Future Shapers: Optimism Is Moral Courage

BRG Director Kurt Eicher sits down with Ian Spier, chief financial officer of Longitude Health, to discuss:

• why Ernest Shackleton’s 1914 Antarctic expedition makes a case for optimism as a core leadership principle
• how moving from investment banking to a not-for-profit health system taught Ian the importance of taking personal risk for the benefit of the organization
• building culture from a blank slate, making decisions on imperfect information, and developing the next generation of healthcare leaders

Selected Transcript Summary

[01:15]
Shackleton, healthcare, and a conversation between friends. Kurt introduces his friend Ian Spier, CFO of Longitude Health. He frames the conversation around the journey versus the destination, leadership through challenge, and aligning a team toward a common goal—all through the lens of Ernest Shackleton’s Antarctic expedition aboard Endurance.

[03:17]
A health system–owned platform with a dual mandate. Ian traces his path from healthcare investment banking to senior vice president and growth officer at Novant Health, where he represented Novant in Longitude’s formation. He explains Longitude’s model: owned and governed by five not-for-profit health systems, backed by more patient capital, and measured as much by operational value for members as by equity value—which is why it uses a cost-plus revenue model.

[06:55]
A long list of headwinds. Kurt runs through the challenges facing healthcare, including runaway spending, affordability, chronic conditions, clinician shortages, and delicate finances.

[08:09]
From a simple hierarchy to a highly matrixed environment. Ian explains how his view of leadership has evolved across each chapter of his career. He recalls a family member’s advice that life is not that hard “if you learn how to apply yourself,” a lesson that took root on Wall Street. Joining Novant—and its new Novant Health Enterprises division—showed him how simple investment banking’s hierarchy had been by comparison.

[10:14]
Taking personal risk for the organization. Having started his career at Merrill Lynch as it was being acquired by Bank of America, Ian learned that taking personal risk could be a problem. In not-for-profit healthcare, he encountered the opposite lesson: self-preservation can lead to paralysis, and the leaders he admires most take personal risk because it is right for the organization.

[13:14]
The Endurance and optimism as moral courage. Ian explains why he chose Alfred Lansing’s book Endurance: Shackleton’s Incredible Voyage. Optimism, he argues, is a life philosophy—and a core leadership principle in healthcare, which is a “ground game… of two or three yards and then a dust-up,” not an “air game.”

[15:50]
Transformational—not just transactional—leadership. Ian describes building leadership around you, borrowing a phrase from former football coach Nick Saban: delegating too much, accepting mistakes, offering stretch roles, and taking a sincere interest in team members’ growth. That is how you build trust and loyalty and help people reach their highest and best roles.

[17:45]
Kurt’s reflection: leadership at every level. Kurt reflects on the leadership he has valued at different stages of his own career: patience and guidance early on; endurance while fundraising at digital health company Firefly Health as capital markets tightened; and now building toward the next chapter during BRG’s growth period. He observes that leadership is “not reserved for the few.”

[20:14]
Building culture from a blank sheet of paper. Ian describes the rare chance to shape Longitude’s culture through the “Longitude Way” and its BEACON principles: build habits, embrace pressure, aim high, (have a) champion mindset, own the outcome, and navigate together. He emphasizes coaching over evaluating and treating pressure as a privilege.

[23:15]
Speed is a superpower. Asked how he steers the “financial ship” across a broad group of member systems, Ian says the members agree that speed is a superpower. That requires making decisions based on partial and imperfect information—perfect information is a falsehood and waiting has a cost—and treating course correction as an opportunity and force multiplier.

[25:39]
Balancing ambition with economic reality. Kurt asks how a CFO reconciles an ambitious vision with the delicate finances of the healthcare ecosystem. Ian’s answer comes back to the patient: a decision that is in the patient’s best interest is worth leaning into.

[28:50]
Do big challenges reveal leadership—or build it? Ian explains Longitude’s philosophy of “build it once, use it many times” to address fragmentation in areas like specialty pharmacy, cell and gene therapy, and clinical trial services. His answer to Kurt’s question—do big challenges reveal or build leadership?—is both, and he hopes Longitude produces the next generation of not only capabilities but also not-for-profit healthcare leaders.

[32:05]
Advice for rising leaders: fill up your briefcase. Ian urges emerging leaders not to fixate on the next rung. Lateral moves and relationships compound over time, and the best outcome for a leader is that someone on their team succeeds. It’s more about the journey than the destination.

[34:45]
Rapid-fire close. Ian names honesty and candor as the leadership traits he values most because “trust is earned in drops and lost in buckets”; “work hard and be kind” as the best advice he’s received; and “there are no such thing as dress rehearsals in life”—a Kennedy line he found on his honeymoon—as a quote that has stuck with him.