The three branches as Michael defined them on 21 September. A is where we are. B is one set of servers instead of two. C advances the research sandbox into an AMA-wide asset and an accelerator for their Databricks work. C is an option to B only — it is not an add-on to A.
These are models, not proposals. No pricing has been offered to the AMA and none should be, per the internal decision of 21 September. Every figure is carried from the executed 2026 SOWs unless a branch explicitly changes it; the combined hosting number follows Michael’s own framing of server expense moving from seven, eight hundred to like five hundred. Treat the shapes as real and the dollars as illustrative.
$351,200 lease-taxed
$480,000 lease-taxed
unchanged vs 2026
unchanged vs 2026
All $730,000 of COHO revenue stays on the MAP program budget line — the line Delane has twice said she cannot fund at current levels, and the one that already absorbed a $214,500 cut into 2026.
$831,200 of lease-taxed infrastructure across two instruments, two SLAs and two renewal conversations. The Chicago lease tax applies to every dollar.
It protects the PS2 commitment absolutely. Nothing here reopens money that is already agreed. If any combined conversation endangers PS2, this is the safe branch.
2026 baseline for comparison: PS2 $852,000 · COHO $730,000 · total $1,582,000 · lease-taxed $831,200, all from the executed SOWs. What none of these model is the live risk: B and C both reach into PS2’s already-agreed budget.
Every payment milestone in both business units, on one calendar, clumped by item type. COHO has already taken a $214,500 cut — 22.7% — while PS2 held flat at $852,000 across both years. That reduction is already banked before any 2027 conversation opens.
Rings mark payments carrying the City of Chicago Personal Property Lease Transaction Tax. Combined lease-taxed exposure moved $860,000 to $831,200 — the pool the infrastructure conversation is aimed at.
$300,000 lease-taxed
$351,200 lease-taxed
$560,000 lease-taxed
$480,000 lease-taxed
$1,691,200 lease-taxed
COHO ran $944,500 in 2025 and runs $730,000 in 2026. Delane is not opening a conversation about a future reduction. She is opening one on top of a reduction already made.
COHO infrastructure runs $128,800 above PS2 — $480,000 against $351,200. The reason is one word: PHI. COHO carries protected health information and PS2 does not.
Three gaps between SOW terms — 226 days, about 32 weeks — delivering against an expired instrument. PS2’s only gap is nine days. A unified hosting arrangement would close it.
Two files in Legal/SOW are byte‑identical, one named PS2 and one COHO. Recovered by OCR, SOW 5 is a COHO instrument — $240,000, Stage 3 maintenance for CommunityHealth and Duncan. The PS2-named copy is misfiled.
Delane Heldt canceled this meeting the day before it was to run — “a few scheduling items have popped up and some key AMA people cannot attend. Will send new dates soon.” The AMA’s own internal synch, set for the half hour before it, came off two minutes later. No replacement date as of 22 September. Everything below is still the read on the room — the roster, the required and optional split, and what the shape of the invite signals. Treat it as preparation held over, not as a record of a meeting that happened.
This is the IT meeting we asked for on August 27, and Delane built it bigger than the note she described. Two PS2 staff are required attendees in a COHO meeting with FHG in the room — against years of the two halves of the building not talking. Three group vice presidents and the CIO are invited as optional.
Thirty minutes, carved out of the team’s standing Validic call. Fourteen AMA-side guests. The guest list is locked — we cannot add anyone.
The required IT seat is Information Security. The CIO is optional.
Our August 27 ask was a cost argument — the Chicago lease tax as the prize, the Analytics Hub and the Data Lab coexisting in one environment, PS2’s always-on instance ramped down. But a VP of Information Security does not own the lease tax. He owns whether two fully segregated environments can safely share one. Today COHO’s instance is completely separate from PS2’s, and collapsing that is a risk decision before it is ever a savings decision.
So answer the segregation question before he asks it. Then the lease tax becomes the reason rather than the ask.
Our principal COHO counterpart and the longest relationship in the engagement — roughly fourteen years on this program. She called this meeting, and it is the report-back she promised after meeting PS2. Sets the annual COHO budget with Sinead and Tam.
The only human acceptance on the invite as of September 21.
Carries the day-to-day client relationships on both COHO delivery sites. Has not yet accepted the invite.
Sits in the analyst layer under Jane Fogg, MD. An analyst made required, not an executive — which reads as an expectation of a technical conversation with specifics in it.
The PS2 program seat alongside Nosal, and a natural adjacency to ClinicianPulse. Second of two PS2 staff required in a COHO room.
The “Jim” from Delane’s August 27 note, now confirmed. He owns segregation, not the lease tax. Relevant to MSA §1.12 (AWS Permitted Subcontractor) and §15.1.6 ($5M Cyber Liability).
Runs the operating cadence — wrote and chaired the August 27 agenda, and gates invoice approval on an attached backlog. No public trace of her title since August 25. Worth asking outright at the rescheduled meeting.
The GVP seat above Delane, peer to Tutty’s PS2 seat. Detroit public health; Trinity and Henry Ford before that. No FHG history — if she attends, frame for someone hearing us cold.
The CIO is optional while her own VP of Information Security is required. The budget holder is not in the required room. Surname corrected from our prior canon, which had it wrong.
Two of her staff are required in this room. She is not.
The IHO half of Tutty’s portfolio — the counterpart structure to Farley’s PS2 tree. Listed first on the invite’s guest array.
Running the Reach-and-Impact QA through September — numbers she inherited and now has to report on. Authored the four-category backlog framework. Surname resolved September 21 after four weeks open.
The room’s stress-tester. One of two leads Delane sets the COHO budget with. Her standing demand is that we work closely with client technical teams — which this meeting answers.
Leads clinical facilitation, the tiered-products conversion and CAC education. ~5 years AMA after ~7 at IHI. The other budget lead.
Leave with a working session on the calendar. Named people, a real hour, a date. Thirty minutes will not survive an open-ended “let’s find time.”
Farris Linett built a six-block agenda to settle process. The meeting refused to be about process. Eighty minutes in, with no agenda slot for it, Delane put next year’s number on the table — and she said it believing the COHO contract ends in December. But the day’s larger news ran the other way: the AMA opened the door to aggregating fourteen years of historical program data, which is an expansion of work FHG already owns.
