HSPH students propose cost-saving public health reforms to Massachusetts legislators as part of inaugural spring challenge

The winning team in HSPH's Spring Challenge, pictured with HSPH Prof. John McDonough (third from left) and members of the Massachusetts Prevention for Health Caucus, presented their ideas at the State House.

April 25, 2012

Massachusetts leads the nation in access to health care—five years after the passage of the state’s health care reform law, more than 98% of all residents and 99.8% of children are covered by health insurance. But the law did not address rising health care costs in the state. Now, legislators are listening to proposals from business and advocacy groups and hammering out the details of a new bill to tackle the problem.

This spring, an innovative new program at Harvard School of Public Health gave students the opportunity to meet with the people grappling with these issues and to contribute their own ideas to the conversation. For the inaugural Spring Challenge, 45 students from across the School competed in five- and six-person teams to develop recommendations for integrating public health policies into the upcoming bill—and finding ways to pay for them.

Following a March 22 kickoff reception, students got a weeklong crash course in policymaking and the politics of health care reform from guest speakers while they worked out their proposals in team meetings squeezed in around their normal course load. At the end, teams faced off before a panel of expert judges to win the opportunity to share their ideas with lawmakers at an April 10 meeting of the legislature’s Prevention Caucus at the State House.

During the competition, students heard from 36 speakers representing state and city government, public health organizations, patient advocacy groups, business and insurer groups, and medical providers. Sofiya Penek, SM ’13, a member of the student organizing team, said that the speakers didn’t consider the Challenge just an academic exercise and really wanted to hear the students’ ideas. “That fueled the students’ excitement,” she said.

A winning proposal

Students on the winning team—Margaret Anshutz, SM ’13, Beenish Mehboob, MPH ’12, James Potter, SM ’13, Martyna Skowron, SM ’12, Colleen Vessell, MPH ’12, and Xiao Zhimin, MPH ’12—offered a comprehensive proposal for integrating community-based public health programs into the framework of Accountable Care Organizations (legal partnerships between doctors and hospitals that provide financial incentives to providers for more efficient and better care). They also proposed establishing a statewide trust fund that would provide grants to support local public health efforts, such as diabetes or asthma programs, and forming a state commission to integrate public health into a range of policies from zoning to transportation.

The Challenge’s speakers offered students a wide-range of perspectives to inform their proposals. Barbara Ferrer, executive director of the Boston Public Health Commission, and Lauren Smith, medical director of the Mass. Department of Public Health, spoke about the challenges of working to preserve and expand wellness and prevention programs in a tough fiscal environment, and the importance of making the case for the long-term economic benefits of a healthier population. Other speakers included Sarah Iselin, SM ’99, president of the Blue Cross Blue Shield Foundation of Massachusetts and Paula Johnson, director of women’s health at Brigham and Women’s Hospital.

A particular favorite among students was the down-to-earth and witty presentation by Rep. Steven Walsh (D-Lynn), House co-chair of the Mass. Joint Committee on Health Care Financing, and Rep. Jason Lewis (D-Winchester), co-chair of the Prevention Caucus, on the political realities facing public health-related policies. Both are key players in the current legislative effort, which is expected to culminate in the passage of a bill before the end of the current session on July 31, 2012.

Payment reform

The final bill is likely to include aspects of the cost-reform legislation filed by Governor Deval Patrick in February 2011, such as reforming the way health care providers are paid in the state. Patrick’s legislation recommended replacing the current fee-for-service system with a system of flat “global payments” to networks of providers for keeping patients well.

Kris Bloch, SM ’13, who co-wrote the case study that provided students with background on the issues, came away from the Challenge struck by the idea that, “Public health really needs to think about return on investment,” he said. “A lot of things we do, we do because they feel good. In a resource-constrained environment, that is not going to be enough to protect the public health initiatives that we want. We have to be able to demonstrate with evidence that our interventions are producing some positive effect at a reasonable cost.”

Skowron, lead presenter for the winning team, came to the Challenge well-prepared from her coursework in health policy and management. But she was able to gain insights that she’ll take into her professional life as a consultant on hospital strategy, she said. “I am grateful to have participated in the Challenge as my culminating experience at HSPH. Even though I am very much focused on hospitals and the management side of health care, this has made me recognize the spark of passion that I have for policy and its implementation,” she said.

Potter, who is studying global health, found this foray into domestic issues to be a valuable learning experience. “I was able to work on an issue that doesn’t have an answer because there is no solution yet,” he said. “We were able to come up with ideas, and people who were actually working on the issue were able to give real feedback.”

Savvy policy recommendations

The student presenters were a big hit with lawmakers at the State House, who encouraged them to continue sharing their ideas. Rep. Harriette Chandler (D-Worcester) said, “This suggests the quality of people we have in public health, and it gives me hope.”

Challenge organizer John McDonough, professor of the practice of public health and director of the Center for Public Health Leadership, was pleased with the inaugural competition. “The Spring Challenge allowed the HSPH community to shine,” he said. “Student organizers invested countless hours in bringing the competition to life. The teams dove into the issue with tight deadlines, crafting dynamic and savvy policy recommendations that Massachusetts legislators are now considering. Many staff and faculty donated time to help organize the logistics, coach students, and judge the competition. It was an exercise we will all remember.”

-Amy Roeder

Photos: Aubrey LaMedica