Creative Writer Pens a New Chapter as Healthcare Policy Analyst

Kathy Mikk is a creative writer.

After receiving undergraduate degrees in English and religion, she went on to receive her master’s degree in fiction. Like so many writers before her, she took a job to pay the bills. That job unexpectedly opened a new chapter in her life—to a career in healthcare policy.

Mikk joined the Dana-Farber Cancer Institute in Boston, first as an administrative assistant for a renowned leader in outcomes research in oncology. Later, she worked in the legal office. “The attorneys had me reading things like the HIPAA [Health Insurance Portability and Accountability Act of 1996] regulations, which were new at the time. I was surprised to find that the work interested me.”

Some of that interest came from the experience of working in an active hospital. “My regular route took me through The Jimmy Fund area, which was the kid’s clinic at Dana-Farber. That was incredibly hard to see. But I also saw what the doctors and other providers were doing to help these kids and their families. It gave me a sense of a mission—helping providers do their jobs made me part of something bigger.”

In her late twenties, she went back to school to become an attorney specializing in health law. From there, she worked in government relations with the Memorial Sloan Kettering Cancer Center in New York. “That gave me the perspective of focusing on policy for one organization both at the local and federal level.”

Working with a Wider Lens

After she and her family moved back to the Boston area, Mikk joined MITRE. Primarily, she supports the CMS Alliance to Modernize Healthcare, the MITRE-operated federally funded research and development center for the Centers for Medicare & Medicaid Services (CMS). She works for several organizations within CMS, including the Center for Medicare & Medicaid Innovation (CMMI) and the Office of the National Coordinator of Health Information Technology.

“Compared to my experience working for individual hospital systems, we have a much wider lens here at MITRE,” she says. That lens captures some enormous problems. For instance, although the United States spends approximately three and a half trillion dollars on healthcare on an annual basis, it ranks last out of high-income nations in terms of healthcare outcomes for patients. Mikk explains that part of the problem is that the traditional U.S. healthcare system pays doctors and other clinicians based on the volume of care they give to patients, rather than the quality of care they provide.

One of the ways to change this system is to reward outcomes instead of quantity. Mikk and her colleagues support CMMI in developing and testing innovative healthcare payment and service delivery models, called “alternative payment models.”

“We help CMMI with whatever they need from start to finish, such as an environmental scan or literature review to establish the state of science,” she says. “We clarify options, such as identifying where there have been bundled payment experiments before. Or we might help clarify the pay-for-performance methodologies.”

Writing Skills Still Useful

Like many attorneys, Mikk finds her writing skills invaluable, even though the style and subject matter are quite different from what she originally envisioned in college. For example, she recently contributed to a first draft of a rule that will soon go out for public comment. As those comments come back in, she will help the federal agency with comment analysis and response to stakeholders.

She also co-authored an article for JAMA (Journal of the American Medical Association) about patient ownership of personal health data. Mikk explains that ownership of data is becoming increasingly important as people are encouraged to participate in their care and as vast amounts of data are collected from wearable sensors, smartphone apps, and in other ways. “We believe patients should be able to aggregate and control all of their data in one longitudinal record—and it should be easily shareable by patients with their providers, caregivers, and others.”

Mikk says she loved working with “super smart people” on big issues at the hospitals—and she feels the same way about MITRE. “We’re contributing solutions to big problems that our country is facing. And I enjoy applying my years of provider experience to these problems. Often I might have an insight that I could know only because I worked in hospitals for so long.”

Mikk and her husband have two children and live in a seacoast town north of Boston. And yes, in her spare time, she’s still writing stories.

—by Bill Eidson

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