Mark Elson Of Intrepid Ascent On 5 Things We Need To Do To Improve The US Healthcare System
An Interview With Jake Frankel
Corporations can demand quality and holistic care from contracted insurer networks and implement comprehensive employee wellness programs that promote physical and mental health. But they should also give people time off! Support work-life balance! And most importantly, create an environment in which all employees have impactful work to do that directly ties to the company’s purpose and the collaborative teams in which to do it. Team purpose is what we evolved for, so make it happen!
As a part of our interview series called “5 Things We Must Do To Improve the US Healthcare System”, I had the pleasure to interview Mark Elson.
As CEO of Intrepid Ascent, Mark Elson leads a dynamic team empowering community collaboration for health. Each year his company builds new connections between more than 500 partners, supporting coordinated, equitable health and social services for seven million or more people. With an interdisciplinary background in anthropology, technology, and policy, Mark sparks integrated local approaches to address global challenges.
Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a story about what brought you to this specific career path?
Absolutely! I grew up in Lindsay, California, a farming town in the San Joaquin Valley. My mom, Jane Elson, founded and served for years as the Executive Director of a Healthy Start center affiliated with the school district. Healthy Start was an early push for cross-sector collaboration, and her center in Lindsay was a one-stop shop for families in the community. If a kid showed up at school on a cold January morning without a coat, the teacher would let Healthy Start know, and a case manager would visit the family. In many cases, the family would soon be connected to all the services they were eligible for — many of which were provided at the center itself — so people wouldn’t have to drive to a nearby city for Alcoholics Anonymous in Spanish, a dental visit, parenting classes, etc. My mom was an inspirational and impactful leader in the community. Her example undoubtedly gave me the confidence to lead Intrepid Ascent from an exclusive focus on health information technology to a broader vision of community collaboration for health.
Can you share the most interesting story that happened to you since you began your career?
When I started working in health care consulting and technology, I thought I might need to check my anthropologist hat at the door. But from day one, I saw social science linkages everywhere: cultural codes of conduct from the clinic to the conference room, complex and often inequitable socioeconomic systems, policy-driven markets filled with creative actors both competing and collaborating, resilient community networks.
Nevertheless, it wasn’t until I started working with an executive coach several years ago that the deeper, more personal side of one of anthropology’s animating concepts — culture — became core for me again. My coach, Kate, is an amazing person who uses her super intelligence and heart to force her clients to take a hard look at themselves in a dynamic process that uses business and personal challenges as opportunities to dig deep and transform.
At the end of her six-month curriculum and having passed through surprisingly dark places (I thought I was all good!), we landed on my superpower: I create vital connections that foster authentic courage. I now realize that my leadership at Intrepid is one way that I do this, bringing people together to support each other in taking their next courageous leap. We do this with each other at my company, and we do this with our clients. It’s a key part of our vibrant culture of authentic leadership, which I like to think is reflected in how we engage with our clients and staff.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
Sure, but let’s say that this was the start of a process of evolution rather than a mistake!
When I started Intrepid 10 years ago, all my business partner Alex Horowitz and I had were some contacts, relevant experience, and the conviction that we could make a difference in our field at the time of health information exchange. We rented a small office in a co-working space in Berkeley, California, and got to know a web designer from Venezuela who offered to stand up our website for a few hundred dollars, and a designer from Michigan who offered to create a logo for a few hundred dollars more. After a brief initial meeting, the designer went off to work up an image of our logo. A few days later, we met again to see our future revealed in front of our eyes! The designer was excited, too. He explained that we needed an animal, like Geico, to make a memorable visual impact. Alex and I would never have come up with such an idea ourselves, but we must have thought that’s what we’re paying a designer to do!
