Tesha Montgomery Sits Outside Every Silo

That Is Exactly Why Houston Methodist’s Integration Is Working

By Jerry Penso, MD, MBA

June 8, 2026

When I sat down recently with Tesha Montgomery, senior vice president at Houston Methodist, to talk about integration and access, I expected a conversation about technology and scheduling. What I got was something more useful: an account of how integration actually gets done when the patient is at the center of every decision.

Tesha is not a physician. She is a nurse who built her career through operations, starting as an administrative fellow at Mayo Clinic, and earned her seat at the system leadership table by understanding clinical workflows from the inside. That background shapes everything about how she leads.

“Access Is Quality”

That is how Tesha frames access. When patients cannot get in, when they wait too long, get transferred between schedulers, or find that a patient’s care is not coordinated at an optimal level, outcomes suffer. The system integration work Tesha leads is built on that premise: You cannot call yourself integrated if your patients cannot move through your system seamlessly.

Houston Methodist is now scheduling across all sites, nearly every service line, hospital-based and clinic-based, through a single access function. More than 21,000 appointments are scheduled a day. A patient referred for an MRI can schedule at any location in the system through one contact. Half of primary care new patient appointments are now self-scheduled. They are deploying AI on phone lines that can cancel, confirm, reschedule, and now schedule new appointments for established patients in primary care in under three minutes, without transferring to a person.

There is a financial argument supporting this transformation that health system leaders understand but boards do not always see clearly. The physician enterprise often looks like a loss on paper. The subsidies are visible; the downstream value is not. Tesha’s team can trace how primary care appointments flow through the system, to imaging, to procedures, to surgical cases, and makes the value of access concrete. When access works, the physician organization stops looking like a cost center and starts looking like what it actually is: the front door to everything that follows.

Structural Position Makes Integration Possible

Houston Methodist president and CEO Marc Boom made a deliberate decision when he pulled Tesha out of the physician organization and positioned her at the system level, accountable to no single entity. She has no direct line authority over hospitals or the physician organization. She sits between them.

Tesha admits she paused when she was asked to take the role. Three years later, she said that she has accomplished more in this position than in any previous role. When you sit outside both structures, you can cut across both. You are accountable to the patient experience, which belongs to no one and everyone simultaneously.

This is a governance insight many health systems have not yet absorbed. Integration cannot be led from inside the physician organization or inside hospital operations. It requires a structural position that is explicitly designed to bridge them.

How She Actually Gets Physicians to Say Yes

Tesha is not a physician, and she does not pretend to be one. However, she sees they have a crucial role in improving access. Early in her career at Mayo Clinic, she asked her physician chair if she could shadow him for a day. He was surprised and elated; this was not the typical ask from administration. He gave her a white coat and introduced her to patients as though she was a resident. She saw the workflow disconnects firsthand, discovered where patient flow broke down, and sat with nurses, medical assistants, and desk staff until she knew the operations from the inside.

That experience became her model. When Houston Methodist’s access transformation model moves into a new specialty or service line, Tesha brings physicians along in four ways.

• First, she has physician medical directors embedded on her access team, one for primary care and one for specialty care. Physicians speak to physicians in ways no administrator can replicate, and she has built that bridge structurally rather than hoping it will happen informally.
• Second, she shows the data in two directions simultaneously—not just what the future could look like, but where the current state has gaps the physician may not see from inside their own clinic. That is a harder conversation, but it is more persuasive because it is honest and specific.
• Third, she invites physicians to visit what Houston Methodist calls its access headquarters, a facility with a war room that looks like air traffic control—screens everywhere, workforce management happening in real time. Physicians who arrive skeptical often leave asking when Tesha’s team can take over their access and scheduling.
• Fourth, the follow-up does not stop after the transition. Her team positions itself as an extension of the physician’s clinic, not a separate administrative function. That ongoing presence is what sustains trust after the change is made.

The Technology Trap

Most health system leaders already know that technology deployed on top of broken processes will not fix those processes. Tesha confirmed what I keep hearing from other health systems: Leaders proceed that way anyway because technology feels like forward motion. It generates less internal friction than the governance conversations, the template optimization sessions, or the uncomfortable discussions about who has authority over what.

What distinguishes Tesha is that she and her team do the harder work. They sit with physicians and look at templates. They examine governance structures and challenge legacy workflows that have been in place for years. Skip that work, and you are deploying technology on top of dysfunction. Houston Methodist has cultivated a culture of innovation. They are in Epic’s top tier for self-scheduling adoption, with AI deployed successfully across phone lines, outbound referrals, and new appointment bookings. Those results did not come from selecting the right vendor. They come from leaders like Tesha, those willing to do the foundational work first.

What Integration Leaders Actually Need

Across the health systems I visit, what separates the ones making real integration progress from the ones still struggling is rarely strategy or technology. It is whether someone like Tesha did the foundational work building physician trust, redesigning processes, and achieving governance clarity before the technology is deployed. What Tesha’s experiences keep pointing back to is consistent: Integration is primarily a trust and operations challenge, solved by leaders who delve deep into clinical reality, physician and patient experience, and process.

Access is quality. If you want to know how integrated your system really is, ask your patients how easy it is to get in the door, move through your system, and come back again. The answer will tell you more than any organizational chart.