Bloomberg Distinguished Professor of Health Economics and Policy, Bloomberg School of Public Health and Carey Business School
Director, Hopkins Business of Health Initiative
Dr. Polsky has dedicated his career to exploring how health care is organized, managed, financed, and delivered - especially for low-income people. His research on issues of cost and quality has influenced the national understanding of interventions in both federal and local programs; and his most recent work focuses on access to quality health care in low-resource settings, with a particular interest in narrow provider networks. He is the co-author of "Economic Evaluation in Clinical Trials," a handbook published by Oxford University Press that provides practical advice on conducting cost analyses in controlled trials of medical therapies.
First, as the Director of the Hopkins Business of Health Initiative, what is the Business of Health?
We’ve been having conversations on the business of health to figure this out as an organization. But now I have two seemingly different definitions. We are all in the business of health. It’s the job of each one of us as we all work to maintain and improve health – for ourselves, our families, our communities, our nation, and across the globe. To that end, the business of health is applying the knowledge and understanding of behavior, incentives, markets, finance, management, and analytics that can make a business successful to advance health is one definition. The other definition emphasizes the word business. The business of health considers the role of business in advancing health. Like it or not, business plays a central role in health and health care. In the U.S., business can innovate, scale, and deliver goods and services to advance health and health care in markets that require the heavy involvement of the public sector for financing, licensing, and regulation. The business of health considers how business can best advance health and address national health system challenges of access, affordability, value, and equity.
Before joining Hopkins nearly four years ago, you were a professor of medical ethics and health policy, and of health care management and economics at the University of Pennsylvania School of Medicine. Why did you decide to join Hopkins and start HBHI?
At the time I decided to join Johns Hopkins University I was Executive Director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania. The organization has a distinguished 50-year history with a focus on research to advance health care policy across the university by uniting the schools across the University. The opportunity to leverage what I had learned at Penn to start something new and different at Johns Hopkins, the world’s number one University in health, was too exciting to pass up. The vision was to create an ecosystem that would catalyze innovative solutions through collaborations between faculty at a relatively new business school with the wealth of expertise at the top ranked health schools across Public Health, Nursing, and Medicine. What has come out of two years of planning with leaders across these schools, who were all passionately committed to innovative ways the University can best address social challenges, was HBHI.
What’s unique about HBHI?
As schools at Hopkins succeed at their central mission, whether in medicine, nursing, public health, or business, HBHI works with these schools to bring them together for collaborative health system solutions. What makes it unique in the national landscape of similar institutions is we’re focused on business being at the table for thinking about how to make the health system work better. We steer clear of ideology and political agendas to create a space where different approaches can convene and learn from each other.
How do you describe your leadership style?
I'm a middle child; I know we can all get along. My strength as a leader is around bringing people together. I try not to be the personality driven leader that's out in the front. My style is more to empower people around a mission to make the whole greater than the sum of its parts. When I describe what HBHI is, I feel like we're building platforms from which people can thrive in a collaborative, interdisciplinary way.
How much of your time is spent on the HBHI initiative and what else are you involved with?
HBHI is like a startup, so it takes at least half of my time. I teach in the public health and business schools, and I love the time I spend mentoring students and faculty. As a member of the National Academies of Medicine I also spend a great deal of time working with the National Academies including working on consensus studies that make recommendations to the government about how health and health care should evolve over time. Currently I’m co-chairing a consensus report that should come out this summer.
I’m also very active in my own research focused on access to quality health care in low-resource settings. As co-director of the Hopkins Economics of Alzheimer's Disease and Services Center, I have an opportunity to help grow a research community in this emerging need to address fundamental questions tied to overcoming economic challenges in the care of persons with Alzheimer's disease. The challenge is we don't have a systematic way we pay for care, so you need the economist on board. And then there are all these drugs coming on the market but there’s a tension between paying for pills versus paying for care. There are big socioeconomic challenges that we can see are coming. And we currently don't have good solutions.
You have special interest in investigation solutions for lower income populations. Can you talk about that?
The US healthcare system is built for people who can pay for it. And then we have all these programs that help people who can't pay for it directly. They must still fit in a system that's really built for the people on our commercial insurance, whose payment rates are two or three times higher. So, the providers organize themselves around those customers. They still accept customers who have Medicaid or Medicare. But we don't really build the system around them and they kind of fall through the cracks. In my research, I think about how providers get paid from insurers and how that impacts access to care for lower income populations and their outcomes.
In your opinion, what are the greatest opportunities to improving the healthcare system? And how can HBHI contribute to good outcomes.
Some of our challenges are around paying for the rising costs. But what I've seen in the past few years is how our health and health care system is something everyone in our country is very passionate about. Everyone prefers to be healthy. And the real challenge is that people have different approaches, so it's hard to move forward. On the optimistic side, I'm seeing so much innovation. The development of the COVID-19 vaccine and telehealth and technological solutions for addressing challenges and access during a very stressful time was extraordinary. The development and embrace of telemedicine for behavioral health is an extremely positive development. But at the same time, it can be overused and abused. In some ways, innovation makes access to healthcare easier for people who need it the most. But a lot of these new innovations are outside of insurance and the reimbursement for visits through telemedicine may go away. What happens then? How do we build the right structures to get the most from these emerging opportunities?
That’s where HBHI comes in. A lot of people are selling their products and not everything works or will work. How do you assess and provide evidence or which ideas are worth pursuing and those that aren't? If we just let the market decide, it’s not sufficient in healthcare because it is a market that combines private and public needs. The market, left to its own devices, doesn't always naturally land on the best solution. At the same time, we must let ideas and innovation thrive, which the business sector is very well positioned to do. But it must have evidence and accountability to pursue those things that provide the greatest value.
Your work life seems intense; what do you do in your downtime?
I have three amazing kids keeping my life full and rewarding. They’re 16, 14, and 6, so I spend most of my time being a dad and husband. And I like to watch movies. And now my kids like to watch movies – but rarely the same ones. When I'm not with my family, I'll work out in the basement, doing Peloton and weight training. That's my quiet time. I have a poker group with friends. But we’re all terrible at poker.