Daniel Williams, senior editor and host of the MGMA Insights Podcast, welcomed Michelle Wright, strategic advisor and board director, for a candid conversation about one of healthcare’s most persistent challenges — execution. 

While medical practices often have sound strategies in place, Wright explained why accountability gaps, weak governance, and underestimated change management efforts routinely derail progress. The discussion also explored evolving compliance enforcement trends and Wright’s deeply personal advocacy work focused on access to care for individuals with profound autism.

A Career Shaped By Both Payers and Providers

Long before she began advising provider organizations, Wright built her career on a technical foundation. A math and computer science major, she started out in actuarial work out of college, which eventually led her into healthcare operations.

Her career took shape at CareFirst Blue Cross Blue Shield, where she eventually became Chief Human Resources Officer and ran a product line. That dual exposure proved pivotal. 

“That gave me a lot of operational and change management experience,” Wright said. “But then during a lot of that time, we also operated provider practices."

"We had employees who were providers, and I worked on site with the providers and directly with them,” she added.

After leaving the Blues seven years ago, Wright began advisory work independently and through Epstein Becker Green Advisors, focusing primarily on provider organizations. 

“I just love working with providers,” she said. “They are the backbone of our healthcare system, and I feel like their perspectives so often get lost in the complicated business of healthcare.”

Today, Wright plays a role when initiatives fail to gain traction. “Usually that’s where I come into play,” she said, “when there’s something big going on in a practice that needs help — just bring everybody together, and make it happen.”

Strategy Isn’t the Problem — Execution Is

According to Wright, healthcare organizations rarely struggle due to a lack of strategic vision. “There are a lot of smart people in healthcare,” she said. “People don’t get into healthcare to do anything else but to take good care of patients.”

Instead, execution breaks down in predictable ways. “I tend to think of it as like three failure points,” Wright explained.

The first is accountability. “You’d be surprised at how many times it’s unclear who owns the outcome,” she said. Using artificial intelligence as an example, Wright noted that responsibility often gets fragmented. “Everybody’s putting AI in, and that’s great," she added. "But it’s really unclear — is it an IT thing? Is it a quality thing? Is it a finance thing?”

The second failure point is follow-through. “We start with energy,” Wright said, “and the plane never lands.” When projects stall, trust erodes across the organization. “It also walks away with the whole organization having a bad taste in their mouth.”

The third factor is change management. “Leaders almost always underestimate what it’s going to take to change behavior,” Wright stated. “Everybody mentions change management, but very few people actually do it well.”

Governance as the Backbone of Sustainable Execution

Governance plays a critical role in closing execution gaps, yet it is often overlooked. “Governance is where things actually need to happen consistently and not get lost over time,” Wright said.

She pointed out that many organizations rely on informal knowledge rather than documented processes. “You’d be surprised at how many of all of these things aren’t well documented or are reliant upon a person,” she said. “The one person who everybody knows, knows it all — but then that person’s not there anymore.”

Effective governance clarifies expectations, supports decision-making, and ensures continuity. Whether applied to compliance oversight, AI governance, or clinical quality standards, governance structures help organizations avoid drift and maintain momentum long after initiatives launch.

Why Change Management Breaks Down Between Operators and Providers

Despite frequent discussion of change management, Wright sees consistent breakdowns — particularly between operators and providers. “I often say it’s like siblings or work spouses,” she explained. “They live in the same household, and they all care deeply about the patients and getting quality outcomes.”

Stress exposes long-standing communication patterns, Wright said. “When there’s stress — or you’re implementing change, which causes stress — those biases and communication styles come out, just like in our relationships at home.”

Listening, she emphasized, is often the missing ingredient. “People are often talking past each other,” Wright said. Successful change requires leaders to slow down, translate perspectives, and intentionally rebuild trust during periods of disruption.

Compliance Trends Practice Leaders Need to Watch

Wright is partnering with MGMA on an April 22 member-exclusive webinar focused on emerging compliance trends, moderated by Wright and featuring attorneys from Epstein Becker Green.

The session will cover both regulatory updates and enforcement shifts. “There’s a change in enforcement trends,” Wright said. “There are a lot of rules ... that have been out there forever, but agencies are enforcing things differently now.”

AI again surfaced as a critical example. “Practices are using AI more — documentation tools, RCM tools,” Wright noted. “But there are also people looking at that [and] using AI more.” 

Claims patterns are increasingly analyzed for anomalies, making internal monitoring essential. “Documentation has to reflect the individual needs of the patient,” she said, “and not just look like a machine copied it over and over.”

Advocacy, Autism, and Access to Care

The most personal portion of the episode centered on Wright’s advocacy for individuals with profound autism. “I have an adult son in his 30s who is profoundly affected by autism,” she shared. “It affects every aspect of our life and his life.”

Despite her professional expertise and connections, access to care remains a struggle. “It took four months to find sedation dentistry for a cracked tooth,” Wright said. “That shouldn’t be like that —  it just shouldn’t.”

Wright serves on the board of the National Council for Severe Autism, advocating at both state and federal levels. “People with severe autism make up about 25% of the autism population,” she said, “but less than 5% of research dollars go to that population.”

Her advocacy reflects both lived experience and systems insight. “I feel both sides of the perspective,” Wright said. “And it’s just so important to me.”

Resources 

• Connect with Michelle on LinkedIn
• Epstein Becker Green
• National Council for Severe Autism
• MGMA Member-Exclusive Compliance Webinar (April 22, 1 p.m. ET)