Telephone Interview with Marion Ein Lewin Tuesday, November 7, 1995, 10 a.m.

1a. Explain the role of the Institute of Medicine (IOM) in administering the Pew Health Policy Fellowship Programs.

This program was brought to the IOM from the American Enterprise Institute (AEI) (1987). The interesting footnote about that move is that when the Pew Health Policy Program was first thought about at the Pew Charitable Trusts and they were looking for an organization to direct it, IOM had responded to the proposal. IOM didn't win the competition; AEI won. IOM at a very early stage had an interest in this program. Until 1988, IOM was not even called officially the program office because most of the national programs until that time were directed out of Philadelphia. However, at the recommendation of Bill Richardson, after he did an evaluation of the program prior to the last refunding, he recommended that IOM officially be the program office.

Since the beginning, the role of our office has been to develop the joint activities of all the programs: to plan the annual meetings, to plan the meetings each year for new fellows, to develop the annual directory and the semiannual newsletters, and to be responsible for the network and really be responsible for the family of Pew fellows over and above their connection to the individual programs and institutions. Also, aside from the whole idea of the networking and the overarching activities, another role that we've had all along was to provide the interface of the programs to the Washington health policy scene, and the meetings each year for new fellows were specially directed to acquainting fellows with what's happening in Washington. Aside from that, we have a role in monitoring the budgets and making sure that all the programs are performing according to the requirements of the program.

1b. How did program variation between sites affect your administration?

I think one of the really wonderful aspects of the program has been the learning curve at every stage. Another important aspect was the evolution of four different programs and the IOM program thinking of themselves mostly as individual fiefdoms all a little bit in competition with each other to a point where everyone now is working toward a common goal. The program has many more synergisms and mutual interests than issues of conflict and divisiveness. In



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