From IRS Clerk to the Head of CMS: Lessons in Leadership

Spotlight on

Charlene Frizzera

Who is Charlene?

Charlene’s positive attitude, combined with her intellectual curiosity, propelled her from a clerk at the IRS to running the Centers for Medicare and Medicaid Services (CMS), the single largest payer for healthcare in the US providing healthcare benefits for nearly 90 million Americans. Charlene spent more than a year as Acting Administrator of the agency – which falls within the U.S. Department of Health and Human Services (HHS) –spanning 2 administrations.

Upon graduating high school, Charlene forwent college and headed straight into the workforce in an entry-level position for the IRS. In between her days as an IRS clerk and running CMS, Charlene was a field auditor, auditing tax returns of businesses, she answered taxpayer questions during tax season, and served as an accountant for HCFA, before ultimately making the move to policy at the recommendation of someone she knew. That’s the common thread for Charlene as she moved from job to job across wildly varying departments - when you work hard, people recognize you have value beyond your current job. Charlene also credits her upward mobility to being incredibly lucky to work in places where people had more faith in her than she had in herself.

Here she shares why listening is the most transferable skill across any job, why multi-tasking is not the holy grail, how healthcare startups can approach working with the government, and why we must shift our thinking away from “disrupting” healthcare.


Always be listening

Whether you are talking with partners or advisors, customers or investors, or even your internal team, listening is the biggest skillset to perfect - and it applies to everyone, at every level. You don’t have to agree with the perspectives offered, but by listening you can still learn from them. If you aren’t willing to listen, then you’re wasting everyone’s time. If you don’t agree with someone’s advice, take the time to think through counterarguments to their points. This will help you gain further conviction in your own beliefs and justify your approach. It all becomes part of your knowledge base.


  • meetings:
    No matter your position, tell yourself, “I am not doing anything else right now but paying attention.” Surround yourself with people who can also do that, especially if it’s something you struggle with. If you can, debrief right after a meeting. Every time you have a meeting, ask what everyone heard, then listen to what is said, not just what you THINK was heard.
  • for the people asking the smart questions:When looking at your staff for those who can take on bigger, and more strategic positions, pay attention to this one thing: Who asked the question in a meeting that they could not have asked before the meeting? This likely isn’t the same person who asked the most questions, but rather the person who connected the dots of what was said, and then asked a thoughtful question that spurred further discussion.
  • to your team:
    For leaders, especially new ones coming into an organization, listen first, then take action. Don’t feel like you have to come in with a presence or ideas for immediate change because once you take action and it’s wrong, it’s very hard to take it back. The action you need to take will become clear if you listen first.

Pay attention to who asked the question in a meeting that they could not have asked beforehand


Multi-tasking is in direct opposition to mindfulness

While listening is one of the greatest skills you can perfect, multi-tasking is one you should forget. Culturally we tend to tout multi-tasking as a holy grail of effectiveness, but it simply isn’t. When you multi-task, you aren’t really listening to what’s happening in the present. You don’t have to worry about the 3 p.m. meeting in the 2 p.m. meeting. It’s not easy to give up the idea that you are maximizing your time by multi-tasking, but it’s really important to focus on being present instead.

When you work hard, people recognize you have value beyond your current job


Want to work with the government? Do your research and plan ahead

At some point in your company journey, you will probably want to get your product paid for by the federal or state government - they are a huge payor in this ecosystem! If you are a healthcare startup, bone up on the basics about how the government reimburses what you offer, how your consumers/patients receive the benefits of your services, etc. It’s rare that the CMS will talk to startups directly. Usually they’re  only interested once you have a validated product with demonstrated value.

The job of the CMS is to help the American people in a positive, low-risk way. In biotech, pharma, TechBio, and more, most companies aim to do the right thing by people, but unlike CMS, the safety of the medicare or medicaid beneficiary is not their number one priority. If you want to start a dialogue with CMS about how your product/service/idea can be reimbursed the first thing you need to ask yourself is, “Who does CMS pay to implement whatever it is you have?”

Think strategically about the space you are in. Will it be subject to change based on political agendas as administrations change? Have a clear understanding of anyone that might NOT like what you are doing, understand why they would feel that way, and prepare an answer to try and change their mind. Remember that CMS has been the same for a long time, and it probably isn’t going to change much.


Absolutely no one is disrupting healthcare

Anyone that says they are “disrupting” healthcare is wrong. There are too many competing forces - politics, industry, and money, to name a few - to disrupt the whole system. You can innovate and change, but it’s impossible to disrupt. For example, you aren’t going to disrupt the entire healthcare system by changing hospital payment policies, but that doesn’t mean you can’t innovate on a new solution here to make that aspect better. It’s tough to change prescription practices. The CMS might cover your product or service, but if doctors don’t adopt it, you won’t make any money. You can make meaningful change by solving specific problems, but you aren’t going to turn the entire industry on its head. Your goal should be to innovate, not to disrupt.

You can make meaningful change by solving specific problems, but you aren’t going to turn the entire industry on its head. Your goal should be to innovate, not to disrupt.