In person at AMA Plaza, Teams for remote. The session was cut from three hours to two by Farris right before the meeting — so that Delane could carve out a separate one-on-one with Michael, held immediately afterward. That conversation is the section below.
Delane has already met with PS2 to discuss our overall work, and asked their product director directly about combining efforts. Read her motive plainly: she is trying to find budget support and reach a broader cost center, by way of IT. PS2 knew the conversation was happening and both sides agreed to report back. They are coordinating, and that is new.
Which is why the IT meeting is not a technical errand. It is the same door she is already pushing on, and we should be in the room when it opens.
Delane Heldt — VP; ~60% of substantive talk time
Crystal — presented the backlog framework
Sinead Forkan-Kelly, MHA, RN — the stress-tester
Pam Kittleson, RPh — carried the Community half
Michael Barbouche
Tam Duong — remote; dropped before the MAP discussion
Kate Nisbet
The entire PS2 side — the wall holds
Denise’s absence matters: whatever landed on 2027 is provisional until it clears someone who was not there and has no FHG history. Frame commitments so they survive Delane re-presenting them.
1:10 Current State — Pam / Michael
1:30 Backlog Approval — Pam / Crystal
2:00 Plan Through 2026 — Pam / Crystal
2:30 2027 Goals — Delane / Michael
2:55 Wrap — Farris
Six blocks compressed into two hours on short notice. They held about forty minutes, then dissolved. Strategy never waited for 2:30 — it leaked forward and ran the back half.
She also said “I’m not gonna have the money I had this year. I’m just gonna say that right out loud” — and, critically, “our contract ends in December.”
MSA 24377 runs through December 31, 2028, with a five-year AMA option. The awareness gap is no longer a hypothesis about what COHO believes — it is on the record. Thursday was a scope conversation inside a secured term, not a renewal. The standing play holds: do not reopen the MSA.
The aggregate dashboard has always been FHG work. On Thursday the AMA widened it, from their side, into something several orders larger: the whole historical record of the program. Delane put the question herself — “of the historical and legacy data that we have, do we need to do anything with it? And what would that look like?” — and then said out loud why it matters to her:
This is the same problem FHG already solved for PS2. Michael’s line in the room: “I see your twenty different ways and raise you to the eighty different ways PS2 did it for a long time. We helped them finally draw that line in the sand.” What followed for PS2 was the ability to speak to the weight of their own work — this many in the Northeast, this many academic medical centers — and from there, recognition, Joy in Medicine, and the health-system motion. The order matters: first they could see themselves, then they could sell themselves.
And all data is good data. Even where the old records are thin, the historical timestamps and metadata carry the arc — who participated, when, for how long. That is exactly what an aggregate view needs to demonstrate trajectory and importance. Start it as an internal portal across every program and participant; a portion of it later becomes external-facing, or an asset class the AMA can leverage. One discipline holds throughout: FHG does not touch the AMA master file. We have been offered many times and said no.
This is an expansion of our work and our support that reaches beyond the direct COHO sites we stand up. Aggregating the program’s whole history is not site work — it is institutional work, and it draws on different budget lines and other cost centers than the ones funding Community and Duncan. So if the COHO direct model is under fiscal pressure, and Delane has told us it is, this is a path to protect and advance our revenue rather than shrink with her site budget.
Michael drove the room here. The obstacle is not OGC. “The asset is the data. The owner is the AMA. In our agreement it’s called AMA Data. The weird bugaboo is the stupid Chicago lease tax.” Two made-up nouns exist: the Data Lab (PS2’s asset) and the Analytics Hub (COHO’s). Delane wanted to merge them; Michael said keep both words — the separate contractual nouns are a helpful structure. What is wanted is both coexisting in one technical environment, plus ramping PS2’s always-on instance down except the half-afternoon a year it is needed.
The outgoing finance leader called the lease tax “a drop in the bucket” and would not engage. Christie is new and cost-savings oriented — Delane’s read is the argument may finally land. “We can certainly talk to Christie about that.” Her IT note goes to Jim, Susan Maliach, and one more, with PS2 looped, framed as the promised report-back from the joint economies-of-scale call.
Pam read Emily’s 10:28 AM email live off her phone. July refreshes pushed the night before: blood pressure control now at goal, confirmation well above goal, medication intensification well above goal, one-month follow-up below but rising. That is Sinead’s August 13 proof-point ask, answered by itself — and it should go back to her under Pam’s name, because the client relationship runs through Pam.
Delane drew the distinction herself: there are the clients who run direct with us, and there are the ones doing the program independently inside their own EHR — and she wants to know “what’s the application of the knowledge to those particular systems.”
We can support both. What we build and prove with a direct client does not have to stay there. Package it as templates and components that travel — into Athena, into other records, into whatever distribution layers the AMA already has — and every one of those becomes a place the program can grow without FHG needing to be the chassis. The more of their program we can help grow that way, the better.
Give the AMA exactly what Community and Duncan see, with the PHI stripped — same lists, same filters, same counts, same trends. “It is a total emulation.” On the roadmap long ago; not built today. Sinead named it her number-one ask. And Delane’s own method argues for it: “you can’t do that unless you take a look at a data set and look at the data and run some data.” Three people, three reasons. Scope it and price it.
Community wants outreach lists carrying gaps plus social determinants plus language, so they can text. Delane asked the framing question — core functionality or customization? Michael: “the word is configuration.” That one word keeps the request out of the category that triggers heavy approval and cost.
And the lesson underneath it, from a Wisconsin FQHC twenty years ago: rates went through the roof and everyone assumed broken data. It was one trusted nurse texting everyone in Spanish while every other outreach looked like a debt-collection call. “We thought we broke the data.” Find that person first, then rig the list to them.
Her point is about how the data gets acquired and verified at the source. Validation at Duncan has run through the physicians — Drs. Stewart and Gillespie, plus Jennifer Clough on quality — and their technical team has not been at the table. Her argument: a physician can validate his own documentation for his own patients, but that is not enterprise validation, and when support steps back nobody technical knows the procedure.
She would rather go slow than launch on data that gets challenged later. That reads against a standing commitment for a complete dashboard by the September meeting, so the date needs reconciling. Crystal and Farris are taking the validation process into the next technical meeting — which is the right venue, and it is the same push we want, since the labs, meds and vitals are still coming across restricted.