Next came the moment of the big reveal: Our future identity was a big, friendly St. Bernard with a barrel of whiskey around its neck, complete with a white cross on a red background, against a backdrop of Alpine peaks, and our name, Intrepid Ascent, in an old-timey font above. My mind ran from, “What in the world?” to “Awesome!” We were super impressed that he had seemingly created something out of nothing. The metaphor seemed so close: We’d guide our clients to the heights of…the Alps of health information exchange?… But did St. Bernards guide people or only dig them out of the snow?… Should we get little barrels of whiskey with the red cross symbol for potential clients?… and so on. One of us had the bravery to ask about the possibility of mountains without the dog, an idea which was rejected by the designer. So we went with his expert opinion and embraced it.
And the dog was memorable! In meetings with potential clients, we’d always get a question about our name and the logo; it was a good ice-breaker. Some people even told us they loved the dog! But a few years later, when we did a brand redesign, the marketing firm had a full set of internal allies on our team ready to deliver the message to Alex and me: The dog must go. We resisted mightily for a couple of meetings, having come to identify with the image, but we could see the writing on the wall. Once the decision was made to thank the St. Bernard for its service, we sheepishly walked out of the room, tails between our legs, perhaps hoping to see a big furry friend come bounding around the corner, jump up to lick us in the face, and give us one last shot of whiskey.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
I have always loved this quote from the Greek philosopher Heraclitus, “You cannot step into the same river twice.” The world is dynamic, flowing around us, emerging new every day.
One implication is that you can make an impact even with limited experience. I often have this in mind when encouraging younger colleagues. My first job in health care was as the proposal manager at a mid-sized consulting firm in a skyscraper in downtown San Francisco. All very fancy in my eyes! But within several months, I was able to talk and write semi-intelligently about emerging care models. These models and the policies, practices, and technologies supporting them were coming together for the first time. I learned so much from a seasoned physician leading the development of the Patient-Centered Medical Home model and was able to help the company in its support of this model because it was a new river we were all stepping into. Change opened up space for a newbie like me to lean in and contribute.
How would you define an “excellent healthcare provider”?
An excellent health care provider gets to the truth of your condition, shares that truth with you in an honest and human way, and collaborates with a team to surround you with the care you deserve to get and stay healthy. Clinicians who provide excellent service — and health care is a service — build trust and momentum by balancing their authority with humility, both in their interactions with you and with other members of the care team. They leave behind medicine’s paternalistic tendencies, recognizing that patients are experts in their own lives and that both other clinicians and non-clinician care team members have essential contributions to make.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
I can’t stop thinking about two books I’ve read that have exactly the same title! Emergent Strategy, by adrienne maree brown, and La Estrategia Emergente (Emergent Strategy), by Alejandro Salazar, which hasn’t been translated from Spanish into English yet. The first is an inspiring application of ideas from evolution and complex systems to personal, organizational, and community growth. Living in the sweet spot of mindful adaptation is the goal. Shift from a focus on strategic planning to strategic intentions, build trust, then relax into decentralization. I love her idea that adaptation reduces exhaustion. As she puts it, “What is easy is sustainable: birds coast when they can.”
The second book relates lessons from this same body of knowledge to organizational growth in a focused way. We’re incorporating key ideas from the book within my company. Basically, the approach is that you open up a process, really a sustained conversation, to identify unexpected positive results bubbling up for you and your clients, emerging value that wasn’t predicted in the last strategic plan. This leads to a breakthrough that challenges the current understanding of the organization, and hard choices based on this breakthrough follow to reframe your distinct capabilities and value. Lean into this change, then hit repeat. As both authors would say: Strategy is a conversation that never ends.
Are you working on any exciting new projects now? How do you think that will help people?
In our service model to promote community health, at Intrepid we work both with hubs that directly foster collaboration across public and private partners and with the spokes as well: from hospitals and clinics and health plans to local government, social service providers, housing agencies, and others. We recently committed to working with schools and other organizations focused on children and youth, seeking to support them as a key contributor to community health. We now have an initial school district client, are doing policy work in another community to enable data-sharing between schools and other partners, and recently completed an assessment of the data assets of a network of school-based clinics. Enabling schools and other organizations serving children and youth to participate (and to be compensated) fully in collaboration for the health of young people will have a profound impact, community by community, as these young people grow. I love how this brings me full circle to my mom’s work leading a Healthy Start center that I mentioned earlier!
