How MHCDS Students Are Tackling the Biggest Challenges in Health Care

Access to care is dwindling, leaving residents vulnerable and health care professionals grappling with the weight of a system in distress. For Kelly Johnston MHCDS’25, a self-proclaimed “ranch kid” turned health care financial expert, this crisis is a call to action.

Johnston, who built a consultancy focused on revitalizing rural hospitals, saw firsthand the struggle to balance patient care with financial realities. “A lot of hospitals have great intentions for patient and population health but can’t make the math work,” she explains. “My goal is to help them connect those dots.”

Driven by this mission, Johnston enrolled in the Master of Health Care Delivery Science (MHCDS) program at Dartmouth, delivered jointly by the Tuck School of Business and the Geisel School of Medicine. The 12-month program, which enrolls medical practitioners as well as health care leaders and executives, emphasizes an interdisciplinary approach to problem-solving. The program culminates in a final deliverable where groups of students tackle real-world challenges facing health care, called Action Learning Projects (ALPs).

Johnston and her team’s ALP, titled “The RURAL Playbook,” focused on St. Vincent Health, an eight-bed critical access hospital in Colorado teetering on the brink of collapse. With her team of five, which included physicians specializing in utilization and volume management and a Medicare billing expert, Johnston and her ALP team identified three key challenges: patient registration errors, missed Medicare reimbursements, and underutilized beds. Together, those issues were causing the hospital to lose millions in potential revenue each year.

“The common theme was lack of education,” Johnston explains. “The facility wasn’t tracking bad debts, the receptionists handling patient registration weren’t aware of their role in the revenue cycle, and there wasn’t a real process for using data to make utilization decisions.”

The team implemented targeted training and meticulous process improvements, including new utilization data dashboards and regular review meetings, to rectify issues severely impacting revenue.

The results were lifesaving.

Within just four months, St. Vincent Health saw a surge in revenue that transformed a projected $3 million loss in 2023 into a projected profit for 2024, rescuing the hospital from demise and ensuring continued access to care for an entire community.

But Johnston and her team didn’t stop there.

“We knew St. Vincent would be the host, but our goal from the start was to address a broader problem in rural healthcare,” she says. “Every team member was so passionate about allowing rural hospitals to remain independent.”

To scale what they learned at St. Vincent, Johnston’s team distilled their insights into the RURAL Playbook, a framework for optimizing operational revenue cycles in rural hospitals. The playbook, which they have already shared with community access hospitals nationwide, is garnering overwhelmingly positive feedback, and the team hopes to expand its content and distribution.

“Our hope is that this project has a life far beyond MHCDS,” Johnston says. “The scope of needs in these rural areas is immense.”

The RURAL Playbook is a shining example of the transformative power of the MHCDS program and its unique approach to action learning. By bringing together diverse perspectives and fostering collaboration, MHCDS helps empower health care leaders to look outside the traditional boundaries of their roles to drive meaningful change. This interdisciplinary learning model, as seen with the incredible turnaround of St. Vincent, has proven to be a catalyst for creating tangible impact throughout health systems and their surrounding communities.

“Health care is incredibly siloed,” says Katherine Milligan D’90, T’07, associate dean for Health Care Management Education who also teaches the ALP course. “Crossing functional lines is immensely valuable. All MHCDS students, regardless of background, are united by a desire to transform health care. The ALPs provide a platform to apply their learning, collaborate, and prepare for an even greater impact.”

For MHCDS students, ALPs are often the highlight of the program. Completing an ambitious project with real-world consequences over nine months—while balancing coursework and busy full-time roles—isn’t easy, but the challenge builds powerful bonds between participants.

“The people make the program,” says Johnston. “My cohort was incredible. And working closely with physicians—who are often in contention with financial leaders within the hospital setting—completely transformed my outlook and how I engage with the doctors I work with.”

Navigating the AI Revolution: The AI Cupid Project

While Johnston and her team’s ALP focused on the rural health care crisis, another team of MHCDS students tackled an emerging issue: helping health care organizations evaluate and implement AI tools.

Arkansas dermatologist Brian Russell MHCDS’25 was part of the team behind the AI Cupid project, as it is known. As a private practice physician, Russell came to MHCDS to delve into the sticking points in the U.S. health care system and identify how he could make a difference.

“I was well versed in what it takes to run a small practice, but I didn’t know all the elements contributing to the system nationwide,” he explains.

While he didn’t enter the program intending to look at AI in medicine—“I had little to no previous interest in AI,” Russell admitted—he chose to join the AI Cupid project because he was impressed with the backgrounds and perspectives of the other group members. But once he was introduced to emerging AI tools, Russell found the challenge fascinating.

"These tools could make a big difference," Russell says, "by reducing the administrative burden on physicians and improving their diagnostic capabilities. But physicians just don’t have the time to vet these tools.”

Partnering with a dermatology residency program and VisualDX, an AI diagnostics startup, the AI Cupid team developed a program to help dermatologists effectively evaluate and utilize AI tools.  Their findings challenged initial assumptions about the barriers to AI adoption.

“We were surprised by how open patients were to the use of AI in their care,” Russell says. “As long as they were informed, most patients were comfortable with AI assisting their providers.”

Instead, the team uncovered an unexpected obstacle: regulatory uncertainty. The lack of clear FDA guidance on AI diagnostic tools creates potential risks for both developers and providers.  The ALP team highlighted the need for education and support to help providers navigate this evolving landscape, understand the role and limitations of the FDA when it comes to AI tools, and fulfill their advocacy and governance responsibilities.

Moving forward, Russell and his team are monitoring the AI space carefully and are considering creating a company to connect healthcare organizations with AI tools that align with their goals and regulatory requirements.”

Supporting Unsung Heroes: The Caregiver Compass

Another ALP, Caregiver Compass, focused on a critical yet often overlooked role within health care: that of caregivers. Luke Porter MHCDS’25, director of Clinical Shared Services for ChenMed, a primary care provider network for seniors, led the project, which aimed to increase uptake of the network’s 24/7 phone triage system and reduce unnecessary hospital admissions. However, initial market research led the team to pivot early in the process.  

“After speaking with case managers and providers, we realized that it’s often caregivers, not patients, who drive the decision to visit the hospital,” says Porter. “That led us to look more deeply at the role of caregivers.”

Inspired by the Design Thinking course central to the MHCDS curriculum, Porter and his ALP team—which consisted of a cross-functional group of health experts from a pediatric emergency physician to a home health executive—embarked on a “listening tour,” conducting interviews with phone triage workers, industry experts, and caregivers to understand their needs.

Their core finding? Caregivers are burned out and overwhelmed, and the stress of the role causes adverse physical and mental health outcomes.

“Caregivers need more support,” Porter says. "Often, they simply want to be heard and have their questions answered by the care team."

The team discovered that while most caregivers attended patients’ appointments, many were unaware of resources like respite support and financial assistance. Even case managers often lacked knowledge of existing support systems. 

To address this gap, Porter’s team created a guide to free and low-cost resources in the Richmond, VA region, which they distributed to caregivers, case managers, and primary care providers. As a result, they saw increased compliance with care plans, greater utilization of the after-hours triage system, and reduced hospital visits among at-risk populations.

Porter plans to expand this resource to other regions and implement systemic changes within ChenMed, such as incorporating caregiver information into electronic medical records, to provide more holistic support.

“MHCDS helped me see how systems work together to drive outcomes,” he says. “That shift in perspective has really changed my approach.”

This story originally appeared in print in the winter 2025 issue of Tuck Today magazine.