FHG Internal · AMA Strategy
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COHO × FHG · Zoom · August 13, 2026 · Delane Heldt + Tam Duong + Sinead Forkan-Kelly  ×  Michael + Pam
The COHO Future-Thinking Session

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 thesis
Make the program a standard others pay for

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 is chassis-agnostic — “it’s not always our chassis.”  In the OCHIN model FHG just takes the aggregate;  the job is to grow the AMA’s data asset, wherever it runs.

Two fundable models
Philanthropy dialect · Payor dialect

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.

Where growth starts
Provider-owned plans · the van lane

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.

Sinead’s challenge
The punch-list for the next pass

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.

New in the room
Tam Duong · the Detroit bridge

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).

Michael’s words — August 13
“There’s no way you get budget to pay for us.”
“It’s not always our chassis.”
“You have all the money.  If you bought smarter, you could spend less.”
“The best subset to become value-creating members — provider-owned plans.”
What’s next
Send Page A to Tam + Sinead
Assemble free-clinic proof points
Elevate at the Aug 27 COHO & FHG session
Subbu → Phil Levy ↔ Denise Fair Razo
Watch Mon Aug 17 — Delane × Karen Kmetik
For Kate · Pam · Subbu · Fitchburg Library, June 24, 2026
Chicago Free Clinic Roadmap

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.

01
Finish the demo site — it’s closer than you think

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.

Kate · Mel
02
Call Ethan first — understand what he knows

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.

Kate (WayForward Resources board connection)
03
Build the plan before you call Meghan

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.

Pam + Kate + Michael (build it together)
04
Host the Thursday evening event

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.

Kate (Emily relationship — Community Health site lead)
05
The ask is specific — the number is $20 million

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.

Pam + Subbu + Michael (the pitch)
Timeline
27 days to go / no-go — Jul 22 is the gate
01 — In progress
Finish demo site
02 — This week
Call Ethan
03 — By Jul 10
Build the plan
04 — By Jul 15
Take it to Meghan
Jul 22 — Verona Library
GO / NO-GO
05 — If GO · Q3
Thursday event + $20M ask
Michael’s words — Fitchburg Library, June 24
“Go to Meghan with a plan, not a question.”
“I’m appealing to you guys to do something.  You’ve been on all these emails.  Nothing’s happening.”
“You’re gonna have this happy little story at Community Health.  You have 30 other free clinics that will all be collapsing.  And then Coho will be dead.”
“Being flat-footed here is not an option.”
“Go to Ethan first — then Meghan with a plan.”

Fitchburg Library · June 24, 2026

To Do.

Every commitment from the Fitchburg Library session.  Check items off as they land.

Immediate — this week
  • Michael · By Friday, June 27
  • Kate + Michael · Before Friday, June 27
  • Michael · Done / confirm sent
  • Michael · Now
This week — after Nancy leaves Friday
  • Pam + Mel · After Friday, June 27
  • Michael · Before whiteboard session
  • Michael · Next week
  • Mel / Kate · Soon
  • Pam + Kate + Michael · Soon — FHG owns it, keep moving
By mid-July
  • Michael + Sean · By mid-July
  • All · By mid-July
  • Subbu · Before next billing cycle
Q3 2026
  • Subbu · Q3 2026
  • Subbu + Michael · Q3 2026
  • Michael · Q3 2026
Ongoing
  • All · Weekly
Checks persist in your browser.  Derived from the Fitchburg Library session, June 24, 2026.
FHG

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.

01
How do we protect this revenue?
$1,582,000 under contract.  A new CFO signing renewals.  Nankivil retiring.  The people who knew our work are almost all gone.  We own the code — but that is a passive defense.  What is the active protection strategy before the renewal window opens?
Figure out: who, how, by when
02
How do we service this revenue?
Not a skill FHG has figured out today.  Lots of change, lots of turmoil on their side.  We need to service this proactively — not wait for them to come to us.  What does that look like with Farley new and Seoh interim?
Figure out: service model, counterpart map
03
What is our aggressive timeline?
AMA IT.  AMA Finance / Loebach.  Cross-leaders.  How do we position our work and confirm where it fits before renewal?  The Databricks build is happening whether we engage or not.
Figure out: sequence, owners, Q3 gates
04
How do we meter our progress?
What milestones do we build in?  What is the barometer of pressure?  How do we assess the health of our relationship and our work on a rolling basis — not just at renewal?
Figure out: quarterly pulse, signals, owners

AMA · Contract Revenue

Revenue.

Two active business units — PS2 and COHO — under one MSA.  2026 committed TCV: $1,582,000.

