Caring for the Patient and Community Through Health Care Policy and Research
Dr. Eric C. Schneider, MD, M.Sc. is a senior vice president for policy and research at The Commonwealth Fund, where he provides strategic guidance for independent research on social policy and healthcare issues in the United States. After studying biology at Columbia University, Dr. Schneider went on to earn his M.Sc. in public health at University of California, Berkeley, and his M.D. from University of California, San Francisco. Since 1997, he has practiced primary care internal medicine at Brigham and Women’s Hospital in Boston while serving as faculty at Harvard Medical School and Harvard School of Public Health. In 2009, he served as the first director of nonprofit global policy think tank RAND’s Boston office where he constructed a highly successful multidisciplinary health services research team.
Dr. Schneider has also served as editor-in-chief of the International Journal for Quality in Health Care and on the editorial board of the National Quality Measures and Guidelines Clearinghouses.
Earlier in August, I had the pleasure of speaking with Dr. Schneider for MedPage Today, where he provided insights on the principal drivers increasing healthcare costs. We soon met again to chat about his personal journey in medicine and his extensive involvement in health policy and quality improvement:
N: How did you wind up choosing medicine?
Dr. Schneider: I had a bit of a circuitous route to medicine. My father was a professor in psychology who instilled in me an interest in science and academics from an early age. However, I was also interested in music and poetry. After high school, I spent several years in the late 1970s playing music and studying other things in New York City before I started thinking what else I would like to do with myself.
I took a trip in Alaska and got a ride with a bush pilot who was a doctor. He told me that I should go into medicine because I would find it very interesting. I then did a volunteer stint at Bellevue Hospital in the 1980s, which instilled in me interest in policy and primary care. On the West side of the hospital were urgent care for patients who had nowhere else to go. I encountered many men who had which was then known as Gay-related immune deficiency (GRID) but would eventually be known as HIV/AIDS. This volunteer experience motivated me to re-enroll in college and eventually take part-time courses at Columbia University.
When I was applying to medical school, I was very interested in the joint M.D.-M.Sc. program between UCSF and Berkeley, which emphasized community healthcare in medical practice. Because of my experiences at Bellevue Hospital, I was very interested in looking at policy and community interventions, and the program seemed like an excellent fit.
N: Tell us more about earning your M.Sc. from UC Berkeley School of Public Health.
Dr. Schneider: I focused on clinical epidemiology, working in in a 30-year old study on livers where we had to track down unmarried 20-year-olds. I wrote about the methodologies we used to track hard-to-find patients. Much of this probably isn’t relevant today because of the internet!
At the joint program, I got to take courses in health economics, anthropology, and sociology. I really enjoyed the pre-clinical training at county hospitals in private practices in Oakland not associated with academic centers. I went on some home visits because many physicians that were our mentors went on home visits.
N: I see that you started teaching health policy and quality improvement at Harvard T.H Chan School of Public Health in 1997, well before it became “in vogue” for doctors to be involved in those arenas. How did you get involved in those fields?
Dr. Schneider: I landed in the middle of a lot of activity in health quality in 1993 and 1994 while I transitioned to my fellowship. At this time, The Clintons were spearheading healthcare reform, and my mentors and I were involved heavily in policy. In fact, my fellowship projects were designed to be involved with some of the studies that the Clintons eventually cited.
I then spent a year in DC with the quality control organization called National Committee for Quality Assurance (NCQA) that developed The Healthcare Effectiveness Data and Information Set (HEDIS). At the time, they only had seven quality measures, but now they have hundreds.
When I got back to Harvard in 1997, I became involved in many projects involving health care quality because I was already involved with several leading thinkers in the field.
N: What drew you to become involved with The Commonwealth Fund?
Dr. Schneider: When I was just beginning my career as a junior faculty member at Harvard in 1998, the opportunity came up to investigate health disparities in Medicaid insurance with the Commonwealth Fund. This was the first time the US government collected data at a rigorous level to investigate health disparities. We had to clean the data a lot, but we eventually revealed quite a few racial health disparities. This encounter began my new relationship with The Commonwealth Fund.
A few years ago, the head of the Fund, David Blumenthal, asked me to join the fund. While I was perfectly content doing research and seeing patients as I had at Harvard, I greatly appreciated the evidence-oriented nature of the organization and their commitment to ensuring quality care to vulnerable populations. I wanted to apply my communication and research skills in the Commonwealth Fund’s various initiatives.
N: How does your training in medicine and public health inform your roles in health policy, quality improvement?
Dr. Schneider: It is very easy to slip into theoretical discussions about health economics and policy, but seeing patients grounds you more in patient care. The perspective from the patient and front-line providers, I believe, makes me a better policymaker.
It also highlighted for me the limitations of scientific results. The Commonwealth Fund is very evidenced-based, but there are times when policy is made on faulty evidence. A scientific perspective allows us to take a step back and look at the data and see overlooked patterns. Using rigorous methods ensures better quality data. Some of the best insights come from studies that yield results with unexpected results, which indicate either new insights or methodological flaws.
We are also beginning to use big data to understand diabetes management and relationships between groups of diseases. It will take plenty of work on the policy side to understand how to fund new treatments and research.
N: What advice do you recommend to aspiring doctors who have an interest in health policy and quality improvement?
Dr. Schneider: First, focus on things they are passionate about and to think in the future. The second ingredient is curiosity. Those who really move medicine and healthcare forward are intensely curious; they read a lot, keep their interests broad. This allows them to bring new insights into medicine. The third ingredient is when you choose a path, be persistent, work hard, and don’t take no for an answer. Just like in sports, you are going to fail more than succeed and you have to deal with the setbacks in a disciplined fashion.
In this era of health policy reform, we are on the verge of powerful life-changing technologies and interventions. There is going to be a tremendous need for thinking intellectually about healthcare delivery. Innovation is going to be more dramatic in the best 10 to 20 years than in the past. We also can’t lose sight about the human element. People have medical needs, but they also have psychological, spiritual, and other needs. Physicians and nurses should hold on to the special social contribution that medicine has to the public.