Rae Godsey, DO, MBA’16, is fluent in many areas of healthcare. A family medicine physician who moved over to the payer side, Dr. Godsey now serves as the associate vice president and corporate medical director of risk adjustment and Stars quality at Humana. Even with her varied experience, she says earning the Physician MBA at the Kelley School of Business helped her see healthcare in a whole new way.
“When I was earning the MBA, I kept having these ‘aha’ moments,” she says. “I realized why my accountant had me do things in a certain way while in private practice. There was a lot lacking without the MBA – it provided me with a holistic view of all the different business components that matter in healthcare.”
In her role at Humana, Dr. Godsey works directly with physicians and healthcare providers across the country to educate them on risk adjustment. Her team teaches physicians and healthcare providers the importance of accurate documentation and coding in order to capture the true health status of their patient population and how that impacts outcomes. Today, CMS hierarchical condition category (HCC) Risk Adjustment models are used to calculate risk scores, which predict individual beneficiaries’ healthcare expenditures, relative to the average beneficiary. Risk scores are used to adjust payments and bids based on an enrollee’s health status (diagnostic data) and demographic characteristics (such as age and gender). The information is also used by CMS to evaluate the burden of illness of patients with Medicare Advantage coverage and to budget and forecast spending for future costs of care.
The MBA provided me with a holistic view of all the different business components that matter in healthcare.”
Dr. Godsey, who was promoted to her current role after graduating with the Kelley Physician MBA, says the introduction of performance-based pay was a paradigm shift for physicians.
“These are things we didn’t consider in healthcare. I didn’t get any training in risk adjustment, but it’s been around since 1997,” she says. “My role the last couple years has been to travel across the nation and work through different channels at Humana to educate my peers and colleagues about risk adjustment, Stars measures and value-based contracting.”
During the Physician MBA Program, Dr. Godsey learned how to put more strategy behind her work. As a physician, she understood her peers’ perspectives and frustrations, and as an MBA, she had direction on how to make inroads.
“The MBA allowed me to speak more clearly to the value of risk adjustment so physicians can understand it from the patient and value-based perspectives,” she says. “Value-based medicine is here to stay, and it’s important to know why it’s valuable from the clinical perspective, too.”
The MBA allowed me to speak more clearly to the value of risk adjustment so physicians can understand it from the patient and value-based perspectives.”
As physicians and healthcare providers move away from the fee-for-service model and towards a value- and outcome-based approach, Dr. Godsey feels prepared to lead in the changing landscape. She applies her newfound business skills each day to help her business move forward.
“The knowledge I gained at Kelley really allowed me to look at everything holistically. I look at utilization, finances and strategy differently now,” she says. “When I’m managing my team, I’m developing success metrics and looking for bottlenecks so we can streamline our processes to be more efficient. And I’m pressing my leaders to do the same.”
Dr. Godsey says one of the greatest takeaways from the Physician MBA Program is the enduring connections with the other physicians in the tight-knit cohort. While she was initially “a lone ranger” in the room as the physician representing the payer side of healthcare, she feels she was able to share her perspective and learn from peers from various disciplines, geographies and healthcare organizations.
“Making those connections across the U.S. was key. Even four years later, though we don’t talk every day, I can pick up the phone and call any one of my classmates, and it’s like an old friend,” says Dr. Godsey. “You get a sense of community when you’re at Kelley. People are there to help you succeed and also to celebrate your victories. I remember when I got my new position; everyone congratulated me. That sense of community was always there and remains there today.”
You get a sense of community when you’re at Kelley. People are there to help you succeed and also to celebrate your victories. That sense of community was always there and remains there today.”
A habitually curious person, Dr. Godsey has never stopped learning. During the Physician MBA Program, she earned a green belt in Lean Six Sigma process improvement. As she found her niche in risk adjustment, she earned certification as a risk adjustment coder (RAC). She says the MBA didn’t just give her new skills in business; it also enhanced her strengths as a leader.
“From a leadership perspective, the biggest takeaway has been in negotiations; understanding that there are often many dimensions and layers to each challenge that we face—whether in clinical practice or managed care,” she says. “We learned to peel back all those layers, find a solution without jumping to conclusions and leverage data and technology to help tell the story. I lead very differently today than I did before the MBA.”
From a leadership perspective, the biggest takeaway has been in negotiations. I lead very differently today than I did before the MBA.”
Dr. Godsey admits she didn’t want the Physician MBA Program to end. In fact, she got so much out of the experience that she wanted to give back to her medical community. She joined the Physician MBA Alumni Board, which advises on the strategic direction of the program, offers mentorship to other alumni and selects alumni events. Not only do alumni connect with each other, but they also network and support new students. She says the program has potential to be an enduring part of a physician’s professional life long after graduation.
“You can complete your MBA and walk away, but there’s so much more to be gained by staying connected to Kelley,” she says. “When I think about what I might want to do next, I consider my sounding board to include the Kelley School, the Physician MBA Program, my fellow alumni and current students. If I were to ever pivot into another area, they would probably be the first people I would call for advice.”
As she considers the path her career has taken and the role the Physician MBA played in the journey, Dr. Godsey doesn’t hesitate to encourage other physicians to take the leap. In fact, she wishes she’d done it sooner.
“Don’t wait. Don’t put off earning your MBA any longer. I put it off and think there were opportunities that I missed. I probably could’ve streamlined my career trajectory a bit sooner had I had my MBA because I learned so much as a result,” she says. “Take that leap of faith; you will not be disappointed.”