$1,614,000
FY 2025 Contracted
SOW 2 + SOWs 4+5
$852,000
PS2 · 2025
SOW 2 · NTE
$762,000
COHO/IHO · 2025
SOW 4 $522K + SOW 5 $240K
$1,582,000
FY 2026 Committed
SOWs 6 + 7 + 8
FY 2025 — Contracted
$1,614,000
IHO re-branded COHO mid-year
  • 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
FY 2026 — Committed
$1,582,000
3 active SOWs · Jan 1–Dec 31, 2026
  • 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

PS2 SOW 6 — Research Application Support · NTE $852,000
ComponentNotesAmount
HostingDataLab + Clinician.Health$351,200
Application ManagementPlatform management$298,800
EnhancementsDevelopment + feature work$194,200
SandboxDev/test environment$7,800
SOW 6 Total (NTE)$852,000
COHO SOW 7 — Production Hosting · Fixed $480,000
MilestoneDue DateAmount
Q1 HostingMarch 2, 2026$120,000
Q2 HostingJune 1, 2026$120,000
Q3 HostingSeptember 1, 2026$120,000
Q4 HostingDecember 1, 2026$120,000
SOW 7 Total (Fixed)$480,000
COHO SOW 8 — Support + Enhancements · NTE $250,000
ComponentNotesAmount
Platform SupportMilestone-based$50,000
Metric UpdatesMilestone-based$50,000
Front-End Enhancement 1Upon delivery$50,000
Front-End Enhancement 2Upon delivery$50,000
Front-End Enhancement 3Upon delivery$50,000
SOW 8 Total (NTE)$250,000
2026 Combined TCV$1,582,000

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.

⚠️
Priority:  MSA renewal must move before the last people with institutional memory of it are gone.  Nankivil (MSA §17 Notices contact) is retiring.  Loebach is a new CFO who did not sign the original.  Neither condition improves with time.
Agreement Architecture
MSA Number24377
Governing PartyAMA & FHG
AMA Signatory on fileMichael Tutty
Renewal Signer (current CFO)Christina Loebach
§17 Notices Contact (AMA)Nankivil — Retiring
§16.2 Dispute EscalationTutty (AMA)
Renewal Risk Factors
New CFO, no prior FHG threadHigh
§17 contact retiring, no replacement namedHigh
Atalan contracted inside PS2 scopeHigh
COHO leadership interim / unsettledElevated
Tutty elevated — continuity anchor in placePositive
FHG owns the code — DataLab runs on itReal leverage

01 Renewal Action Items

Immediate — through Tutty, not Nankivil

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.

Q3 2026

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.

Know Your Position

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.

Saturday Lunch · Nancy Nankivil · Unprovoked

“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.

⚠ Direct Competitive Threat · Inside PS2
Jane Fogg has brought a
ClinicianPulse competitor
into AMA PS2.
Atalan Tech’s Clinician Retention Intelligence (CRI) — a burnout and retention measurement tool working directly with health system sites — has been contracted into PS2.  This is the territory that would have been FHG’s growth lane.  It is not the fault of the team today.  It is lost opportunity.  And it now sits inside the same business unit (Farley) where FHG has SOW 6.

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

The Core Idea

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

Open Question — Do Not Resolve Now

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

Eliminated

Center for Health Equity

Maybank out.  CHE folded into COHO.  Named equity physician leader seat empty.

Eliminated / Refilled 18 months later

COO Seat

Giacomin gone.  Seat eliminated; Dr. Wig installed June 1, 2026.

Created

COHO — CHE + IHO Merged

Four pillars: SDOH · Medical Education · Community-Centered Solutions · Data-Driven Research.  FHG’s MAP Dashboard work lives here under Seoh.

Created · June 1, 2026

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.

Created · Leader Vacant

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

John J. Whyte, MD, MPH
CEO & EVP · eff. July 1, 2025
CDC → CMS → FDA → Discovery → WebMD CMO → AMA.  Restructuring is his.
FHG WINDOW
Dr. Wig (Wigneswaran, MD, MBA)
COO · eff. June 1, 2026
Nephrologist.  Walmart / UnitedHealth / Cigna / Fresenius.  Nancy: “Do you know our new COO from Fresenius?”
CONFIRM TIE
Christina Loebach
SVP & CFO · eff. ~March 2026
Replaced Hagerty.  Will sign the MSA renewal.  No prior FHG thread.  Introduce through Tutty before renewal.
RENEWAL SIGNER
Michael A. Tutty, PhD, MHA
SVP, Career Advancement Collective · PS2 in mandate
Signed MSA 24377.  Named in MSA 16.2 for dispute escalation.  FHG’s highest-value continuity anchor.
FHG ANCHOR
Heather Farley, MD, MHCDS, FACEP
GVP, PS2 · promoted June 1, 2026
Joy in Medicine + Organizational Biopsy.  Survey-first instruments.  New.  Nancy: “a lot of challenge in front of her.”  Atalan/Fogg sit in her BU.
SOW 6 ANCHOR
Hannah Seoh
Interim Lead, COHO · elevated from GVP IHO
Running consolidated CHE + IHO on a thinned bench.  “Interim” may signal a search.  SOWs 7+8 in her lane.  Establish now before a permanent hire.
SOW 7+8 · INTERIM

03 Tutty / CAC + Farley / PS2 in Depth

The CAC Structure — What It Means for FHG

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.

