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Reliably Well brings you thoughtful conversations from those who are shaping the future of healthcare, focusing not just on the technical side of the industry, but on the human element, the stories, the struggles and triumphs of individuals who are driving change. Join us for candid discussions that highlight both the challenges and rewards of working in a field where humanity and healthcare intersect.

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We’re really excited today to welcome Julie Forte Smith to our podcast. And we’re so thankful that not only she’s a part of our organization, but that you get to hear from her. Julie’s a seasoned healthcare executive where she’s had a career that’s been dedicated to supporting emergency medicine providers through the ever evolving and complex dynamics of dealing with payers and all the regulations and reimbursement reform. Throughout Julie’s career, she’s been

an influential voice in the industry. She actively participates in a lot of different key healthcare organizations and has held many senior leadership roles in several organizations. We’re thankful that she’s now our chief revenue officer at Reliance Healthcare, where we get to be the beneficiary of Julie’s deep industry expertise and passion for empowering clinicians to deliver life-saving care while receiving the reimbursement they deserve. There’s never been a more important time for your role, Julie, and

Welcome to the Reliably Well podcast. Thank you. It’s fun to be here and it’s fun to get to talk about these things in a conversational style, right? So that’s great. Yeah, Julie, we’re really fortunate to have you on the podcast, but we’re super fortunate to have you as part of the team. Whenever we’re out talking to other people in the industry, we start mentioning your name and people get super envious of the fact that you’re part of our team.

just goes to show how well-known you are in the industry and how much you’ve influenced others and how much you’ve shared and taught others. But tell us, those that might not know you, own this, who are listening to this, what’s your story? How did you get in, both kind of personally but professionally, how did you get into where you are today?

I guess you could say it was a little bit serendipitous because I could have headed directly where I planned to. So I got involved with emergency medicine because I was moving with my husband to grad school and I was putting myself through school and needed a J-O-B. And back then, if you were moving to a new town, you went to Barnes and Noble and you got the big newspaper for that town. And so I opened the newspaper and I looked through.

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And there was an executive assistant slash administrator job. And I had done clerical work in high school and undergrad as well as waitressing tables. And so I went, huh, I’ll apply for that. And that just happened to be a executive assistant for the incoming president-elect of the American College of Emergency Physicians, as well as the site administrator at what at the time was Tenants Flagship Hospital in Dallas.

for the group that he was the medical director of. And so I began working, know, Monday through Friday, if you will, right next to the ER as the only non-clinical person on the team. And it was an incredible experience because that work that the clinicians do is not only honoring, it’s almost holy when you watch what emergency medicine clinicians do day in and day out. And as the only non-clinician team member,

Occasionally, there’d be a really tough outcome and a family member might not have anyone to sit with them yet. And my team would come get me and they would give me the honor of sitting with that family member and tell their loved ones arrived to support them in what was going on. And so I just saw it at a very personal level. I learned about circadian rhythms, did the schedule, all that kind of stuff. But at the same time, I was taking minutes

in these very high powered emergency medicine committee meetings around the passage of EMTALA. And I met everybody who was anybody in emergency medicine and the energy and the passion and the intellect in those rooms, quite frankly, was just a little bit addictive. And I really loved what I was doing. So I was headed off to grad school for behavioral neuroscience, but I kept

progressing with that entity and that role and I thought it’ll take me years to get the same level of relationships and the same level of opportunity. And so I stayed and that’s kind of what happened. I was blessed with relationships that you don’t normally get in your 21 year old something job while you’re wrapping up your last year of college. And it’s been a really fun and engaging opportunity for sure.

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So I want to go back to something that you said, Julie, because I think that somehow somewhere we always start talking about food on the podcast. I don’t know what it could mean that we’re in the deep South, but you’re talking about wanting to pursue a degree in neuroscience and relationships, but then you kind of threw, you kind of had a throwaway line just a little bit ago that you were waiting tables. Is there anything you learned in the hospitality industry that allowed you to?

thrive in making relationships with high powered people at a young age? I think so. I think everybody should work with the public in one degree or another. And my first job was actually a games person at an amusement park. And then I constantly was waiting tables. And so you have to meet a stranger. And you have to anticipate the needs of that stranger.