Crystal presented four categories — standard development (FHG), modifications and new requests (AMA review), and break-fix (awareness only). Then Farris made it a condition: “When I get the invoice… I’m gonna expect a backlog attached — this is what the invoice represents, this is the backlog we approved. I will then approve it.” And right now: “is there a backlog? Not really.” Both tabs need filling, plus a forecasted column.
Delane, thinking out loud: MAP began as a checklist for hypertension. “Is it a quality improvement protocol? Not quite sure. What IS the MAP framework?” Her market read is the useful part: “where the world is going is not more process, labor, more things to do. Give me the quickest thing we can do and let me do it really quickly.” Michael closed the IP question by giving it away: “We don’t own any measures.”
On record with senior management and Dr. Whyte: one-on-one practice facilitation cannot scale — “that’s a growth strategy, not a scale strategy” — so it converts to a group membership offering. This is the membership package from August 13, now a decision rather than an idea, and the hook for the provider-owned-plan argument.
No agenda, no third party. Farris cut the session from three hours to two precisely so this could happen. It ran until Delane’s clock ran out — she says “I have five minutes” partway through and closes with another meeting to reach “in three minutes” — so it ended against a hard stop, not a natural one. Michael left the line open on the way out: “Let me know on any of these more strategic things. Just holler, text any time.”
This was a trade, and an uneven one. Michael gave her intelligence; she gave back the condition of her own house. That is not a trade a client makes with a vendor.
Michael brought her most of what follows — the plans, the Healthsperian route to Whyte, the Phil Levy bridge to her own new boss, Ehrenfeld’s exit from AHW, Stadler as successor, the Froedtert documents that landed this week. She was hearing much of it for the first time; her replies are short and receiving. What came back was her budget, her boss, her staff, and her own posture.
“The lead, my strongest person with knowledge and skills to advance work… one of the more hard people to work with. She’s my number one at this point, who can do all this stuff for me.” They clash, and Delane said so plainly. Michael defended her: “She’s very earnest and that passion comes through. I want her to be able to see what the sites can see, so she can take things further.” That defense and the PHI-free emulation are the same ask.
“I’m trying to explain to her the beauty of actually having data versus teaching people how to use their data without actually seeing the data. She’s not getting it.” The friction is the IHI background — “no one’s got time for playing massive quality improvement programs.” Where Delane does see talent: helping people use their data, build plans, implement them. Lincoln and the facilitation team report to her.
Two people, one of whom she finds difficult and one of whom she thinks is missing the point, against a program she needs to grow with less money than last year. Every ask we make of COHO lands on that bench.
Michael framed it as a challenge, not a proposal: “a challenge I bring to you today that doesn’t have an easy answer.” FHG built a Molina model on WISHIN — a resource he admits he had discredited — and it holds everything you would want for any AMA metric, today or in the future. The plans already write big checks for it and cannot do anything with it.
On Monday, Molina asked unprompted: “what do we need just to get us out of the HEDIS business and into this chronic-disease-improvement business?” He was hinting at the AMA program.
Then the doctrine: “If we want to work with health systems, we have to work with their affiliates… and the plans, who pay them. If you leave out the people that pay them, you’re going to get absolutely nowhere.”
Delane took it: “The plan one is where I think we can actually go.” And she brought her own evidence — from prediabetes, plans want AMA measures and cannot implement them because they lack the data. Her open question is a better one than the one Michael asked: do you get plans to adopt collectively?
Michael’s caution stands with it — the plans are not liked by this administration, “and I don’t want it to be something that gives you singed. You’ve got to figure out the politics side.”
If the plans are where COHO has to go, this is the road. Healthsperian is very friendly to the AMA, and “more critically to a group that’s very friendly to John Whyte.”
The big plans have already signed a pledge toward advancing chronic disease — “that’s this administration’s play. There could not be a greater thing.” The register is fixed and Michael named it: you follow the script — chronic disease, patient-centered, can they get the device on their phone.
The opening, said plainly: “If Whyte had the confidence to build out that program with you leading it, you could get that with Healthsperian. Catch Whyte on a good day with it.” That is a route to the CEO that does not run through her new GVP, and it puts her in front of it rather than behind it.
Full disclosure given unprompted — not on their payroll, gets nothing from them, they are friends with John.
Her homework, and she owes a text: the Healthsperian site, Patrick Kennedy’s Action for Progress, and the release videos — Whyte MCs the last one.
Delane is three weeks into working for Denise Fair Razo, and she has no read on her yet beyond the resume. Michael handed her the shortest path there, and it is a person FHG already knows well.
“GVP from that market is very close to Phil Levy.” Denise ran the Detroit Department of Public Health and came up through Henry Ford and Trinity; Phil is Wayne State and Wayne Health. Same city, same orbit. Michael: “If you haven’t talked to Phil, you should talk to Phil… I speak to Phil a lot. If that’s a discussion you want to have, we can do that right away.”
Unprompted, she said: “I have to reach out to him because we’re supposed to license all our content to him at some point. We never did.” There is an unexecuted AMA-to-Levy content license sitting on the table. It gives her a legitimate reason of her own to call the exact person who is the warm path to her boss.
Her read at three weeks: Denise “thought she was taking over the Center for Health Equity” and now CHE and IHO are merged — “it’s a total cluster.” But the handles are there: a personal connection to cardiovascular disease and stroke prevention, “a pretty rational person,” real health-system experience, and willing to help in the health-system space. “With that, I think I have something to at least work with.”
Denise’s arrival is what unfreezes Delane. Which means the Phil Levy introduction is not a courtesy — it is the thing that lets our counterparty start moving again.
Read this as one thing: a place the AMA program can grow, with money already behind it.
Why it has been slow. Jesse Ehrenfeld — AMA past president — ran AHW and “left somewhat unceremoniously.” The endowment traces to the Blue Cross conversion some twenty years ago: loaded with cash, and carrying a public perception that nothing good has come of it. The delay since has been post-departure cleanup for a public oversight board and a clean audit. Michael Stadler is next in line — Michael offered to put him in front of Delane on Zoom.
Why it is moving now. This week, unsolicited, FHG received a series of documents from Froedtert and the Medical College of Wisconsin on AHW’s behalf. Michael’s read: data flow and stand-up inside sixty days, which puts 16th Street as the first site, in-year. That is the first concrete timing anyone has given her.
