Ep 64: Advancing Health Policy Through Research

[00:00:18] Sanjula Jain, Ph.D.: Well, welcome back to Her Story. I’m Sanjula Jane, Chief Research Officer at Trilliant Health and a member of the Her Story advisory council. And I’ll be hosting today’s conversation. And today I’m delighted to welcome Dr. Melinda Buntin to the program. Dr. Buntin is currently the Mike Curb Professor and Founding Chair of the Department of Health Policy at the Vanderbilt School of Medicine, and has truly built an accomplished career at the intersection of health economics, and health policy.

Melinda, thanks for being with us today.

[00:00:45] Melinda B. Buntin, Ph.D.: I am delighted to be with you and to join such an interesting group of people that you’ve had on this show.

[00:00:52] Sanjula Jain, Ph.D.: Well, we’re thrilled. I’m so excited to have today’s conversation. I’m definitely a little bit biased as a fellow health services researcher. And so I’ve had the pleasure of studying your work throughout my entire career. I’m excited to introduce you to our audience. You’ve established yourself not only as kind of one of the nation’s leading health services researchers and health policy experts, but really from my vantage point have been a champion of bringing evidence-based principles to practice. And as part of that, you’ve founded a lot of different initiatives, which we’ll dive into momentarily, but as you think about your foray into healthcare leadership, I’m curious if you consider it to be more accidental or intentional.

[00:01:33] Melinda B. Buntin, Ph.D.: Yeah, that was a hard question for me to even think about. I’ve been asked it before. And I would say this. I think I’ve been opportunistically intentional. So not accidental, because each time I’m in a leadership position, I take it very seriously. I think hard about the way I need to lead the effect that I have on morale and motivation. But I am not one of those people who, throughout her career has always looked to, what’s the next job I’m going to do? What leadership opportunities am I going to move on to? I always focus doing the job that I’m doing now to the best of my ability, and that has led me to have opportunities throughout my career.

[00:02:14] Sanjula Jain, Ph.D.: And so then, at what point did the interest in health policy emerge?

[00:02:18] Melinda B. Buntin, Ph.D.: So I can pin down that I started to be very interested in policy in high school, when I took a foreign policy class. And so it’s often an inspirational teacher who can get you interested in a subject. And then I gravitated towards health over time because I realized that I wanted to make a difference in people’s lives. And doing that in the context of healthcare was where I could really use my problem solving skills, my interest in economics and policy, and bring them to bear within this country on the everyday lives of people, because healthcare is just one of those things that touches every family deeply. And yet it’s such a complex system that requires so many both industry and government leavers to make it run arguably as well as it does run now.

[00:03:05] Sanjula Jain, Ph.D.: The field of health policy formerly in terms of going to get your doctorate or getting a master’s degree in it, is something that I think has become slightly more common in recent years. But, .When you set out to get your PhD, I suspect it wasn’t a very common path that many folks took. And so I’m curious, what was the healthcare landscape like when you were deciding to enter graduate school? What were the conversations in healthcare at that time?

[00:03:33] Melinda B. Buntin, Ph.D.: Yeah. So I graduated from college right in the midst of the Clinton health reform plan. And I got a job in Washington, DC. It was very exciting to watch everything unfolding with those debates. And I looked at what happened and the failure of the Clinton health reform plan, and who had played a big role in those discussons. And I felt like it was the health economists who hald really swayde the day. And I decided that I wanted to go back to grad school to be a health economist, to be there when the debate came around again, and to be able to talk about not just the cost of healthcare, but the benefits that we get as a society when we have more access to healthcare and more complete health insurance. So I was highly motivated to get a doctorate, become a health economist, and be part of a policy debate using that degree. But you’re right. It wasn’t that common. So I did enter Harvard’s Ph.D. Program in health policy. I think I might’ve been in the sixth cohort. But, the people in the original cohort were still around. And the field is still growing. Here at Vanderbilt, we just started a doctoral program in health policy, and we are just looking at applications for our third cohort now. And we have fantastic people applying. So the field is still a growing one a quarter century later.