The best people in hospitality make that guest feel important and they notice they need water before they know they need water. And they notice that their napkin fell before they noticed that the napkin fell, right? So that’s a skill that serves you well in any area of life. So yeah, I think everybody should wait a few tables in their life and work with the public. And I did everything from your low level pizza hut to…

fine dining and so you learn how to make a lot of relationships and you learn how to diffuse someone who’s very unhappy, which certainly comes into play in our clinical environments, right? People are having a stressful day, they’re having a day they didn’t anticipate and so quickly building a rapport with them and putting them at ease and establishing trust, that’s really important and all those things go back to being a really good waitress.

you’re probably more qualified to go to medical school if you’ve weighted tables as opposed to making an A in a biology class, we’re learning about plants, but we won’t go down that rabbit hole. Very true. As you’ve joined our organization, Julia, you’ve become familiar that at Relias Healthcare, we have five passions and those passions are people, innovation, quality, value, and excellence. Of those five, what do you…

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getting to know you, you kind of can flex into all five. But which one do you connect with the most and why? So for me, I connect the most with the people. And the reason being that none of the other four happen without them. And so not only do you have to have the people, but you’ve got to have people who just at their core are excited about the other four. Right. So for me, people are first.

And then I can geek out for a really long time on innovation, but great innovation only happens if you have quality and excellence, right? So they all play together, but people is the driver of the success for every other area. So when we’re talking about Julie, when we’re talking about those people that drive success for you personally, who’s had that greatest influence on your life, who’s driven that success for you personally in your life.

So yeah, so I just lucked out with an amazing grandfather who is part of that greatest generation. He served in both World War II and Korea. He was an executive. He was a Renaissance man in that he would fix anything with his hands, but then he would take my grandmother off to the symphony. But he wanted to accomplish something every day. And he actually put himself

through engineering school by being a miner. He grew up in Park City, Utah, and all of his relatives were miners, and he knew how to work. And so I just grew up with every day that I’m at grandma and grandpa’s house, we are waking up early and we are putting cowboy boots on and we are moving irrigation ditches or we are just anything under the sun. He also taught me about money. So my first deal was I showed horses for him.

And at the horse show, he bought me a shoe shining kit. And I, when I wasn’t showing, I was going around polishing boots for two bits, which I learned from him was two quarters. And so he just taught me about how good it feels at the end of the day to know, just have that satisfying rest that you worked with your hands and you accomplish something. So, that’s a big thing for me. I want to.

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do something, accomplish something every day, whether it’s work or a hike or whatever it is, and that came from him. And then just the other thing is I have daughters, and that is an incredible influence in your life. I remember when they were due, the oldest was due, very dear pastor of mine talked to me, the whole team talked to me the night before I was going in for my C-section, and he said something that I’ve never forgotten. He said, you you think,

you’re going to impart so much wisdom for this little one. You’re gonna teach them, you’re gonna grow them. And that is so true, but he said, you will grow more. They will teach you more about yourself than you will ever impart in them. And so kind of that, it’s the bookends, right? I followed hard after my grandfather. I hope I’m leaving my path in a way that my girls will want.

to follow hard after me. And then I’ve just had amazing mentors in the industry. David McKenzie has been like a father to me, you know, to have met him when I was 20. So many people like that, whether they’re on the board of ASAP or the president of ASAP or whether they were just a clinician that I worked with.

people in my faith, I’ve just been really blessed by people who I admire and I kind of look for those folks. And then I just kind of keep my eye and I try to get lunch and breakfast and invite them to tell me, what am I not doing great? What do you see in me that needs to be rubbed off? And I’ve just learned a lot from that and I’m grateful for it. Yeah. And I would say that you’re a Renaissance woman.

Julie, it makes sense to me that you had called your grandfather Renaissance man. I could go so many different directions now, but I feel like that all of your interests and all the things that you grew up doing allow you to be kind of like a Swiss Army knife. You enjoy the summer camp world. have horses. We can probably get into that in a little bit.

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our current environment in healthcare feels like you’ve got to have a Swiss Army knife to be able to deal with all the challenges. you could distill down to one or a couple of challenges that you’re navigating professionally now and you’re helping Relias navigate now, what piece of your Swiss Army knife are you using and kind of what is the challenge that you see that you’re really dealing with today?