Where it goes. Four WIN-funded systems — 16th Street FQHC, Froedtert, Advocate Aurora, Ascension — with BAAs across all four. Then the rural expansion: Tony DeFranco, close to Stadler, carrying both AHW funding and Molina, wants the program statewide before this one has stood up, and asked Michael to map the 2027 installation path — Ashland, Superior, La Crosse. WCHQ sits behind it as the third piece.
One caution on the relationship: the promised material has not been arriving, and Delane knows it. She is also carrying a serious family situation, and both Michael and Delane extended real grace. Any nudge stays warm.
Michael asked whether the Chicago framing had resonated. The sponsorship framing helped — and specifically helped Tam, who had been stuck on whether payors should sponsor things. “Who buys outcomes” was the unlock.
Then the part worth keeping. Her team had struggled to think about not-for-profit correctly, because the nonprofits they have sat on are community service organizations, not grantmakers:
That validates Page A directly and names the tier — mega-foundations, five-year horizon, sold on avoided downstream cost. Not community foundations. And she arrived at it on her own, which makes it hers to defend internally.
Michael named CPT and refused it — “the radioactive nuclear waste of the assault on CPT and what’s happening with all of that, the RFI and more” — and moved on. With the AMA’s core franchise under direct assault, and Delane three weeks into a new boss while holding a shrinking budget, opening that front would have cost the plans conversation. Treat it as a standing rule with her. He gave the same discipline to the plans themselves: they are not liked by this administration, “and I don’t want it to be something that gives you singed. You’ve got to figure out the politics side.”
The budget number was said in the big meeting. Everything that explains it was said here. She has been treading water for months waiting for a boss; her two staff are one difficult star and one new hire who does not yet see the point; her most important external partner has stopped delivering; and she believes her own organization made a fourteen-year strategic mistake it cannot undo. That is the actual condition of the counterparty, and none of it appears in any deliverable or invoice.
Delane brought her two FY-strategy leads — Tam Duong (Director, Health Systems Transformation) and Sinead Forkan-Kelly — to hear the thesis from Michael directly. Explicitly future-thinking, not current ops (Duncan and Community Health parked). Michael put it flatly: there is no way COHO gets budget to pay FHG, so the AMA program has to become a standard that someone other than the AMA pays for, with FHG doing the measurement.
Delane widened the circle to the people who will write the strategy. The place to raise it again is the Aug 27 COHO & FHG planning session.
The four pillars are the “purposeful collision” loop — access, outcomes, clinician burden, cost. Swap the funder in and out: philanthropy or the health plan, same loop. And it does not have to run on our platform — “it’s not always our chassis,” as Michael put it. In the OCHIN model FHG just takes the aggregate; the job is to grow the AMA’s asset of data, wherever it runs.
Page A — philanthropy funds → free clinics deliver → FHG + AMA (the Community Health Chicago prototype). Page B — keep FFS + a prospective PMPM ($50–$100/mo) + shared savings; 16th Street FQHC / Molina; Solventum codes as a placeholder for the AMA’s; OCHIN + WCHQ as the data rails. Molina is “all in” on a ≤2-page amendment.
The cleanest first membership subset is provider-owned plans — every dollar saved for the plan flows back as top line to the owning system, a double win, sold “with Gilligan and his golf bag.” The middle-ground growth lane is Phil Levy’s mobile vans — cardiovascular, drawing unsolicited plan inbound, warm on Delane’s signal.
She walked the pitch to ground: the real audience is philanthropy, not the health system. Three challenges — need more proof points of FHG success in free/charitable operations; it’s a risky-payor moment for that audience; and the ask bundles the clinics + FHG banner + an AMA slice. Treat these as the next-iteration list, not resistance.
Tam Duong — ~5 yrs AMA (prior CHE), ~7 yrs IHI; leads the clinical facilitation team + the tiered-products conversion + CAC education; owns the “can the program make money” riddle. And live at the close: the new COHO GVP is from Detroit — Phil Levy’s close friend — confirming the Denise Fair Razo ↔ Phil Levy bridge (via Subbu).
FHG has a live demonstration site at Community Health Chicago — 3,400 people on the platform, SDOH data coming in, cancer screening being built now. There are 30+ free clinics in Chicago. They are collapsing. Meghan Phillipp is the central hub for the entire nonprofit community in all of Illinois. She has access to the philanthropic community, the city of Chicago, and the state. The ask is $20 million. AMA writes no check. FHG runs the platform.
You’ve been on all these emails. Nothing’s happening. If you’re stuck, say so. But we need to get going — or you’re going to have a happy little story at Community Health while Coho dies around it.
The Director of Growth Operations is already on the platform and loves it. SDOH data — transportation, housing — being built in now. Cancer screening overlay coming. Language work for a Polish- and Spanish-dominant population (one English-speaking person on site) is coming together. Emily re-engages with patient-level data when those go live. This is almost ready. Finish it.
Ethan Maddy works for Humana. Michael met him at the AMA. Kate, you sit on the WayForward Resources board — that’s the connection. Subbu connected with Ethan 6/26. FHG owns this — keep it moving, don’t stall on who has the next step. Understand what he knows. Understand who he can convene. “He’ll talk to you.” Do this before you call Meghan. Note: when the Meghan demo is ready, it will be its own dedicated fhglabs.studio site — not folded into this page.
Meghan Phillipp is the central hub for the entire nonprofit community in all of Illinois. She is trusted across the city. She doesn’t have a day job — this IS her work. Do not go to her with a question. Go with a plan. The plan is: FHG has a live site. 30+ Chicago free clinics on MAP metrics. Meghan convenes the philanthropic community, the city of Chicago, and the state of Illinois to fund the deployment. AMA writes no check. FHG provides the platform. Build this before you call.
When the demo site is ready, invite the Chicago free-clinic network in for a Thursday evening. Appetizers. Let Community Health’s own clinicians run a tour of how they’ve configured it for their population — SDOH, cancer screening, Polish and Spanish language overlays, chronic disease management. FHG does not present. The clinicians present. That’s how the model spreads — clinics sell each other.
