By Adam Beyer
Amid a changing health policy landscape, Charles Mathews MPP’04, sees his Sanford degree as a critical tool.
Mathews, a vice president at Boston Healthcare Associates (BHA), has a niche role in the industry: helping companies figure out how to show the value of new technologies to payers (insurance companies) so they will pay for them. In particular he focuses on new medical laboratory tests.
“I like to say I’m one of the top five molecular diagnostic reimbursement consultants in the world because I think there are only three of us,” he joked.
Mathews did not arrive at the Sanford School’s Masters in Public Policy program as laboratory expert or even a health policy specialist. After graduating from Colgate University with a history degree, he had worked in the House of Representatives for four years.
During his time as a legislative aide, he became familiar with issues as diverse as agriculture, welfare, trade, foreign affairs, and health care. On a typical day, he would meet with a wide range of groups, advocating for specific policies.
Of all the issues swirling around Congress, Mathews said health care policy stood out to him as an area where he could make a difference.
“In something as complex as the U.S. healthcare system there are plenty of problems, but that means there are plenty of opportunities for incremental improvement,” Mathews said.
For example, his office had worked on a bill that allowed the Medicaid program more flexibility to cover different breast cancer treatments, which was ultimately passed into law.
However, he also recognized that he needed more skills to analyze and assess the impact of different policy initiatives.
“I was getting a lot of info thrown at me, and I wanted to be a more sophisticated interpreter of that information.”
Mathews said the policy background gave him the tools to do this. While a student, he said he valued his economics and statistics courses, citing the analytical skills he gained and his economics course with Helen “Sunny” Ladd, the Susan B. King professor of public policy.
He was also able to increase his focus on a policy area he was passionate about. “On Capitol Hill, my issue though was I was a mile wide and an inch deep,” Mathews said.
At Sanford, he was able to study health care policy and learn from advisor Don Taylor while writing his masters project on how genetic testing information would influence adverse selection in long term care insurance. He also was influenced by Chris Conover, a former professor in the Sanford School who specializes in health regulation and the uninsured.
Mathews’ studies were not confined to Sanford, however. He also took courses at the Duke Law School, the Fuqua School of Business and at the School of Public Health at the University of North Carolina.
At Sanford, he said he felt surrounded by passionate people.
“Everyone had a focus,” he said. “It was not about grades or impressing the teacher. It was, ‘I want to learn so can go to the next step of my career.’”
Leaving Duke, he moved to Boston, his wife’s hometown, and landed his job with Boston Healthcare Associates.
Although Mathews said his daughters believe his job is just all about making PowerPoint slides, the work is broader than that.
Clients approach him asking how they can get their medical products covered by health insurance plans. For example, a company may have a new drug targeting prostate cancer or a new medical device for helping patients with heart disease and need ways to make it financially practicable. His work involves doing extensive background research and interviews with physicians, hospitals, and public and private payers (insurers). He interprets this information and leverages his understanding constantly changing policy minutiae to craft detailed reports.
“I believe my experiences at Sanford prepared me particularly well for consulting,” Mathews said. “[At Sanford] there is a big emphasis on taking complex topics and preparing simple ways to clearly communicate the key facts.”
He recalled an exercise in which former professor Art Spengler had him prepare a five page memo on a topic then reduce it to three pages, then summarize in one page.
“At first you say, ‘I need all of these words’ but eventually you learn that cleaner is better.”
These skill helps him with clients on an on-going basis.
Increasingly, he has been participating in conferences and roundtable discussions on the future of the health care with industry leaders. Looking ahead, we can be certain that there will be uncertainty about health insurance, he advised. Although many people focus on the potential repeal of the Affordable Care Act (ACA), Mathews noted that payment reform policy changes are very important and often overlooked. These changes seek to make costs depend on value and quality of care rather than fixed fee for service costs. He believes this focus on value for money spent will continue regardless of repeal and reform.
No matter what happens with the ACA, Mathews said he feels prepared, in large part due to his experience at Sanford. Mathews also makes it a point to assist other Duke alums as they attempt to navigate working in health policy, walking them through different opportunities available in consulting, the pharmaceutical industry, and policy shops.
“People with MPPs are good at taking complex information, analyzing it, and clearly communicating the implications. There is always a need for people who can do this well,” he said.