NameRoleStatus
C-Suite & SVP
James Madara, MDPrior CEO (2011–2025)Out  Handoff to Whyte July 1, 2025.
Denise HagertySVP & CFOOut  Replaced by Loebach ~March 2026.
Jon GiacominSVP & COOOut  COO seat eliminated; Wig fills it June 2026.
Lori PrestesaterSVP, Health SolutionsOut  Replaced by Jeremy Knight.
GVP Layer
Aletha Maybank, MD, MPHChief Health Equity Officer · GVP CHEOut  Departed end 2024.  CHE eliminated.
Sanjay Desai, MDChief Academic Officer · GVP ChangeMedEdForced Out  Education Center restructured.
Frederick Chen, MD, MPHChief Health & Science OfficerOut  Not replaced.
Margaret Lozovatsky, MDCMIO + AI Center LeadOut  → Premier Health May 4, 2026.  AI Center leadership-vacant.
COHO / IHO Ops — People FHG Worked With
Michael Rakotz, MDGroup VP / VP Health OutcomesDone  Anchored MAP BP / Release the Pressure.
Kate Kirley, MD, MSDirector, Chronic Disease & PreventionQuit  Per Michael.
Greg WozniakVP, Health Outcome AnalyticsOut  Lead analytics counterpart on COHO side.
PS2 — People FHG Worked With
Christine Sinsky, MDVP Professional SatisfactionRetired  May 31, 2025.
Nancy NankivilDirector, Practice Transformation · MSA §17 ContactDone  Had lunch with Michael unprovoked — she is out.  Nothing actionable flows through her now.  Re-paper §17 through Tutty.
Tom EasleyChief Mission Officer + Exec Publisher, JAMARetiring Sept 30  Garcia + Andrews through Sept 30.
Staff Layer — Primary PS2 Coordinators (Likely Gone)
Caitlin NosalPS2 Research Sandbox + Clinician.Health coordinatorLikely Out  One of FHG’s primary day-to-day PS2 contacts.  Confirm status through Tutty.
Purva ShawPS2 Research Sandbox + Clinician.Health coordinatorLikely Out  Primary PS2 research sandbox contact.  Confirm status.  If she is gone, map who has picked up this work.
Erica EddyPS2 staffRIF'd  Worked with FHG at the operational level.
Lauren McConnellAMA staffRIF'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.

🔒
FHG owns the code.  AMA owns the DataLab data.  Atalan has no foothold in the DataLab — they are a survey tool, not an infrastructure play.  Named FHG personnel on SOW 6: Barbouche (CEO) · Brendemuehl (VP Data & Analytics) · Kittleson (Channel Dir) · Lopez Thong (PM).

01 PS2 Watch List

JF
Jane Fogg, MD, MPH
Physician Director, Organizational Transformation (PS2) · Reports to Farley
Deployed Atalan Tech CRI inside PS2 — ClinicianPulse competitor, working directly with health system sites on burnout measurement.  FHG lost growth territory here.  This is the Fogg incursion. ATALAN ANCHOR
AP
Alicia Pilarski, DO
Joining PS2 from MCW · Chief Well-Being Officer, Froedtert/MCW · Kern Institute
Triple-bridge: AMA PS2 × MCW/Kern × AHW.  Not from the Fogg orbit.  Michael routed her into the MCW + AHW thread June 20.  Can Michael Stadler help us here?  Stadler’s MCW relationship and AHW ties may be the warm path to Pilarski without going through Fogg.  Update June 24:  Michael confirmed to Delane Heldt (COHO Ops call) that Pilarski is joining PS2 and will send Delane her information — opening a PS2 ↔ COHO operational bridge on this thread.  Route through Delane.  Not Fogg.  Not Gilligan. FHG ASSETSTADLER ANGLEDELANE BRIDGE
NN
Nancy Nankivil
Director, Practice Transformation · MSA §17 Notices Contact · Retiring
The FHG thread with the most institutional memory in PS2.  She had lunch with Michael unprovoked.  Use the remaining time to understand who the next layer is.  Re-paper §17 replacement immediately. DEPARTING

02 The Farley Relationship — Building It Fresh

New GVP · Promoted June 1, 2026

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.

⚡  BREAKING · June 24, 2026 · ~2 hours ago
Zoom w/ Delane Heldt

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.