Ok, thank you for that. Let’s now jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
Let’s start on the bright side. Many people in the US receive health care services that are among the best in the world. Second, the US system compares well on key process measures “such as influenza vaccination rates for older adults, lower rates of postoperative sepsis after abdominal surgery, and more use of patient-facing health information technology for provider communications and prescription filling.” And third, as recently reported by the New York Times, the rate of Medicare spending increases over the past decade has dropped dramatically, generating $3.9 trillion less in spending than anticipated, relieving a major threat to the US budget in the process — and no one knows exactly why. “Older Americans appear to be having fewer heart attacks and strokes … [and] parts of the health system appear to have become more efficient.” So something is afoot, and I’d wager that key factors include the shift during the same period toward greater access to care via the Affordable Care Act, the slow and steady transition to value-based payment, including by Medicare, and the adoption of Electronic Health Records and associated approaches to health information exchange that reduce fragmentation and duplication of services.
Nevertheless, even if some health care outcomes stand out, we’re just scratching the surface when it comes to overall health outcomes for three primary reasons. First, the health care system is an island in the ocean of society, and our society nudges people to choose sedentary, screen-filled, and lonely lifestyles in far too many ways, which are baseline factors for the chronic conditions that overwhelm our clinics and hospitals. Structural inequality further circumscribes options for healthy lifestyles for a shamefully high percentage of Americans. Second, barriers to consistent access to the health care island for high-quality care is all too difficult for many, even in the wake of the Affordable Care Act, especially among historically marginalized groups. And third, health care financial incentives continue to favor volume (as in, how many knees can we place today?) over value (as in, how many people can we connect with for preventive checkups to help them stay healthy)?
As a “healthcare insider”, If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system?
For sure. I’ll offer a change for each of the three drags on health outcomes in the previous question.
First, given that health care doesn’t have a monopoly on health, it’s time to get off the island. The good news is that the move upstream toward prevention and addressing social drivers of health is real. We’re participating in this tremendous step from health care organizations to strengthen and collaborate with social service providers to provide whole person care to vulnerable populations. But it’s not enough. So let’s re-invest a big slice of the $3.9 trillion in Medicare savings over the past decade into social programs. The high-income countries with much better health outcomes than the US all spend significantly more per capita in this area, and it’s not a coincidence. In the long run, a healthier and happier population works harder and smarter, generating a return on investment for the government through higher tax revenues.
Second, to address limits on health care access, let’s make the Affordable Care Act Medicaid expansions permanent, expand safe health care access to immigrants regardless of status, and structure federal incentives for population health improvement so that the states that sat out expanding Medicaid seriously consider coming back to the table.
Third, scale value-based payment from pilots and voluntary programs to mandatory and permanent payment reform across public and private insurers. We’ve got the care models, the data infrastructure, and the community will to do it now and to do it right. This would push the first two changes — the move upstream to address social drivers of health and health care access — across the tipping points they need to reach orbit with sustainable momentum.
What concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
Great question — let’s start with individuals. Policy changes cannot solve problems for people, but they can create favorable conditions for people to face their challenges with courage. The more favorable the conditions, the more likely that people will feel their agency to choose health and well-being and to take responsibility for this choice. In interactions with the health care system, this involves engaging in shared decision making with our physician or care team.
Community is where life happens and is often the determining factor in our health. We have similar health outcomes as our friends and as people in our zip code, and we have better health outcomes simply by spending time with other people. This means that community leaders improve health when they build opportunities for civic, social, and cultural engagement.
Local health and social care providers can manifest cross-sector collaboration to address social drivers of health for community members in three key ways. First, gather around common tables to learn about each other and identify shared strategic intentions. Evolve this into shared governance when possible. Second, reimagine the care team beyond the four walls of your clinic or organization. Third, implement collaboration workflows for newly distributed care teams rooted in the experience of the individuals served.