The specific ask to Meghan: get the philanthropic community, the city of Chicago, and the state of Illinois to fund a $20M deployment. A portion of that comes to FHG to stand up the sites. Meghan convenes. Ethan bridges to Humana. FHG provides the platform. Community Health is the proof it works — 3,400 people on the platform today. That is not a pilot. That is a model. The number is $20 million. Say it.
Fitchburg Library · June 24, 2026
To Do.
Every commitment from the Fitchburg Library session. Check items off as they land.
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Michael · By Friday, June 27
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Kate + Michael · Before Friday, June 27
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Michael · Done / confirm sent
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Michael · Now
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Pam + Mel · After Friday, June 27
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Michael · Before whiteboard session
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Michael · Next week
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Mel / Kate · Soon
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Pam + Kate + Michael · Soon — FHG owns it, keep moving
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Michael + Sean · By mid-July
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All · By mid-July
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Subbu · Before next billing cycle
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Subbu · Q3 2026
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Subbu + Michael · Q3 2026
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Michael · Q3 2026
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All · Weekly
AMA · June 2026
4 Questions
for Today.
These are what we are here to figure out. No owners yet — that is part of what we are solving.
AMA · Contract Revenue
Revenue.
Two active business units — PS2 and COHO — under one MSA. 2026 committed TCV: $1,582,000.
- PS2 SOW 2 · Jan 10–Dec 31$852,000
- IHO SOW 4 · Jun 6–Aug 31$522,000
- IHO SOW 5 · Nov 12–Dec 31$240,000
- Total$1,614,000
- PS2 SOW 6 · Jan 1–Dec 31$852,000
- COHO SOW 7 · Feb 27–Dec 31$480,000
- COHO SOW 8 · Feb 27–Dec 31$250,000
- Total$1,582,000
01 2026 Payment Milestones
AMA · Master Agreement
MSA
Renewal.
This is the biggest timeline driver in all of it. The MSA governs every SOW. Acting promptly on renewal is not optional.
01 Renewal Action Items
Re-paper MSA §17 Notices Contact
Nankivil is the named §17 contact and she is done. Nothing actionable flows through her now. Go to Tutty: who replaces her? This is both an administrative task and a useful signal about who Tutty trusts at the legal-notice level.
Get a thread with Loebach before the renewal conversation starts
Loebach will sign the next MSA. She replaced Hagerty in approximately March 2026. FHG has no prior thread with her. A warm introduction through Tutty — framed as a courtesy, not a negotiation — is the target. Do not let the first Loebach interaction be the money conversation.
The DataLab runs on FHG code. That is real leverage — use it.
AMA owns the data. FHG owns the code. The AMA DataLab is the operational hub for the entire Organizational Biopsy today. FHG built and runs it. Atalan cannot step into that role — they are a survey tool, not an infrastructure play.
The sabers are rattling. There will likely be RFP pressure. Brittany (Brit) Thele, Kyra, and others may try to use that to put FHG on the defensive. Do not take the bait. FHG has real leverage here and the renewal conversation should come from that position — confident, not anxious. We are not asking to stay. We are explaining what happens to the DataLab if we leave.
Strategy · What We Are Navigating
Horizon.
What Michael learned at lunch with Nancy on Saturday — unprovoked, which means it matters. Then what we have to think forward from there.
“Lots of staff departures. Lots of upheaval.”
Nancy sought this out. She is retiring and she chose to have this lunch. The organization below the GVP line has been hollowed out — the people FHG worked with, who understood the work, are gone or leaving. New physician coming in from MCW: Alicia Pilarski, DO — not from the Fogg orbit, a potential FHG asset. But almost everyone at AMA who had real context around our work is gone.
The people who would vouch for FHG at renewal are mostly gone. We are starting from a smaller base than we think.
ClinicianPulse competitor
into AMA PS2.
Atalan is working directly with AMA member health systems through PS2 as the channel. They are running the Whyte thesis before FHG is. A competitor, inside the tent.
01 The Whyte Thesis — FHG’s Natural Alignment
Business units must support member organizations and member systems.
Whyte’s restructuring from CHE/IHO to COHO is a clear signal: AMA is reorganizing around member system support, not standalone programming. FHG’s products exist to help health systems perform better. That is the same thing Whyte is building toward. Make this argument before the renewal conversation, not during it.
The risk: Atalan is making the same argument, and they are already inside PS2 with a live contract. FHG needs to be specific about what we can do that Atalan cannot.
02 The Rev-Share Question
Should FHG propose a revenue-sharing model to one or both BUs?
FHG brings the product, AMA brings distribution to member systems, revenue from health system contracts is shared — 50/50 on paper. But in practice, these models tend to stall on who gets credit, compliance questions, and governance headaches. AMA’s legal layer adds more friction than a commercial partner would.
Hold this question for now. The smarter near-term move is building the relationship and the trust that would make a rev-share conversation possible. Proposing it cold is a risk to the base revenue.
AMA Intelligence · New AMA Under Whyte
New AMA.
Whyte CEO since July 1, 2025. Dr. Wig COO since June 1, 2026. CHE eliminated. IHO + CHE merged to COHO. Career Advancement Collective created. PS2 under Tutty and Farley.
01 The Restructuring
Center for Health Equity
Maybank out. CHE folded into COHO. Named equity physician leader seat empty.
COO Seat
Giacomin gone. Seat eliminated; Dr. Wig installed June 1, 2026.
COHO — CHE + IHO Merged
Four pillars: SDOH · Medical Education · Community-Centered Solutions · Data-Driven Research. FHG’s MAP Dashboard work lives here under Seoh.
Career Advancement Collective (CAC)
Education Center + AMA Ed Hub + PS2 + Strategic Insights under Tutty as SVP. FHG’s anchor lives inside this structure. Farley runs PS2 as GVP reporting to Tutty.
AMA Center for Digital Health and AI
Whyte’s signature initiative. Lozovatsky departed May 4, 2026 to Premier Health. Open. FHG entry path.
02 Who Runs AMA Now
03 Tutty / CAC + Farley / PS2 in Depth
PS2 is now inside a larger portfolio under Tutty. That is good news and a complexity.
The good: Tutty’s elevation gives FHG a senior SVP anchor inside the CAC. He signed our MSA. He knows our work. His mandate now includes Ed Hub, Education Center, and Strategic Insights alongside PS2 — which means FHG’s research and data infrastructure could be positioned as a CAC-wide asset, not just a PS2 vendor.
