FAIR Health Access Interview with Robin Gelburd, President of FAIR Health

June 20, 2024

When Robin Gelburd, founding President of FAIR Health, was selected to helm the newly created nonprofit organization nearly 15 years ago, there was no precedent for an organization that would bring such an unparalleled visibility into the healthcare system. Harnessing her distinctive professional background and experience, Ms. Gelburd led FAIR Health with a unique vision that established the organization as a trusted, objective source of data amid an ever-changing healthcare landscape. Under her tenure, FAIR Health has not only fulfilled its founding mandate but also has come to serve the full spectrum of stakeholders in the healthcare sector and beyond.

As Ms. Gelburd plans to step down from her role, targeting her retirement for the end of the year, she spoke with FAIR Health Access about FAIR Health’s pioneering role over the past 15 years and what she is most looking forward to in her next chapter.

FAIR Health Access (FHA): Following a 25-year career as an attorney, you assumed leadership of FAIR Health. How did you come to be selected to lead FAIR Health? What made you decide to take on the role?

Robin Gelburd (RG): There was a degree of serendipity associated with the opportunity I was afforded to lead FAIR Health. Following an early career as a litigator and a corporate lawyer, I sought to use my legal skills in a sector that touched me at a human level. I joined a stellar healthcare law practice, where I met Stephen Warnke. In early 2009, Stephen and I met for lunch, where I expressed to him that I was contemplating moving on from my position as General Counsel at an academic medical research foundation and assuming a new role, not necessarily in the legal sphere. Shortly thereafter, Stephen was asked by the New York State Office of the Attorney General to serve as Chairperson of a new nonprofit pursuant to a legal investigation into out-of-network insurance reimbursement practices—prior to FAIR Health’s formal establishment. With our last conversation probably echoing in his ears, Stephen asked if I would be interested in serving as President of FAIR Health.

At the time, FAIR Health consisted of nothing more than a document, the settlement agreement that had been penned by the New York State Attorney General’s office and the other parties to the investigation. Having over two decades’ worth of experience as a corporate and healthcare attorney, I believed that leading FAIR Health would bring all of my professional roads together; all roads seemingly had led to the doorstep of this settlement agreement. I was enticed by the challenge of coloring in the lines of the agreement and effectively breathing life into FAIR Health. I also knew that if Stephen—who in my mind is a brilliant lawyer with the most integrity imaginable—was willing to serve as the Chair of this new organization, we would be embarking on a truly rewarding professional journey.

FHA: Given the aggressive timeline in the settlement agreement that gave rise to FAIR Health, what were the main priorities that guided the launch of FAIR Health? What were your biggest challenges in fulfilling the mission outlined for FAIR Health?

RG: FAIR Health was created with a mission to bring fairness, integrity and transparency to insurance information for all healthcare stakeholders. For that reason, it was important to establish and adhere to FAIR Health’s neutrality and independence from day one. Because we were, in the metaphorical sense, renovating a house that people were already living in, we acted with efficiency and speed, though not at the expense of the quality of the data or of those hired to join the team.

One of our biggest challenges was to operationalize that which had been central to the investigation that gave rise to FAIR Health: to ingest the billions of healthcare claims from the prior organization that had been the subject of the investigation and assure the data’s quality and integrity. We tapped talented researchers, economists and statisticians to evaluate the data and recommend methodologies that could be used to continue to aggregate and validate the data, so that once we began to disseminate the benchmark products, all stakeholders and organizations who had relied upon the data prior to the settlement would be able to trust and use the data for their needs.

FHA: As the founding President of FAIR Health, you were a pioneer in the healthcare transparency landscape.
a. How has the environment in the healthcare sector changed since FAIR Health was first created 15 years ago?
b. What was the most significant change FAIR Health and the healthcare landscape underwent during your tenure?
c. What has been most rewarding to you in the 15 years you have served as President?

