Catalyst Conversations

"If his dentist had taken his blood pressure, we likely would have found his autoimmune disease before we needed the transplant."
 
 Helen Drexler, CEO of Delta Dental of Colorado, opens with her own family. Her son saw a dentist once or twice a year while his kidneys were failing, and nobody in that chair took his blood pressure. In this conversation with host Sas Mukherjee she explains why the mouth has been treated as a separate country from the rest of the body: separate providers, separate records, separate insurance, separate rules for what gets paid.
 
 She talks about what gum inflammation can signal elsewhere in the body, why dental insurance grew up on its own track from medical, the dental deserts inside the Denver metro, and a mobile clinic run by two hygienists with a wheelchair ramp that goes to people who have not seen a dentist in years. On the system as a whole: "We don't have well care, we have sick care."
 
 She also talks about the year that was both her best and her worst, how a non-profit plan lives by "no margin, no mission," why fax machines are still everywhere in dental offices, why her son kept asking why he had to pay his deductible again, and what she tells young leaders who want to work in a system that needs fixing.
 
 CHAPTERS
 00:00 Cold open: her son, and the blood pressure nobody took
 00:37 Welcome: Sas Mukherjee introduces Helen Drexler
 01:05 A career that started in the lobby
 01:57 The grassy knoll: best year, worst year
 03:28 The moments that shaped her leadership
 04:54 Mission versus margin in a non-profit: no margin, no mission
 07:07 What counts as meaningful innovation
 08:57 What she is most excited about right now
 10:55 Why dental is still a silo
 13:32 Her son's kidneys, and the blood pressure that was never taken
 15:24 Why dental insurance is not medical insurance
 18:37 Dental deserts in the Denver metro
 20:43 No silver bullet: bringing care to the member
 21:37 The van with the wheelchair ramp
 22:31 The biggest challenge in U.S. healthcare: sick care, not well care
 24:10 Fax machines and the two bookends
 25:33 Why do I pay my deductible again?
 25:55 A CEO says broken, and keeps innovating
 26:40 Advice for young leaders
 28:07 Thanks and close
 
 GUEST
 Helen Drexler, CEO, Delta Dental of Colorado.
 https://www.linkedin.com/in/helendrexler/
 https://www.deltadentalco.com/
 
 HOST
 Sas Mukherjee, President and CEO, Catalyst Solutions.
 https://www.linkedin.com/in/sascfo/
 
 ABOUT
 Catalyst Conversations brings payer executives, clinicians and policy voices into plain-spoken conversations about the systems behind American healthcare.
 
 Watch on YouTube: https://youtu.be/FPksoBeHcGQ?si=53NGyEv0mWBbrStq
 More from Catalyst Solutions: https://www.catalystsolutions.com/
  

"Children are the most vulnerable population in the country, because they don't have a vote. They don't have their own money. They don't have their income. They are not employed. So how do they get healthcare?"

Dr. Vipul Mankad has spent a career in the rooms where that question gets answered. In Part 1 of this two-part conversation with host Sas Mukherjee, he traces the path from a small town in India, where his father was the family practitioner who removed cataracts, delivered babies and managed an epidemic, to Cook County Hospital, NYU, Cornell, and a research career in sickle cell disease.

Then the pivot. Invited to chair a pediatrics department in Kentucky, he decided that working molecule by molecule was too small, co-founded a children's hospital, and watched managed care arrive from the West Coast. When the university realized insurers could cut it out of the network entirely, it started its own health plan. Dr. Mankad became its medical director, and got his first real look at the payer side of the equation.

Twelve years later he reinvented himself again, taking an unpaid role with the Senate Committee on Health, Education, Labor and Pensions so he could learn how health law is actually written. He was there as Kennedy and Hatch built CHIP, and as value-based purchasing, quality divided by cost, became the concept later folded into accountable care.

Part 2 covers what worries him now: Medicaid funding pressure and access, genomics-enabled personalized medicine, and remote home monitoring.

GUEST

Dr. Vipul Mankad, academic physician, pediatric hematology and oncology. Co-founder of a children's hospital in Kentucky. Board member, Catalyst Solutions.

HOST

Sas Mukherjee, President and CEO, Catalyst Solutions.

ABOUT

Catalyst Conversations brings payer executives, clinicians and policy voices into plain-spoken conversations about the systems behind American healthcare.

"The Rural Health Transformation Program funding is not meant to patch operating losses. It's meant to change the operating models."

The One Big Beautiful Bill Act put $50 billion over five years behind rural health transformation. Spread across the states, that works out to a strikingly small number per rural resident, which means the difference between systems that transform and systems that stall will come down to how the money is used.

Host Sas Mukherjee, President and CEO of Catalyst Solutions, is joined by two people who have sat on the government side of this problem:

Lisa Hettinger, former Medicaid Director for the State of Idaho and a member of the Catalyst Solutions Advisory Board.

Adam Herbst, partner at Sheppard Mullin and former Deputy Health Commissioner for New York State, where he oversaw aging and long-term care.

They get into why tightening oversight of supplemental payments matters more than headline cuts ("unpredictability is often more dangerous than outright cuts"), why redeterminations hit rural communities hardest ("most people losing coverage aren't gaming the system, they're missing the paperwork"), and why a decade of technology fixes has failed to stick in rural communities that do not trust outsiders and cannot get broadband.

Lisa dismantles the most persistent myth in rural recruiting: that specialists would come if the town were nicer. "There are no theys out there. We just simply do not have enough cardiologists available, period."

The back half turns to what actually works: regionalizing high-acuity care without abandoning local access, designing sustainability from day one rather than after the grant sunsets, sharing resources across state lines the way telecom companies already do, and using AI as a force multiplier for thin teams rather than as a decision-maker.

"Rural health doesn't lack innovation. It lacks integration and disciplined execution. The future belongs to those willing to transform early, not those who are waiting for relief."

CHAPTERS

00:00 Show open

00:13 Sas Mukherjee on Catalyst Solutions and rural health

01:31 Meet Lisa Hettinger and Adam Herbst

01:56 OBBBA and the squeeze on supplemental payments

03:37 Redeterminations, work requirements and enrollment churn

04:33 "Most people losing coverage aren't gaming the system"

04:51 What rural leaders should redesign first

06:04 Regionalizing high-acuity care without abandoning access

06:35 Why technology keeps failing in rural communities

08:05 Can telehealth replace the rural hospital?

10:37 "There are no theys": the cardiologist misconception

14:13 How vendors earn trust in a low-trust environment

15:43 What the Rural Health Transformation Program is for

16:44 The two misunderstandings that sink applications

18:15 $50 billion over five years, per rural citizen

18:45 Don't ignore history: what past CMS funding taught us

20:16 Where AI is a force multiplier, not a buzzword

21:47 Designing sustainability from day one

23:18 "If you've seen one Medicaid, you've seen one Medicaid"

23:49 "Rural health doesn't lack innovation"

24:19 Shared resources across state lines

28:20 State borders don't define rural communities

31:20 AI, triage and the data trust catch-22

33:51 Closing thoughts

34:21 The Catalyst Solutions point of view

ABOUT THE SHOW

Catalyst Conversations brings payer executives, clinicians and policy voices into plain-spoken conversations about the systems behind American healthcare. Hosted by Sas Mukherjee, President and CEO of Catalyst Solutions.