leaders are actively working to provide each person with the tools that they need to be successful. That means understanding that the approaches and tools may differ from person to person. We have a menu of development activities that the organization offers, and we continue to expand that menu — looking at opportunities that may appeal to individuals with varying career goals, interests, and learning styles. Some of those learning options have been developed internally and others are professional growth opportunities for emerging leaders, such as those sponsored by valued partners like CHCS and the National Association of Medicaid Directors. The key is maintaining a full continuum of services and supports that is responsive to the varying interests of our workforce.