The complexity: Farley now runs PS2 day-to-day as GVP reporting to Tutty. Farley is new to the role, survey-first in her instrument philosophy, and navigating Atalan/Fogg pressure within her BU. FHG needs a relationship with Farley that is not mediated entirely through Tutty — because Tutty’s portfolio is large and his attention will be distributed.
The question: does FHG position within the CAC broadly — a Tutty-level conversation about what FHG can do across the whole collective — or within PS2 specifically, a Farley-level conversation about ClinicianPulse alongside Atalan? Both. Tutty first to set the frame; Farley to execute within it.
AMA Intelligence · The Culling
Who Left.
If you worked with someone at AMA below the GVP line and you have not confirmed them recently, assume they are gone. Most of the people who knew our work have left.
| Name | Role | Status |
|---|---|---|
| C-Suite & SVP | ||
| James Madara, MD | Prior CEO (2011–2025) | Out Handoff to Whyte July 1, 2025. |
| Denise Hagerty | SVP & CFO | Out Replaced by Loebach ~March 2026. |
| Jon Giacomin | SVP & COO | Out COO seat eliminated; Wig fills it June 2026. |
| Lori Prestesater | SVP, Health Solutions | Out Replaced by Jeremy Knight. |
| GVP Layer | ||
| Aletha Maybank, MD, MPH | Chief Health Equity Officer · GVP CHE | Out Departed end 2024. CHE eliminated. |
| Sanjay Desai, MD | Chief Academic Officer · GVP ChangeMedEd | Forced Out Education Center restructured. |
| Frederick Chen, MD, MPH | Chief Health & Science Officer | Out Not replaced. |
| Margaret Lozovatsky, MD | CMIO + AI Center Lead | Out → Premier Health May 4, 2026. AI Center leadership-vacant. |
| COHO / IHO Ops — People FHG Worked With | ||
| Michael Rakotz, MD | Group VP / VP Health Outcomes | Done Anchored MAP BP / Release the Pressure. |
| Kate Kirley, MD, MS | Director, Chronic Disease & Prevention | Quit Per Michael. |
| Greg Wozniak | VP, Health Outcome Analytics | Out Lead analytics counterpart on COHO side. |
| PS2 — People FHG Worked With | ||
| Christine Sinsky, MD | VP Professional Satisfaction | Retired May 31, 2025. |
| Nancy Nankivil | Director, Practice Transformation · MSA §17 Contact | Done Had lunch with Michael unprovoked — she is out. Nothing actionable flows through her now. Re-paper §17 through Tutty. |
| Tom Easley | Chief Mission Officer + Exec Publisher, JAMA | Retiring Sept 30 Garcia + Andrews through Sept 30. |
| Staff Layer — Primary PS2 Coordinators (Likely Gone) | ||
| Caitlin Nosal | PS2 Research Sandbox + Clinician.Health coordinator | Likely Out One of FHG’s primary day-to-day PS2 contacts. Confirm status through Tutty. |
| Purva Shaw | PS2 Research Sandbox + Clinician.Health coordinator | Likely Out Primary PS2 research sandbox contact. Confirm status. If she is gone, map who has picked up this work. |
| Erica Eddy | PS2 staff | RIF'd Worked with FHG at the operational level. |
| Lauren McConnell | AMA staff | RIF'd |
Contracts · PS2 & SOW 6
PS2.
Practice Sustainability & Professional Satisfaction — now inside Tutty’s Career Advancement Collective. Farley runs it. Fogg/Atalan is in it. SOW 6 TCV: $852,000.
01 PS2 Watch List
02 The Farley Relationship — Building It Fresh
Heather Farley, MD, MHCDS, FACEP
Joy in Medicine. Organizational Biopsy. Survey-first. She is new to this GVP seat and she has inherited Atalan/Fogg as a fait accompli in her BU. That is also a problem she has: two well-being measurement vendors in her unit, possibly competing for the same site relationships.
Do not pitch against Atalan. Lead with the difference: Atalan uses surveys; FHG reads the exhaust from the actual work. They measure different things. A ClinicianPulse one-pager that makes this clear — without attacking Fogg — is the right first move. Nancy: “a lot of challenge in front of her.” FHG can be a resource to Farley, not another thing on her plate.
Delane Heldt (VP Strategic Scaling & Operations, COHO) — one-on-one Zoom with Michael, June 24. The call opened three paths and produced three committed to-dos.
Contracts · COHO & SOWs 7+8
COHO.
Center for Optimal Health Outcomes — CHE + IHO merged. Now led by a permanent Group VP: Denise Fair Razo, named July 2026. Duncan Regional and community health are the near-term anchors. SOWs 7+8: $730,000.
Denise Fair Razo, MBA, MPH, FACHE — the permanent COHO leader is named.
The interim question just got answered. The AMA has named Denise Fair Razo Group Vice President of the Center for Optimal Health Outcomes — the center that houses SOWs 7+8 and Delane’s MAP work. She now sits at the top of COHO (CHE + IHO merged), a peer to Tutty’s PS2 GVP seat. Surfaced July 13 in the team channel: Michael’s flag, Pam’s press-release link, and Denise’s own LinkedIn announcement.
Who she is — not a physician; a public-health / health-administration leader. Most recently Chief Public Health Officer for the City of Detroit, running the Detroit Health Department (~250 staff) and the city’s COVID-19 response since her 2019 appointment by Mayor Mike Duggan. Before Detroit: group practice director at Henry Ford Health (primary care, behavioral health, multi-specialty), and earlier Trinity Health. Education: BA Michigan · MPH UC Berkeley · MBA Wayne State (Ilitch) · FACHE. Board seats: Michigan Public Health Advisory Council (Whitmer appointee), Big Cities Health Coalition, Public Health Foundation.
Her own framing (LinkedIn): “lasting improvements in health don’t happen in silos — they happen when physicians, health systems, public health, policymakers, researchers, and communities come together around a shared purpose.” Systems-and-public-health language that maps cleanly onto COHO’s four pillars: access, outcomes, clinician burden, cost.
What it means for FHG. The relationship-reset risk the interim alert warned about is now live — a new leader at the top of our most active COHO front, landing right as the MSA-24377 renewal clock runs. But there is a warm way in, not a cold one. See the Phil Levy path below.
