Michael S. Sherman

Michael S.
Sherman
MD, MBA, MS, CPE
Senior Vice President & Chief Medical Officer
Harvard Pilgrim Health Care and Tufts Health Plan

Dr. Michael Sherman serves as chief medical officer and senior vice president for health services for Harvard Pilgrim Health Care, a not-for-profit health plan that has been recognized by NCQA as one of the top health plans in the nation for over a decade and which provides a variety of insurance options to more than 1.3 million members in Massachusetts, New Hampshire, Maine and Connecticut.  

Dr. Sherman is responsible for Harvard Pilgrim’s medical trend management, pharmacy management, provider engagement strategy, medical informatics, clinical policy/utilization management, regulatory affairs and HEDIS, disease management services, quality, and wellness offerings.  As Harvard Pilgrim’s chief physician executive, he has focused the organization on introducing innovative outcomes-based reimbursement models, including both primary care and specialty Medical Homes and bundled payments for a variety of procedures.  He has also been a pioneer in developing outcomes-based payment agreements with pharmaceutical companies that go beyond the historical “pay for pill” approach and tie reimbursement to patient outcomes. 

Dr. Sherman serves as chair of the Board of Managers of the Harvard Pilgrim Health Care Institute, which encompasses the Department of Population Medicine at Harvard Medical School and is the only appointing medical school department in the US based in a health plan and on the Advisory Board of the Institute for Clinical and Economic Review (ICER). He also is the current chair for AHIP’s CMO Leadership Council, comprised of chief medical officers from health plans throughout the United States.

Prior to joining Harvard Pilgrim, Dr. Sherman served as corporate medical director, physician strategies for Humana, focusing on developing collaborative programs with provider organizations to support their mutual goal of delivering the highest quality care to their patients.  Before joining Humana, Dr. Sherman held several leadership positions with UnitedHealth Group, including serving as vice president, network and consumer solutions, for Ingenix (now part of Optum) and as chief business development officer for United’s Medicare Part D business.   Prior to UnitedHealth Group, Dr. Sherman held the position of vice president and general manager at Thomson Medstat (now IBM Truven), which provides healthcare information solutions to the payer, provider and research markets.   He also served as vice president, business development and product management, for HealthAllies, an organization created to provide discretionary medical benefits to the cash-pay market, which was purchased by UnitedHealth Group in 2003 and previously held positions at Immusol, a San Diego-based biotechnology company, where he served as vice president, medical and clinical affairs and as director, business development, at Total Renal Care (now known as Da Vita), a national provider of dialysis services.

Dr. Sherman holds a B.A. in Anthropology and Natural Sciences and an M.S. in Biomedical Anthropology from the University of Pennsylvania. He received his M.D. from Yale and M.B.A. from the Harvard Business School. Dr. Sherman is a diplomate of the American Board of Anesthesiology and American Board of Medical Management, and he practiced as a cardiac anesthesiologist prior to pursuing his MBA.  In 2009, he was named a fellow of the American College of Physician Executives in recognition of his national contributions to the field of medical management, and he currently serves on the faculty of the Department of Population Medicine at Harvard Medical School.  In 2013, Dr. Sherman was appointed by then Governor Deval Patrick to represent the health plan perspective on the Massachusetts Statewide Quality Advisory Committee, where he currently fills one of six seats.

Dr. Sherman often speaks at national and regional conferences, most frequently on the subject of outcomes-based pharmaceutical agreements, and he has lectured as part of the Harvard Business School executive education program on value measurement in healthcare.  He currently serves on the board of directors and as co-president of the Harvard Business School Healthcare Alumni Association, the board of advisors for the Harvard Business School Healthcare Initiative, the board of directors for the Personalized Medicine Coalition, and board of overseers for Boston’s internationally renowned Museum of Science.   Dr. Sherman also serves as a mentor for emerging physician executives enrolled in the AHIP Executive Leadership Program and formerly served on the board of directors of Massachusetts Health Quality Partners.