I feel like we are in a fight for the longevity of hospital-based specialties. I feel like the clinical care is excellent. The clinicians’ relationship with their patients is really good. And we’ve worked out a lot of the kinks of that dynamic. But the regulatory framework and the market forces, the financial market forces,

If I were going to triage what’s most needed, it’s sustainable, appropriate reimbursement. And without that, every card falls, right? When I ran a national coding company, I would constantly remind the coders, because it’s a very monotonous role, right? What you do means a clinician is there for a patient, someone’s father, someone’s baby, someone’s mother, on their worst day.

And it’s that money that allows, that’s just the truth, the money, the funding allows that clinician to be there on somebody’s worst day. And that’s really important to me. And so when you look at EMTALA, which has a beautiful goal, when you look at Prudent Layperson, when you look at the No Surprises Act, they are all important undergirdings of a good safety net, but they haven’t been funded. And that’s an enormous chasm.

And so if we can’t align the market forces and the regulatory forces to sustain the cost of delivering that care, the whole system crumbles. And so that’s what I spend most of my time trying to push back a tide from, right? So helping clinicians document better. So we do get every penny because the margins are razor thin, even when you do it excellently. And then the environmental factor. It’s really interesting to me from a regulatory and environment standpoint that

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Hospital medicine is the only place it’s completely legal to shoplift. I walk in I get my service and I walk out and I don’t pay and I didn’t plan to pay and nobody chases me and no alarms go off and there’s no monitor that dings and I go back into my life, right? And I might not pay because I forgot I might not pay because I I feel like boy medicine they’re wealthy They don’t need my money someone else does there all kinds of reasons, but we need to support that

And so working with legislators and lobbyists and communicating that need, it just sits so unwell with me that we’ve put together a regulatory framework that says that Dr. Johnsey’s talent, his gifting, his work is the right of someone else without him getting paid.

There has to be a balance there. So how do we handle that? How do we push back on it? So that’s why I do the different board activities, the speaking, the regulatory activities. And I think that the Swiss army knife is communicating the picture well so that you can reduce bias against this idea that clinicians just make a lot of money. So you’re just whining for people to get more money and bringing the right.

people together. A little more than a year ago, I brought all of the high level executives from Medicaid managed Medicaid. So, Aetna, UnitedHealthcare, all the big boys with the FHQCs, with emergency medicine, and they had never sat down together, right? And that’s how this stuff gets solved. We like to talk about like the payers or Darth Vader and I admit they kind of feel that way to me. But when I sit down with them and talk with them,

they care about vulnerable patients too. So how can we find the place where we align and make a change? I think that’s the Swiss Army knife. I love the way that you tie, you know, sometimes the mundane or even the drudgery of the task that we have to do and put it to the bigger picture. I think that helps us all to see that, you know, those simple blocking and tackling things that we have to do.

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They do go into a very dramatic moment for somebody else. They do add to a bigger picture for us all. You’ve had a lot of accolades. You’ve had a lot of praise to you. Again, we hear about that ourselves on the side when we talk about you as being part of our team. Of all of those achievements that you had personally and professionally, what are you most proud of?

You know, I’m still working on it. I’m still working on, want to get something lasting that stabilizes the reimbursement. But in getting closer to that, it’s things like being a voice that was able to really push the RAND study forward, right? Because there are always doubts in a room.

It’s that think tank, bringing the Medicaid leaders and the healthcare leaders together to talk about it. Those are the things that I get really excited about and that I go, okay, that, if I could get that done, that’s lasting. That survives beyond my last day in emergency medicine and the hospitalist medicine and reimbursement. So I think I’m still working on it, but that’s what will.

That’s what’ll make it. And then the other thing is when someone that I have had on my team is able to talk about the difference that I made for them, I get crazy excited about those things. Because growing entities is phenomenal, but growing people and them being able to say, I’m different because we spent time together, that I get really excited about. Yeah. And I, and I love how your

linking, whether it’s payers talking with FQHCs and emergency medicine, it’s the people interaction with that policy or a legal document or leverage or anything like that. It’s really this human connection that maybe that is the solution for what we’re trying to do. I think you kind of spoke about that really eloquently. I’m curious if anybody listening is like

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me and you interact with Julie for a little bit. I wonder if you’re human. How do you do all this stuff? How do you be 21 years old and be this administrator and your grandfather and you enjoy it? Prove to me that you’re human or kind of in another way of like in this world where everybody’s got their online persona, their kind of LinkedIn, CV that is all beautiful and polished and everything’s neat and tidy.

