Scaling Healthcare Innovation

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sachinjainSachin Jain, MD, MBA is the Chief Medical Officer for the California-based Medicare healthcare company CareMore. Prior to this role, Dr. Jain was the Chief Medical Information and Innovation Officer at the global pharmaceutical company Merck, focused on leveraging digital health and data. He was also an attending hospitalist physician at the Boston VA-Boston Medical Center and a lecturer in healthcare policy at Harvard Medical School. He co-founded the Elsevier journal Healthcare: The Journal of Delivery Science and Innovation and is the co-editor-in-chief. From 2009-2011, Dr. Jain worked at the US Department of Health and Human Services, helping to launch the Center for Medicare and Medicaid Innovation and implementing the HITECH Act.

Dr. Jain studied government at Harvard College and went on to earn his MD from Harvard Medical School and MBA from Harvard Business School. He was on faculty at Harvard Business School while completing his medical residency in internal medicine at Brigham and Women’s Hospital, and he is affiliated as a senior institute associate at the school’s Institute for Strategy and Competitiveness.

I had the opportunity to ask Dr. Jain about how he merged his interests in medicine, public policy, and business, what it’s like working in each of those fields, and what advice he has for current medical students with many interests.

V: How did you get interested in medicine?

Dr. Jain: Medicine was always a part of my family growing up. My father was an academic pain management physician at Memorial Sloan Kettering Cancer Center. My dad’s oldest sister was a physician, and my dad’s younger brother was also a physician, and I have another aunt who is a scientist. My family did a lot of work in healthcare for the underserved in India, and so a lot of our dinner table conversations would be about things that happened related to my dad’s work, or to our work in India. Over middle school and high school, I cultivated an interest in public policy and government, so as I started to understand healthcare, I started to understand all the challenges faced by the healthcare delivery system.

V: How did you pursue this interest in public policy and government in college, and balance it with your interest in medicine?

Dr. Jain: In college, I was lucky to be connected with some mentors through a lot of serendipity. My freshman year of college I did a project with Deborah Stone who was a visiting professor at the time focused on home health care. I also did an internship for the National Academy of Social Insurance. I was still struggling through college because Ihad cultivated all of these policy interests, and I wasn’t sure whether I was going to go to medical school, or law school, or whatever. I took a course on health care in America, taught at the time by Howard Hyatt and Don Berwick. Don was a leader of the quality in healthcare movement, and Howard Hiatt was the former dean of the Harvard School of Public Health and mentored a lot of prominent physicians, so they basically called all of their friends to teach some seminars. It was great, because you just got a sense of how you could be like a physician activist and physician leader. This was pre-Obamacare, and there was a huge access challenge. It broadened my worldview from just the access problems to quality as well. So then I applied to medical school with this knowledge and vision for what I could become, which was one of these people.

V: While you were in medical school, you were kind of thinking maybe a JD, maybe MPP, maybe an MBA…how did you settle on the MBA?

Dr. Jain: I originally applied to the Harvard Kennedy School, coming out of college, and I actually deferred my admission, because I thought I would do it between my third and fourth year of medical school. During medical school I did a project for David Blumenthal when he was a professor at Massachusetts General Hospital and writing a book on healthcare policy and the presidency. I was helping him with a literature search, and what was kind of sad when I researched the topic was that health policy hadn’t changed very much from 1988, when I was 8 years old, to 2002 when I was 22 years old. I basically thought that a career in health policy was a career potentially in futility. It seemed like it was the same people saying the same things just separated ten years apart. That didn’t feel like it was going to be fulfilling. Obviously, that didn’t prove to be true a few years later, but that got me thinking that a degree in management would be better than a degree in public policy. So I started to meet people like Peter Slavin and Gary Gottlieb, who were the presidents of MGH and the Brigham at the time. I got to see that maybe the unit of change where I could make the most influence was at the organizational level. That’s how I shifted gears to do an MBA.

V: What do you think the MBA added to the knowledge that you got in medical school? Did it lead to any tension when you graduated, as some MD-MBA students have nowadays, between clinical work and careers in business?

