Policy Prescriptions

Health care once seemed simple: You got sick, called a doctor, and
paid the bill as best you could.

Today health care accounts for nearly 20 percent of the total U.S. gross domestic product—about $3 trillion of economic activity annually. It’s also the largest item in the federal budget, making up 28 percent of all government spending.

Intertwined in that economic juggernaut is a complex patchwork of private health insurance, as well as the increasing threat of deadly pandemics capable of spreading with ever-increasing speed and breadth across the globe. Taken as a whole, it makes for a bewildering mess—or, in the view of some academic researchers, a rich area of study to untangle.

With a greater focus on how the health care system functions, particularly in the wake of the 2009 Affordable Care Act, Vanderbilt has adjusted its own research and teaching programs surrounding public health and health policy.

For two decades Vanderbilt has offered a master of public health (MPH) degree, run for most of its history by the School of Medicine’s Department of Preventive Medicine, and designed primarily for clinicians who wanted to pursue careers in clinical and health services research. But during the past four years, the program has changed dramatically, adding tracks in global health and health policy to the traditional course of study concentrated around epidemiology. As a result, students with nonclinical backgrounds are entering Vanderbilt’s MPH program for the first time in its history.

The other major change came in 2013, when Vanderbilt created the Department of Health Policy, which now houses the MPH program and is chaired by Melinda Buntin, professor of health policy, who previously served as deputy assistant director for health at the Congressional Budget Office (CBO).

“This is a watershed moment for the medical center and the university,” said Dr. Robert Dittus, associate vice chancellor for public health and health care and the Albert and Bernard Werthan Professor of Medicine, at the time of Buntin’s hiring. “At few times in our nation’s history has there been more attention on health care policy.”

For her part, Buntin’s own shift from research—early in her career she spent a decade as a health economist at RAND Corp.—to Washington policy circles, and then into a university role, has offered her a broad perspective on a changing health care system. In all her roles, she says, “the mission was really consistent with my own mission and with the mission of the Department of Health Policy, which is to bring research and data to bear on important policy questions.”

With an undergraduate degree from Prince­ton’s Woodrow Wilson School of Public and International Affairs and a Ph.D. in health policy from Harvard, Buntin has deep roots in academia. Even her initial foray into the federal workforce—she took a leave from RAND to work for the U.S. Department of Health and Human Services—had a strong research bent. In that role she helped implement and evaluate a federal program that offered funding to clinical providers to adopt electronic health records and use them to improve care.

That HHS position, and the one that followed at CBO after passage of the Affordable Care Act, allowed Buntin to remain above the political divisions in Washington while still getting a front-row view of some of the most seismic policy shifts the U.S. has ever experienced.

Of her involvement with the stimulus bill, Buntin likes to say, “Though I was working for an executive branch appointee, it was on the only issue about which Hillary Clinton and Newt Gingrich had ever held a joint press conference.”

And the CBO, with its sole job of advising Congress in a nonpartisan way about the budgetary effects of any significant proposed legislation, is an almost completely unique institution in the world, she says. “Bob Reischauer, an early director of the CBO, had this great saying about CBO: ‘It’s the only place in Washington where you’re paid to tell the truth and people have to listen.’ Everyone there knows their job is to give advice to the best of their ability, and they do it extremely well.”

‘When Can We Hire Your Students?’

It was during her second (and last) year at CBO that Vanderbilt landed on Buntin’s radar. She had been invited by several leading universities to deliver talks on health policy. At first Buntin turned them all down, focusing instead on her role in helping lead the CBO’s Health, Retirement and Long-Term Analysis Division as it worked through an avalanche of requests that came in the wake of the health-reform bill’s passage.

“But in my second year at CBO, I realized that part of my value there was all my connections with academic researchers, because we got great insights into the work they were doing, research that might be relevant to something we were working on,” Buntin says. “So I went back to the list of schools that called the previous year, one of which was Vanderbilt. And from the very day I gave the talk, it was clear that really exciting work was happening here.”

