reprinted from Issue 15, Fall 2012 of Frontiers of Medicine (PDF)
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“At CHCF, we try to act as a catalyst – something that, when added to a system, creates movement which then can be self-sustaining.”
The core challenge of philanthropy is: how do you take an amount of money that is trivial compared to the scope of the problems, and make a difference?" says Mark D. Smith, MD, MBA, president and chief executive officer of the California HealthCare Foundation (CHCF).
His foundation’s mission is to work as a catalyst to fulfill the promise of better health care for all Californians, supporting ideas and innovations that improve quality, increase efficiency and lower the costs of care. The foundation makes grants totaling about $40 million annually. "If you are running a free clinic, that sounds like all the money in the world," says Smith. "But the Medi-Cal program has spent three times that already today. The good news is that we have few constraints on how we spend it, save our own creativity."
Medicine and Business
Born and raised in Brooklyn, Smith enrolled at Harvard in 1968, becoming a political leader on campus and helping form the Afro-American Studies Department. Midway through college he took several years off, helping lead the first African Liberation Day demonstration and working in textile mills in the South. While finishing his Afro-American Studies degree at Harvard, he enrolled in pre-med courses after developing an interest in the social and political aspects of medicine.
After earning his medical degree from the University of North Carolina in 1983, he started his primary care residency at San Francisco General Hospital (SFGH). "Within a couple of months, those of us who trained at that institution at that time knew more about what we would later come to call HIV than any doctors in the world," says Smith. He specialized in HIV/AIDS, and continues to see patients at SFGH’s Positive Health Program. Many of his peers and mentors became legends in the field. "They combined a spirited inquiry and academic rigor with great compassion and humanity," he says.
As co-president of the housestaff union, he also served on the hospital’s executive committee, getting his first glimpse of healthcare financing "It became clear to me that there was a whole world of organizational and management science that I knew nothing about," says Smith. So while completing a general internal medicine fellowship at the University of Pennsylvania, he also earned an MBA as a Robert Wood Johnson Foundation Clinical Scholar at the Wharton School.
After serving in several clinical and policy positions related to HIV/AIDS, he joined the Henry J. Kaiser Family Foundation, in part attracted by the different kind of intellectual challenge that philanthropy offered. He has led the CHCF since its founding in 1996.
Investing in Sustainability
"At CHCF, we try to act as a catalyst – something that, when added to a system, creates movement which then can be self-sustaining," says Smith.
For example, he watched many pilot programs disappear after initial grant funding ran out. "Those programs were never scaled, priced or organized for sustainability," he says. He established CHCF’s Health Innovation Fund, which invests in businesses that further its mission. It recently funded a small tele-dermatology company with a strong business model. "They have a sales approach and a pricing structure that means the patients are getting seen, the clinics are happy, and they are making money," says Smith.
Smith also helped found the CHCF Health Care Leadership Program, a part-time fellowship based at UCSF’s Center for the Health Professions which helps health care professionals develop management, finance, accounting and negotiation skills. "That program is a direct outgrowth of my experience in the Robert Wood Johnson Clinical Scholars Program and the MBA program, and helps clinicians successfully assume management responsibilities," says Smith.
Most recently, the CHCF led a collaboration of eight foundations, the Centers for Medicare and Medicaid Services, 15 states, and the design firm IDEO in developing a user-friendly interface for health benefits exchanges, called Enroll UX 2014. If the recently upheld Affordable Care Act is fully implemented, the program could help up to 40 million Americans enroll in health insurance plans. "It was an amazing collaboration of different actors from around the country, with a great outcome," says Smith. "We hope this will accelerate the usability of the exchange to millions of people."
Smith lives in Oakland with his wife, Pamela Calloway, an attorney. Together they have a grown son, Langston, who currently lives and works in Beijing.