At one point during his Osler training, Alexander Billioux realized he’d been admitting the same patient about once a month. She had a history of diabetes and heart, lung and clotting problems. Only later did he learn that she lived on a housing voucher in a four-story walk-up with a spiral staircase, making it dangerous to come and go to appointments.
These days, Billioux (Osler, 2010; Thayer assistant chief of service, 2014) is helping to develop national care delivery models that screen for such health-related social needs as housing and access to healthy food. The senior adviser to the front office at the Center for Medicare and Medicaid Innovation says he draws from his training and mentoring experiences, which included leading efforts to reduce waste and harmful medical practices.
Now—more than ever—Osler trainees eager to explore ways to improve outcomes on a larger scale are choosing electives in government. Or, they can opt to enter a new health systems management fellowship that trains them in health care policy, created by psychiatrist Chester Schmidt and Sanjay Desai, Osler medical training program director. “This fellowship,” says Desai, “exposes junior physicians to the most challenging problems of our health delivery system.”
Osler trainees who choose this path can also seek guidance from Billioux and Anand Parekh (Osler, 2002), who is now chief medical adviser for the nonprofit Bipartisan Policy Center in Washington, D.C.
Parekh believes the uncertainty about the future creates opportunities for new approaches and bipartisan efforts. “People need to work across party lines,” Parekh says, “to ensure the coverage gains realized through the Affordable Care Act are maintained.”
On campus, the fellows work with Scott Berkowitz (Osler, 2007), Johns Hopkins Medicine’s senior medical director for accountable care. Sarah Johnson Conway (Osler, 2016), the inaugural health systems management fellow, assists Berkowitz in strengthening and developing payment models that focus on patient-centered care while reducing costs.
In addition to supporting Berkowitz’s work, Conway works alongside other Johns Hopkins leaders in health policy (see sidebar on page 2). Berkowitz, Parekh and Billioux—the three earlier trained Osler trainees with these interests—took advantage of building their own electives and experience.
As a second-year resident, Parekh, who also holds an M.P.H., did an elective at the Centers for Medicare and Medicaid Services. Following his residency, he served for a decade in the Department of Health and Human Services, developing national initiatives on chronic disease prevention and care management for individuals with multiple chronic conditions. Now, in his role with the Bipartisan Policy Center, Parekh works to address aging, prevention and global health issues.
Billioux’s work and research began with a focus on diseases of poverty, including HIV/AIDS and tuberculosis in India, Guatemala and South Africa. The year after completing his assistant chief of service year, he served as a White House fellow.
Berkowitz, a cardiologist, credits his “outstanding” clinical training for helping to inform his policy work. He took a year leave of absence to work for the state of Illinois on health care.
Since 2011, Berkowitz has led efforts at Johns Hopkins to study shared savings and payment models, most notably the Johns Hopkins Medicine Alliance for Patients—a Medicare Shared Savings Program accountable care organization Berkowitz helped craft. It includes more than 2,000 medical providers offering high-quality care and services to 38,000 Medicare beneficiaries across Maryland and Washington, D.C.
Berkowitz and Conway continue to channel their interest in public policy from within Johns Hopkins Medicine. “It’s important that all Osler alumni and M.D.s globally try to take an interest in understanding how this work will impact our patients,” says Berkowitz, “and to participate in making it better.”
Billioux couldn’t agree more. “Doctors can tell stories of patients’ lives across the spectrum. With that privilege comes responsibility: We must give those patients a voice.”
4 Osler-Trained M.D.s Weigh in on the Future of Health Care Policy in America
The Affordable Care Act (ACA) may be history, but the issues behind it aren’t going away. From soaring health care costs to poorly managed chronic diseases, millions of Americans are bound to feel the consequences. We asked four Osler-trained M.D.s with experience in health care policy to answer a question on this topic.
What are your biggest concerns regarding the state of health care policy in the U.S.?
SCOTT BERKOWITZ: Navigating implementation of many different semi-aligned policies and programs, in the setting of increased complexity; a lack of clarity about how the landscape will evolve in the current political climate; and always maintaining focus on the patient — and ensuring that we are providing the best possible clinical care by using the best data to support it.
ALEXANDER BILLIOUX: I can’t comment specifically, but the work I do at the Center for Medicare and Medicaid Innovation is already improving care and lowering costs. I will continue to lead work on care delivery models focused on enabling health systems to engage in population health. That includes addressing social and environmental factors affecting our beneficiaries’ health.
SARAH CONWAY: This is an interesting time for me to be beginning my career, given the rapid rate of change likely in coming years. The key principles remain the same, though, including the need to ensure we are caring for the sickest and frailest patients in a sustainable way and maintaining adequate coverage for them under any new system.
ANAND PAREKH: I think we’ll have to wait and see. I am a cautious optimist. Remember: We’ve never moved in a straight line. We need to build upon the progress of the last many years and work together. This could be a several-year transition period. Of course, we will need to ask if alternatives are viable for insurance companies and if new legislation will cover as many people as the ACA did.
