Eli Y Adashi, MD, MS, CPE, FACOG
Professor of Medical Science
Women & Infants Hospital
101 Dudley Street
Providence, RI 02905
Peter Karczmar, MD
Clinical Assistant Professor of Medicine
Warren Alpert Medical School of Brown University
The concentration will foster familiarization with the statutory, regulatory, financial, and administrative “scaffolding” of health care financing such as Medicare, Medicaid, and SCHIP (The State Children's Health Insurance Program) as well with key administrative constructs such as CMS (Centers for Medicare & Medicaid Services), AHRQ (The Agency for Healthcare Research and Quality) and HRSA (The Health Resources and Services Administration) to name a few. Most importantly, students will progressively appreciate the policy-setting implications of the statutory, regulatory, and administrative framework underpinning the practice of medicine in the United States.
Healthcare in America: Pre-clinical Elective Schedule
Timeline of Activities
Years I & II
Students enrolled with the Health Policy concentration will be encouraged to identify one or more project areas deemed of special interest and to identify appropriate mentors as their guide. Students will be advised to familiarize themselves with the topic(s) of their choosing with the clear understanding that the deliverable will be a submitted article to a peer-reviewed mainstream medical journal. So that students may have enough time to see their projects to completion, topics will be limited to qualitative and/or quantitative analyses of existing data sources or issues of the day. Upon selection of a topic, students will be expected to tackle the fine points of the subject matter through reading as well as through inquiries with relevant external parties if and when required. The latter could take the form of telephone calls or of meetings with relevant sources. When appropriate and feasible, a student may in fact choose to visit a relevant organization such as the RI Department of Health or more ambitiously, CMS (mostly in Baltimore, MD) or HRSA (Rockville, MD).
Given the demands of the academic calendar of the medical school, Health Policy students will be expected to make significant progress in their area of scholarly inquiry during prior to starting the clinical rotations. Concentration students will meet regularly with the co-directors at a frequency of once a month. Planned for the early evening hours past the end of the business day (field trips excepted), the meetings will take the form of one of the following formats: Student-led discussions, Guest faculty-led seminars, Guest faculty-led lectures, Faculty Co-Directors-led field trips. In addition to the expected summer research experience, student members of the “Health Policy” concentration will also be expected to participate in the preclinical elective “Health Care in America.” This elective consists of a series of evening lectures in which local and national health policy experts discuss important topics in US health policy. This lecture series will help participating students to develop a solid understanding of health policy concepts which then can be applied to their individual scholarly projects.
Years III and IV
During years III and IV, communication with the students will rely on email exchanges, phone calls, and pre-coordinated meetings as needed, which, depending on availability, may include participating in pertinent monthly health policy concentration meetings as well as lectures in the “Health Care in America” series. Students will be strongly encouraged to use an Independent Study Elective during their fourth year to complete work on their scholarly projects if required. There will be a Year IV April session during which students will present final deliverables with an eye towards evaluation (please see below under Project Evaluation).
The evaluation of student work will be dictated by the rigor of the scholarship involved. Special emphasis will be place on synthetic, analytic, and creative qualities which though based on facts, lead to novel reflections, conclusions, or recommendations. Put another way, significant weight will be attached to the ability to connect dots and to create a whole that is more than the sum of its parts. While other scholarly products are appropriate, the stated intent of the “Health Policy” concentration is the submission of an article to a peer-reviewed mainstream medical journal. As such, peer-reviewed articles lend themselves well to evaluation as per Glassick’s principles which will be applied as a matter of course.
Subject to the aforementioned premise, potential sample projects that students might complete in the context of the proposed concentration could include:
- Reducing Preventable Hospital Readmissions: Evolving Payment Reforms.
In principle, this project will trace the evolution of the relevant concepts and the payment reforms designed to address this all important - if difficult - health care delivery challenge. Apart from drawing on national initiatives such as spearheaded by CMS, the student will be encouraged to explore the unique efforts launched by the State of Maryland by way of its Health Services Cost Review Commission (HSCRC). Assessing the performance of Rhode Island Hospitals in this context could also be entertained. To state the obvious, redress of the readmission dilemma will constitute a sea change in provider accountability, coordinated care, and pay for performance. As such, the centrality of the subject matter cannot be overemphasized.
- Healthcare-Acquired Conditions (HACs) and the Patient Protection and Affordable Care Act.
In principle, this project will examine several facets of this all too common and critically important health care delivery dilemma. At a minimum, the nature of the issue and past efforts to address it will be thoroughly mastered and discussed. Special attention will be paid to the fact that effective 2011, the Patient Protection and Affordable Care Act will discontinue Medicaid payments to states for services related to HACs. The impact of this measure and others like it on the welfare of the patients in question and on the nation’s health care expenditures will be carefully reviewed. Inevitably, the relevant policies of Medicare and of commercial insurance plans will also be detailed, discussed, and compared.
- The Primary Care Workforce: Progress and Incertitude.
In principle, this project will explore the primary care workforce crisis, describe its origins, and detail its various solutions. Front and center will be the changes anticipated in the representation of those insured and in the growing needs of the old and frail. Special emphasis will be paid to evolving solutions such as “teaching community health centers,” payment reforms, and the expansion of the National Health Service Corps. In this regard, the contributions of the Affordable Care Act towards the resolution of this critical issue will be the subject of significant attention.
Maximum Number of Students
This concentration can currently accommodate a total of five students per year.
(alternatives to Summer Assistantships)
At the time of this writing, no sources of student funding can be identified other than the Summer Assistantship Program. However, subject to the nature of the project, a reassessment of potential sources of student funding will be undertaken at the State, Federal, Foundation, and Brown University levels. In fact, students, having been appropriately guided, will be encouraged to go online and/or call potential funding organization such as The Commonwealth Fund, The Robert Wood Johnson Foundation, and The Fogarty Center to name a few possibilities.