On the day the Affordable Care Act was scheduled for a vote before Congress, Tiana Korley remembers pushing her son in a stroller between police lines past crowds of yelling protestors to the Longworth House Office Building. Her husband was working a shift at the hospital that day, so she needed to look after her 10 month-old son, Noah. It was just another day balancing career with family life.

image for Tiana Korley“He (Noah) was totally oblivious to it all,” she said. “It’s just they (children) come along and you just kind of make it all work.

Tiana never imagined her career would take her to Washington D.C. but she is glad it happened that way.

As a legislative assistant on health policy and later senior health counsel to Rep. Jim McDermott (D-Wash.) and a member of the professional staff of the Ways and Means Subcommittee on Health, she worked on numerous health policy issues including the ACA and later went on to become the senior advisor to the deputy administrator for program integrity at the Centers for Medicare and Medicaid Services (CMS). Tiana has also worked as a consultant for the MITRE Corporation, which operates CMS’s federally-funded research and development center, the CMS Alliance to Modernize Healthcare, and was involved in shaping policy around the new alternative payment methods.

Today, the Drinker Biddle alumnus is an associate general counsel at the University of Michigan, where she supports the university’s clinical research efforts, handles fraud and abuse matters, and various accountable care organization matters. With all of the new rulemaking that was triggered by the ACA, Tiana said her background knowledge of Congress’ priorities in drafting the law and CMS structure have given her a holistic approach to her work at the university. Monitoring and evaluating new CMS and Center for Medicare & Medicaid Innovation initiatives and making sure the university is on top of compliance is an important part of her job.

"A lot of different things came out of the ACA that I think health systems are still kind of adapting to, even though it’s not even really new anymore. And then we’ve had subsequent legislation that’s come to pass around the SGR repeal with MACRA,” she said. “Having to make sure that you follow CMS rules and whatever guidance comes out of it, whether you want to do alternative payment models or want to stay in the merit-based incentive payment system, that’s all new legislation that CMS is just beginning to implement.”

From private practice to Capitol Hill

Tiana has always had an interest in health policy issues and got her master’s in health administration at The Ohio State University prior to attending law school at Northwestern University. She joined the Chicago office of Gardner Carton & Douglas as an associate in the health care practice in 2002.

In 2005, Tiana left the firm to become assistant general counsel at the University of Chicago Medical Center. Her husband, an emergency medicine physician and traumatic brain injury researcher, was working on his residency at Northwestern Memorial Hospital at the time. When he landed a faculty position at John Hopkins Hospital in Maryland, Tiana had to move with him and leave behind a job she adored. Tiana became an associate counsel at Bon Secours Health System, Inc., for two years before interviewing with McDermott amidst the development of the ACA in 2009.

McDermott, who is a psychiatrist, had practical insight into how legislation affects physicians’ practices and working with patients. Tiana said it was a phenomenal time to work for McDermott and he shepherded the passage of three provisions in the ACA, including the Self-Referral Disclosure Protocol. Tiana said she is sad he is retiring later this year.

“I really do credit him with making people think,” she said. “The ACA became about (Congressional) member’s different priorities and people would try to cram it full with all sorts of different things. He really did encourage looking at things that really needed to be addressed, whether it be fraud and abuse laws applied to the new Medicare Shared Savings Program, including the gainsharing civil monetary penalty law; and creation of the self-referral disclosure protocol. Also he fought for inclusion of a provision around home visits. He’s just a great voice and he’ll just really be missed. “

Tiana left McDermott’s office to work for CMS and later returned to Capitol Hill to be his senior counsel when he was on the Ways and Means Health Subcommittee from February 2013 through May 2014, splitting time between McDermott’s personal office and the Ways and Means Subcommittee on Health. When the opportunity arose, Tiana joined MITRE, and provided thought leadership and policy advice on payment models and supported the development of the Health Care Payment Learning Action Network.

When asked what has surprised her the most about the business and regulatory changes that have happened as a result of the ACA, Tiana said the rapid pace of change that’s expected of everyone in the industry. On the one hand, the health care industry has been forced to adapt and adhere to prescriptive timelines set by Congress and CMS. But at the same time, Tiana said she is sympathetic to the fact that CMS doesn’t have a large staff to handle the growing demands imposed upon it through legislative initiatives, including the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

It’s all uncharted territory and there’s not always time to fully evaluate the unintended consequences and impact of new policies that are rolled out. In the upcoming year, Tiana said monitoring the rollout of MACRA, including establishment of new payment models; and consolidation in the insurance industry will be important issues to watch. The growing consolidation in the insurance industry could have unintended consequences for provider reimbursement.

“From a health care provider standpoint, we’re just asking our physicians to do more and more whether it is meaningful use, whether it is new payment models and new participation in whatever initiative CMS rolls out,” she said. “It’s just a time of rapid change, which makes my job super exciting but it also is just very challenging to adhere to all of the different timing constraints that we have.”

Flexibility and building a career

Tiana said moving from Chicago to Washington D.C. for her husband’s job and finding unique and interesting career opportunities for herself has been a rewarding experience. Balancing two professional careers is a challenge for many families, Tiana said, and the key to making things work is flexibility and finding organizations that support and value your work. She encourages young associates to be open minded to change.

“It is really just to be flexible and to follow your career wherever it leads you. I was at the firm and then I thought I would be at U of C forever and that didn’t work because my husband took me to the east coast. I loved Bon Secours but when the Affordable Care Act started ... I’ve always had a love for health policy...so I went to the Hill,” she said. “The flexibility to do non-traditional things can ultimately help you because the experience, particularly with CMS and the Hill as non-traditional experiences, have really enabled me to bring things to the organization, that are unique, and, hopefully add value to the organization.”

Tiana said she loves working in a hospital environment and is excited to do this again with the University of Michigan.

“One of the best things that I love about my job is being in a hospital supporting physicians and our research enterprise,” she said. “It’s just a dream job. I really like it.