In addition to Vanderbilt’s academic research and its individualized approach to teaching, Buntin valued the university’s vision of bringing people together from across campus in various disciplines to explore issues related to health policy.

“With the passage of the Affordable Care Act and the focus on changes in the health care delivery system—which were really ongoing before and after the health-reform bill passed—there was a greater understanding of the need to examine policy issues, health care financing, economics, all of those things, because they are spurring a lot of the change that’s going on in the health care sector,” she says.

Those changing dynamics of health care, coupled with a new generation of college graduates interested in public service and social entrepreneurship, also has sparked interest in health-policy topics among a wider group of students than just those with clinical training. Plus, there are jobs to be had. Organizations ranging from places like the Centers for Disease Control and Prevention and the CBO, to health care startups and local government or nonprofit agencies, have an ever-growing need for public-health expertise.

“When I left D.C.,” Buntin recalls, “all my friends and colleagues had this parting question: ‘What kind of students are you going to train, and when can we hire them?’”

Dr. Marie Griffin, the current director of Vanderbilt’s MPH program and one of its original founders, along with Wayne Ray, MS’74, PhD’81, and Dr. William Schaffner, says the addition of students with different backgrounds has led to noticeable changes in the classroom.

“I have appreciated the broader diversity of students, especially those who come with a couple of years of work experience,” says Griffin, who is a professor of both health policy and medicine. “Students in the global health track, for example, are interested in different things than our traditional MPH students. That has challenged faculty teaching in the program—in a good way.”

However, she and Buntin both say they want to ensure that MPH students continue to get the same one-on-one attention from professors as the program grows. “I can genuinely say that what we offer our students is extremely special,” Buntin says. “You will never be in a lecture class of 200 people, which may be common in other programs.”

As the program continues to spread its footprint, Griffin says efforts are underway to recruit additional faculty, as well as offer more formal ways for MPH alumni to reconnect.

“We’re creating an MPH alumni association and are very interested in continuing to build alumni relationships,” she says, adding that the MPH program enrolled its first students in 1996 and will host events at this year’s Reunion in celebration of its 20th anniversary. And within the next five years, the Department of Health Policy hopes to launch a Ph.D. program of its own.

At the same time, Buntin’s health policy department is deepening its ties with relevant disciplines across campus. For example, the department co-hosts a seminar series with the economics department, which also attracts people from the Owen Graduate School of Management and the law school.

“We fill that seminar room with people in white coats, people with pocket protectors—whatever analogy you want to use,” Buntin says. “That’s the kind of intellectual environment that draws people back—when you hear the questions economists are asking of physicians, and vice versa.”

Next year the health policy department plans to offer two courses through Vanderbilt’s Center for Medicine, Health and Society, which houses one of the most popular undergraduate majors on campus. And this past fall, the department worked with Ranga Ramanujam, professor of management at the Owen School, to develop a workshop for medical residents and fellows about value in health care, using the business-school case study method. Buntin is exploring other cross-campus collaborations as well. She is also working with state lawmakers searching for alternatives to expand health care access in Tennessee and hopes to connect them with other experts.

M. Eric Johnson, dean of the Owen School and Bruce D. Henderson Professor of Management, welcomes the department’s cross-campus overtures. “In health care, both policy and business go hand in hand,” says Johnson, whose own academic expertise is in health care information technology. “At Owen we’re excited to have someone of Melinda Buntin’s stature at Vanderbilt building a strong health policy group.”

Dr. William Cooper, MD’91, MPH’97, Cornelius Vanderbilt Professor of Pediatrics and former director of the MPH program—technically, he was also the program’s first graduate in 1996 because his name came first in the alphabet—worked on efforts to broaden Vanderbilt’s involvement in health policy before Buntin’s arrival. But her Washington experience “really brought a unique perspective,” he says, noting that she has been involved in recruiting energetic new faculty members.

As for her own connections in Washington, Buntin continues to stay in touch with friends and colleagues. In March, for example, she participated in a bipartisan congressional retreat outside Washington focused on health policy.

“I always want my research to be relevant and grounded,” she says.