[00:04:44] Sanjula Jain, Ph.D.: Yeah, I remember when I was applying to programs. It was like a lot of universities had a health policy program, but it was either buried and it wasn’t explicitly called out. there were a handful of ones that actually did. So it’s going to be exciting to see how that changes over time. So, one of the things I think that is really fascinating about your career is that you’ve really spent a lot of time in each of the, what I’ll call, sub sectors. So you’ve spent time in the private sector, government, now academia. How were you thinking about your path coming out of finishing your doctoral training, you went over to Lumen Group and ran. What did you set out to do at that time?

[00:05:20] Melinda B. Buntin, Ph.D.: Yes. So I worked at Lumen Froup and that was where I got exposed to a wide variety of health policy issues, again, against the background of the Clinton health reform debate. Then I went to get my Ph.D. at Harvard. And then I was faced with choice of a lot of different places where I could take my degree. And I decided to go to Rand Corporation. And the reason was that I realized about myself that I, number one, worked best in teams and best in multidisciplinary teams because I’ve benefited so much during my doctoral career from collaborating with clinicians and sociologists and people in other disciplines. And then, two, I realized that the work that I wanted to do looking at the health care system writ large required access to data and programmers and a whole team of people that could help me really do what we would now call data science in health policy. But then we just thought of as really using huge numbers of Medicare claims and the like to do research. And Rand seemed like the best place to do that.

[00:06:20] Sanjula Jain, Ph.D.: Yeah, Rand is definitely one of the preeminent research institutions, prime from day one in that regard. So from there you also then went on to be the Chief Economist and, if I get the title right, it was Founding Director of the Office of Economics, Evaluation, and Modeling, right?

[00:06:36] Melinda B. Buntin, Ph.D.: Yes, long title.

[00:06:38] Sanjula Jain, Ph.D.: Within Office of the National Coordinator for Health IT. So just, because I feel like this field of health economics, health policy, health services is really complex, just for our audience’s purposes, what did you do? What was your charter in that role to start?

[00:06:55] Melinda B. Buntin, Ph.D.: Well, when I talk about being opportunistic, I think this is a great example of it. So obviously, this was shortly after President Obama was elected president. And there were a lot of things going on in the health reform arena. I had been at Rand at that point almost 10 years, 9 years. And I thought it’d be interesting to play a role in what was going on, but I didn’t know exactly where I’d fit in. And I spoke with someone who I had met early in my doctoral career, Dr. David Blumenthal, who is now the President of the Commonwealth. Fund And we had written a couple of papers together early in my graduate career. And then, he hadn’t mentored me for my dissertation, but we’d kept in touch through conferences and the like. And he was named National Coordinator for Health IT, and I went to talk to him about working for him. And I started out by saying, David, I really don’t know anything about health IT. And so, I’m not sure if I’m the best person for this job. And he had a very ready answer to that. And he said, I need you because I need an economist who can think about the incentives that we’re creating when we’re implementing the HI-TECH Act. And I, number two, know that you care about the end goal. You care about using health IT to improve access to care, care quality, and health outcomes. And you see health IT like I do, as a means to an end. And you’re going to pick up all the technical knowledge that you need to along the way, but what I need you here for are these things that you do bring to the table, which is that economic perspective. And I would say that I did perform that role sort of as his economic advisor. But then I realized that there were other things that I could align my expertise to, including evaluation methods, modeling of adoption of healthcare, and the like. And so that’s when what had turned from really an advisor role into an office director role. And that group grew because there were so many things that needed to be done to support the billions of dollars that we were trying to spend wisely to bring the healthcare system forward into the 21st century.

[00:08:56] Sanjula Jain, Ph.D.: So, not only did you basically kind of create your job and you sought out the opportunity, but you basically founded a division within a kind of established organization. Now, arguably, this was at a time when there was a lot of change happening in healthcare period. So there was probably a lot of moving pieces, but just unpack that a little bit for us. I how do you even start that? What were the conversations? Did you say, David, we’re going to start this team and this is what we’re going to do? What were the conversations?

