Karen Smoler Heller joined GNYHA in 1990. In the mid-1990s, as information technology developed and large public data sets became available, she built The Health Economics and Outcomes Research Institute (THEORI) to conduct original research on microeconomic models for prospective payment, comparative performance measurement, and performance-based payment, with an emphasis on appropriate risk-adjustment. In addition to fee-for-service models, THEORI develops payment models for graduate medical education and uncompensated care, as well as models to support population health initiatives. THEORI also conducts survey and outcomes research, and creates web-based applications to support GNYHA members’ internal research and participation in collaborative projects to improve quality and efficiency. Among THEORI’s many notable achievements have been developing the Medicare program’s payment system for inpatient psychiatric services and developing New York State’s Medicaid acute inpatient and psychiatric payment systems, as well as its methodology for distributing funding for uncompensated care. In 2008, Ms. Heller became Executive Vice President of the Department of Health Economics and Finance. The Department’s finance activities center on macroeconomic and government budget trends; public and private sector policies and practices affecting health care finance, reimbursement, and insurance coverage; hospital financial operations; and capital formation. In 2018, she stepped down as Executive Vice President and is now Senior Advisor, a position in which she continues to conduct original research and train new THEORI analysts and economists. Prior to joining GNYHA, Ms. Heller served at the New York City Office of Management and Budget, where she was responsible for fiscal oversight of the Department of Health and the Department of Mental Health. She began her career as a securities analyst in the financial services sector. Ms. Heller holds an MBA in finance from New York University and a BA from Sarah Lawrence College.