Tell us about Julie the human or maybe I don’t know what a horse master is called. Somebody who can send the horses in the wild wild west. yeah. So I think that is what shows that I’m human is that I crash. So there are some business books that talk about kind of the burst model that you just go, go, go, go. And then you kind of have to fall back.

And so there are weekends where I go to sleep and my sweet husband knows don’t wake Julie and it’ll be 10 or 11 before I wake up on a Saturday morning. Not every weekend, of course, but like maybe one out of four where I just crash. And then I really had to built in restorative things into my life or, or I start to get prickly. Does that make sense? Like the impatience, the

The quick wit, the quick decision maker can get sharp and really rub on people and that’s never what I want. So I have to really like, okay, I am getting a hike in nearly every day or at least a walk around the neighborhood. I am spending time just quietly, not perfectly every day, but several days a week just in restorative things.

Because I get prickly and I get tired and I crash and then I can get impatient really fast. So it’s those things. And the biggest thing I found is I, in a world where there’s so much friction, I spend a lot of time trying to be really present. My phone is not out. In fact, my daughters get annoyed about it because I’m not good at returning text messages because my phone is not out. But I…

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work at being present and being present tires you, right? Being present in the discussion, not doing emails during the meeting. And so I just, the most human part of me is that I get tired and I crash. And then I have found that I have to do a couple of things. I have this little practice that’s the world for me that before I lay my head down every night, I have to have found three beautiful things along the way in my day. And it,

It undoes whatever friction, whatever ugliness was there, right? So sometimes that’s a leaf that fell off a tree while I was hiking. A lot of times it’s some little kid that I bumped into and just the way they look at the world is so sweet, right? So just those reminders that the Lord is good and he is faithful and the world is beautiful despite being broken. That’s what restores me and

keeps me from being a prickly porcupine, because otherwise I would head that way. Yeah. Well, one of my favorite GK Chesterton quotes is that happiness is gratitude doubled by wonder. That’s phenomenal. reflect on what there is to, what we should be grateful for, but then to have this childlike wonder about what it is. I do have to ask a follow-up question though, Julie. Yeah.

I would imagine most of the people listening to this are type A. They feel like that they’ve got to go, go, go, go, go. And they may not like there could be shame about having like sleeping till 10 o’clock on a Saturday morning. You know, what would be your encouragement to the people that say, I can’t do that? I just can’t do it. One of the things is they wouldn’t hold anyone else to that standard.

Every type A person that I know is gracious to their loved one, their friend, their colleague. They encourage them to take the vacation. They encourage them to take the hike. They are excited that they got to go to their favorite concert. And so why are you treating yourself more harshly than you treat others? And it really is about you want to be that successful person, accomplish a lot.

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Every empirical study shows that you only do that through rest and restoration. That the longer you wait to restore yourself, that diminishing return, right, you can find a million articles that tell you that. So I think it’s both give yourself the kindness that you afford to others and just look at the evidence because you’re not helping yourself when you take yourself to the point of burnout or beyond.

So, so, so valuable words there that’s absolutely true for us to learn, learn those limits before they’re kind of forced upon us. because, we’ll, we’ll all find that point someday. I think. I will say I am always a little chagrined at myself when my husband does finally wake me up and I’m like, it’s 11 really, thankfully it’s not an every weekend thing, but yeah. Well, I really appreciate getting the chance to talk with both of you, but I especially appreciate getting to work.

with you. You’re both just really authentic, phenomenal human beings. And that’s what I love about Relias. And so thanks for letting me chat. That’s our privilege. Thank you, Julie. Absolutely. Thanks, Julie.

Thank you for joining us on Reliably Well, where we explore the intersection of healthcare and humanity. We hope these conversations inspire you to see the people behind the policies, the passion behind the practice, and the purpose that drives innovation in healthcare. If you enjoyed this episode, be sure to subscribe, rate, and review our podcast. Your support helps us to continue sharing these important stories.

For more insights and updates about what we’re up to at Relias, visit us at ReliasHealthcare.com and follow us on your favorite podcasting platform. And if you have any stories that help to demonstrate the humanity in healthcare, please let us know at reliablywell at ReliasHealthcare.com. We look forward to hearing from you and telling your story. Until next time, stay well, stay inspired, and keep bringing humanity to healthcare.