WCHQ Pipeline
35 health systems.  MAP presented June 23 in Madison.  Well received.  Karen intro to Delane inbound.  Tier 1 (free / all 35) + Tier 2 (member benefit / coaching).  Several million people.
See COHO below ↓
MAP = UDS Successor
Delane’s own language.  OBBB transition mechanism.  Team-based care Zoom — next week.  Already committed.
See Path C ↓
OCHIN Whiteboard
Virtual whiteboard strategy session agreed.  Michael sends briefing material to Delane first.
See Path D ↓
Committed on the call — Michael’s to-dos: ✓  Send Delane TFC Zoom times — today ✓  Send Delane Pilarski info ✓  Send Delane OCHIN briefing material

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.

Leadership question — answered:  The “interim” signaled a search, and the search has landed.  Denise Fair Razo is the permanent Group VP of COHO (named July 2026).  That resolves the uncertainty and confirms the risk it flagged:  every counterpart relationship at the top of COHO now resets to a leader FHG has no history with.  The move is to build that relationship warm, through Phil Levy — not cold.  See below.
⚡  New · July 13, 2026 · Group VP, COHO + CHE

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

The warm path · mounted July 15, 2026

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.

Phil × Subbu — July 14, 2026 (Molina Proposal Refinement call)

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.

Phil Levy · Wayne State · Phil Levy · Wayne Health

Prior Interim Lead, COHO

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.

COHO Ops · VP Strategic Scaling & Operations · Call June 24

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

Community Health — Good Momentum, Needs Definition

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.

Duncan Regional Hospital — Going Well

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.

Open Thread — Squandered Lead

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

NameRoleStatus
Michael Rakotz, MDGroup VP / VP Health OutcomesDone  Anchored MAP BP.
Kate Kirley, MD, MSDirector, Chronic Disease & PreventionQuit
Greg WozniakVP, Health Outcome AnalyticsOut  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.

The Framing

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.

Path A · PS2 · Survival
Wind down Clinician.Health → Research Sandbox only

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.

Path B · COHO · Growth — Highlighted
Grow through a nationwide organization

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.

Path C · Healthsperien · The Convener Play

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.

Path D · OCHIN · The Delivery Rail

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.

Open Question

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.

01
Re-paper MSA §17 through Tutty — not Nankivil
Nankivil is done.  Nothing actionable flows through her now.  Go to Tutty: who replaces her as the §17 notices contact?  Administrative necessity before the renewal conversation.
Owner: Michael · Immediately
02
Stadler path — burnout work → Pilarski → PS2
Stadler’s connection to burnout research and the MCW/Kern orbit makes him a potential warm path to Pilarski, who is joining PS2 from exactly that world.  The most credible PS2 on-ramp not inside the Fogg orbit.  Explore before approaching Pilarski cold.
Owner: Michael · Q3 2026
03
Document the Duncan + Community Health pattern
Duncan Regional and the Community Health lane are working.  That is a real asset.  Name it, document it, and build it into the COHO expansion proof point.  What is succeeding?  What is replicable nationwide?  This is the material for the Path B conversation.
Owner: Subbu + Michael · Q3 2026
04
Build a Loebach thread before renewal
Loebach will sign the MSA renewal.  She has no prior FHG thread.  A warm introduction through Tutty — framed as a courtesy call, not a money conversation — is the target before Q4.  Do not let the first interaction be the renewal ask.
Owner: Michael · Q3 2026
05
Fogg — conditional on revenue path only
Fogg has moved on.  Nothing actionable there unless it opens a specific path to revenue generation.  Do not spend energy here without a visible thread.  The Farley leave-behind (ClinicianPulse exhaust vs. Atalan survey) is still worth building — but that is the Farley play, not the Fogg play.
Owner: Michael · Q4 2026 · Conditional
06
Schedule Healthsperien × Delane Zoom — national TFC model
Agreed on the June 24 Delane call.  Agenda: the national team-based care (TFC) model — how MAP positions FQHCs for the OBBB transition, the HRSA play, and the administration connection.  Michael committed to sending times on the call.  Already committed — send before end of day.
Owner: Michael · This week · Already committed
07
Send Pilarski info to Delane
Confirmed on the June 24 call.  Alicia Pilarski (DO, MCW/Kern, joining PS2) — Michael will send Delane her card.  Opens a PS2 ↔ COHO operational bridge on the Pilarski thread.  Route through Delane.  Not Fogg.  Not Gilligan.
Owner: Michael · Immediately
08
OCHIN virtual whiteboard — send Delane briefing material first
Agreed June 24.  The OCHIN arc needs a dedicated virtual whiteboard strategy session with Delane.  Not a quick brief — a co-development session.  Michael will send briefing material to Delane first so she arrives with context.  The OCHIN thread involves the broader Whyte orbit and an administration connection that has to be handled carefully.  Do not cowboy it.
Owner: Michael · After the TFC Zoom · Soon
FHG Internal · AMA Strategy · Updated June 24, 2026 Confidential