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Professor of Economics Jessica Holmes is a member of Vermont's Green Mountain Care Board, which regulates health care in the state.

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Faculty Voice: Shaping Health Care Policy from the Classroom

April 19, 2017

Professor of Economics Jessica Holmes recently discussed how her role as a member of Vermont's Green Mountain Care Board opens up opportunities for her students and how her students' research benefits the state.

Q: What is the Green Mountain Care Board (GMCB) and what is your role on the board?

JH: The GMCB is a five-member board appointed by the governor of Vermont to regulate health care in the state. We regulate health insurance rates, hospital budgets and large capital expenditures. We are also responsible for reforming the payment and delivery system in an effort to lower costs, improve quality, and increase access to health care. So we are essentially tasked with health care reform as well.

There are four part-time board members–of which I am one–and a full-time chair. At the moment there are two vacancies–one for the chair and one for a part-time board member. I am in my third year in a six-year term.

Q: How does it feel to have such a serious responsibility that impacts thousands of peoples’ lives?

JH: I think about that every day. It’s an enormous burden and it’s an enormous opportunity. I have to think about Vermonters and what is best for them in a way that I never had to before. Reading an article about policy is very different than creating policy. It’s a challenge but one that I’m enjoying. 

I’ve learned a tremendous amount by working with legislators, hospital and insurance executives, and the consumers who attend our public meetings. Every decision we make has both intended and unintended consequences and the challenge is to understand both. In the end, I only hope that my work on the Board helps make health care more affordable and more accessible for all Vermonters.
Q: So how does a Middlebury economist end up on a state health care board?

JH: I have been teaching a class called Health Economics and Policy on and off for 15 years. My approach to teaching has always been to bring the “real world” into the classroom, marrying practice with theory. Several years ago, I reached out to the members of the GMCB to see if they had any strategic policy challenges that my students could work on and they did. It was through that class and my service on the Porter Hospital Board that I became familiar with the work of the GMCB. At some point there was an opening, and I was invited to apply.

I’d been teaching for a long time. I realized that the more I understood about how policy was made, the better I would be as an educator. I also thought my work on the board would open doors for my students. There’s a great deal of human capital in our classrooms and putting the students’ creativity and fresh perspective to work on real challenges that Vermont faces would be an incredible opportunity for them and the State. I wanted to join my two interests, which are health policy and teaching, and this was a good way to do it.

Q: How does your work on the GMCB inform your teaching?

JH: Last fall, in my Health Economics and Policy class, I divided the students into small teams and asked them to tackle several policy challenges faced by the GMCB. These challenges ranged from the mental health and opiate crisis to reimagining how we measure the optimal allocation of health care resources in the state.  My students read the academic literature, interviewed dozens of stakeholders, and visited health care facilities across the state. They learned a great deal in the process but so did I.

Some of their insights and recommendations are now being factored into the board’s decision-making. For example, the board was so impressed by one team’s work on the effectiveness of the state’s Certificate of Need laws (regulatory laws that require health facilities to seek GMCB approval to buy major new equipment or to open up a new facility) that we are now recommending changes to the statute. This effort was inspired by student research. 

The GMCB is also responsible for updating Vermont’s Health Resource Allocation Plan, a document designed to help guide health care expenditure decisions. This summer, we’ll revise the document, based in part on my students’ research. 

I sometimes teach a class called the Economics of Social Issues. I haven’t taught it since I’ve been on the GMCB but the next time I do, I would absolutely leverage my policy work with the state.

Q: How do the students react to working on projects based on actual policy challenges? 

JH: The evaluations from the class tell me it was transformational for the students. They learned a lot but it was more work than a typical class and more stressful because they knew the challenges were real and people were counting on them. Several high-level state officials came to hear their final presentations, including Al Gobeille, the former chair of the GMCB who is now Vermont’s Secretary of Human Services. 

What I’ve found is that when students know it matters, and somebody might act on their recommendations, the quality of the work goes way up. It’s not for a grade anymore. It’s for real. The more you introduce authentic challenges with real impact on the world, the more students are invested in learning. I try to shape my classes this way as much as I can and this connection to policy work at the state makes that even easier. 

Q: What are you teaching next? 

JH: I’m on leave in the fall. In the spring I’ll teach Health Economics and Policy again but as a senior seminar. I decided to put the second half of my leave on hold since my time on the GMCB is limited and I wanted this opportunity to bring more of Vermont’s health care challenges into the classroom. It will be a valuable research experience for our students and potentially useful to the Board. I’m constantly thinking about how to bring students into the other world that I live in. I’m already thinking about projects we can do next spring.