Executive Spotlight: Trisha Fahey

Leadership, Strategy, and Sourdough: A Conversation with Trisha Fahey

Trisha Fahey has seen every corner of healthcare—from health system deals to pharmacy benefit strategy to early-stage growth. After a stretch working independently with startups and investors, she’s now in a full-time sales role and actively open to advisory and board opportunities. We talked about how she works, what founders often miss, and the value of staying sharp across roles.

Q: What inspired your transition into fractional work?

I’ve always had a strong interest in strategy and helping companies think more holistically. But really, I wanted out of the corporate grind—those nonstop, back-to-back meetings. After decades in leadership, I stepped back for personal and family reasons, took time off, and reflected on what I wanted to do next.

That’s when I reached out to a venture capital contact and asked, “How can I help your portfolio companies?” It clicked from there. I realized I could use the experience I’d built over 30 years to add real value—without having to live inside a rigid full-time structure.

Q: What’s been the most surprising part of working fractionally?

Honestly, I didn’t anticipate the shift in community. In a full-time role, you’re constantly engaging with your team. In fractional work, I had check-ins with clients, but they were far less frequent. I realized I had to build my own community.

I joined groups like HIMSS (Michigan chapter) and Women in Business Leadership. It wasn’t just about networking—it was about staying plugged into the industry and keeping that social-professional energy alive.

Q: You’ve spent a lot of time in pharmacy benefits and strategy. What challenges are healthcare leaders facing right now?

So many! The pharmacy benefit space is under a microscope—regulatory and legal pressure, the J&J lawsuit, Wells Fargo issues, ERISA-related lawsuits. There’s a demand for transparency, especially around pass-through pricing.

Add to that the reality of vertical integration—a few big players dominate. As a leader, you’re trying to ensure value, service, and fair pricing in what is essentially n oligopoly. It’s tricky, and it takes sharp, experienced leadership to navigate it.

Q: How do you help early-stage and mid-sized healthcare companies scale effectively?

When I entered the fractional space, I studied funding patterns and company stages—Series A, B, C. Early-stage CEOs are often pulled in 15 directions. They need someone who can come in, bring structure, and help them prioritize.

I found my niche with Series A and B companies—they’ve raised funds and have basic infrastructure but need to grow efficiently. That’s where I can jump in and create systems, bring strategy, and help scale without adding chaos.

Q: How do you manage multiple clients while still delivering high impact?

Discipline is key. But also, deep client understanding. You need to know what they need, how much time that takes, and structure your agreements well. Some clients need you intensely up front and then taper off. Others want long-term advisory support.

For me, I never took on more than three clients at a time. That’s my cap. It keeps the quality high and gives me the bandwidth to manage my pipeline—something fractional execs sometimes forget. You need time to do great work and to keep new opportunities flowing.

Q: How did you land on “three” as your ideal number of clients?

It came from experience. I paid attention to what clients really needed, the scope of my projects, and how much time I could give while staying sharp and engaged. Three just... works. Plus, people love threes, right? Three bullet points, three options—anything more gets overwhelming!

Q: What are some of the biggest personal and professional benefits you’ve experienced?

The flexibility is huge. I can block out time to be with family, travel, and actually unplug.

For example, my daughter is working in Rome right now, and we got to take the whole family out there for an extended vacation. That just wouldn’t have been possible in a full-time role. I was able to leave knowing my clients were in a stable place. That kind of freedom is rare—and valuable.

Wealth isn’t just defined as financial. It’s also mental, emotional, and spiritual wealth. Especially post-COVID, I realized I wanted a life that honored all of that.

Q: What’s one piece of advice you’d give to someone exploring the fractional path?

Take the time to reflect on your purpose and strengths. What lights you up? What kind of impact do you want to make?

A mentor told me early on to write a one-pager—laying out your skills, areas of focus, and how you can help. Even if you never use it, the exercise gives you clarity. I iterated mine a lot, getting feedback from other fractionals and mentors. It helped me evolve.

Q: How can healthcare startups best use fractional executives?

Listen. Really listen to what’s keeping them up at night. Maybe they lost their sales lead, or they’re struggling to break into the payer market. Maybe they’re deep in fundraising and need someone to keep the ship steady.

Fractional execs can be the steady hand, the strategic guide, or the connector who brings in the right talent. But it only works when it’s a true fit—not a square peg in a round hole.

Q: Are there go-to-market mistakes that pop up again and again?

Absolutely. One of the biggest is trying to go too broad, too fast. Companies want to hit every segment—employers, health plans, health systems.

I always say: Start where your product fits best. Go deep. Then expand. I worked with a company that was amazing in health systems, but they wanted to pivot into the health plan space. I encouraged them to “land and expand” from their existing strength, instead of chasing every vertical at once.

Q: If you weren’t in healthcare, what totally different career would you try?

I got into sourdough baking during COVID and loved it! I’d open a floral shop/café/bakery—that’s my little dream.

I still buy flowers from Trader Joe’s, make arrangements for my house, and teach others how to make sourdough bread. My daughter’s super entrepreneurial, so maybe I’ll get to help with her bakery someday.

Q: What’s the coolest place you’ve ever taken a client call from?

Definitely the Upper Peninsula of Michigan. It’s remote, peaceful, and stunning. I spent a chunk of the summer there and found reception up north to take a few calls. Lake Superior is pristine—still under the radar, and just so calming.

I live in a beach town in Michigan too, and people don’t realize the beaches here rival California’s (minus the snow, of course!).

Q: And finally—if you had to give your career a tagline, what would it be?

Strategic thinker who loves to give back.

That really reflects my whole journey. After 30 years, I want to keep using my skills to help others grow—startups, founders, emerging leaders. That’s the kind of impact that excites me