[00:09:25] Melinda B. Buntin, Ph.D.: The office was growing so fast. So, people remember this was a while ago now, but this was the Great Recession. Congress passed the stimulus bill, the American Recovery and Reinvestment Act. Part of that bill was called HI-TECH and it included money to give doctors, hospitals, and other healthcare professionals incentives to adopt electronic health records. And there were literally billions of dollars worth of stimulus funding available to give incentives for those healthcare organizations and players to adopt health IT, but also billions of dollars worth of grants to bring forward and advance that agenda. So we really had to spend money quickly but wisely. And that meant that we had to staff up and that we had to act really like a startup within government. And so even though we were part of the Department of Health and Human Services bureaucracy, there’s more than 60,000, 70,000 people who work for HHS nationwide, we would have meetings, literally weekly or bi-weekly meetings where everyone would come into a conference room and stand up, we’d have those standing meetings that was not a thing in government at the time, to figure out how we were going to break down barriers and award grants quickly and efficiently, get programs and regulations promulgated quickly by working with different parts of government and the like. So I really felt like we had a startup culture within an enormous, enormous bureaucracy, it must be admitted.

[00:10:44] Sanjula Jain, Ph.D.: You talked a little bit about kind of this startup feel,within the government and a lot of fast paced movement at the time. As I think about a lot of the things that you’ve gone on to do even since then, I think a lot of what sets you apart is this entrepreneurial mindset that you have, which, i’s not something we tend to attribute to those kind of in more of academic government context for what it’s worth. And a lot of our friends out in Silicon Valley and kind of that side of the house would talk about building things from scratch, through building net new organizations. But you’ve really built within. Have you ever kind of had this moment where you said, well, maybe I should go start my own startup or my own company to go tackle some of these issues versus I’m going to go take a lot of these solutions and ideas to existing institutions?

[00:11:33] Melinda B. Buntin, Ph.D.: Yes, I’ve thought about it a lot. So, I really do think we had a startup culture at HHS in the Office of the National Coordinator at that time to implement that complete suite of new programs. So that really was building something not from the ground up, because there were people who’d worked in that office for years. But again, the office, I think quadrupled in size during my first year there and things like that. So really building fast, hiring, running fast in many different directions. And I thought I would probably go from there to something like Silicon Valley, like a health IT startup, because it was so exciting. You could see the potential. So how did I end up at another government job, at the Congressional Budget Office? Well, I thought that, in the wake of passing the Affordable Care Act, there would be a lot of attention to our other major health program, Medicare. And I spent a lot of my career doing research about how to improve the Medicare program. That did not prove to be true. So a lot of time was spent during my time at CBO sort of re-litigating the Affordable Care Act, considering repealing different parts and the like. But nonetheless, when I went into the Congressional Budget Office, and if you talked to my colleagues there, they will probably remember and laugh all of my color coded charts, but we really had to start a research agenda from scratch. The ACA for the Congressional Budget Office was an enormous effort. People worked round the clock, seven days a week, on this enormous piece of healthcare legislation. And then once it passed, we had to figure out what the next agenda was. What research did we need to be doing? What models did we need to be building to be ready for the next set of questions? And so we really did do a ground up exercise there to figure out how to redeploy this incredibly talented group of people to do the models and the research needed for upcoming health debates. So that was fun. It was not starting from scratch. The CBO is also actually a very small sort of nimble and entrepreneurial agency. Believe it or not, there’s really only a little bit over 200 people who work there. And that includes everyone from the IT people and the general counsel to the people who run models of the entire federal budget.

[00:13:38] Sanjula Jain, Ph.D.: Wow. So I’m sure you’ve heard this, but there’s a lot of discussion in the industry around kind of these parallels between what you’re describing in terms of research, doctoral training and research, and entrepreneurship. And I’m curious how you think about some of the translatable lessons from back to core research, writing those dissertation papers, to actually living in real life and being a part of these real time policy discussions. Like where are the parallels?

[00:14:07] Melinda B. Buntin, Ph.D.: Yes. I totally remember sending an email message to my dissertation committee after I had started my job at Rand and saying, hey, who knew that working was a lot, like writing a dissertation? I’m working on a project and I have these senior members of the team and I have a project officer and I’m accountable to them. And then I remember, they all wrote back and thought it was really funny, but true. And I think that’s true throughout all of our career. We’re doing research, we’re pursuing ideas. We work within an organization. And whether it’s our Dean, or someone who works at a foundation, or the NIH who we’re looking to to fund our work, we’re always working within the structure of our team, our research question we’re trying to answer, and then our clients, who are the people who are going to use our research or promote our research. And if other people don’t find value in it then you won’t be funded and get that next project.

[00:14:58] Sanjula Jain, Ph.D.: I’m just kinda curious, have you observed, I guess, this healthy tension of kind of those who create and inspire the research and see all this value, but then translating it over to the actual users and kind of making sure they understand the value of it and are able to apply it? How do you reconcile those two, given where you sit kind of seeing both sectors?

