Bridging Health Policy and Economics: How the RWJF Health Policy Fellows Program Helped Carrie Colla Make an Impact

By Marisa Coulton

Health economist Carrie Colla had been teaching at The Dartmouth Institute for Health Policy and Clinical Practice for seven years when she decided it was time for a change. She loved the work but wanted to make sure her research was getting into the hands of policymakers.

“In the beginning of your career, you’re often just focused on getting your work done, and then you make a transition into caring about how, and whether, your work is used,” she said. “You really want to have an impact and make sure your research is making it to the right people and the right decision makers.”

But that was proving difficult. “I didn’t realize how hard it was to impact policy from afar,” she said. Based at Dartmouth College in New Hampshire, she was removed from the center of the health policy world and lacked the network of people she needed to navigate the landscape. She wanted to get into the thick of things, but how?

“I thought that doing the Robert Wood Johnson Health Policy Fellows (RWJF) program would both inform my teaching in better ways, and my research,” she said. “And I would say it was true on both counts. It made my teaching better and made my research better and more impactful.”

By the time Colla applied to become an RWJF Fellow for the 2017–2018 year, she was more than ready. She’d been shoring up her health policy expertise for decades, ever since she was a high school student working in her father’s clinic. She filed papers and called patients about their lab results. “Doing two things that are a bit antiquated now,” she said with a laugh. But making those calls was invaluable to her learning and growth. “I learned a lot about how health care works and some of the barriers to getting good treatment in health care,” she said. “I understand, probably more than most economists, what the clinic is like. What health care on the ground looks like for patients, physicians, and other clinical staff.”

Colla was exposed to health care both at home—her father a doctor, and her mother a nurse—and out in the community where she grew up, just outside of New York City. When Colla and her father would run errands in town, her father would frequently bump into patients. Colla observed the interactions, rapt. “I could tell that they valued his expertise and his insight. So, I was always just curious about medicine,” she said. In college, Colla was torn between pursuing medicine and pursuing math at Dartmouth. A lifelong math lover, she ultimately chose to pursue an undergraduate degree in economics. She took a fascinating sociology class that explored different health policy problems and tacked a public policy minor onto her degree.

She graduated and found work as an economic consultant, but it did little to feed her passion for health care. “At the time, I was working on hospital mergers and vitamin price-fixing conspiracies,” she said. “Stuff that was tangentially related to policy.” It was only when she transitioned to a role at the RAND Corporation, a think tank in Washington, DC, that her interest shifted to health care economics.

She completed a master’s degree in economics, followed by a doctorate in health economics at the University of California, Berkeley. Her dissertation was about an employer requirement to provide health benefits in San Francisco. She fielded a survey of Bay Area employers about their health benefits and sick leave policies to understand how employers had reacted to the requirement.

“Policy is usually better when it’s worked on by more people with different viewpoints.”

Colla was beginning to see how her economics background could be used to influence policy. “Economics plays a big role in health care,” she said. Whether or not you have insurance “makes a big difference in your ability to pay for catastrophic care,” she said. Still, she hesitated to make the leap to health policy. “Unless you have the relationships and the network, it can be hard to understand how to get policymakers the right information, in the right format, at the right time.”

Colla’s fellowship placements took her to the House of Representatives and the Center for Medicare and Medicaid Innovation. Her favorite aspect of the program was witnessing bipartisan policymaking in action. She attended an event by the American Enterprise Institute where then-governor of Colorado John Hickenlooper, a Democrat, and then-governor of Ohio John Kasich, a Republican, respectfully discussed a bipartisan proposal to stabilize the individual health insurance market.

Bipartisan policymaking has a special place in Colla’s heart. “Policy is usually better when it’s worked on by more people with different viewpoints,” she said. If both sides agree on the policy, then it “has more staying power,” she added. “It’s not going to flip when the next party comes into power and tries to change it.”

The RWJF Health Policy Fellows program was well-suited to Colla’s values, as the program is strictly non-partisan. Her cohort included both Democrats and Republicans, and conversations were always respectful and productive. She is still in touch with them today.

“We reach out to each other, send group texts, and get together for meals and events whenever we can,” said Karin Rhodes, a member of Colla’s cohort. “Always cheerful and optimistic, Carrie frequently organized social events and brought the group together for fun and mutual support.” Colla’s initiative was “all the more remarkable,” said Rhodes, because Colla had her hands full, having moved to DC with her entire family—her three young children, husband, and her parents. “And that is not saying anything about the broad base of knowledge and skills and bipartisanship [even during politically fraught times] that she brought to her placement,” added Rhodes.

Colla returned to Dartmouth after the fellowship and was promoted to full professor with tenure. Not long afterward, she was recruited to join the Congressional Budget Office (CBO) as director of the Health Analysis Division. The CBO’s core mission is to provide research and modeling that serves as the basis for estimating changes in the economy in response to federal legislation. The Health Analysis Division analyzes a range of federal programs and policies such as Medicare and Medicaid, and the subsidies provided through the health insurance marketplaces.

“The network that you meet in the Robert Wood Johnson Foundation Fellows program… is really instrumental in doing my job now.”

Colla manages about 35 health economists who design and maintain microsimulation models, produce reports and articles on a range of policy issues, and play a key role in estimating the budgetary and coverage effects of proposed changes in healthcare programs for Congress.

“Broadly speaking, we focus on health care markets,” she said. “[We] try to understand and inform Congress about what the economic and budgetary effects of a piece of policy will be,” she said. It’s a challenging job, she added, because the work is high- stakes and often receives a great deal of scrutiny. But her team makes it all worth it. “Working with the staff at CBO is one of my favorite things about the job. Everybody is incredibly smart. There’s a strong public service ethos. Everyone really cares about getting things as correct as we can.”

Colla said she would have been unlikely to get the job without the fellowship. It gave her the knowledge she needed to be successful in the role. “There are a lot of things that I learned in the fellowship that would have been hard to learn without an experience on the ground,” she said, and added that it is one thing to read about something like the budget reconciliation process, for example, but quite another to live it, gaining a “nuts and bolts” understanding of how it works.

In her current role, she interacts with the RWJF Health Policy Fellows network routinely. “A lot of the people I met during the fellowship are people I talk to in the context of this job, whether it be congressional staff on both sides of the aisle, or experts in different areas that are relevant to my job,” she said. “The network that you meet in the Robert Wood Johnson Foundation Fellows program… is really instrumental in doing my job now.”

To those considering the program, she says: “Do it, exclamation point! There are limited opportunities in your life to gain a totally new experience and be able to learn the amount of material that you learn in the fellowship in one year.” The fellowship, she added, affected her trajectory significantly, and “sharpened” her focus on policy.

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Learn more about RWJF Health Policy Fellows by following us on LinkedIn! For more information about the upcoming fellowship application, visit our website. We appreciate your support in building a strong and diverse network leaders and maintaining a workforce skilled in health policy. Email info@healthpolicyfellows.org for questions about program opportunities.