Thom Walsh, PhD, MS
Thom Walsh is a healthcare regulator, Dartmouth professor, author, and public writer. He studies how governance, incentives, and institutional design shape what care costs, who it reaches, and whether the institutions that deliver it stay worthy of public trust.
Roles
Member of Vermont’s Green Mountain Care Board, the state’s independent health care regulator, reviewing hospital budgets, insurance rates, and major reform.
Professor of the Practice of Health Policy at Dartmouth’s Geisel School of Medicine, teaching health systems to clinicians, executives, and policy students.
Author of two books and essays in Health Affairs, the Milbank Quarterly, Washington Monthly, and The American Prospect.
Current focus
What makes care affordable where people actually meet it?
The gap between an affordable premium and an affordable visit — and what it takes to close it.
When is a hospital actually efficient?
Moving past a single financial ratio toward spending that is visible, decomposed, and explained.
What makes an institution worthy of trust?
Trust as a form of capital that institutions earn, spend, and can quietly deplete.
How can AI strengthen judgment, not replace it?
Using AI to test reasoning and surface weak assumptions before decisions are made.
Books
Forming the Foundation for Better Care
What matters most to patients should shape how care is measured and improved.
About the books →Engage Your Patients, Align Your People
Knowing what to change, and how to get it done, when payment moves from volume to value.
About the books →Selected affiliations & outlets
Dartmouth·Green Mountain Care Board·Health Affairs·Milbank Quarterly·Washington Monthly·The American Prospect
About
I work at the intersection of healthcare regulation, teaching, and public writing — on how institutions can make better, more affordable, and more trustworthy decisions.
My work begins with a plain observation: most people, given the chance to design a care system from scratch, would not build the one we have. Costs climb, outcomes lag, and the institutions meant to serve patients often answer to other pressures first. The useful question is not whom to blame, but what in the system produces those results — and what can be changed.
I came to policy through patient care. For nearly three decades I practiced as a board-certified specialist in complex spine problems, work that included building a multidisciplinary spine center and a shared-decision-making program at Dartmouth-Hitchcock. Watching how measurement, incentives, and institutional habit shaped what patients actually received sent me back to school — for a master’s in evaluative clinical sciences and a PhD in health policy — and then into teaching, advising, and regulation.
I was the first in my family to finish college, raised in a rural, lower-income community. That background still shapes how I read questions of affordability: from the side of the households most exposed when the system fails them.
What connects the work
Four ideas recur across the teaching, the regulation, and the writing. Affordability, measured where people actually meet the system rather than where it is easiest to report. Efficiency, understood as spending that can be decomposed and explained rather than reduced to a ratio. Trust as institutional capital — earned, spendable, and quietly depletable. And governance as the practice of keeping all of this observable, so that good intentions are backed by something a public can check.
Where to begin
Start at your feet. Pick up that one right there. Take care of it. Then do another. That’s how we do it.
My first job, at ten or eleven, was clearing rocks from a neighbor’s field so feed corn could be sown. The field looked impossible. My grandfather — who worked a granite quarry and took odd jobs to help my mother raise us — gave me the only instruction that made the work possible. It is the one I still reach for on every problem that looks too big to start.
A healthcare lesson from my grandfather’s fieldSelected affiliations
For editors & organizers
Thom Walsh is a healthcare regulator, Dartmouth professor, author, and public writer. He serves on Vermont’s Green Mountain Care Board and teaches health policy at the Geisel School of Medicine. His work focuses on affordability, hospital efficiency, institutional trust, and the governance of health systems worthy of public trust.
Thom Walsh is a healthcare regulator, Dartmouth professor, author, and public writer. He is a member of Vermont’s Green Mountain Care Board, the state’s independent health care regulator, and Professor of the Practice of Health Policy at Dartmouth’s Geisel School of Medicine. His current work examines healthcare affordability, hospital efficiency and pricing, institutional trust, and the design of governance that keeps these choices visible to the public. He is the author of two books and writes for Health Affairs, the Milbank Quarterly, Washington Monthly, and The American Prospect. He came to policy after nearly three decades in patient care.
Thom Walsh is a healthcare regulator, Dartmouth professor, author, and public writer whose work connects healthcare affordability, public accountability, institutional trust, and responsible decision-making.
He is one of five members of Vermont’s Green Mountain Care Board, the state’s independent health care regulator, where he helps oversee hospital budgets, commercial insurance rates, health data governance, and statewide reform. He is also Professor of the Practice of Health Policy at Dartmouth’s Geisel School of Medicine, teaching health systems and policy to clinicians, executives, and public health students.
His current writing and research develop practical frameworks for evaluating hospital efficiency, affordability, and institutional stewardship. His essays appear in Health Affairs, the Milbank Quarterly, Washington Monthly, and The American Prospect, and he is the author of Finding What Matters Most to Patients (2019) and Navigating to Value in Healthcare (2017).
Walsh came to health policy through patient care, practicing for nearly three decades as a board-certified specialist before earning a master’s in evaluative clinical sciences and a PhD in health policy from Dartmouth.
Writing
Selected writing for scholarly and general audiences on what care costs, why, who gains and who absorbs it, and how governance can keep those answers in public view. Filter by theme below.
Earlier pieces — in The Atlantic, Forbes, the New America Foundation, and a BMJ video abstract — are listed in the curriculum vitae.
In progress
Books
Both books come from the question that runs through the rest of the work: what should we measure, and whom should it serve? Written for leaders and clinicians, they trace a path from the patient’s experience to the systems and incentives that shape it.
Forming the Foundation for Better Care
What matters most to patients should shape how care is measured and improved.
Patient-reported outcomes, shared decision-making, and motivational interviewing are familiar names and unfamiliar practices. The book shows leaders and clinicians how to use them together, at the point of care, so that what matters to the patient in front of you actually shapes the plan.
View the book →Engage Your Patients, Align Your People
Knowing what to change, and how to get it done, as payment moves from volume to value.
A practical guide for organizations making the transition to value-based payment, written for leaders who were flying blind — lacking the data on outcomes and costs they needed to act.
View the book →Teaching
My teaching is for clinicians, executives, policy leaders, and students who need to understand healthcare as a system — not only a market, a profession, a bureaucracy, or a moral enterprise, but all of these at once.
Where I teach
Approach
I teach health systems the way I read them. Start with something concrete — a bill, a budget, a decision that went wrong. Find the system that produced it. Name the tension inside that system. Only then reach for the concept that explains it, and ask what it implies. Students leave able to see structure where they used to see noise.
In 2025–26 I began integrating deliberative AI into the classroom: asking students to use AI to test their reasoning, find weak assumptions, and weigh evidence — to strengthen judgment rather than to generate answers.
Course topics
Speaking & contact
I welcome inquiries about guest lectures, panels, and policy convenings; executive education; regulatory and affordability strategy; responsible-AI and governance sessions; and editorial collaborations. Advisory work is selective.
Views expressed on this site are my own and do not necessarily represent the views of the Green Mountain Care Board, the State of Vermont, Dartmouth College, or any affiliated institution.