RG: Fifteen years ago, we felt like pioneers in a stagecoach going out west. Healthcare transparency was not discussed very vigorously in the public square. An early article in a healthcare publication alluded to the fact that healthcare price transparency had no precedent prior to October 27, 2009, the date of FAIR Health’s creation. Healthcare is a highly regulated, highly evolving environment. Having an orchestra seat to the healthcare system, FAIR Health remained prepared to support with our data all stakeholders—consumers, researchers, payors, providers, policy makers and others—within this evolving environment.

Bringing transparency to healthcare consumers was, in our view, like giving them keys to a car they had never driven before. We tiered the launch of the FAIR Health Consumer website—what had been referred to as the “crown jewel” of the settlement agreement—to prepare consumers with the equivalent of “driver’s ed,” a rich educational curriculum developed with health literacy experts, which was jargon-free and which explained important concepts related to healthcare data and healthcare claims. Months later, we began populating the consumer website with cost data that consumers could use on their own healthcare journeys. We first posted the out-of-network, non-negotiated amounts, which had been at the center of the investigation that gave rise to FAIR Health. As health plans began changing their designs to offer certain high-deductible health plans, FAIR Health further evolved to equip patients and families with estimated in-network amounts for services, as insured individuals would be responsible for a certain level of payment for those in-network services before meeting their deductibles. Similarly, in-network amounts became prominent in various state and federal legislative and regulatory initiatives, as well as a factor in certain plan out-of-network reimbursement models. Accordingly, FAIR Health quickly developed a suite of benchmark modules that spoke to that need for trusted in-network values for those various uses.

The most rewarding aspect of my 15-year tenure has been assembling the most talented, dedicated and ethical team of professionals—the village that has fueled FAIR Health’s success. Born out of an intense demand for transparency, FAIR Health sits in such a unique space in the healthcare system. It takes a special team of professionals to recognize and fulfill that unique role.

FHA: What makes FAIR Health unique?

RG: FAIR Health’s origin, mandate and role it has come to occupy in the healthcare sector are unmatched. Rarely is a self-sustaining, independent nonprofit organization created out of a legal investigation. Rarer still is a charitable 501(c)(3) nonprofit tasked to support not just consumers, researchers and government officials but the commercial industry as well—a business under a nonprofit roof with the incredibly important mandate to bring fairness and integrity to the healthcare system, not separate and distinct from our other charitable activities but as core to our founding mission.

FAIR Health is firmly established as a purple organization: completely nonpartisan, independent and trusted by all parties in a highly politicized environment. Red and blue states rely on our data to help inform programs for workers’ compensation, auto liability, surprise billing, women’s wellness and crime victims. FAIR Health is akin to a healthcare canary in the coal mine because we are trusted by all. Hearing the frustrations of consumers and other stakeholders alerts us to the types of information needed to iron out certain pain points. Policy makers often ask us for data or other expertise as they consider different changes in the policy sphere; we are often aware of changes that may be around the bend. With our data, we have shined our flashlight at the different corners of the healthcare system to allow reforms to proceed or public health interventions to be framed. FAIR Health is vital to so many within the healthcare ecosystem, including consumers, academic researchers, government officials, insurance plans, hospitals, providers—the list goes on. That we serve all these roles with a nimble, tight staffing complement rather than the thousands who populate other healthcare organizations also makes FAIR Health unique.

FHA: At the time of its creation, there was no precedent for an organization like FAIR Health—an independent, neutral nonprofit serving all healthcare stakeholders with an objective, trusted source of data. How did you shape and execute your unique vision for FAIR Health amid a fast-changing healthcare environment?

