Meet Meena Seshamani, MD, PhD: She’s the optimist leading the Center for Medicare at the Centers for Medicare & Medicaid Services (CMS) for the U.S. Government. When much of the healthcare industry seems threatened by buckling budgets and an overextended workforce, Dr. Seshamani’s vibrant personality, tireless work ethic, and motivational leadership style are buoying the teams that run operations and policy for the health coverage of the 63 million Americans in the Medicare program. Among her colleagues, she is known as a boss who meets her employees in the trenches and works beside them.
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February 2023As a John Hopkins-trained otolaryngologist and an Oxford University-trained PhD in economics, Dr. Seshamani’s penchant for healthcare reform has overlapped for decades with her life as an otolaryngologist. During her residency years, she forged a path that was, as of that time, untraveled: While her co-residents tackled basic science research at various Hopkins labs, she investigated how businesses made decisions to offer health benefits to their employees, and she scrutinized how the U.S. healthcare system was financed.
Working to ensure that the program is affordable and sustainable for future generations is the north star of a lot of the work that we do. —Meena Seshamani, MD, PhD
This was the setting when, during the fourth year of her residency, Dr. Seshamani was recruited to help found the Office of Health Reform at the Department of Health and Human Services during the Obama administration. Acknowledging the value of pursuing such an experience, her residency program director at Johns Hopkins worked to help grant her a leave of absence so she could accept this opportunity. During those two years, Dr. Seshamani drove regulations to implement the Affordable Care Act.
Dr. Seshamani has ascended to the upper echelons within both surgery and health reform policy in a world where women are far outnumbered by men. She evinces no sense of weariness or disenchantment from the challenges she endured to become the director of the Center for Medicare. “I think you need to have a clear sense of the ‘true north’ that guides you. Discover what fires you up, what gives you joy in the work you do, and see what opportunities there are. It is incredible when the decisions you make reaffirm your passions.”
Seeing how she makes improvements every day that impact millions of people is the true north that guides Dr. Seshamani. And isn’t that incredible? I was curious how a leader of Dr. Seshamani’s caliber remains tirelessly optimistic and motivated about her work so that she can successfully tackle the daunting project of healthcare reform.
This interview was condensed and edited for clarity.
SR: What does a typical day look like for you?
MS: I spend my time in a few different capacities. One is working with the team that implements Medicare policies and operations to make sure that our programs are running smoothly. I spend a lot of time guiding the team: crystalizing how we can advance health equity, how we can expand access to coverage and care, and driving innovation for high quality, whole-person care. Working to ensure that the program is affordable and sustainable for future generations is the north star of a lot of the work that we do. That’s one bucket of what I do on a day-to-day basis.
Another is engagement. I know all too well, because I was actively practicing medicine as of a year ago, that while you can have a 2,000-page technical regulation, what does that truly mean when someone needs healthcare? It means we must be able to listen to everybody in the ecosystem—physicians and hospitals, community organizations, people who represent patients—and understand where they see opportunities for the healthcare system to improve, and also get their feedback, after we implement a policy, about what parts of it are working or are hindering care. There’s both that internal nature of driving the work forward, and then the external engagement.
Also, within the administration, I do a lot of work with the Hill, interfacing with the White House and other agencies, to coordinate activities to advance President Biden’s priorities.
SR: What experiences helped prepare you for your work leading the Center for Medicare at CMS, including briefing the President and his team at the White House?
MS: I think we get very good training as surgeons to present complex ideas in a succinct and concise manner. I believe that training helped me learn how to distill concepts, to be able to tell people what they need to know, to be able to organize and explain complex pieces of information in an expedient fashion.
SR: Does watching your family’s relationship with the U.S. healthcare system inform your work at CMS?
MS: Of course, although not only my own family. There are so many times when I was caring for patients and thought, “Gosh—I want to make that process of care better, for this patient, and for everyone who comes after him.” That drives a lot of what I do.
My child is also one such example. I have a 10-year-old who has bilateral hearing loss. When legislation was being considered to bring dental, hearing, and vision benefits to Medicare, my child said to me, “Mommy, when are you going to get hearing aids for people with Medicare? Because I wear hearing aids! You know how important this is!”
SR: It sounds like your child’s aware and engaged in your policy work, even at such a young age. Tell us about your path as a doctor before working at CMS.
MS: I did a lot of volunteer work in hospitals when I was younger, and I really liked helping people in that clinical way. I assumed I’d go to college, major in biology, and become a physician. Then, I took an economics course the second semester of my freshman year and realized I really liked economics. In fact, I ended up majoring in economics, while also completing my pre-med courses. Toward the end of my undergraduate years, I took a class in health economics. We studied health policy and the imperfections of the healthcare market; that inspired me to write my undergraduate thesis in healthcare economics. In that way, I brought together my academic interest in economics with my love of healthcare.
When I started medical school, I received a Marshall Scholarship, which enabled me to also complete my PhD in health economics. I wanted to do more in the space where medicine and economics intersect. When I returned to medical school, as I was planning my rotations, I decided to complete my surgery rotation first. During that rotation, I kept thinking, “Surgery is so great!”
SR: Was that the point when you realized you had a genuine passion for surgery?
MS: Yes! At the same time, though, I started to feel a sense of panic because I realized I wasn’t going into internal medicine like every other person who was performing the kind of research I was passionate about. I expressed this concern to the late J. Sanford Schwartz, MD, a legend in my field and mentor of mine, and he told me, “You should go into whatever medical field is really interesting to you, and you’ll find ways to bring your interests together.” That was heartfelt advice that helped give me the confidence to continue on my path.
SR: His advice sounds inspirational. Did you find that you followed it?
MS: Absolutely. I ended up going to Johns Hopkins for residency in part because Lloyd Minor, MD, who was the chair of the ENT department of the time, said, “We need to get more people from surgical fields into health policy and healthcare management.” He was willing to let me pursue my passions at Johns Hopkins. Through the healthcare economics research that I had completed, I ended up getting to know people in the health policy world. Then, in 2008, when Obama won the Presidential election and his team was making a concerted push for healthcare reform, the administration contacted me and asked me if I would be interested in joining them in their work at the White House.
At that point I was still in residency, and I said, “That’s great! I can, you know, help you with some research projects.”
And they told me, “No you don’t understand; we mean that you have to come work for us full time.” I explained that I was actively completing my rigorous residency training where I couldn’t easily leave to take up a new job somewhere else—or so I thought!
But when I shared this job offer with my program director, he and my chairman said to me, “This is a once-in-a-lifetime opportunity. Let’s see if we can make it happen.” And they did.
SR: It sounds like you’ve had some wonderful mentors who helped support you along your path.
MS: Many of the interactions and sense of purpose that drive my life are and have always been about my relationships with people. I have my relationships with my own mentors and teachers. I have relationships with the 790 people who are my direct reports on the Medicare team. And then there are the broader relationships I have—the 63 million people in the Medicare program, the 1 million clinicians who treat those patients, the 6,000 hospitals with almost $1 trillion in claims each year. Like my mentors modeled for me, how I manage and lead people is what matters. How do you inspire and motivate them so everyone can be part of a cohesive team? I think the answer lies in identifying your north star. And I think that’s at the core of a lot of the work I do.
Dr. Rapoport is an attending physician in otolaryngology–head and neck surgery at the Veterans Affairs Medical Center in Washington, D.C., and an assistant professor at Georgetown University’s department of otolaryngology–head and neck surgery.