Lessons in Leadership: An Interview with Harrison Frist, FCV Operating Partner

Q: What did the earliest version of naviHealth look like, and what's one leadership decision from the earliest years that impacted the latter ones?

HF: The earliest version of naviHealth was a small team with a thesis and not much else - no scaled book of business, no infrastructure, and a lot to prove. Early on, there was an intentional tone set that we were not only going to build a great business but also one that had a positive impact on the patients we served - specifically, to help them live more fulfilling lives. That early intentionality mattered because it set a framework for how we made decisions through the growth and, at times, uncertainty for the next decade.

Q: naviHealth grew to serve more than 10 million Medicare Advantage members with operations nationwide. How did things change in the operating seat when it scaled that fast?

HF: The job changes from doing the work to building the systems and leading the teams and people who do the work. Early on, I took great comfort in knowing most of what was happening in the business firsthand and with the ability to make changes quickly when necessary. At scale, my job became making sure the right information flowed effectively and trusting the people closer to the ground to make the calls I was used to making myself. The biggest shift was probably in how I thought about talent - at 10 people you can carry a gap yourself; at thousands of employees and operations across the country, a gap in leadership gets amplified, not absorbed.

Q: You were COO before you became CEO. What did running operations teach you about the business that you would not have learned starting in the CEO's chair?

HF: Running operations means living with the consequences of strategy, not just setting it. You see exactly where a plan breaks down when it meets the reality of hiring, systems, and frontline execution. That perspective gave me a healthy respect for how hard it is to actually deliver on a strategic vision, and it made me a more grounded CEO. Understanding the operating system and knowing what questions to ask and leading indicators to look for helped make me a more effective CEO.

Q: After Optum acquired naviHealth, you stayed on as CEO and joined Optum's Home & Community leadership team. What leadership skill matters more inside a large parent company than an independent one?

HF: Influence without full authority. As an independent company, if I wanted something to happen, I largely had the ability to make it happen. Inside a larger organization, you're one part of a much bigger system, and you have to build alignment, make the case, and bring other stakeholders along - you can't just decide. While there can be great benefits of joining something larger - most importantly the ability to amplify impact on the patients we served - patience and clear communication of the 'why' become even more important as the decision itself.

Q: You've had board experience across private, public, and nonprofit organizations. What's a question a board should be asking management more often than it actually does?

HF: I will answer this with a few questions - and ones that are applicable to any board.

"Where are we going?" and maybe more, importantly, "How are we going to measure our progress to successfully getting there?" Measuring results, regardless of whether it is an early-stage private company, large publicly traded organization or non-profit, is critical to be able to make decisions amongst an executive team or a board.

"What are you not telling us?" or some version of it. Boards tend to ask management to defend the plan that's already on the table, rather than probing for what's been left out of the narrative - the risk that didn't make the slide, the person who isn't performing, the assumption nobody has stress-tested. The best board conversations I've been part of spend less time on the numbers and more time asking what could make the numbers wrong - and how the board can help management mitigate those.

Q: FCV invests in early-stage healthcare companies. How would you recommend founders keep mission-driven culture intact while scaling?

HF: Culture doesn't scale by itself. Founders, CEOs and executive teams must be just as intentional about how they are building a culture as they are about selling their next customer or raising their next round of capital. Culture scales through the people you hire and promote into leadership and the stories you choose to tell about what gets recognized and who got rewarded. Founders and CEOs, for example, should watch who gets promoted as closely as they watch their financials, because that's the clearest signal to the rest of the organization about what the company actually values, regardless of what's on the wall.

Q: You're a pilot outside of work. Is there a discipline from flying that shows up in how you lead a team?

HF: Flying trains you to run checklists and always attend to the details no matter your level of experience, and to keep flying the plane while you're diagnosing a problem rather than freezing on it. Both habits translate directly to leading a team - you don't skip the fundamentals because you're experienced, and you don't stop making decisions just because you don't yet have full information.