RG: As we breathed life into FAIR Health, we proceeded thoughtfully and methodically, recognizing the incredible complexity of the data we were making transparent. We also sought to assure that FAIR Health as an organization was transparent to the entire healthcare sector—prepared to defend and support every operational decision, forging ahead with the most neutral and independent motivations. Working amid the backdrop of a highly regulated, fast-evolving healthcare environment did not allow the luxury of celebrating any single victory or resting on our laurels. We continued to turn our attention to the next demand waiting around the corner, filling all the informational gaps needed by diverse stakeholders and meeting them where they were by providing the same data, albeit tailored to their roles and needs.

My decades-long experience as a healthcare attorney and as a patient and consumer of healthcare services, as we all are, infused this extraordinary opportunity to help unravel the complexities of the healthcare system by elevating healthcare data for diverse audiences.

FHA: How did your 25-year legal background inform the expertise that you brought as a lawyer to the executive role at FAIR Health? What new competencies were necessary to transition from being an attorney to an executive of a new nonprofit organization?

RG: When I assumed leadership of FAIR Health, I brought a hybrid set of distinct skills honed over two decades as a federal law clerk, litigator, corporate then healthcare lawyer and general counsel of a medical research foundation. My legal and healthcare background proved central to my ability to breathe life into FAIR Health: an understanding of the various interests and needs of providers, payors, researchers and policy makers; communicating verbally and in writing with care and accuracy; seeking fairness and integrity; assessing risk to a client—in this case my client was now FAIR Health; and recognizing the need for diplomacy in a highly charged environment. The ability to express the importance of what FAIR Health was undertaking and to advocate on behalf of the care and seriousness with which we were carrying out our mandate was incredibly important.

Moving into an executive role allowed me to tap into what I had also learned as a general counsel, serving as a lawyer who also was involved in business decisions, namely, the importance of balancing an organization’s legal interests with its leadership and direction. Now that I was President of FAIR Health, building the team to fulfill our mission moved me squarely into the executive role. None of FAIR Health’s success would be possible or enjoyable without a collaborative team rowing in the same direction; selecting the team based on qualities like a strong work ethic, dedication and commitment to FAIR Health’s mission was vital as an executive.

FHA: How did the challenging period of the COVID-19 pandemic inform FAIR Health’s priorities and result in tangible impacts on the healthcare sector?

RG: While we will be forever indebted to the true healthcare first responders—those on the front lines of treating COVID patients—FAIR Health immediately transformed into the “data first responder” during the pandemic. FAIR Health was sitting on billions of claims that we promptly began tapping to shed light on and help stakeholders grasp how this meteoric change was impacting the population and healthcare system. Our data showed how quickly telehealth services transformed access to mental health and other services, geographic areas hardest hit, the cost to the healthcare system and the adverse financial impact on healthcare providers due to the closure of dental and medical offices.

We issued a series of data reports on myriad topics that helped fuel concrete healthcare policies. For example, taking note of our white paper, which showed that those with intellectual and developmental disabilities (IDDs) had higher COVID mortality rates than did other populations, policy makers prioritized the issuance of vaccines to that population at a time when the vaccine rollout was still highly controlled and not widely available. Likewise, our studies showing the impact of the pandemic on pediatric mental health informed discussions at school boards about whether or not to continue school closure practices. Our studies about long COVID led to invitations from national and international organizations and agencies, such as the World Health Organization and the International Association for the Study of Pain.

FHA: What do you see as FAIR Health’s lasting role in the healthcare sector?

RG: FAIR Health’s lasting imprint on the healthcare sector writ large is very satisfying. On the macro level, our analytical white papers, infographics and data resources are relied upon by government officials, academic researchers, policy makers, healthcare executives and others. Our data are not only highly utilized by organizations in their day-to-day operations—adjudicating claims, assessing in-network and out-of-network fee schedules, premium and benefit design, provider network design and so forth—they are also integrated into statutes and regulations that serve as the selected benchmark for jurisdictions to support specific healthcare programs. FAIR Health is usually referenced as an independent third-party database, unaffiliated with any interested party. Oftentimes, that only refers to FAIR Health as there is usually no other party that can meet those requirements. On the micro level, an increasing number of consumers are accessing the data, educational curriculum and resources on the FAIR Health Consumer site to make their personal healthcare decisions and personal planning.

