Professional Profile of Robert F. Coulam

Robert F. Coulam, PhD, JD, has 30 years of experience in evaluation, research and development, health policy, health financing, and reimbursement for health services. He is a lawyer and a policy analyst, having studied large-scale contracting, research, and health care programs for public and private clients. Selected examples of his experience include evaluations of alternative financing and reimbursement methods in contracting for health care services; evaluation of state efforts to expand coverage of the uninsured; and studies of national security issues, including interrogation policy and weapons procurement. He has performed this work as a researcher, practicing attorney, academic, state official, and consultant. His work has been published in Health Services Research, Health Affairs, Health Care Financing Review, Hospital Topics, Inquiry, and other health services research journals.

Dr. Coulam is Research Professor in Health Care Administration at the Simmons School of Health Sciences. In that position, he teaches courses in health policy, health law, and health ethics in the Graduate Program in Health Care Administration and takes the lead on developing a collaborative health services research program at the School. Prior to joining Simmons, he was a Principal Associate at Abt Associates Inc. in Cambridge, Massachusetts, one of the nation’s leading health services research firms.

Dr. Coulam is lead author of a recent book on how Medicare contracts with health plans, in particular, how Medicare sets the prices it pays to health plans (American Enterprise Institute, 2009). He has directed a series of technically demanding, administratively complex, and politically sensitive research projects in his career. Currently, he is Project Director for the University of Minnesota/Emory University/Simmons College project to evaluate certain state initiatives to expand coverage to the uninsured. This project is being done for the Centers for Medicare and Medicaid Services (CMS). He is also currently Project Director of a University of Minnesota/Simmons project to develop and evaluate alternative approaches to measuring physician resource use – a research project designed to create the platform for better connecting physician payments to quality and cost of care. He was Project Director for the Abt Associates/Univeristy of Minnesota’s Evaluation of Medicare’s Private Fee-For-Service Pro-gram. In that role, he lead in the management, technical design, and synthesis of results for a com-prehensive evaluation of one of the few alternatives to HMOs in the Medicare + Choice (M+C) program. He directed the seven-year Abt contract with the Health Care Financing Administration (HCFA)—the predecessor to the Centers for Medicare and Medicaid Services (CMS)–to support the Medicare Competitive Pricing Demonstration, leading a large team of academic researchers and industry experts in the numerous design and logistical challenges posed by HCFA’s attempts to implement a competitive pricing demonstration in four different sites over these years. Dr. Coulam directed efforts to assist in drafting a report to Congress and also oversaw a series of studies on the effects of Medicare payment levels on benefits, market entry, and enrollment of health plans. This project, and the studies that grew out of it, along with his earlier work on the design of competitive bidding systems in traditional Medicare, have given him extensive experience in the payment system reform movement for both Medicare and commercial health care delivery models.

From 1995 to 1998, Dr. Coulam directed Abt’s Evaluation of the Effectiveness of the Operation Restore Trust Demonstration (ORT), another sensitive project involving multiple agencies within DHHS and the Department of Justice. ORT was the federal government’s landmark effort to test new methods to detect and deter fraud and abuse in Medicare. This project involved major technical and inter-agency political challenges, including briefings and reviews at the highest levels of HCFA, the Department of Health and Human Services (DHHS), the DHHS Inspector General, and the head of the Health Financing Branch of the Office of Management and Budget (OMB). Dr. Coulam has also played a major role in the technical design and synthesis of studies of health care contracting. He played a lead analytic role in Abt Associates’ evaluation of the early Medicaid Expansions in the 1990s. In addition to his project work at Abt Associates, Inc., Dr. Coulam has been a Visiting Lecturer at Massachusetts Institute of Technology and an Assistant Professor at Carnegie-Mellon University.

Dr. Coulam holds a B.A. with highest honors from Harvard College, a J.D. with high honors from Harvard Law School, and a Ph.D. from the Harvard Kennedy School.