Amy Lischko
Assistant Commissioner
Health Care Finance and Policy

I have been in public health policy and health services research for 15 years and can't imagine a better career path.

After majoring in Food Science and Nutrition as an undergraduate, I joined the Peace Corps. I worked as a nutrition and primary health care educator in a rural village of Liberia, West Africa. The need for a better medical system was palpable there, but so were the barriers to improvement. I was nagged by the feeling that I could contribute much more in the U.S.

I returned to the states and began a graduate program in Health Policy and Management with courses in Epidemiology and Biostatistics. I enjoyed statistics; its application to health policy and delivery questions thrilled me. I wanted to apply this statistical rigor to research on and evaluations of public health programs.

After graduating, I worked as a clinical epidemiologist helping researchers to design their studies while providing statistical and analytical support. I enjoyed this work, but missed thinking about broader health policy questions, so I decided to accept a position with the Massachusetts Department of Public Health. There, I managed a federally funded demonstration grant.

The goal was to change the cost-based, facility-specific reimbursement methodology for nursing facilities to a prospective system based on patient care needs. The statewide payment system that emerged is still largely in place. Once that grant ended I wanted to move closer to community programs and provide support to grassroots efforts aimed at improving the health and lives of people.

At the New England Health and Poverty Action Center at Tufts University School of Medicine, I managed evaluations of community demonstration projects, was involved in policy work for adolescent and maternal/child health, did community-based surveys, and performed both process and outcome-oriented evaluations.

After a few years, however, I began to crave state-level action. Although fieldwork brought me closer to people and programs, I felt that I could be more effective if I were able to make systemic changes. When a position became available at the Massachusetts Rate Setting Commission, I jumped at the chance to get back into public policy.

In the climate of health care deregulation, the Commission soon became the Division of Health Care Finance and Policy. As the agency's role changed and expanded, so did mine. I became Director of Health Systems Measurement and Improvement in 1996, and an assistant commissioner in 2000. Helping to shape the agency during its transformation was one of the most exciting and rewarding aspects of my career.

I now lead a group of policy analysts in monitoring and evaluating the health care industry. Our audience is comprised of purchasers, payers, policymakers, and consumers. We study every aspect of the health care system using multivariate statistical analyses, logistic regression and modeling techniques, and qualitative methods such as one-on-one interviews and focus groups. It is exciting, ever-changing, and deeply rewarding.

I am also enrolled in an interdisciplinary doctoral program in health services research at Boston University. This program will afford me additional skills, knowledge, and exposure to other methodological training that will enable me to contribute even more.

Many complex challenges confront our health care system today, and I am as excited as I was 15 years ago to be involved with providing data and analysis that helps policymakers find workable solutions.