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Family Medicine & Community Health Elective Course Description

Course Name: Health Policy: The Public Payer Perspective
Course Number: FC-459
Elective Type:  C
Coordinator(s): Viveka Zawisza, MD


Contact: Karen Rayla
Department: Family Medicine & Community Health
Sites Available: Quincy
Months Offered TBD
Number of Students/Month: 1
Prerequisites: UMMS 4th year students
Enrollment Process: Approval from coordinator required; email approval to electives@umassmed.edu to schedule

Elective Description:  This elective offers a unique experience in a public payer setting through the Office of Clinical Affairs (OCA) which provides clinical leadership to MassHealth, the Massachusetts Medicaid program.  OCA is a part of the Center for Health Policy and Research within Commonwealth Medicine, the healthcare consulting arm of the University of Massachusetts Medical School.  OCA is fully embedded within MassHealth and supports a full range of medical management functions, including clinical policy, utilization management, pharmacy, quality, clinical analytics, and oral health on behalf of MassHealth programs. Working closely with MassHealth since 2001, we ensure that patients receive medically necessary, appropriate, cost-effective, quality care—in compliance with state and federal regulations.

Learning Objectives:

By the end of the rotation the student will understand how clinical leaders and public payers:

  • Determine health policy priorities
  • Assess the existing health policy landscape
  • Assess the evidence-based literature for quality of evidence
  • Develop medical necessity guidelines
  • Conduct utilization reviews

The student will also complete an individualized project based on a match of personal interest and current opportunities at OCA.

Learning Opportunities: The student will participate in a range of both shadowed and independent activities. This rotation offers a unique opportunity to interface with MassHealth leadership including the Chief Medical Officer, Director of Pharmacy, and Director of Quality. This includes shadowing, individualized projects, and direct mentorship. Under the supervision of an Associate Medical Director and other members of the OCA team, the student will gain a dynamic working knowledge of clinical health policy through hands-on training and exposure through this rare public sector opportunity. The student will be able to take part in optimizing patient care delivery from within the public payer system and gain unique knowledge and skill sets to which they may not ordinarily be exposed in medical school or residency. This includes application of clinical knowledge to policy determinations in a publically funded health care program.