AMA press release · AMA COHO center · LinkedIn · Detroit Health Dept bio · Big Cities Health Coalition
Phil Levy, MD — the Detroit bridge to Denise.
Phillip D. Levy, MD, MPH, FACEP, FAHA, FACC — Edward S. Thomas Endowed Professor of Emergency Medicine at Wayne State; Chief Innovation Officer of Wayne Health; Director of the Center for Population Health Accountability; founder of the Wayne Health Mobile Unit Program (2020). A Detroit cardiovascular / health-equity leader who has run 110+ funded studies (NIH, CDC, AHA). He is already an FHG relationship — the People.Health / Molina Wisconsin prevention-cohort work runs through him.
Why he is the bridge. Denise Fair Razo’s entire career is Detroit public health + Wayne State (her MBA is from Wayne’s Ilitch school). Phil is embedded in exactly that world. Michael’s directive in the channel: “very friendly to Phil Levy, MD; Subbu should speak with Phil.” This is a non-cold path into the new COHO leadership — Phil can give us the real read on Denise before any AMA-side outreach.
Yesterday’s Subbu × Phil call was primarily about the Molina Wisconsin prevention-cohort proposal — but Phil himself surfaced the AMA angle. He raised Denise directly as the incoming COHO Group VP, ex-Detroit public health, and Subbu wants to connect them once she is settled. Phil knows her from the Detroit public-health world; the introduction is his to make when the timing is right.
Rest of the call, for context (Molina lane): Phil personally drove the refined cohort-targeting strategy — geography-first (greater Milwaukee working example), a 27–45 age band, and a prevention-screening buy-in feeding a risk-adjusted plan. He also raised a Michigan-reuse question (no Michigan counterpart named yet), a Blue Cross Michigan gig-economy market observation, and a Crystal Mountain golf-outing fundraiser with two Republican state representatives (with Tom Hartle) — a second, political / legislative relationship track.
The action: Subbu → Phil to get his take on Denise and time the introduction. Warm the path before FHG goes to COHO leadership directly.
Hannah Seoh — We have no relationship here
Elevated from GVP IHO + VP Performance & Operations. Running consolidated CHE + IHO on a thinned bench (Rakotz, Kirley, Wozniak all gone). SOWs 7+8 are in her lane. We do not have a relationship with her and going in cold to an interim who may not last is not a strategy. The right play is a Whyte-level approach — anchor the COHO relationship at the top, not with whoever is holding the interim title.
⚠ Update, July 2026: with Denise Fair Razo named permanent Group VP, the interim question is resolved from above. Whether Seoh remains as a deputy under Denise or rotates out is unconfirmed — do not assert. Either way, the anchor relationship is now Denise, not the interim seat.
Delane Heldt — Active thread. Engaged and ready to move.
Delane runs the operational scaling layer of COHO. Michael had a one-on-one Zoom with her June 24. She is the right person. Key intelligence from the call:
WCHQ (Wisconsin Collaborative for Healthcare Quality) — 35 health systems. Michael hosted WCHQ in Madison June 23 and Karen presented MAP as the go-forward measurement platform. Well received. Michael asked Karen to reach out to Delane directly. The model: Tier 1 (free/public base — all 35 systems get MAP access) + Tier 2 (AMA member benefit — enhanced coaching and training through affiliate partners). 4–5 of the 35 are current AMA members; the other 30 are the lure to membership. Delane already has the WCHQ member list — Michael will give her the Tier 1/2 framing so she can segment accordingly. This is a several-million-people bump to MAP’s enrolled denominator.
MAP business model in motion: Delane confirmed AMA is actively transitioning MAP’s intensive coaching, training, and support from free/public to a membership benefit model, delivered through affiliate and channel partners. The free/public base stays. The coaching layer moves up-tier. Business model still being finalized — but the direction is set. WCHQ’s Tier 1/2 framing fits cleanly.
AMA legislative affairs angle: Delane was in Washington, DC talking to AMA’s legislative affairs team about how MAP could support access from a legislative angle. Deep interest expressed. This thread needs a follow-up before momentum fades. The Healthsperien → HRSA arc fits cleanly here.
Avoiding Gilligan: Michael was explicit on the call: “I don’t want to take anything to Gilligan or any of that crew.” WCHQ routes through Delane, not through Market Strategy & Growth. Do not cross the streams.
01 What Is Going Well — Build From Here
We have something here. Figure out what.
Community Health is an active PopulationManager client through the COHO channel. The data is built. The relationship is real. What is replicable? What is the expansion path to the broader Chicago free-clinic network? Name it and own it before the next COHO conversation.
Strong thread. Protect it.
Duncan is a working proof point in the COHO lane. A community hospital in Oklahoma using FHG infrastructure through the AMA channel. That is the story. Document what is succeeding and make it the template for the Seoh expansion conversation.
Meghan Phillipp + Ethan Maddy. Where is this?
Meghan Phillipp (Third Horizon, Chicago) and Ethan Maddy are the people who can drive Community Health expansion across the Chicago free-clinic network. Michael told Meghan directly: “I want to find a path for you and Ethan to be the leaders and drivers of this.” That was May 18. Being flat-footed here is not an option.
Subbu and Pam — you have been cc’d on every Meghan email. What have you done with them? Why are you not taking action here?
02 COHO Departed Counterparts
| Name | Role | Status |
|---|---|---|
| Michael Rakotz, MD | Group VP / VP Health Outcomes | Done Anchored MAP BP. |
| Kate Kirley, MD, MS | Director, Chronic Disease & Prevention | Quit |
| Greg Wozniak | VP, Health Outcome Analytics | Out Analytics lead gone. |
Strategy · Potential Paths
Paths
Forward?
These are potential paths — not the only paths. There are real headwinds: departures, an interim COHO lead, a competitor inside PS2, and a renewal clock ticking. The assets are real too. The task is being smart about which path to walk.
This is self surgery. Amputating an arm is not the goal — but it may be the survival strategy.
Read both paths before deciding. One is protective. One is expansive. They require different moves and carry different risk profiles.
FHG walks away from Clinician.Health platform operations and moves to a pure Research Sandbox mode — serving both PS2 and COHO as a growing analytical asset under Whyte-led AMA, without owning the delivery infrastructure. There is real revenue loss here. That is the amputation. But the Research Sandbox is a growing asset in the new AMA and this move protects the core.