[00:15:21] Melinda B. Buntin, Ph.D.: So that is one of the things that I work the hardest at in my career. So most recently, as you mentioned at the beginning, I’m now at Vanderbilt. So I was the Founding Chair of the Department of Health Policy here at Vanderbilt in the School of Medicine. And I thought very hard and deliberately about what will set us apart. And what I have tried to do is imbue in my colleagues here in the department, but also let everyone around us in the School of Medicine know, that we are not people who simply do research and publish it in journals, which is not to say that we don’t do basic methods research and things like that as part of our portfolio, but we seek to influence policy and give decision makers the data and evidence they need to make good decisions. And so everyone of the department is incented, and we talk about it constantly, how do we take this research, make it accessible and usable by decision makers? So literally just yesterday I was talking with my team about setting our performance goals for the year and everyone in the department has one of their pillars being, how they’re going to help their team boost the policy impact of the work that we do.

[00:16:34] Sanjula Jain, Ph.D.: Wow. Well, that’s music to my ears because that’s exactly the intersection we both get to have the pleasure of working in. I don’t want to gloss over something we talked about of founding a department, right? So you go from national scale working at CBO and the Office of National Coordinator. And now you’re bringing it local and you’re going deep at a academic institution. How do you do that? Where do you start? Who do you pitch the idea to? How did you gain the buy-in? What does it take to create a department, particularly in a field that, yes, healthcare, because of the ACA and some of these reforms, has gotten more attention and funding, but, kind of where we started, health policy as an actual degree program and an area of focus is still not mainstream, I would argue.

[00:17:21] Melinda B. Buntin, Ph.D.: Yes. So, I’ll take that question in a couple of different directions. And one, I’ve already told you, I’m opportunistic. So I discovered, when coming to give a talk here at Vanderbilt, that Vanderbilt was interested in having a department of health policy. And I was looking for a new challenge. And this opportunity to really, again, have a startup in a strange place, have a startup in academia, seemed really exciting to me. And as I talked to people at Vanderbilt, I realized that Vanderbilt is a place where you can build things like this and where other people want to see you succeed. That said, in my first few meetings with other department chairs at Vanderbilt School of Medicine, they didn’t really know what health policy was. I had to be sure to explain to them. Coming from DC, everyone knows what health policy is. Here in Nashville, not everyone knows what health policy is. So I had to build an understanding amongst my colleagues about what health policy was and what was the value that we were going to add to the institution. And that’s an ongoing process because it’s really important for me to do that and have our work understood by our colleagues because we’re all part of that same promotion and tenure system within the School of Medicine. So we are constantly, I’m constantly, working to make sure that people understand the value we’re adding in health policy. And that’s part of our mission with policy impact. I think it’s not hard for my colleagues to see that now, and especially during the pandemic, where we did so much research and analysis to help policymaking, I think we’re more integrated with the School of Medicine than we’ve ever been.

[00:18:53] Sanjula Jain, Ph.D.: Do you see that shift kind of happening naturally over time, as you think about the next generation of educating our leaders from, school of medicine, school of public health, school of business, how do all these kind of disciplines come together, ultimately in the broader field of healthcare?

[00:19:10] Melinda B. Buntin, Ph.D.: I do. I see a real change. I will say one of the things that I did, for myself as much as for my colleagues, was, a few years ago, I wrote a piece for the New England Journal of Medicine Catalyst about the role of health policy in schools of medicine in the US. And so I looked at all of the degree granting institutions, and it was clear immediately from the data that all of the top 20 med schools had either a school of public health that had a department of health policy, or a major center or institute of health policy within their institutions. And then all, at that time 140 some odd institutions, granting medical degrees, about half of them had some type of policy entity. So it was clear we were getting established in the field. That said, I think we’re still evolving towards a period of time when all medical professionals receive some training in health policy. So we’re becoming more and more integrated with the School of Medicine curriculum and the like. And I remember back when I began my career, I would often find myself talking to a medical professional, and especially if that person was an older physician, there’d be a point in the conversation,, I could just feel it coming where that person would say, “now for you to really understand medicine, you need to shadow me for a week”. And I always wanted to say, “if you want to really understand the healthcare system, you need to come and look over my shoulder at my computer for a week”, but I was way too polite to ever say that. But I think there’s now a much broader understanding in the medical field that these things are both true, that we need to have an understanding of how clinics and hospitals and the like operate day to day at the real level, what’s the real effect of healthcare policy and financing on the ground, but then also healthcare professionals need to understand how they fit into the broader system and why the system is the way it is.