Dr. Jain: The MBA really broadened my worldview. I had had a narrow view of perspectives on clinical policy and medicine, and I hadn’t yet really thought about business and entrepreneurship, and the role of large and small enterprises in actually changing care. People I talked to who knew me were basically observing me change before their eyes, in terms of my vocabulary and things I was thinking about and how I was viewing the world. That was pretty exciting for me. But I also fell in love with medical practice during my third year of medical school. I really enjoyed my medical teams, I liked the intellectual challenge, I liked learning medicine, I liked taking care of pts, I liked the relationships I built with families, and loved the relationships I built with other colleagues and patients. So it became very obvious to me at that point that I wanted to keep doing clinical work. The other piece of it is that if you want to make an impact in healthcare, and you want to change healthcare practice and behaviors, you have to live it. It’s very easy to sit in a startup or sit in a company and try to change healthcare from the outside, but I think your ability to do so is greater when you can think about how things are going to work in the real world.

V: What was it like working at the US Department of Health and Human Services? How did that opportunity come up during your residency?

Dr. Jain: Obama was elected president and I knew he was going to focus on healthcare reform, and it felt like an opportunity to return to my first love, which is health policy. A lot of Harvard faculty at the time, a lot of my mentors, were going to DC to work on the Obama administration, and I just jumped at the opportunity to go work with David Blumenthal when he offered it to me. I was able to take a leave from residency at Brigham and Women’s Hospital. A year later, Don Berwick became administrator of Center for Medicare & Medicaid Services (CMS), and he offered me the opportunity to join his senior management team, and so I did that. Working in the government really changes your whole perspective. When you are practicing and you’re training in medicine you really only think about the environment in which you train and your worldview is the places that you train at. But in the course of thinking through and working on federal policy and federal missions, you see that healthcare is really diverse and the country is really big and there’s a lot going on around the country. There’s rural healthcare and there are different delivery systems, and there are organizations that are focused on chronic disease management, and more. You just meet these really fascinating and interesting people, because everyone comes to Washington at some point or another.

V: So after your returned from your time in government and finished your residency, you went on to be chief medical information and innovation officer at Merck. What inspired you to take that role, and what were some of the things you learned out of that experience?

Dr. Jain: I think one of the things the government spoils you with is scale. You’re thinking about national issues all the time. One of the amazing things about working in a pharmaceutical company like Merck is that it’ s global. You’re not just thinking about healthcare in one country, you’re thinking about it in 150 countries. I was asked to be the digital health and big data leader for the entire company, and I was given a large mandate that was endorsed by the board and executive committee. It was an interesting question, which was, how does a global pharmaceutical company leverage data and digital health tools to improve healthcare delivery? I was able to build a team from scratch, and I did a lot of that in government, so it was a nice extension of what I was previously doing.

V: Now, in your new role as Chief Medical Officer at CareMore, what are some of the main things you work on?

Dr. Jain: I always tell people, working at CareMore is bringing together everything that I love. It’s clinical medicine, it’s policy, it’s business, and it’s transforming healthcare. I lead a clinical organization of over 800 dedicated clinical staff, so a big part of my job is helping to steer that ship. On any given day I’m traveling all over the country to meet the clinical staff that we have in over seven states. I’m working on trying to innovate the clinical model, which is really designed around taking care of frail elderly, but now we’re also pivoting and trying to apply to model to Medicaid patients, to make available better primary care to those patients. We’re working with Emory medical center to get the model substantiated in an academic environment, and I’m trying to recruit new clinicians, because we’re growing, and we need top talent.

V: Looking back on your medical education and training, are there any areas that you wish could have been changed? I know you’re a big advocate of students learning about health policy.

Dr. Jain: The best advice that I’ve ever gotten, that I sort of didn’t follow, but in retrospect is truly the best advice, is that there’s a season for everything. I think there’s a season to be a medical student, and in that season, you should really focus on being the best medical student you can be. There’s a mindshift that happens between each phase of your career that I think some people fail to make. So in high school, you do like ten things and you’re rewarded for it, and you go to college and it’s the same thing. Then you get into a great medical school and you’re doing ten things on campus. But in medical school I would say be a great medical student, and then pick one or two things that you’re really passionate about, and build community and mentorship around those one or two things. Don’t lose sight of the fact that you have to earn and develop your clinical identity first and foremost, because that’s the foundation for all this other work that you’re going to be able to do.