I am an analytical strategist who spent twenty years inside
the system you're trying to navigate.
April Smith-Hirak, PhD — Founder, 99 Directions LLC
I am a behavioral scientist by training and a strategic advisor by practice. My work is grounded in one core capability: the ability to analyze complex systems (regulatory, organizational, political, behavioral) and find the specific point where pressure produces movement.
That skill came first. What made it powerful was spending twenty years inside the federal health enterprise, where I developed an intimate understanding of how the US healthcare system thinks, where it resists change, and how technology and emerging medicine are pressing against infrastructure that was never built to accommodate them.
The Analytical Foundation
I hold a PhD from Yale University in health and social psychology, earned with a Dean's Scholarship and including an M.Phil. and M.S. My dissertation research at the Rudd and PACE Centers was grounded in experimental design, multivariate methods, and behavioral health research. I think in systems. I analyze interactions between inputs, identify which constraints are real and which are behavioral, and find the specific lever that makes large, complex structures move. My undergraduate degree in psychology is from Ithaca College, magna cum laude.
Inside HHS
For fifteen years I worked inside the US Department of Health and Human Services, progressing to Regional Health Administrator for Region II, senior federal public health authority for 32 million people across New York, New Jersey, Puerto Rico, and the U.S. Virgin Islands. From Deputy Regional Administrator (2010) to Acting Regional Health Administrator (2016) to formal appointment (2020), my portfolio spanned emergency response, federal grant administration ($30M+ annually), equity strategy, and, increasingly, health technology and innovation.
I led a nationwide digital health and emerging technology strategy across all 10 HHS regional offices. I contributed to HHS AI Taskforce working groups on healthcare delivery and public health, and to AI governance strategy that advanced to the White House level. I held a High Risk Public Trust clearance (Tier 4), renewed July 2025, valid for reactivation through 2032.
On the innovation side, I conceived and led the first regional-office-driven Federal Health Innovation Summit in New York, convening eight federal agencies across three departments in partnership with the Deerfield Foundation, bringing NIH, the Office of Science and Technology Policy, and ONC leadership together with biotech founders and investors. I designed and led three executive roundtables with the NYC Economic Development Corporation connecting early-stage founders with federal health innovation leadership.
I served as executive lead for COVID-19 response across four jurisdictions and as regional lead for Operation Warp Speed, coordinating directly with U.S. Army command on four-jurisdiction logistics, stakeholder alignment, and equitable vaccine distribution.
Before HHS
II spent six years at the Centers for Disease Control and Prevention in Atlanta. My experience there spanned policy, partnerships, coalition building, and several rotational leadership roles before I stepped into infectious disease policy and strategy in my final three to four years. I advised CDC C-suite leadership during H1N1 and other national emergencies, contributed to landmark HIV regulatory economic analysis (CDC Director's Award for Excellence), and coordinated cross-agency response to an international false positive assay crisis spanning FDA inspectors, scientists, and foreign manufacturing facilities. I contributed to congressional briefings on thimerosal safety, taking genuinely contested biomedical science and making it legible to decision-makers operating under intense public and political scrutiny.
Recognition & Speaking
Member, inaugural cohort, AI Federal Leadership Program (Partnership for Public Service, 2023). Selected Fellow, Public Health Leadership Institute. Guest Faculty, Columbia Business School Digital Health Strategy Program. Speaker, HIMSS 2024. Recurring featured speaker, NYC Digital Health Innovators Summits (five summits, 2022–2024) at Columbia University. Keynote panelist, HWCLI "Techquity and Transformation" Conference alongside Senator Charles Schumer and Brookings Institution scholar Nicol Turner Lee, PhD.
When My Federal Chapter Ended
In July 2025, my office at HHS was eliminated as part of one of the largest restructurings of federal health infrastructure in decades, a moment that ended the careers of thousands of senior federal officials simultaneously.
I had spent twenty years watching health technology companies, some genuinely transformative, fail to navigate a system I understood from the inside. Not for lack of science or product. For lack of a senior guide who could read the terrain clearly, identify the actual constraints, and help them avoid the strategic mistakes that slow or stop promising companies.
The healthcare system wasn't built for the pace of technology or the breadth of what's now medically possible. It exerts homeostasis. It resists. It has specific structural and behavioral logics that determine what moves and what doesn't. I spent two decades learning those logics from the inside.
99 Directions is the practice I would have wanted to exist when I was on the other side of the table.
My Philosophy
I work with a small number of clients at any given time. That's the design of the practice, not a limitation of it. The value I provide is judgment, systems fluency, and the ability to think alongside you at the highest level of your strategic challenge. That requires depth, not volume.
Confidentiality is foundational. My clients include competitors in some markets. I operate with strict confidentiality across all engagements. What you share with me stays with me.
Direct access is the point. At this stage of the practice, I personally lead every engagement — every call, every deliverable, every conversation. That's not a constraint. It's the whole design.