[00:20:55] Sanjula Jain, Ph.D.: A big piece of that story is this idea of writing and, with research comes a lot of writing. But I think it’s such an important vehicle for how we share ideas and get different communities to think differently, especially as our industry has historically been so siloed. One of the additional initiatives that you’ve been really at the forefront of is your work at JAMA. Tell us a little about kind of what that initiative is and what your charter is.

[00:21:21] Melinda B. Buntin, Ph.D.: Yes. So I am the deputy editor of a still relatively new, because we’ve been publishing original research for less than a year now, a JAMA network journal called JAMA Health Forum. And it has been really fun to get off the ground. It’s actually been far more fun than I ever expected. I work as part of a fantastic editorial team headed by John Ayanian at University of Michigan, who’s our editor-in-chief, but backed up by a really professional team of people who handle the JAMA network and produce and promote and oversee what our journal does. It has been great because I have been able to see, from start to finish, articles come in, get reviewed, get better, viewpoints get refined, but just create an outlet for our field where we just don’t have enough outlets to get information out, information, opinion, and original research. So it’s been so fun. It’s been really rewarding. And I get to work with both wonderful authors and with wonderful colleagues on it, which, as you advance in your career, becomes more important to you, that you get to work with people you enjoy being around.

[00:22:29] Sanjula Jain, Ph.D.: And I know one of the kind of goals is to diversify the perspectives and the individuals who are contributing, kind of back to one of your things about bridging kind of theory, and industry, and practice. And so, there are a lot of folks that I work with on the industry side who have a lot of perspective to share from running a hospital, or being in pharma. And everybody aspires to write and share, but we get busy. And I’m curious, as someone who is clearly juggling many initiatives, and teaching, and still doing research, any advice for how folks can kind of prioritize and make time for this type of thoughtful writing?

[00:23:08] Melinda B. Buntin, Ph.D.: It is so hard. So I’m just going to start by saying that. I. did continue writing and publishing while I had the government jobs that we’ve just discussed. And because I did that, I’ve had opportunities to, for example, return to academia and return to Vanderbilt, to be an editor at a journal, but also to be able to write things that are disseminated and widely read, and that is rewarding when you’ve done all of the hard work to come up with those ideas. So that is what I would encourage people to do, even though it’s hard. And I know it’s hard because some of those things I wrote were nights and weekends and things like that. And I had small kids and stuff like that. It is great when your ideas are out there and you can engage with other people about them. So it is worth it. That said, I can promise your listeners that at JAMA Health Forum, we try and make the publication process as easy and painless as possible. We have really quick turnaround times. We have really smart editors who direct you how to revise your piece very specifically. So it doesn’t feel like a guessing game where you’redoing round after round of revisions. And so we’re proud of our quick turnarounds and our very effective editing. And many people have written to me and said, thank you so much, publishing in JAMA Health Forum was one of the least painful publishing experiences I’ve ever had.

[00:24:28] Sanjula Jain, Ph.D.: Yes. I think that that’s really true. So on behalf of all the writers out there, I thank you and the team for making that so, and I think underlying part of that though, is, I’m seeing this theme in your career where there’s a lot of these established, I don’t want to say processes, but you know, just norms of ways of how we do things. And the academic publishing is one of those. And so it’s not lost on me that it’s probably no easy feat to put the things in place to make those review cycles faster and make it more accessible. How are you able to, internally with your teams, push the needle on that, where these are things that have been in place for so long?

[00:25:08] Melinda B. Buntin, Ph.D.: No, I think you said it yourself just now. It is the team. So, identifying the high-performing team and the team that works well together. And the high-performing team has got to bring people with different talents and backgrounds to the table. I really believe in that. Our team at JAMA Health Forum includes people from a variety of backgrounds, perspectives, disciplines, Lived experiences, and that makes us a stronger team. But we have a common goal, which is to publish important and policy relevant research in a timely fashion. Having that mission and having the right team to execute it is the most important thing.

