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HL20: Karen Davis, PhD—Economist, Healthcare is More Than a Numbers Game

 |  By Chelsea Rice  
   December 02, 2013

In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is the story of Karen Davis, PhD.

This profile was published in the December, 2013 issue of HealthLeaders magazine.

"I think it's the most exciting period in healthcare probably ever in the United States."

Growing up on a wheat farm in Ponka City, Okla., a small town about 100 miles north of Oklahoma City, Karen Davis, PhD, was raised with "that basic Midwestern ideal value system that you try to help people out, and you use the talents you've been given to do that."

Davis, who is a professor in the Department of Health Policy and Management, and director of the Roger C. Lipitz Center for Integrated Health Care at the Bloomberg School of Public Health at Johns Hopkins University, was actively involved in 4-H as a girl, which she says rounded out her philosophy on life. That, combined with her early interest in statistics and economics, has led to desire to improve the healthcare system in this country and everyone's access to it.

"The first 'H' is for the heart, which represents that you have a commitment to justice. The second 'H' for the head represents a commitment to scientific approaches. Hands demonstrates a commitment to service and helping people, and the fourth 'H' is for health," says Davis.

Having worked in health policy and reform for more than 40 years, Davis is excited about where healthcare is headed today. She got her start in economics, eventually earning a PhD in economics from Rice University. While at college in 1960s, Davis was influenced by the social movements that were taking place.

"At that time, economics was all about opportunity for people to be educated, healthy, and to work and be contributing members of society, so my early professional career was really shaped in an era of commitment to civil rights, social justice, equity, and opportunity. As I finished my studies I moved specifically into the health field and focused on how to apply all of those concepts," says Davis.

Five years after the passage of Medicare, Davis worked as an assistant professor of economics at Rice University in Houston and a senior fellow at the Brookings Institution in Washington, D.C. She studied the impact of that legislation and became very interested in the difference Medicare made in helping improve access to care for the elderly and particularly minorities and those with low incomes. For her research work, she was elected to the Institute of Medicine, as one of its first female members, in 1975.

In 1977, Davis served as deputy assistant secretary for health policy in the Department of Health and Human Services during President Jimmy Carter's administration. She worked on expanding Medicaid to pregnant women and children and tying eligibility to the poverty level, which eventually became law starting with expansion in late 1980s and early 1990s.

Davis returned to academia in 1981 as a professor of economics and chairman of the Department of Health Policy and Management at the Johns Hopkins School of Public Health. She continued to research effective strategies for healthcare cost containment, and through teaching, she says, tried to convince more students to go into the field of health policy and economics.

With a background in economics, Davis absolutely believes in the power of comparative data to change minds and inform policy. In 1992, Davis began to work for the Commonwealth Fund, the private foundation established in 1918 with the mission to "promote a high-performing healthcare system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults."

From 1995 to 2012, while Davis served as the president of The Commonwealth Fund, she was frustrated with how the U.S. healthcare system compared internationally with systems that not only provided higher rates of healthcare coverage for their citizens, but managed to afford it.

In 2005 she established the Commonwealth Fund Commission on a High Performance Health System. The comparative outcomes and quality of care data the Commonwealth Fund put forth demonstrated that the United States clearly did not have the best health system in the world. Davis says this comparative research on international systems helped to "motivate and create the will for change" in Congress.

The timing of her leadership at the Commonwealth Fund was particularly influential in the development and implementation of the Patient Protection and Affordable Care Act. The foundation funded research focused on strategies to improve access to care and to help pay for that care by improving quality and lowering costs. The foundation's efforts timed particularly well with a Congress and a president willing to make health reform a national agenda priority.

"We had an opportunity to get the right information into the hands of those who can implement the change. The strategy was both in knowing how to anticipate the issues but also knowing at what time to have things ready. When the window of opportunity opened up and President Obama made the surprising decision to say to Congress 'You come up with a plan,' we had a plan ready when that moment in time came," says Davis.

In 2009, Davis was heavily involved maintaining the momentum of the PPACA. She moved to Washington, D.C., and worked with Congress on the implementation of the healthcare law, she says, responding to every invitation to attend briefs and meetings. Earning herself the nickname, "Johnny Appleseed," Davis traveled domestically during this time to "spread the message of innovation." She shared models of care she had witnessed internationally with leaders of large U.S. health systems to help establish best practices in this new era of reform.

"I find that in between government and academia, the foundation world is really the bridge," says Davis. "Being in the foundation world is about figuring out what are the big issues ahead and what do people need to know to make informed decisions and how to effectively communicate that to people in the position to effect change."

Having retired from the Commonwealth Fund in 2012, Davis returned to a career in academia and research at Johns Hopkins, working on what she anticipates will be the next big policy issue. Her current research centers around integrated care, she says, and explores how to better finance not only acute care coverage but also long-term care so "people have the opportunity to age without going bankrupt."

"I think it's the most exciting period in healthcare probably ever in the United States," says Davis. "When I talk with healthcare leaders, it's obviously challenging adapting to a new way of caring for the population, but it's the greatest opportunity to do what we went into healthcare to do, to see people get the care they need but do it in a way that's best for patients and do it in a way that's best for society."

Chelsea Rice is an associate editor for HealthLeaders Media.
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