When we were created 15 years ago, we had an enormous role to fulfill but were nonetheless a very small, unknown organization. Over time, public reference to FAIR Health in media outlets evolved from a New York nonprofit organization to FAIR Health, a national nonprofit organization. Today we are typically and simply described as FAIR Health without any qualification, underscoring the trustworthiness that our name alone now carries.

FHA: FAIR Health has enjoyed the long retention of its staff. What would you attribute to the FAIR Health team’s lack of attrition and longevity? What qualities have you looked for when shaping the FAIR Health team?

RG: Being the mother of three sons was extremely helpful in creating the kind of team and culture that brought FAIR Health to where it is today. At FAIR Health, I sought to replicate the family environment that had governed my home life. I made sure that we were creating a team who would collaborate with and respect one another, had a spring in their step because they enjoyed working with each other as well as the substance of the work, and who had the integrity and dedication that would be critical to our success.

FAIR Health’s culture is both open door and “open Zoom tile.” We do not stand on formality, every question is welcome and everyone at any level is free to make recommendations to enhance our work. Our staff are committed to FAIR Health’s mission and are invigorated by the level of sophistication at which FAIR Health works; in the technology we use to ingest, store and process our claims; the statistical expertise in evaluating the data; the healthcare questions we probe with our data analyses; the web design we use; and the way in which we communicate with all of our audiences. It’s heartening to see that instead of people voting with their feet to leave FAIR Health, they vote with their seat and stay.

FHA: Why are you targeting December 2024 as the date for your retirement? What are your plans for retirement? What are you most looking forward to in this new chapter?

RG: Being cognizant of “founder’s syndrome”—the awkwardness that sets in when a founding leader stays on too long and begins to think that the organization is their own—I always knew that at a certain point it would be healthy for FAIR Health to receive new leadership. December 2024 is a logical target date for me to step down. It coincides with the 15-year anniversary of FAIR Health’s founding, and the organization is on solid footing with an exemplary Board of Directors and self-sustaining team of professionals inculcated with our values. My intended retirement date also coincides with another exciting milestone. After I had announced and advised the Board of Directors of my planned December 2024 departure, I learned that I would become a grandmother with the privilege of indulging a grandchild at the end of the FAIR Health rainbow. Not only am I looking forward to spending more time with this expanded part of my family, but I am also excited about traveling more and exploring other interests that I had put on pause during the past 15 years.

FHA: What will you miss most about the job at FAIR Health?

RG: I will miss the professional excitement and adrenaline that fuel every day at FAIR Health. The past 15 years have been one long marathon sprint—not a short sprint and not a methodical marathon. We have sprinted at a marathon pace because the challenges are never-ending and there is always something new, different and impactful that we must attend to. It has been exhilarating to navigate this ever-changing environment, always ready to serve healthcare stakeholders at the macro and micro levels. Most of all, I will miss the people with whom I have worked over the past 15 years. I have treasured the creative problem-solving, always amazed at how our streamlined team can accomplish so much and respond to so many needs in the healthcare system with such utter versatility.

FHA: The Board of Directors is leading the search for your successor. Looking ahead, what are you most excited about for FAIR Health’s future?

RG: FAIR Health’s extraordinary Board of Directors has the best interests of FAIR Health at heart as true fiduciaries to the organization. As they proceed with this thoughtful, systematic search process, I have great trust and comfort that FAIR Health will be in good hands when I leave.

FAIR Health has an exciting future ahead. I am thrilled at the notion that each day the team will continue to experience that exhilaration of responding and adapting to new changes in the healthcare system, in the questions they are asked, roles they are asked to play and gaps they are asked to fill. I am excited about the new challenges that will inevitably be presented to them and will be cheering them on from the sidelines.