I spent twenty years inside the system you're trying to navigate.
April Smith-Hirak, PhD Founder, 99Directions LLC
The Lens
I am a behavioral scientist by training and a strategic advisor by practice. My work is grounded in experimental design and multivariate methods. I structure the right question before answering it and distinguish what evidence actually proves from what it claims.
I analyze how systems behave under pressure: where constraints are structural versus behavioral; how incentives, stakeholders, and institutional logic interact to produce resistance or movement; and which constraints are real versus artifacts of how people respond to each other and the system itself.
This lens allows me to see where decisions are made, how messages land or fail, and what second-order consequences a strategy will produce before they become visible. I translate that into clear, actionable strategy: the specific pathway, sequence, and framing that moves the system.
Behavioral science came first. Twenty years inside the federal health enterprise made it operational.
Forged Within the System. Built to Navigate It.
In July 2025, my office at HHS was eliminated as part of one of the largest restructurings of federal health infrastructure in decades.
I had spent twenty years watching health technology companies 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 and help them avoid the mistakes that slow or stop promising companies.
99Directions is the practice I would have wanted to exist when I was on the other side of the table.
Background
I began my federal career at CDC, where I developed an early understanding of how large health systems move: through policy, partnerships, and the translation of complex science into decisions under pressure. I worked across crisis response, federal policy, and emerging technology strategy in environments where decisions carried real consequence.
At HHS, I spent fifteen years progressing to Regional Health Administrator for Region II, serving as senior federal public health authority for 32 million people across New York, New Jersey, Puerto Rico, and the U.S. Virgin Islands. My portfolio spanned emergency response, federal grant administration, digital health strategy, and AI policy.
I led regional coordination for Operation Warp Speed and served as executive lead for COVID-19 response across four jurisdictions. In parallel, I led nationwide digital health and emerging technology strategy across all ten HHS regional offices and contributed to federal AI governance work that advanced to the White House level.
The work I’m most proud of is what I built that didn’t exist. I conceived and launched the first regional-office-driven Federal Health Innovation Summit, convening eight federal agencies across three departments alongside biotech founders and investors. I designed executive roundtables connecting investors, AI leaders, and federal health innovation leadership to enable direct, working-level exchange. Across each of these efforts, I identified where the system could move and built the structure to make it happen.
Philosophy
I work with a small number of clients at any given time. That's by design, not a limitation. 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.
Eduaction
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PhD, Yale University — Health and Social Psychology
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BA, Ithaca College — Psychology, magna cum laude
Selected Recognition, Teaching & Speaking
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Guest Faculty, Columbia Business School — Digital Health Strategy Program
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AI Federal Leadership Program — Partnership for Public Service (Inaugural Cohort)
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Fellow, Public Health Leadership Institute
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HIMSS 2024
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NYC Digital Health Innovators Summit (2022–2024)
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HWCLI Techquity and Transformation Conference (2021)