Corporations can demand quality and holistic care from contracted insurer networks and implement comprehensive employee wellness programs that promote physical and mental health. But they should also give people time off! Support work-life balance! And most importantly, create an environment in which all employees have impactful work to do that directly ties to the company’s purpose and the collaborative teams in which to do it. Team purpose is what we evolved for, so make it happen!
Leaders can listen; it all starts there. Learn to listen to both qualitative and quantitative stories coming from all directions. Channel your listening and strategic conversations into hard choices to focus on real value. And don’t obsess over making data-“driven” decisions” — you’re not an algorithm, so aim for data-informed. Stay open so you notice the diamonds in the rough, knowing that there are plenty given the opportunities to make real progress toward healthy people and communities.
The COVID-19 pandemic has put intense pressure on the American healthcare system, leaving some hospital systems at a complete loss as to how to handle this crisis. Can you share with us examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these issues moving forward?
The COVID-19 pandemic exposed fissures between local public health agencies, on the one hand, and health care providers on the other. Here’s a simple example related to data infrastructure: Most primary care physicians did not have ready access to their patients’ COVID-19 test results coming out of public health labs, making it impossible for them to proactively support many of their patients with COVID. In Santa Cruz, we worked with the County and the local health information exchange organization to enable COVID test results to flow from public health labs to providers across the community. Advances like this took place all over the country, so now we’re better prepared for the next public health crisis. However, the federal funding that flowed to local public health departments to address the pandemic is now coming to an end, exposing systemic underfunding once again. For public health to thrive across our communities, we need commitment to sustained budget support.
How do you think we can address the problem of physician shortages?
We need to make it so that nurses, physician assistants, nurse practitioners, and case workers can practice at the top of their license. This allows for a more efficient distribution of responsibilities within the healthcare workforce. Additionally, supporting patients with knowledge and involvement in their care can lead to more effective healthcare utilization. In that same vein, dedicating resources to preventive measures and promoting overall well-being can alleviate some of the burden on our physicians and emergency rooms, ultimately contributing to a more balanced and sustainable health care system. Finally, artificial intelligence may offer opportunities to reduce administrative burden on physicians, enabling them to focus their time with their patients in the most impactful way.
How do you think we can address the issue of physician diversity?
We need to make a basic commitment to equitable primary and secondary education. We need to ensure that recruitment and counseling happen across the country among all interested schools and students. And finally, as the nature of practicing medicine evolves, we need to make sure that physicians do not need to check their full humanity at the door, something critical to young people today; doing so may help the profession regain the draw it has had for past generations.
How do you think we can address the issue of physician and nurse burnout?
I mentioned a few ideas in the previous two responses. Distribute responsibilities better with other caregivers. Channel more resources toward prevention — and primary care. Explore AI and related tools to reduce excessive documentation and administrative burden. And most importantly, create work environments in which physicians draw upon their full selves, rather than feeling like highly trained cogs in a bureaucratic machine. As a start, use human-centered design practices to understand and grapple with provider experience.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)
I’ve got two for y’all. Take your pick or major bonus points if you do both, and a gold medal if you combine them!
- Learn another language. Like, really learn another language and use it in your daily life! Make all schools in the US mandatory dual-immersion so our children graduate bilingual (I’d advocate for Spanish/English in most cases). Adults can learn too! The resources available for language-learning today are amazing. I’ve spent the past five years becoming fluent in Spanish, and it’s changed my life. Spanish, by the way, is very hard. I’m not sure why I hear folks say that it’s easy — they clearly haven’t gotten to the subjunctive! Learning another language aligns with so many of our best values, reclaims intellectual territory we’re ceding to the machines, and enables human connection and cultural understanding in surprising and wonderful ways. Embarking on this path allows you to inhabit both fun and challenging new roles. For me, this meant basically becoming a kid again, the person in the room making the most mistakes, which you absolutely have to embrace. Now I’m almost back to being an adult. :-)
- Take up birding! It’s a great entry point into the web of relationships in the natural world all around us. Birding gets you outside and teaches life-or-death lessons on climate change and biodiversity through some of the most beautiful creatures on earth.
How can our readers further follow your work online?
https://www.linkedin.com/in/markelson/
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.