[00:25:47] Sanjula Jain, Ph.D.: So, taking all of that together, kind of shifting gears a little bit, so going back to where we started, I asked, so what inspired the interest in health policy? I personally have had the fortune of being able to read the work of folks like yourself and other women to kind of say, okay, this is a path, right? This is a career path. But when you started, I suspect that wasn’t as common. And so I guess the first question is, how has the fact that you’re really one of the few female health policy leaders of our generation shaped your approach to kind of the industry, but then leadership at large?

[00:26:20] Melinda B. Buntin, Ph.D.: I have been fortunate to not be among the vanguard generation and to have been able to work with women who were really part of that vanguard generation. And a few years ago, I was thinking about some of the amazing women that I had the opportunity to work with in my career. And I realized a significant fraction of them were women who had chosen not to have children. And so I’m so grateful that for me, when I came behind them and had their mentorship, that I had the ability to figure out how to have children and fit them into my career. And of course I did have great mentors, I think, like Kathy Schwartz, who was a great example of balancing. Actually I just used a word I hate. I hate the word “balance” when we’re talking about career and family. Figuring out how to juggle, I think you used that word earlier, and I think juggling is a much better metaphor, how to juggle having a career and family. And she was very straightforward with the graduate students that she worked with about the challenges of doing so, but also the choice of doing so. So, I was lucky to have people like her, but then also just these women who were inspiring and brilliant and dedicated to their career. That was great too.

[00:27:30] Sanjula Jain, Ph.D.: And so, zooming out along the way, there have been many mentors as you’ve described, and bosses and colleagues, both male and female, that have been a part of your career. What’s been the most difficult pieces of feedback that you’ve received from any one of them? And how did you overcome it?

[00:27:46] Melinda B. Buntin, Ph.D.: Well, I already mentioned David Blumenthal, who has been a wonderful mentor to me for a large part of my career. And I remember talking to him about the choice to leave the Office of the National Coordinator, he had already left because he only had a two year leave from academia to do that, the choice of whether I should take the job I’d been offered at the Congressional Budget Office. And he counseled me that if I took it, I would probably be closing doors for myself, that I might not be able to return to a research career or academia because a second federal job sort of was going to brand me as a fed. And that was hard for me to hear. And it didn’t prove to be true because here I am at Vanderbilt, but he was right. And he was right to tell me that. And he was right to make me think hard about what I was doing. And because he told me that, I did work hard when I was at the Congressional Budget Office to maintain ties to colleagues, to continue to try and publish research and the like. And that did keep doors open for me later on in my career. But that was hard to hear, that I was making a choice that really could change my career trajectory. But I’m glad he told me that.

[00:28:53] Sanjula Jain, Ph.D.: It’s a really good thread though, because I think many of us touching academia in some form have probably gotten a version of that advice to some extent. And I’m curious, as you think about healthcare, we have more interdisciplinary, these labels of, okay, you’re really a, you’re a government person or you’re an industry person. And I think a lot about that. I worked in industry, but, I pride myself in still being an academically trained researcher and all of that. So, as we think about the next decade of careers and these kinds of different sub sectors, will we see more breaking down those labels?

[00:29:27] Melinda B. Buntin, Ph.D.: I think that so many things will change we probably can’t even predict right now. I do think that there’s no one now who questions the need to do multidisciplinary research to advance policy issues. That was not true, necessarily 20, 30 years ago. It’s unquestioned now. And I think that openness to new ideas, styles of working, and the like means that we’re going to be open to people moving in and out of different types of research careers. I think academia, healthcare, education, all of these things have been challenged by the pandemic and will never be the same. And so that will also open up opportunities. We’re going to figure out what’s the right mix of virtual and in-person learning. Same thing with teamwork. So there’s just so many things about work that are going to change and yet aren’t yet settled. I can’t believe that the things that you’ve just mentioned about how we work and how rigid we think our career trajectories are won’t change as well.

[00:30:30] Sanjula Jain, Ph.D.: Yeah, that’s very well said. We’ve talked a lot about your different roles on your hats, and you’ve mentioned being a mom, and you’re right. It’s a constant juggle. And so along the way, I’m sure you’ve had to make a couple of different difficult decisions and trade-offs. Has there been one in particular that really stands out?