The Stadler-to-Pilarski path is the on-ramp. Her MCW/Kern identity is a natural bridge to research-partner positioning. If Stadler has a direct connection, that is the warm path in.
This is the growth play and the highlighted path. WCHQ is the proof of concept — not the thesis. The real question is how FHG grows through a nationwide COHO-anchored network.
Lean into Healthsperien and Patrick Kennedy and the national threads already in motion. COHO’s mission is member system support. FHG’s infrastructure — the Research Sandbox, the DataLab, Clinician.Health, and Duncan Regional as the Community Health proof point — can reach and serve health system networks at scale without COHO needing to hire the capacity.
The renewal argument lives here: FHG is not asking to stay. FHG is offering to grow the thing.
Healthsperien-led. Healthsperien-convened. AMA COHO + FQHCs.
There is a third path — not a defensive move and not a raw growth play — that runs through a relationship FHG has already built. Healthsperien is the federal-policy convener spine: Tom Koutsoumpas (Founder & President), Ray Quintero (Managing Partner), Patrick J. Kennedy, Andrew MacPherson. The model is clear: FHG is the data side; Healthsperien is the boots-on-the-ground policy and stakeholder side. They convene; FHG measures. Neither side carries the whole thing.
The entry point is Tom → Whyte. Tom Koutsoumpas and John Whyte are close personal friends. On February 2, 2026, Tom hosted the Action for Progress launch — Whyte appeared as fireside-chat partner alongside FDA Commissioner Makary. That is not a loose connection; that is an anchor. A Tom-brokered conversation with Whyte on the COHO + FQHC thesis arrives warm and with standing — not as a cold call from a vendor seeking renewal.
The audience is FQHCs. Healthsperien has already opened the lane. Subbu formalized the FHG ↔ Healthsperien partnership with Ray Quintero on May 19 — Andrew MacPherson co-anchoring. That call established the model: Healthsperien takes FHG to the Medicaid Director, health plan, and FQHC ecosystem across 30+ states. The infrastructure exists. What has not happened yet is the AMA COHO + FQHC co-development conversation under Whyte.
The co-development frame: Healthsperien convenes the COHO member systems and the FQHC ecosystem. FHG provides the measurement substrate. AMA COHO provides the national channel and the credentialing. Duncan Regional and Community Health are the proof points that something is already working. Build the brief; let Tom broker the room.
What the Delane call confirmed — June 24. Michael laid the Healthsperien × MAP thesis out directly with Delane. Her language for it: MAP is the “worthy successor to UDS” — the Uniform Data System that FQHCs currently report against under HRSA mandates. The move is from UDS (“Mickey Mouse reporting”) into the improvement arena: team-based care models, coaching, cardiovascular improvement as the clinical entry point. If the administration sees this as helpful through HRSA and related programs — “this is a good thing.” The OBBB (One Big Beautiful Bill) is the federal transition mechanism. Delane was already in DC with AMA’s legislative affairs team on exactly this framing. The alignment is real. “In this world of only helping the members, FQHCs are not going to be rolling in the dough — we have to think strategically.” Next step agreed on the call: a working Zoom next week with Delane on the national TFC (team-based care) model. Michael committed to sending times.
OCHIN is not a prospect. OCHIN is asking how to get in.
OCHIN is the Epic-hosting consortium behind approximately 240 FQHCs and 300+ community organizations. They are not a contact we are cultivating — they are a partner who flipped direction this week. After the June 17 Erica Neher meeting, the read is unambiguous: OCHIN went from the rail we have been studying to a partner asking how to get in. Erica's read on the model — existing reimbursement + prospective payment + shared savings — was that it "looks really, really attractive to everybody." They are 100% behind taking the Molina + 16th Street concept to the rest of the Molina markets and to the broader FQHC market.
The paper is done. The NDA executed June 11 — James Maldonado signed for OCHIN. The Jennifer Stoll call is unblocked. Jennifer Stoll is OCHIN's Chief External Affairs Officer — their federal-policy and White-House-facing seat. This is the call.
The federal-money opening. OCHIN CEO Abby Sears is taking a federal-appropriations ask to RFK. The read is she will not get it. That is the opening: our model — health plans put the money in — is the alternative to the ask that will not land. Jennifer Stoll is exactly the seat that would carry that argument into the federal register. Walk in with that framing.
What OCHIN brings. They already have a value-based fair engagement program with Molina National at the national level — not just Wisconsin. Their Epic tools (Compass Rose, the Cheers campaign module) can stand up proactive outreach and tracking at every FQHC they host. They will not charge FHG; for the first engagement at 16th Street they will charge no one. Their ask is a share of shared savings or a strategic seat. That is a workable term.
The OCHIN → AMA COHO arc. OCHIN is the delivery rail under the FQHC ecosystem. Healthsperien is the convener. AMA COHO is the channel. The Stoll call is the moment to name that alignment explicitly: OCHIN's 240 hosted FQHCs + COHO's member health systems + Healthsperien's federal-policy reach + FHG's measurement substrate. That is a coherent national architecture. None of the four can build it alone.
Four asks for the Stoll call: (1) OCHIN's explicit public support for the 16th Street model; (2) begin marketing the model to other Molina markets and FQHCs now — do not wait a year; (3) a focused OCHIN counterpart; (4) a clean microsite that explains the model — not the current FQHC site. The urgency frame: if OCHIN waits, they become irrelevant to the very model they are best positioned to carry.
OCHIN × Delane — virtual whiteboard session agreed, June 24. Michael laid out the OCHIN arc with Delane on the call and she is in. But this one needs its own dedicated whiteboard strategy session — virtual, soon. Not a briefing. A co-development call. Michael’s posture: “I don’t take the liberty of saying let me just cowboy this one up.” He will send Delane briefing material first so she arrives with context. The OCHIN thread involves the broader Whyte orbit and an administration connection that has to be developed carefully — not handed off cold.
What other paths are there?
The four above are coherent. They are not the only options. There are headwinds in both directions and the landscape is shifting fast. What paths have not been named yet?
AMA · Next Actions
Moves.
Top 8 moves that survive scrutiny. Several original candidates were set aside. Moves 06–08 added from the June 24 Delane Heldt call.