[00:30:48] Melinda B. Buntin, Ph.D.: When you have a two career family, sometimes you have to be willing to make moves and take turns and things like that. I remember when my husband decided that we needed to move back to LA. We lived in LA when I worked at Rand, then relocated to the Washington office, and then he said he wanted to move back to LA to write a book about the LAPD. And I thought, oh my goodness, I had a small child at the time. I thought the last thing I can handle is a trans-continental move. But you do those things. And I think it was actually for the best for both of us. It was definitely the best for him because he wrote a book and that was a landmark part of his career. And it was great for me because I got to establish, re-establish, those in-person relationships that I had had with my colleagues in the headquarters in Santa Monica. And so I think it was good for me ultimately, too, even though I definitely didn’t see it when we were discussing the logistics of moving with a toddler.

[00:31:44] Sanjula Jain, Ph.D.: Yeah, moving is never fun

[00:31:49] Melinda B. Buntin, Ph.D.: Yeah.

[00:31:50] Sanjula Jain, Ph.D.: So as you think about, back to where we started, if you think about young Melinda in high school, thinking about all the career aspirations you had, what’s one piece of advice you would give your younger self?

[00:32:02] Melinda B. Buntin, Ph.D.: It’s so funny because we have a JAMA Health Forum podcast and this is a question that we ask some of the authors that we have on the podcast too. And I never had to answer it myself. So I guess one of the pieces of advice I’d give myself is to be always on the lookout for luck and seize it. And what I mean by that is that I remember my younger self hearing from people like this, like me on this podcast, talking about how lucky they’d been in their career. And I looked at them and I was like, but you worked so hard and you’re smart and things like that. And now that I’m older, I know how lucky I am. I know all the privileges I have and the opportunities I’ve been given and how I had, though, to be able to see them and seize them. And so that is the advice I’d give to my younger self, is to worry less about it and seize the opportunities that are presented.

[00:32:59] Sanjula Jain, Ph.D.: I love that. Well, so speaking of seizing opportunities then, you have really blazed a trail forward and have accomplished so much in your career. And you still have many more chapters of your book to write as you continue to make healthcare better. As you think about the legacy that you want to leave behind, and this is the toughest question, what would be the title of your autobiography?

[00:33:22] Melinda B. Buntin, Ph.D.: Oh, I’m definitely dodging this one.

[00:33:24] Sanjula Jain, Ph.D.: I know.

[00:33:25] Melinda B. Buntin, Ph.D.: I can’t imagine anyone other than my family members would ever want to read my autobiography. But I do. I have been starting to think about writing a book. It was maybe, sometimes they talk about how vacations can open up your head space. So actually over this past holiday, I started thinking about how I actually could write a book because there’s been a thread through my career related to healthcare financing. And since this is a video recording too, I can show you that I pulled off my shelf this book here called “The Problem That Won’t Go Away” and it’s an edited volume by Hank Aaron. And it was published in 1996, so a quarter century ago. And it includes chapters by lots of people who are still prominent members of the health policy community, prominent experts in the field, about the issues we were facing with health policy and financing again, in the mid-90s. And so many of them are still here. So the problem still hasn’t gone away. So what I would like to do is I would like to be able to figure out a positive spin on this title and say, and I don’t know what it is yet, so I can’t give you the exact answer, but I would like to write a book that says here’s some steps we can take to at least reduce this problem. And so I haven’t figured out exactly how to flip this title from Hank Aaron’s volume. But that’s my goal, is to think about a book, or at least a series of papers, that will be really constructive about what we have learned about how to improve healthcare financing and get more value out of our healthcare system

[00:34:47] Sanjula Jain, Ph.D.: I love it. And I’m also personaly interested in, I feel like you’re playing with all these different mediums and now you’re doing some podcasting of your own. So maybe you’re going to find a way to bring all these modalities together.

[00:34:58] Melinda B. Buntin, Ph.D.: That would be great. That would be great if I could do it in a multimedia format. I love that idea. Thank you.

[00:35:05] Sanjula Jain, Ph.D.: Well, Melinda, this has just been phenomenal. Thank you so much for spending some time with us today. We really appreciate all the contributions you’ve made to the industry and looking forward to continuing to track your work.

[00:35:14] Melinda B. Buntin, Ph.D.: Thank you for asking me. And this has been a fun conversation, and I know we’ll have many more.

[00:35:19] Sanjula Jain, Ph.D.: Yeah, likewise.